Vivien Swanson

Fluvoxamine, placebo, and cognitive behaviour therapy used alone and in combination in the treatment of panic disorder and agoraphobia☆

Abstract One hundred and ninety patients meeting DSM-III-R criteria for panic disorder with or without agoraphobia were randomly allocated to (a) Fluvoxamine, (b) placebo, (c) Fluvoxamine + cognitive behaviour therapy, (d) placebo + cognitive behaviour therapy, or (e) cognitive behaviour therapy alone. Patients were treated over 13 weeks and all participated in nine sessions plus follow-up at 6 months. Numbers in each group were as follows—(a) Fluvoxamine: entered n = 36, completed n = 29, attended follow-up n = 23; (b) placebo: entered n = 37, completed n = 28, attended follow-up n = 21; (c) Fluvoxamine + cognitive behaviour therapy: entered n = 38, completed n = 29, attended follow-up n = 24; (d) placebo + cognitive behaviour therapy: entered n = 36, completed n = 33, attended follow-up n = 30; (e) cognitive behaviour therapy: entered n = 43, completed n = 30, attended follow-up n = 28. A balance across treatments for therapist contact was attempted. A fixed-dose medication regimen was used with patients taking 150mg Fluvoxamine per day. A range of process and outcome measures both therapist- and patient-rated was used. Outcome at treatment end point and at 6-month follow-up was assessed in terms of both statistical and clinical significance and revealed that all active treatments showed improvement over time. This improvement was better preserved over follow-up in those groups receiving cognitive behaviour therapy (Groups c, d, and e) with these groups showing larger proportions of patients continuing to achieve predetermined criteria of clinically significant change on the Hamilton Anxiety Scale, Kellner and Sheffield Symptom Rating Test, and the Fear Questionnaire-Agoraphobia Scale at 6-month follow-up than those of the medication-alone groups (Groups a and b). The largest and most consistent treatment gains were evidenced by the cognitive behaviour therapy (Group e) and the Fluvoxamine + cognitive behaviour therapy (Group c) groups, with the latter showing these gains 2 weeks earlier in treatment, at Day 28 rather than Day 42.

Employees' perceptions of organizational restructuring: The role of social support

Organizational change and restructuring is often perceived as leading to increased occupational stress, impacting negatively on the psychological well-being of employees. This pragmatic study investigates the role of social support and dispositional affect as moderators of role stress post-restructuring for employees in a public utility company. A total of 176 employees, including 37 managers, 60 graded staff and 78 industrial staff completed a self-report questionnaire, approximately 1 year postrestructuring, retrospectively assessing role conflict, ambiguity, overload and positive and negative feedback pre- and post-restructuring. Results suggested that overall role stress increased for managers/ senior officers and graded staff, but not for industrial staff. Social support was linked with lower role stress, more positive feedback and less negative feedback at post-restructuring. For certain role stressors this impact was moderated by dispositional affect, but the effect was not consistent across occupational groups. Positive affect enhanced the effect of manager support in reducing role conflict for graded staff, and the effect of co-worker support in increasing positive feedback and reducing negative feedback for industrial staff. Findings suggest that managers should pay particular attention to support and feedback for employees during periods of chronic occupational stress following organizational restructuring.

Earning and learning: how term‐time employment impacts on students' adjustment to university life

The number of students in higher education has risen sharply in recent years, and an increasing proportion of students combine paid employment with university life. In a review of studies which have investigated the relationship between ‘earning and learning’, it is noted that the overall focus to date has been on the negative impact of combining these roles. This suggests that term‐time employment leads to poorer adjustment to university life in terms of academic performance, social inclusion and psychological well‐being. However, we suggest that methodological problems are evident which make it difficult to draw firm and generalizable conclusions regarding the interrelationship between university life and part‐time employment roles. The paper suggests that a psychological transactional approach focusing on both positive and negative outcomes of role interrelationships could be adopted to more accurately inform universities, student bodies and employers of optimal ways of combining study and employment.

A Controlled Comparison of Cognitive—Behaviour Therapy, Diazepam and Placebo in the Management of Generalized Anxiety

Generalized anxiety patients were randomly allocated to Cognitive-Behaviour Therapy, Diazepam or Placebo and managed in a primary care setting. Treatments were balanced for degree of psychologist/patient contact. A range of outcome measures, including patient self report, psychologist assessor and general practitioner ratings were used. Large variations within group response to treatment emerged. At the end of active treatment the superiority of Cognitive-Behaviour Therapy was suggested. Post-study psychotropic prescription and psychological treatment was assessed at a 12-month follow-up. The Cognitive-Behaviour group revealed the lowest incidence of subsequent treatment interventions.

Stories of weight management: Factors associated with successful and unsuccessful weight maintenance

OBJECTIVE Although behavioural interventions are successful in achieving short-term weight loss, most individuals regain most or all of their weight within a few years. Our aim was to investigate factors that can help in long-term weight maintenance. DESIGN Qualitative interviews were conducted in order to elicit experiences, successes, and difficulties associated with weight control over the lifespan. METHODS Participants were 20 adult volunteers (aged 30-67) including lifelong weight maintainers, active weight maintainers who have maintained weight loss, and weight gainers. Thematic analysis was used to highlight differences between weight groups. RESULTS Successful weight maintainers adopt a staged approach to weight management, including monitoring weight fluctuations and having a clear alarm signal for weight gain that triggers immediate action. They have several behavioural strategies for weight control, comprising relatively small adjustments to diet and/or exercise behaviour and also have clear strategies for coping with lifestyle interruptions. In contrast, unsuccessful weight maintainers display negative cognitive factors, including erratic or inconsistent weight vigilance, failure to respond to warning signs of weight gain, and failure to restrict weight unless in a positive mindset. Further, their coping strategies for weight gain or failed actions are poor. CONCLUSIONS The results suggest that successful weight maintainers, irrespective of current weight band, adopt a staged behavioural approach to weight management that allows them to maintain a fairly stable weight. Encouraging the use of such strategies in those who typically regain weight after dieting may aid them in maintaining weight loss.

Predicting treatment outcome on three measures for post-traumatic stress disorder.

The aim of the present study was to investigate predictors of treatment outcome for Post-traumatic Stress Disorder (PTSD) after treatment completion and at 15-months follow-up (n = 48), in a trial of Eye Movement Desensitisation and Reprocessing (EMDR) versus Imaginal Exposure and Cognitive Restructuring (E+CR). Factors associated with treatment outcome were investigated using regression analyses with the mean change scores in three assessor and self-rated PTSD symptomatology measures, including the Clinician-Administered PTSD Scale (CAPS), the Impact of Events Scale (IES) and the PTSD Symptom Checklist (PCL) from pre- to post-treatment and pre-treatment to follow-up as the dependent variables and demographics, trauma, clinical and personality measures as independent variables. Irrespective to outcome measures and assessment points it was found that four variables were able to predict significantly treatment outcome. These included baseline PTSD symptomatology, number of sessions, gender and therapy type. Overall, our results showed that it is difficult to use pre-treatment variables as a powerful and reliable tool for predicting treatment outcome, as significant predictors were found to be sample-specific and outcome measure-specific. Clinical relevance of the present results and directions for future research are discussed.

Psychometric properties of the Parental Bonding Instrument and its association with psychological distress in a group of incarcerated young offenders in Scotland.

Abstract  Background: The Parental Bonding Instrument (PBI) was developed in order to help quantify the parental contribution to psychological distress. It has subsequently been shown to be of value in examining the influence of parents in many diverse areas including delinquency. Method: A shortened form of the PBI and the Hospital Anxiety and Depression Scale (HADS) were administered to a group of young offenders held in custody in Scotland. Results: High levels of psychological distress were linked with low parental care, but there were no associations between psychological distress and parental control. However, an analysis of the factor structure found that, although the care factor of the PBI showed good internal reliability, the control factor was less well defined in this group. Conclusions: It is suggested that a three-factor solution representing care, control with regard to independence and protective control may be more appropriate.

Developing Maternal Self-Efficacy for Feeding Preterm Babies in the Neonatal Unit

Developing maternal self-efficacy offsets negative psychological consequences of premature birth, improving maternal well-being. We investigated women’s experiences in a neonatal unit (NNU) in Scotland in semistructured interviews with 19 primiparous mothers of preterm babies. We explored their experience of preterm birth and development of self-efficacy in infant feeding behaviors, identifying emergent and a priori themes. Women reported experiencing loss and biographical disruption in relation to mothering, loss of autonomy, and searching for normality after premature birth. Providing breast milk symbolized embodied contact with their baby and increased maternal confidence. They developed motivation, knowledge, and perseverance and perceived success from positive feedback, primarily from their baby and health professionals’ support and encouragement. Women actively constructed opportunities to develop ownership, control, and confidence in relation to interactions with their baby. We linked sources of self-efficacy with potential behavior change techniques to be used in practice to improve maternal confidence in the NNU.

Randomized clinical trial of a brief psychological intervention to increase walking in patients with intermittent claudication

Increased walking is often recommended for patients with intermittent claudication (IC). Current methods to increase walking in these patients increase capability but not daily behaviour. This trial assessed whether a brief psychological intervention could increase daily walking at 4 months.

MANAGING TWO ROLES

The main reasons for students combining term-time employment with university life are seen as financial, although additional benefits and costs are associated with ‘earning and learning’. Most studies focus on the negative impact of combining these roles, suggesting that students’ term-time employment leads to poorer adjustment to university life in terms of academic performance, social inclusion and reduced psychological well-being. Methodological problems with previous research have made it difficult to draw firm and generalizable conclusions regarding the interrelationship between university life and term-time employment roles. The current study adopts a pluralistic approach to study the links between psychological well-being, satisfaction with academic performance and social integration and students’ term-time and vacation employment. The first phase, reported here, consisted of qualitative research. Nine focus groups were conducted with undergraduate students at Stirling University, Scotland. These data were examined using a content analysis approach. Both positive and negative aspects of combining work and studying were discussed within the focus groups. This provides a balanced picture of combining the two roles. Results are discussed in relation to the models of complementarity, spillover and separation.