Treatment Integrity and Differential Treatment Effects

Bhar and Beck (2009) examined the extent to which treatment integrity procedures were implemented in studies comparing psychoanalytic psychotherapies and cognitive-behavioral therapies. Consistent with other reports on attention to treatment integrity in psychotherapy research, the authors noted that most of the evaluated studies did not adequately implement treatment integrity procedures. This highlights methodological neglect of treatment integrity and a need to amend errors in monitoring the independent variables under investigation. This commentary considers how Bhar and Beck's investigation affects the dodo bird verdict that all psychotherapies are presumed to be of equal efficacy. Further, ways to examine the treatment integrity of process-oriented treatments (e.g., humanistic, psychoanalytic) are discussed.     

Treatment of Aptitude X Treatment interactions

The main effects in psychotherapy research have been smaller than expected. Rather than concluding that psychotherapy has weak effects, clinical researchers have argued that average effect sizes are reduced because of mismatches between clients and treatment. Hence, Aptitude X Treatment interaction (ATI) research has been viewed as a promising new frontier in psychotherapy research. If ATI research is to become a productive and progressive program, then researchers will need to focus their attention on interesting and meaningful ATIs. This will require greater theoretical precision and a stronger emphasis on construct validity. Specific issues addressed in this article include Type II and Type III errors, manipulation checks from both the patient and practitioner perspective, considerations of the strength of treatment, the need to test rival hypotheses, and the desirability of collaborative research.     

Drug Treatment as HIV Prevention: Expanding Treatment Options

Research conducted during the first 20 years of the AIDS epidemic provided a solid foundation of data supporting methadone treatment as HIV prevention. Drug users in methadone treatment were consistently found to reduce the frequency of drug use, risk behaviors, and infections. These data have been consistent over time and across cultural settings and have been used to promote the expansion of drug treatment as a prevention intervention. More recently, data have emerged suggesting the prevention potential of medication-assisted treatments other than methadone (buprenorphine/naloxone and naltrexone). Still, with a few notable exceptions, global drug treatment coverage for opiate injectors remains remarkably low and only a few treatment interventions for stimulant use have shown efficacy in reducing HIV risk. Importantly, more recent data provide support for the role of drug treatment programs in improving access and adherence to antiretroviral treatment and that injection drug users in substance abuse treatment are more likely to achieve sustained viral suppression. While important challenges remain in maximizing its impact, the scientific literature provides strong evidence of the efficacy of drug treatment as an HIV prevention strategy.     

Treatment of hypertension

Summary In the Munich Blood Pressure Study (MBS), a cross-sectional study (MBS I) with follow-up (MBS II) of a random sample of 3,198 citizens aged 30–69 (response rate, 69.3%), treatment and control of hypertension were examined.Of the actual hypertensives 59% (221) in MBS II (373) were on drug treatment and about two-thirds (150) of those being treated had controlled blood pressure (BP). Women's BP was better controlled than men's.Of the 221 treated hypertensives 85% (188) received types of drugs or drug combinations which were in accordance with the recommendations of the German Hypertension League. However, this did not apply to the prescribed dosages of the various drugs. Of the treated hypertensives 52% were either on a diuretic, on a beta-blocker, or on a combination of both drugs. Rauwolfia alkaloids combined with a diuretic were given to 27%.In 79% of the participants who had received a beta-blocker either alone or in combination with other antihypertensive agents and who still had high BP values, the prescribed beta-blocker dosage was below the recommended daily dose. Fatigue was the most frequently reported symptom, possibly attributable to antihypertensive drug treatment.Electrocardiographic signs of left ventricular hypertrophy were found less frequently in controlled hypertensives, in comparison to treated but uncontrolled hypertensives or untreated hypertensives.Abbreviations AV Atrioventricular - BMI Body mass index - BP Blood pressure - DBP Diastolic blood pressure - GKV Gesetzliche Krankenversicherung - ISH International society for hypertension - LVH Left ventricular hypertrophy - MBS Munich blood pressure study - NHANES National health and nutrition examination survey - SBP Systolic blood pressure     

Treatment of Eczema

Eczema is a chronic inflammatory skin disease that has reached nearly epidemic proportions in childhood. Moreover, it is a difficult disease to control and, with its onset in childhood, is often the first manifestation of atopy. The clinical features of eczema include itchy red skin accompanied by dryness and lichenification. In the past, treatment options consisted primarily of avoidance of soap and water. These options have considerably improved with both nonpharmacologic and pharmacologic approaches. However, eczema is still a treatment challenge. Part of the problem in developing new treatment options has been the relative failure in translating basic science information into clinical application. It is hoped that the newer biologics will help bridge this gap and lead to greater success rates.     

Treatment of pterygium

The treatment of ocular pterygium has been subjected to the development and application of various new strategies in the last few years. The worrisome problem of recurrence seems to have been significantly reduced with the newer methods of treatment. The field is however, still evolving. This review sets out to examine the various newer approaches to treating pterygium and in spite of the recent developments, to highlight the remaining challenges thereby suggesting the possible direction of future research. Also, to suggest treatment options for Ophthalmologists working in environments with limited resources. A library search and Internet search of PubMed and Google was conducted in 2010. Search terms included "pterygium in combination with surgery", "radiotherapy", "chemotherapy", "graft", and "recurrence." Abstracts were reviewed and relevant articles especially those published from the year 2000 to date were given more attention and when possible, reviewed in full. The relevant references in such articles were also reviewed. In conclusion, excision and adjunctive treatment with mitomycin C or conjunctival autograft is the most acceptable and most popular mode of treating both primary and recurrent pterygium. Outcomes seem to have been further improved with adjuvant combination therapy and the introduction of newer approaches to treatment.     

On Beginning Treatment

In 'On Beginning Treatment' I compare and contrast the 'correct' procedure for beginning an analysis that I was taught in the 1940s with how I begin treatment now in the 1990s. I argue that my present method is less rigid, less authoritarian and more realistic than the 'classical' procedure I was taught 50 years ago. I end the paper with some reflections on training analyses and their economic and emotional significance for both training analyst and trainee analysand.