A rapid multi-component treatment for an obsessive-compulsive disorder

A 67-yr-old woman with a 45-yr history of obsessive-compulsive problems related to fear of contamination was treated rapidly by a multi-component intervention. Questionnaire data following treatment showed the patient to be free of obsessive-compulsive complaints, and these were corroborated by behavioral observations. Follow-up probes conducted 6, 12 and 18 months later revealed continued maintenance of treatment gains. Patient-therapist contact time totalled 6 hr, about one-third of the time employed by Marks for exposure and response prevention, indicating the cost-effectiveness of a multi-component treatment intervention.     

The use of problem solving to reduce examination and interpersonal anxiety

A 32-yr old woman was treated for examination and interpersonal anxiety by the use of systematic problem solving. Her anxiety occured because domestic difficulties prevented her from preparing for and taking examinations. This procedure was used after cognitive desensitization was unsuccessful in reducing her anxiety. The problem solving procedures provided her with skills in identifying and engaging in appropriate behaviors to reduce domestic pressures. Following treatment her anxiety attacks decreased from approximately five a day to one per week. In addition, the client was able to apply the problem solving skills to other, non-treated areas of her life.     

A comparison of two relaxation procedures for reducing cognitive and somatic anxiety

The effectiveness of two different relaxation procedures was compared in treating snake anxious people who expressed anxiety primarily in a somatic or a cognitive manner. Forty moderately snake phobic subjects were categorized as either “somatically-anxious” or “cognitively-anxious” on the basis of a questionnaire. Half of the subjects in each group were given modified progressive relaxation training, and the other half received training in Agni-Yoga for four sessions. After completion of training, approach distance, subjective fear and pulse rates were measured during a snake approach test. In addition, a snake fear scale was given to each subject prior to and after approaching the snake. The results provided tentative evidence that the two relaxation procedures produced differential effects according to whether subjects expressed anxiety somatically or cognitively.     

A comparison of relaxation training and competing response training to eliminate hair pulling and nail biting

A 17-year-old female with a 14-year history of hair pulling and nail biting was treated with relaxation training and competing response training. While introduction of relaxation training produced an initial decline in hair pulling, there was a gradual recovery of the maladaptive behavior to baseline levels. The competing response procedure consisted of clenching fists for 3 min whenever hair pulling or nail biting occurred or were likely to occur. By the use of the competing response hair pulling and nail biting decreased, eventually to zero. Follow-up over a 2-year period revealed that the treatment effects were maintained.     

Biofeedback treatment of long-standing eye closure reactions

A 34-yr-old woman, who had a 13-yr history of being unable to keep her eyes open, was treated successfully by EMG biofeedback and relaxation training. Relaxation training reduced self-recorded eye closures at home, but failed to reduce the frequency of eye closures recorded during office treatment. Biofeedback training was used first for relaxing the frontalis muscle when her eyes were closed and later with her eyes progressively more open. Following biofeedback training she was given assertion training to increase her social contacts. At 6-month follow-up, she was able to maintain normal eye-openings, and reported having fewer interpersonal problems.     

The use of stimulus control procedures to eliminate persistent nocturnal awakenings

A 22-yr-old male with a 6 yr history of sleep onset insomnia and frequent nocturnal awakenings was treated with relaxation training and stimulus control procedures. The stimulus control component consisted of a variety of procedures for associating sleep with the bed and non-sleeping activities with other stimuli. In addition, the client self-punished for nocturnal awakenings. The relaxation procedure, used first, reduced the time the client needed to fall asleep and several somatic complaints, but did not reduce nocturnal awakenings. The addition of the stimulus control/punishment procedures eliminated nocturnal awakenings.     

Multifaceted treatment of compulsive hair pulling

This paper reports on the successful use of a multifaceted behavioral approach to treating compulsive hair pulling. Specifically, this approach involves heightening the client's awareness to maladaptive overt and covert behaviors. The client is then taught to use newly learned coping self-instructions, self-statements and behaviors. The couse of treatment is discussed, and the techniques employed.     

Behavioral treatment of chronic hair pulling in a two year old

Chronic hair pulling, exhibited by a 27 month-old boy was ameliorated in a 15-week treatment. The methodology focused on teaching the parents to apply a specific combination of differential reinforcement and response-chain interruption procedures. Follow-ups at 6 and 12 months revealed neither the recurrence of hair pulling nor the appearance of other problematic behaviors.     

Stress and brain noradrenaline: a review

Noradrenergic neural systems have been expressly implicated in pathophysiological conditions induced by stress. The majority of experimental evidence supports a central role for brain noradrenaline in mediating the effects of stress and predisposing an organism to stress pathology as well as in producing a well-documented consequence of stress exposure-behavioral depression. This review briefly discusses the noradrenergic (NA) pathways involved, the functioning of NA synapses and their associated receptors and focuses directly upon the effects of stress on NA activity in the brain. These broad categories are discussed in terms of: 1. behavioral versus neurochemical explanations for the effects of stress; 2. the methods used to produce stress; 3. measurement of NA and its major metabolite ("turnover"); 4. regional brain effects of stress; 5. effects of pre-stress alterations in brain NA activity upon subsequent stress-induced brain NA changes; 6. correlation of stress-induced brain NA changes with peripheral manifestations of stress; and 7. predisposing factors in stress-induced neurochemical alterations.     

Bias and therapist influence in behavioral assessment

This paper illustrates several types of unwanted bias and indicates some of their adverse effects on assessment and planning for modification. Although bias and influence cannot be eliminated from the interview, their effects can be reduced by having the therapist use behaviorally neutral interviewing, informing patients early of the importance of providing accurate and specific information, and withholding recommendations and advice about modification until assessment has been completed. Occasions when the therapist may depart from a neutral stance during assessment are noted.     

Treatment of hairpulling (Trichotillomania): A comparative study of habit reversal and negative practice training

Hairpulling is an uncommon behavior which has received little study and for which effective treatment has not been established. The present study evaluated the habit reversal and the negative practice method of treatment with 34 subjects randomly assigned to the two treatments. Habit reversal was about twice as effective as the negative practice with respect to the average percentage reduction in hairpulling episodes, the number of subjects who stopped hairpulling entirely, and those who stopped almost entirely. Follow-up phone calls or a single booster session were often effective in preventing or correcting the relapses. It appears that hairpulling can be successfully treated by brief habit reversal training with substantial and enduring benefits.     

A left-ear advantage for identifying the emotional quality of tonal sequences

Tonal sequences differing in emotional quality were presented dichotically. Subjects listened to a specified ear and judged the emotional tone of the stimulus heard at that ear. Accuracy was better for identifying the emotional tone of stimuli presented to the left ear. This left ear advantage was greatest where the target and competing stimuli were of different affect. The findings provide further evidence for the role of the right hemisphere in processing emotional information.     

A systematized introduction to behavior therapy training

A course designed to train graduate students in clinical psychology in a number of intervention techniques for adult clients is described, based on the behavioral systems and personalized instruction approaches to training. The objectives for the course are stated, and its features reviewed. The impact of the course on students' subsequent performance is briefly considered.     

Myoclonus epilepsy associated with ragged-red fibres (mitochondrial abnormalities): Disease entity or a syndrome?: Light- and electron-microscopic studies of two cases and review of literature

A report is given of an association of dyssynergia cerebellaris myoclonica associated with Friedreich's ataxia and mitochondrial myopathy in 2 patients. They had suffered from gradually increasing bursts of myoclonus since the wage of 14 and childhood, respectively. The other striking clinical features included generalized convulsions, mental deterioration, intention tremor, ataxia, muscular atrophy and deformity of feet. Muscle biopsies revealed ragged-red fibres in both cases. On electron microscopy these fibres contained subsarcolemnal aggregations of abundant abnormal mitochondria with proliferation of inner membranes or paracrystalline inclusions. One of these patients showed elevated blood lactate and pyruvate with an increased lactate/pyruvate ration, apparently of primary origin. These 2 cases resemble those reported briefly by Tsairis et al. (1974). An association of dyssynergia cerebellaris myoclonica associated with Friedreich's ataxia and mitochondrial myopathy in these 2 patients is unlikely to be coincidental but may represent one nosological entity. This myoclonus epilepsy syndrome associated with ragged-red fibres is compared with other possibly related mitochondrial encephalomyopathies.     

The use of contingency contracting in controlling adult nailbiting

An adult patient agreed to contribute money to a strongly disliked organization for failure to increase fingernail length. Nailbiting was discontinued for the duration of the contingency contract and a follow-up 3 and 6 months later indicated that the increase in nail length was maintained.     

The effects of social skills training on behavioral and cognitive components of anger management

While cognitive change and other methods for the management of anger have reported successes, little attention has been paid to the systematic assessment of the effects of one type of treatment (e.g., behavioral) on an area targeted primarily by the other (e.g., cognitive). In the present study both behavioral and cognitive changes were assessed when a treatment strategy devoted to changing behavior alone was used. Results indicated that changes in behavior altered cognitions, and that a strategy designed to alter cognitions alone was unnecessary.     

Postnatal growth and development of the gerbil brain

The Mongolian gerbil brain undergoes most of its postnatal growth and development during the first 2 weeks of life. At birth the gerbil weighs only 4% of its adult body weight, and the cerebrum and cerebellum are only 24 and 9.9%, respectively, of their adult weights. The cerebrum is more mature at birth than is the cerebellum. At 7 days of age, the cerebrum contains 55.7% of its adult DNA content, whereas the cerebellum has amassed only 17.2% of its adult content. By 21 days of age, cerebral growth is essentially complete, as measured by DNA, RNA, and protein accumulation. Cholesterol content approaches adult values in the cerebrum by 60 days of age. The rate of growth of the cerebrum and rate of RNA accumulation peak at 7 to 8 days of age. The cerebral protein velocity curve reaches its maximum at 10 to 11 days, that of DNA at 12 days, and cholesterol at 17 days of age. Conversely, the cerebellum at 21 days of age has only 65.6% of its adult protein content and 77.4% of its adult weight, although DNA multiplication is nearly complete. Myelination, as measured by accumulation of cholesterol, is not complete until sometime between 90 and 180 days of age. The velocity maxima of the other cerebellar constituents occur at about 12 to 13 days of age.     

Chronic pain and depression: a review

An interesting association has long been observed between chronic benign pain and depression. Some investigators have even suggested that chronic pain is indeed a particular form of depressive illness. A close examination of literature reveals many fundamental problems with such claims. Research in this area is generally weak and while there may be an interesting relationship between depression and chronic pain both at the psychosocial and biochemical levels, it would be a gross error to equate chronic pain with clinical depression. Chronic pain is not a primary psychiatric disorder.     

The rapid treatment of a case of writer's cramp using band-aid biofeedback

This case history reports the treatment of writer's cramp in a 22-yr-old university student by the application of a piece of tape over the thumb. The tape provided tactile feedback which enabled her to monitor and correct hyperflexion in the thumb and maladaptive movements in her other fingers. Following a week of treatment, the student remained symptom-free for 2 yr. The recurrence of her cramp at this time was again readily eliminated.