R. Julian Hafner

Psychological treatment of essential hypertension: a controlled comparison of meditation and meditation plus biofeedback.

Twenty-one patients with essential hypertension were randomly allocated to eight 1-hour sessions of meditation training, meditation plus biofeedback-aided relaxation, or a no-treatment control group. Statistically significant falls in systolic and diastolic blood pressure occurred after both training programs, although overall reductions in blood pressure were not significantly greater in either program than in the control group. Meditation plus biofeedback-aided relaxation produced falls in diastolic blood pressure earlier in the training program than did meditation alone. All patients practiced meditation regularly between training sessions: The amount of practice did not correlate with the amount of blood pressure reduction after training. On questionnaire measures of psychological symptoms and personality, sex differences emerged, with females showing significant abnormalities in hostility scores and males showing significantly raised levels of somatopsychic symptoms. In females, outward-directed hostility fell significantly and assertiveness increased after training, but in males, somatopsychic symptoms were unchanged.

The treatment of obsessional neurosis in a family setting.

The limitations of a patient-centred approach to the treatment of obsessive-compulsive disorders are underlined by the failure of modern behaviour therapy techniques to help usefully more than 50 per cent of patients. The concept of family homeostasis is discussed in relation to two cases of obsessive-compulsive neurosis which failed to respond to patient-centred treatment over several years. The successful treatment of these cases in a family context is described. It is suggested that the comparative success of behaviour therapy in treating obsessive-compulsive disorders, which were previously regarded as generally intractable, has encouraged the premature use of patient-orientated behavioural techniques in cases where family therapy may be more appropriate. Although there is evidence that helping the families of obsessive-compulsive patients to verbalise feelings facilitates symptomatic improvement, the precise mechanisms whereby improvement occurs require further elucidation.

Predicting the outcome of behaviour therapy for agoraphobia.

Multiple linear regression analyses were conducted on questionnaire data obtained from 33 agoraphobic women and their husbands before and after intensive exposure in vivo for the agoraphobia. The dependent variable in the regression equation was treatment outcome as determined by changes in composite ratings of patients two main phobias. On this criterion, patients improved by 64% immediately after treatment and by 69% 1 year later. The main predictors of treatment outcome were patients pre-treatment levels of agoraphobic disability and of extrapunitiveness. The main pre-treatment predictors of change during follow-up were patients levels of social fear, and of fears which suggested dependency problems. When post-treatment questionnaire responses were used to predict patients phobia change during follow-up, husbands scores contributed 50% to the variance. This finding, together with clinical observations, suggested that if husbands were unable to fully acknowledge the emotional impact upon themselves of rapid and substantial improvements in their wives, then they were unlikely to facilitate further phobia improvement in their wives during the first 6 months of follow-up. It was concluded that involvement of the husbands in their wives therapy would increase the likelihood of continuing phobia improvement after treatment.

Behaviour therapy for agoraphobic men

Eighteen men and 49 women with agoraphobia were offered behaviour therapy based on graded exposure in vivo to feared situations. Eight of the men and 6 of the women refused or terminated treatment prematurely, the men because of unmanageable anxiety, and the women for reasons unrelated to anxiety levels. The 10 men who completed the programme were compared with 10 women matched for age. Women experienced significantly more panic attacks during exposure than men, who instead were concerned mainly with fears of losing control of aggressive impulses. The effects of exposure were broadly comparable: both men and women reported over 65% improvement in their main phobias, and between 30 and 50% improvement in other symptoms, 12 months after treatment.

Predicting schizophrenia outcome with self‐report measures of family interaction

This study is based on 18 patients admitted to a psychiatric hospital with a DSM-III-R diagnosis of schizophrenia who currently were living with one or both parents. Patients and parents completed several questionnaire, including the Parental Bonding Index (PBI), the Family Environment Scale (FES), the Hostility and Direction of Hostility Questionnaire (HDHQ), and the Brief Symptoms Inventory. Observer ratings of patients symptoms also were made. Outcome was predicted best by patients ratings of mothers on the PBI and by mothers scores on the HDHQ Criticism of Others scale. Other significant outcome predictors were the number of previous admissions to hospital, patients scores on the HDHQ Projected Hostility scale and the FES Expressiveness scale, and fathers scores on the FES Achievement-Orientation scale.

Agoraphobia in women: factor analysis of symptoms and personality correlates of factor scores in a clinical population.

Abstract One hundred and sixty female patients with a DSM-III diagnosis of agoraphobia completed a measure of fears and general symptoms (FSS) and personality (HDHQ). Many patients had significant psychological symptoms in addition to their agoraphobia. FSS scores were factor analysed. First-order analysis revealed agoraphobia as a heterogeneous clinical entity occurring independently of a large General Symptoms factor which included panic attacks. Second-order analysis revealed a General Symptoms/Social Phobia factor and a well-defined but heterogeneous Agoraphobia factor comprising the lower-order factors Claustrophobia, Travel Fears and Agoraphobia (fear of crowded public places). Correlations of first- and second-order factors with HDHQ scores showed that the Travel Fears factor was not associated with abnormal personality traits, whereas the Claustrophobia and Agoraphobia factors were. This suggested that travel fears should respond well to behaviour therapy per se, whereas additional treatment aimed at modifying abnormal personality traits may sometimes be indicated for claustrophobia and fear of crowded places. The heterogeneous nature of agoraphobia and the large size of the independent General Symptoms factor underlined the desirability of a multi-modal approach to treatment and research.

Spouse-Aided Therapy in Psychiatry: An Introduction

This paper underlines the failure of contemporary individual and marital psychotherapies to help many married people with persisting psychological disorders. It examines the spouses contribution to the maintenance of psychological disability, and discusses the problems of constructively involving such spouses in conjoint therapy. Spouse-aided therapy addresses this problem by inviting the patients spouse to become a co-therapist. It is explicitly not a marriage therapy, and is conducted on a goal-orientated time-limited out-patient basis. During discussion of problems with achieving treatment goals, the focus of therapy shifts from the patients symptoms to marital interaction. Confrontation of the spouses contribution to the patients continuing disability then becomes possible, and is followed by changes in marital interaction which generally facilitate the patients improvement. Many couples choose to proceed with marital therapy after spouse-aided therapy has allowed them to reconstrue the patients symptoms in interactional terms.

Predicting the effects on husbands of behaviour therapy for wives' Agoraphobia

Abstract The husbands of 33 agoraphobic women were studied systematically before and for 1 yr after their wives received intensive exposure in vivo mainly in small, cohesive groups. Although most husbands reported improved personal adjustment 1 yr after their wives therapy, many had experienced transitory negative reactions such as anxiety and depressive symptoms. These were most likely to occur after large, rapid improvements in the phobic and general symptoms of severely-disabled patients. Such improvements challenged the husbands capacity to adapt to their wives changed attitudes and behaviour, particularly regarding sex roles. These findings explain why reports of negative effects on husbands are found infrequently in behavioural studies of agoraphobia, which generally exclude patients with major additional symptoms, have relatively high drop-out rates and generate improvements comparatively slowly. In contrast, group exposure in the present study generated rapid improvements and inhibited dropping-out, even in patients with severe additional symptoms and problems, who were included in the study. Thus, the likelihood of repercussions on the husband was maximized. Negative effects were most likely in husbands who had adapted to their wives disability as part of a sex-role stereotyped view of marriage, and in husbands who were persistently critical and unsupportive of their wives.

A comparison of the factor structure of the crown-crisp experiential index across sex and psychiatric status

Abstract Factor analysis was conducted on responses to the CCEI of the following population samples: 120 normal men; 117 normal women; 115 male psychiatric patients; and 180 female psychiatric patients. Factor correlations between the 4 samples were calculated using Cattells S index. Components reflecting the subscales Obsessionality, Hysteria and Phobic Anxiety appeared in at least 3 of the 4 samples, and were strongly intercorrelated, confirming the factorial reliability of these subscales. These findings are consistent with previous psychometric research on the CCEI. A component reflecting Somatic Anxiety appeared only in the female patient sample. The Depression subscale was clearly represented in the first component derived from all 4 samples, but in association with items from other subscales. A component corresponding to the subscale Free Floating Anxiety did not appear in any sample, and some reasons for this were proposed. It was concluded that the CCEI remains a reliable, valid and convenient instrument for research into neurotic disorders. The addition of a new subscale to assess symptoms related to Panic Disorder was suggested, together with some minor modifications that would facilitate the use of the CCEI as a measure of changes in symptoms over time.

The FIRO model of family therapy: implications of factor analysis.

Schutzs FIRO model contains three main elements: inclusion, control, and affection. It is used widely in mental health research and practice, but has received little empirical validation. The present study is based on factor analysis of the resources to FIRO questionnaire of 120 normal couples and 191 couples who were attending a clinic for marital/psychiatric problems. Results confirmed the validity of the FIRO model for women only. The differences between the sexes reflected a considerable degree of sex-role stereotyping, the clinical implications of which are discussed.