Padmal de Silva

Engagement and outcome in the treatment of bulimia nervosa: first phase of a sequential design comparing motivation enhancement therapy and cognitive behavioural therapy.

Despite the major advances in the development of treatments for bulimia nervosa, drop-outs and a lack of engagement in treatment, continue to be problems. Recent studies suggest that the transtheoretical model of change may be applicable to bulimia nervosa. The aim of this study was to examine the roles of readiness to change and therapeutic alliance in determining engagement and outcome in the first phase of treatment. One hundred and twenty five consecutive female patients meeting DSM-IV criteria for bulimia nervosa took part in a randomised controlled treatment trial. The first phase of the sequential treatment compared four sessions of either cognitive behavioural therapy (CBT) or motivational enhancement therapy (MET) in engaging patients in treatment and reducing symptoms. Patients in the action stage showed greater improvement in symptoms of binge eating than did patients in the contemplation stage. Higher pretreatment scores on action were also related to the development of a better therapeutic alliance (as perceived by patients) after four weeks. However, pretreatment stage of change did not predict who dropped out of treatment. There were no differences between MET and CBT in terms of reducing bulimic symptoms or in terms of developing a therapeutic alliance or increasing readiness to change. The results suggest that the transtheoretical model of change may have some validity in the treatment of bulimia nervosa although current measures of readiness to change may require modification. Overall, readiness to change is more strongly related to improvement and the development of a therapeutic alliance than the specific type of treatment.

Prepared phobias and obsessions: therapeutic outcome.

Abstract Sixty-nine phobic and eighty-two obsessional patients, treated at the Maudsley Hospital, were rated for ‘preparedness’, the evolutionary significance of the content and behaviour of the disorder. Reliable ratings ( r = 0.78 and 0.90) of the dangerousness of the object or situation to pretechnological man indicated that the content of the large majority of the phobias and obsessions are judged as evolutionarily significant. Degree of preparedness, however, did not predict outcome of therapy, suddenness of onset of the disorder, severity of impairment, intensiveness of the treatment received, or age of onset. Nor was there any significant relationship between preparedness and certain other variables in the obsessional sample: stimulus generalization, effect on life style, impaired reproductive capacity and abnormal personality. The implications of these findings for the hypothesis that human phobias and obsessions are prepared, and for the clinical usefulness of the concept of preparedness, are discussed.

A CONTROLLED TRIAL OF COGNITIVE-BEHAVIOURAL AND BEHAVIOURAL TREATMENT OF ANOREXIA NERVOSA

This study was undertaken to investigate whether a cognitive-behavioural treatment procedure was superior to a standard behavioural treatment, in the outpatient therapy of patients with anorexia nervosa. The two treatments were also compared with a control treatment procedure consisting of routine outpatient management. Each group consisted of eight subjects. All the groups showed some improvement, but the findings did not provide support for the prediction that cognitive-behavioural treatment, designed specifically to manipulate both attitudes and behaviour, was superior to the other types of treatment. The implications of the findings are considered.

The role of traumatic experiences in the genesis of obsessive–compulsive disorder

This paper discusses the role of traumatic stress in the genesis of obsessive-compulsive disorder. While the early classical conditioning theory of the onset of obsessive-compulsive disorder has only limited empirical support, authorities have always recognised the role of stress in precipitating this disorder, and in triggering relapse in those who have been successfully treated. Here, clinical cases are cited that show a causal link between severe trauma and the onset of obsessive-compulsive disorder. The nature of the traumatic reaction and the possible mechanisms by which it leads to frank obsessive-compulsive disorder are discussed. The apparent links between this and posttraumatic stress disorder are also explored. Finally, implications for therapy are considered.

Is the selective information processing of food and body words specific to patients with eating disorders

The selective processing of food- and body size-related information was investigated using a modified version of the Stroop task. Anorexic and bulimic patients and matched female controls were compared on the basis of categorical (diagnosis), dimensional (restraint and drive for thinness) criteria, or both. The findings suggest that the phenomenon assessed by the Stroop paradigm is not exclusive to patients with a clinical eating disorder, but patients and those control subjects who are restrained eaters with a high drive for thinness share a selective processing of information related to shape and eating. The discussion focuses on the implications of these findings.

Obsessional-compulsive imagery.

Abstract An account of imagery occurring in the context of obsessional-compulsive disorders is presented, using data from clinical cases and from the literature. Four distinct types of such images are identified and described. Observations are made on their prevalence, formal properties, functional significance, content and relation to stress. The relevance of the study of this phenomenon to the understanding of and theories on imagery in general, is commented on. Finally, issues of treatment are briefly discussed.

Personality and addictiveness in anorexic and bulimic patients

Abstract Fifty-nine female patients with anorexia nervosa were compared with 122 bulimics on their EPQ scores and an addiction score derived from the EPQ. The bulimics scored significantly higher than the anorexics on Psychoticism and Neuroticism, and lower on Social Desirability. They also scored considerably higher on addiction, and tended to be more like drug addicts.

Perceived control over events in the world in patients with eating disorders : a preliminary study

Original article can be found at: http://www.sciencedirect.com Copyright Elsevier Ltd. [Full text of this article is not available in the UHRA]

The tsunami and its aftermath in Sri Lanka: Explorations of a Buddhist perspective

This paper discusses the tsunami disaster in Sri Lanka with special reference to Buddhism, which is the majority religion in the island. The role of religious beliefs and of religion in general in strengthening coping skills is well known. Buddhism, with its specific views on the human condition and its use of psychological strategies, is almost unique among world religions. The Buddhist responses to the tsunami have been discussed widely, if largely informally, in Sri Lanka, and many concepts and practices have been highlighted and focused on. This paper provides an overview of the relationship between culture and traumatic experiences, with a brief discussion of the role of religion in mental health. It then goes on to explore some relevant Buddhist concepts and practices which can be used in clinical settings.

Buddhism and behaviour modification

Abstract There has been in recent years a growing interest in the similarities between Buddhism and the principles and practice of behaviour modification. Mikulas, for example, has pointed out many similarities and argued for greater integration. The present paper examines the literature of Early Buddhism with a view to assessing how far its approach is similar to that of behaviour modification and to examine some specific behaviour-change techniques used in Early Buddhism in relation to similar techniques developed and used by modern behaviour therapists. The implications of these findings are discussed in relation to theory and clinical practice.