Treating infidelity in same-sex couples

Psychotherapy with same-sex couples does not differ markedly from standard couple therapies; this is also true for treating couples facing infidelity. However, same-sex couples often design their relationships differently, without tradition and formal marital contracts to prescribe behavior. Based on clinical experience and the empirical research, this article addresses the differing norms involved in affirmatively treating infidelity in gay and lesbian couples within the framework of integrative behavioral couple therapy (IBCT). Two cases illustrate the process and outcome of IBCT with same-sex couples.     

Treating infidelity: clinical and ethical directions

This article addresses clinical and ethical directions in treating clients coping with infidelity. Developing competence in this domain requires familiarity with empirical research regarding infidelity, individual and cultural differences involving non-monogamy, and assessment and intervention skills related to treating infidelity. Practical directions will entail distinguishing among responsibilities to individual partners versus their relationship and managing related potential conflicts of interest with other involved parties. Confidentiality assumes increased complexity when confronting undisclosed infidelity in couple therapy and when a client engaging in high-risk behaviors for contracting STDs or testing seropositive for HIV has not informed his or her partner(s). Finally, we discuss therapists' need to concretely articulate their values that influence treatment of infidelity.     

Clergy burnout: an integrative approach

Understanding how clergy, who begin their careers with high idealism, optimism, and compassion, burn out is difficult. One body of research suggests that clergy, among others, burn out because of the systems in which they work. From this perspective, burnout is the result of external systemic factors such as bureaucracy, poor administrative support, and difficult work conditions. The other body of research suggests that burnout is the result of intrapersonal factors such as high idealism, Type-A personality, narcissism, and perfectionism. It is our position that these two bodies of research are compatible, and that by integrating the Self psychology of Kohut with the general systems theory of Bowen, it becomes easier to understand burnout. Further, by integrating these two theories, principles for treatment become clearer.     

Site specific therapy: an integrative approach to treating melanoma

There have been many proposed theories for effectively treating melanoma, especially through the regulation of histamine. Histamine has been proven to be a major regulator of the immune system's T-helper cell subset balance and major shifts in this balance towards TH2 cytokines have contributed to diseases such as asthma, lupus and cancer. Histamine also causes suppression of interferon-induced proteins needed for anti-tumor response and activates T-suppressor cell function in cancers such as squamous cell carcinoma and melanoma. Scientific evidence has suggested the possibility of an anthistamine approach as treatment to these diseases and for melanoma, there has been great promise. This is due to the fact that melanotic cells have been elucidated to express histamine receptors and as a result, regulation of histamine could occur specifically at the site of these epidermal growths. Another factor to consider is how effective an inflammatory response can be when combined with regulation of histamine. Inflammation is a very powerful tool against pathogenic environments by causing cytokine recruitment and migration of dendritic cells to infected sites. Adequate stimulation of an inflammatory response at the specific site of any cancerous region would greatly weaken its evasive mechanisms. However, there are no reports showing high efficacy utilizing the benefits of regulating inflammation and histamine that could cause TH1 subset levels to predominate, down-regulate T-suppressor cells, up-regulate interferon-induced proteins and properly sustain migration of dendritic cells concurrently. These benefits have been proven in separate instances for a range of diseases but have not been assessed as a combined modality for melanoma therapy. Therefore successful melanoma treatment should integrate these principles involving: the use of H2 antagonists for preventing the negative effects of histamine, monoclonal antibodies to ensure an effective dendritic cell response, and routine pro-inflammatory induction at the specific site of the melanotic tissue to ensure recognition of the cancer that has evaded immunity.     

Treating chronic migraine headaches: an evidence-based practice approach

Psychologists and other mental health care professionals are generally trained to incorporate empirical evidence into clinical practice, but few have been taught formal techniques for doing so. Given the rapidity of progress in the clinical sciences, there is a growing need among practitioners to access current, clinically relevant research and have strategies for integrating these research findings into the clinic. In the field of medicine, evidence-based medicine took hold in the early 1990s to provide a framework and skill set for translating research into practice. This method is now widely known as evidence-based practice (EBP) to reflect its applicability to multiple disciplines. In this article, we present a general overview of EBP, illustrate how we used this approach to develop a treatment plan for a patient who had chronic migraine headaches, and discuss some of the opportunities and challenges EBP presents to mental health professionals.     

Different treatment modalities for recurrent bipolar affective disorders: an integrative approach

Pharmacological, behavioural and psychotherapeutic procedures for the acute and prophylactic treatment of mania and depression are considered in outline. It is argued that the manic state is the primary disorder, with depression being a secondary homeostatic response to mania: the prophylaxis of depression thus depends upon the successful long-term control of mania. Suggestions are made regarding ways in which nonpharmacological techniques may be developed to achieve the prophylactic effectiveness against recurrent bipolar affective disorders which is, at the present time, to be found only among pharmacological treatment procedures.     

Working with parents of aggressive preschoolers: an integrative approach to treatment

In this article, we briefly review contributory factors within the child, parent-child interaction, and parents that have been put forward to explain the causes of aggressive problems in children. We then review various treatment approaches that have been used with this population and identify which component--the child, parent, or interaction--is targeted in each approach. A case example is provided to illustrate our perspective on treatment. We use a structured interview to categorize the mother's perceptions and subjective experience of her child and their relationship. Associations between the mother's perception of the relationship with her child, her parenting behavior, and the behavior of the child are discussed.     

Illness and symptom perception: a theoretical approach towards an integrative measurement model

Several models have been proposed to conceptualize psychological representations of health, illness, and bodily sensations. These models differ as to the cognitive and affective components they include, whether they study the interaction of these components, and whether associations between psychological representations of bodily states and affective and behavioral reactions to these representations are considered conditional. These different conceptualizations and corresponding measurement approaches exist in parallel without resulting in synergistic effects or theoretical advancements within the field. In this paper, we review theoretical models on perception and attitudes and construct an integrative theoretical framework on psychological representation of bodily symptoms as well as more abstract representations of health and disease. The aim of this combination of approaches is to unify the strengths of different research domains in the conceptualization and measurement of mental representations of bodily states. Furthermore, the aim is to specify new, testable predictions and implications about the (conditional) relationship of these mental representations and affective and behavioral consequences. A core element in this integrative model is comparison. We review how comparison processes can change the cognitive and affective reference frame for illness and symptom perception and in turn affective and behavioral reactions. We discuss implications for measurement of illness and symptom representations as well as implications for clinical practice. Finally, we make suggestions for a research agenda to validate the proposed model as well as to address new questions derived from it.     

Exploring the roles of approach and avoidance in depression: an integrative model

Human behavior can be organized around two fundamental motivational principles: the desire to approach positive outcomes and the desire to avoid negative outcomes. Both approach and avoidance motivation are relevant to a range of psychopathology, including depression. However, with some notable exceptions, avoidance processes have been underemphasized in the literature on motivational processes in depression. This review will examine the roles that approach and avoidance play in depression and will present an integrative model of approach and avoidance processes in depression. Both approach deficits and avoidance motivation are argued to play a role in limiting positive experiences and reinforcement for non-depressed behavior, contributing to the onset and maintenance of depression. In addition, avoidance processes are argued to play a role in negative information processing biases that may increase vulnerability to the onset and recurrence of depression. Lastly, avoidance processes and dysregulation in the connections between the approach and avoidance systems may contribute to depression by promoting inappropriate perseveration in the pursuit of unattainable approach goals. Theoretical rationales and empirical evidence for each of these roles are presented. Understanding the roles that both approach and avoidance play in depression may help to inform current conceptualizations of depression and improve treatment outcomes.     

Control theory and psychopathology: An integrative approach

Perceptual control theory (PCT; Powers, 1973 ) is presented and adapted as a framework to understand the causes, maintenance, and treatment of psychological disorders. PCT provides dynamic, working models based on the principle that goal‐directed activity arises from a hierarchy of negative feedback loops that control perception through control of the environment. The theory proposes that psychological distress arises from the unresolved conflict between goals. The present paper integrates PCT, control theory, and self‐regulatory approaches to psychopathology and psychotherapy and recent empirical findings, particularly in the field of cognitive therapy. The approach aims to offer fresh insights into the role of goal conflict, automatic processes, imagery, perceptual distortion, and loss of control in psychological disorders. Implications for psychological therapy are discussed, including an integration of the existing work on the assessment of control profiles and the use of assertive versus yielding modes of control.     

Designing optimal calcium phosphate scaffold-cell combinations using an integrative model-based approach

Bone formation is a very complex physiological process, involving the participation of many different cell types and regulated by countless biochemical, physical and mechanical factors, including naturally occurring or synthetic biomaterials. For the latter, calcium phosphate (CaP)-based scaffolds have proven to stimulate bone formation, but at present still result in a wide range of in vivo outcomes, which is partly related to the suboptimal use and combination with osteogenic cells. To optimize CaP scaffold selection and make their use in combination with cells more clinically relevant, this study uses an integrative approach in which mathematical modeling is combined with experimental research. This paper describes the development and implementation of an experimentally informed bioregulatory model of the effect of calcium ions released from CaP-based biomaterials on the activity of osteogenic cells and mesenchymal stem cell driven ectopic bone formation.The amount of bone formation predicted by the mathematical model corresponds to the amount measured experimentally under similar conditions. Moreover, the model is also able to qualitatively predict the experimentally observed impaired bone formation under conditions such as insufficient cell seeding and scaffold decalcification. A strategy was designed in silico to overcome the negative influence of a low initial cell density on the bone formation process. Finally, the model was applied to design optimal combinations of calcium-based biomaterials and cell culture conditions with the aim of maximizing the amount of bone formation. This work illustrates the potential of mathematical models as research tools to design more efficient and cell-customized CaP scaffolds for bone tissue engineering applications.     

An integrative approach to neurotoxicology

Exposure of human populations to a wide variety of chemicals has generated concern about the potential neurotoxicity of new and existing chemicals. Experimental studies conducted in laboratory animals remain critical to the study of neurotoxicity. An integrative approach using pharmacokinetic, neuropathological, neurochemical, electrophysiological, and behavioral methods is needed to determine whether a chemical is neurotoxic. There are a number of factors that can affect the outcome of a neurotoxicity study, including the choice of animal species, dose and dosage regimen, route of administration, and the intrinsic sensitivity of the nervous system to the test chemical. The neurotoxicity of a chemical can vary at different stages of brain development and maturity. Evidence of neurotoxicity may be highly subjective and species specific and can be complicated by the presence of systemic disease. The aim of this paper is to give an overview of these and other factors involved in the assessment of the neurotoxic potential for chemicals. This article discusses the neurotoxicity of several neurotoxicants (eg, acrylamide, trimethyltin, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine, manganese, and ivermectin), thereby highlighting a multidisciplinary approach to the assessment of chemically induced neurotoxicity in animals. These model chemicals produce a broad range of effects that includes peripheral axonopathy, selective neuronal damage within the nervous system, and impaired neuronal-glial metabolism.     

Event-related theta oscillations: an integrative and comparative approach in the human and animal brain.

This report provides a synthesis of results in both cat and human brains in order to point out the importance of theta responses during cognitive processes and P300 paradigms. The unique features of this report consisted of the fact that human and cat data during several cognitive paradigms were compared. The results open the way to formulate the selectively distributed theta system in the brain as analyzed by Ba?ar, Schürmann and Sakowitz (this issue).     

Traditional versus integrative behavioral couple therapy for significantly and chronically distressed married couples

A randomized clinical trial compared the effects of traditional behavioral couple therapy (TBCT) and integrative behavioral couple therapy (IBCT) on 134 seriously and chronically distressed married couples, stratified into moderately and severely distressed groups. Couples in IBCT made steady improvements in satisfaction throughout the course of treatment, whereas TBCT couples improved more quickly than IBCT couples early in treatment but then, in contrast to the IBCT group, plateaued later in treatment. Both treatments produced similar levels of clinically significant improvement by the end of treatment (71% of IBCT couples and 59% of TBCT couples were reliably improved or recovered on the Dyadic Adjustment Scale; G. B. Spanier, 1976). Measures of communication also showed improvement for both groups. Measures of individual functioning improved as marital satisfaction improved.     

Microglia dysfunction in schizophrenia: an integrative theory

Schizophrenia is a devastating illness of unknown etiology. It is characterized by increased brain ventricular volume, suggesting a progressive neurodevelopmental condition. There is evidence suggesting a correlation between in utero viral exposure and subsequent occurrence of schizophrenia. Many neurotransmitter systems have been implicated as being dysfunctional in schizophrenia. There are also data suggesting immune system dysfunction in schizophrenia, and a negative correlation between schizophrenia and rheumatoid arthritis. Microglia are phagocytic immune cells in the central nervous system (CNS) derived from peripheral blood monocytes. They are involved in brain development, neuroproliferative and neurodegenerative activities, several CNS illnesses, and CNS viral immunity. They may also be involved in neurotransmitter regulation. The current theory postulates microglial dysfunction initiated by early CNS viral exposure results in the abnormal neural development and neurotransmitter dysfunction seen in schizophrenia.     

Purinergic dysfunction in mania: an integrative model

The purinergic system, which includes the anticonvulsant and antikindling neuromodulator adenosine and the neurotransmitter ATP, modulates second messenger systems, neurotransmitters, energy metabolism and different behaviors, such as sleep, motor activity, cognition, memory, aggressive behavior and social interaction. At the same time, mania is characterized by similar behavioral changes and a molecular basis to explain the pathological activation observed during manic episodes has been also associated with second messenger systems dysfunction and kindling. This hypothesis put forward an integrative model of neuronal communication, associating a reduced adenosinergic activity, mostly at A1 receptors, with the complex network of changes on neurotransmitters pathways related to manic behavior.