Paul Latimer

A components analysis of biofeedback in the treatment of fecal incontinence

Fecal incontinence is a socially disabling symptom for which rectosphincteric biofeedback has been reported to be dramatically effective. The most commonly employed biofeedback procedure incorporates three separate and potentially effective components: (1) exercise of the external sphincter muscle, (2) training in discrimination of rectal sensations, and (3) training synchrony of the internal and external sphincter responses. This paper reports the results of single case experiments employed with eight incontinent patients to examine the contributions of each of these components. All eight patients improved, but only one required the biofeedback procedure as it was originally described. Three responded to sensory discrimination training, one to exercise training, and one to the training of synchronous sphincteric responses; three recovered independently of the effects of biofeedback. Despite the achievement of continence, the rectosphincteric reflexes following treatment continued to be abnormal in every case. These findings suggest that the character of the external sphincter response to rectal distension is an unreliable index of sphincter function and that exercise and sensory discrimination training procedures are effective for some cases of fecal incontinence.

Crohn's disease: a review of the psychological and social outcome

A review of the psychosocial literature relating to Crohns disease reveals that most available studies have been aetiologically oriented and that there are important gaps in our knowledge about the psychological and social concomitants of the disease. Some future research possibilities are discussed.

Carbon dioxide as a reciprocal inhibitor in the treatment of neurosis

Abstract A patient with long standing ‘panic’ attacks was successfully treated using a variant of systematic desensitization with a carbon dioxide-oxygen mixture as a reciprocal inhibitor.

Psychophysiologic disorders: a critical appraisal of concept and theory illustrated with reference to the irritable bowel syndrome (IBS).

The concept of psychophysiologic disorders and the major theories invented to account for such disorders are critically reviewed. The Irritable Bowel Syndrome (IBS) serves to illustrate the application of each theory and provides a vehicle for their appraisal. The tendency to think of physical and psychological as separate entities rather than separate languages has led to attempts to make a categorical distinction between disorders caused by psychological factors and those caused by physical factors. Some of the theories developed to account for psychophysiologic disorders are unscientific and none can adequately account for all the features of IBS. It is concluded that the concept of psychophysiologic or psychosomatic disorder is outmoded.

Is horror a necessary component of flooding (implosion)

Abstract Experimental results indicate that presentation of horrifying scenes is not necessary to obtain a favorable outcome in the treatment of phobias by flooding. Prolonged exposure to the feared object, even under relatively pleasant conditions is sufficient. Subjects were college students who rated highly fearful of rats. They were randomly assigned to one of three experimental groups and to a no treatment-control group. Treatment groups differed along the dimension of harshness of scene presentation. Control group subjects received no treatment but were assessed repeatedly as were experimental subjects. All experimental subjects showed improvement irrespective of treatment received-after treatment they were all willing to come closer to a live rat and experienced less anxiety at the closest point. However, subjects exposed to horrid scenes were judged by an independent evaluator as less likely to avoid fearful situations. The discussion centers on the discrepancy between raters evaluation and other measures, implications of the results for treatment, and on the generalizability of findings to a patient population.

Gastric stasis and vomiting: behavioral treatment.

A patient is described in whom gastric stasis and vomiting of 28-yr duration were successfully treated with behavior therapy. Failure of conventional medical treatment in the face of continued vomiting led to consideration for surgery. The need for surgery was obviated by the successful application of exposure and response prevention, which resulted in a complete elimination of vomiting. Changes were produced, not only in the overt behavioral manifestation (vomiting) but in gastrointestinal motility as well. Although there was a lag, gastric emptying returned to normal. The improvements were maintained at over 1-yr follow-up study.

A case of homosexuality treated by in vivo desensitization and assertive training.

Sexual deviation is not a unitary condition, amenable to a single treatment approach. Deviant sexual arousal has been overemphasized while inadequate attention has been given to associated behavioural problems such as deficient heterosexual arousal, deficient heterosexual skills and gender role deviation. A client with homosexual arousal and requesting aversion therapy was treated successfully and rapidly using in vivo desensitization and assertive training. The treatment is described and the importance of the behavioural analysis in directing the course of therapy is stressed.