Assessing peer entry and play in preschoolers at risk for maladjustment.

This study evaluated the psychometric properties of an observational rating system for assessing preschoolers' peer entry and play skills: Observed Peer Play in Unfamiliar Settings (OPPUS). Participants were 84 preschoolers at risk for psychopathology. Reliability and concurrent validity are reported. The 30-min paradigm yielded reliable indexes of engaging and disruptive behavior. Adequate interrater reliability and stability were obtained with minimally trained observers. OPPUS scores were related in expected ways to independent observations of disruptive and engaging behavior during parent-child interactions. OPPUS scores were associated with parent-rated self-control and internalizing behaviors. OPPUS scores were associated with parent ratings of play skills for children with school experience and assertiveness for children without school experience. The OPPUS is a useful, brief method for assessing peer entry and play behaviors in preschoolers.     

Psychodynamic, time-limited group therapy in rheumatic disease--a controlled study with special reference to alexithymia

Forty-six female patients with rheumatoid arthritis or primary Sj?gren's syndrome participated in a prospective, controlled study of psychodynamic, time-limited group therapy. The paper concentrates on the qualitative outcome evaluated according to the patients' perceptions of what was appreciated as being most helpful in the group. Yalom's 'curative factors Q-sort' served as parameter of effect. Special attention will be given to the prevalence of alexithymia in rheumatic patients, and to the possibilities of ameliorating alexithymic features through group therapy.     

The relative efficacy of two interventions in altering maltreated preschool children's representational models: implications for attachment theory

A narrative story-stem task was used to evaluate the efficacy of two competing, developmentally informed preventive interventions for maltreated preschoolers and their mothers designed to modify children's internal representations of self and of self in relation to other. One hundred and twenty-two mothers and their preschoolers (87 maltreated and 35 nonmaltreated) served as participants. Maltreating families were randomly assigned to either the preschooler-parent psychotherapy (PPP, n = 23), psychoeducational home visitation (PHV, n = 34), or community standard (CS, n = 30) intervention group at baseline. Thirty-five nonmaltreating (NC) families served as comparisons. Narratives were administered to children at baseline and at the postintervention evaluation. Children in the PPP intervention evidenced more of a decline in maladaptive maternal representations over time than PHV and CS children and displayed a greater decrease in negative self-representations than CS, PHV, and NC children. Also, the mother-child relationship expectations of PPP children became more positive over the course of the intervention, as compared to NC and PHV participants. These results suggest that an attachment-theory informed model of intervention (PPP) is more effective at improving representations of self and of caregivers than is a didactic model of intervention directed at parenting skills. Findings are discussed with respect to their implications for developmental theory, with a specific focus on attachment theory and internal working models of relationships.     

The development of dissociation in maltreated preschool-aged children

Dissociation reflects disruptions in the integration of memories, perception, and identity into a coherent sense of self, and may develop following childhood maltreatment. The preschool years were identified as an important period for the development of dissociation. However, prior research has not examined the development of dissociation during this time. In order to address this gap, evidence of dissociation in 45 maltreated children, assessed for sexual abuse, physical abuse, and neglect, was compared with dissociation in 33 nonmaltreated children. Rather than depend on adult observer reports of behavior, the study sought to gain an understanding of dissociation from the child's own point of view. Because self-reports have limitations with such young children, a measure of dissociation evidenced in children's narrative story-stem completions was utilized. Maltreated children, especially physically abused children and sexually abused children, demonstrated more dissociation than did nonmaltreated children. Moreover, during the preschool period maltreated and nonmaltreated children followed different trajectories such that dissociation increased for maltreated children but did not do so for nonmaltreated children. Findings suggest that although the self is normatively integrated during the preschool period, it becomes increasingly fragmented for some maltreated children. Results are discussed in terms of cascading effects of maltreatment throughout development, and the importance of developmentally sensitive interventions.     

The efficacy of group therapy for patients with irritable bowel syndrome

Twenty patients with irritable bowel syndrome underwent six weeks of group therapy incorporating behavioral and didactic techniques. Psychometric follow-up study revealed a significant reduction in dysphoric emotions despite the persistence of somatic complaints. These findings are evaluated in the context of the subjects’ cognitive styles of locus of control and field-dependence.     

The effectiveness of time-limited psychotherapy in a university counseling center

Investigated the effects of eight-session, time-limited therapy on clients' self-concepts. Fourty-two students who sought psychotherapy or personal counseling at the university counseling center were assigned randomly to either time-limited, time-unlimited, or control groups after screening with the MMPI to eliminate the most severely disturbed clients. The Bills Index of Adjustment and Values was administered pre- and post-therapy. Results of a two-way repeated measures analysis indicated significant improvement in both time-limited and unlimited groups, but not in the controls. The two treatment groups did not differ in improvement. A 2 1/2 year follow-up of 18 of the former clients suggested that treatment gains were maintained and were equivalent for those who received time-limited and open-ended therapy.     

Client interpersonal and cognitive styles as predictors of response to time-limited cognitive therapy for depression.

This study examined the relationship between cognitive and interpersonal styles and outcome among 24 clients who received time-limited cognitive therapy for depression. The authors hypothesized that this relationship would be mediated by therapeutic alliance. They found that clients' interpersonal style, particularly an underinvolved style, was predictive of treatment outcome. As predicted, the impact of this style on outcome was mediated through the therapeutic alliance.     

The efficacy of cognitive-behavioral therapy and the problem of drop-out

Treatment drop-out is a common problem in the everyday practice of psychotherapy. In the cognitive-behavioral psychology literature, there are scant data on drop-out from therapy and the data available vary widely according to the definition of drop-out and the intensity of treatment. This study presents results obtained in the Behavioural Therapy Unit of the University of Barcelona. Of the 203 patients seen in the unit, 89 (43.8%) dropped out, mostly in the early stages of the intervention. The most common reasons for this were low motivation and/or dissatisfaction with the treatment or the therapist (46.7%), external difficulties (40%), and patients' feeling of improvement (13.3%). Patients who dropped out differed from those who continued; they more often presented affective or eating disorders or problems with impulse control. The observed drop-out rate is in line with figures reported for psychotherapy in general and by those studies which have considered cognitive-behavioral therapy in particular.     

The efficacy of personal construct therapy: a comprehensive review

Prior narrative and quantitative reviews have suggested that personal construct therapy (PCT) is an efficacious and viable form of treatment. However, these reviews failed to include all published, controlled PCT outcome studies and did not account for all measures of outcome. The present quantitative review, therefore, offers a comprehensive integration of the 22 published studies that compare PCT to a control group, examining its overall efficacy at posttest and follow-up as well as its effects for different types of outcome measures. Overall, the efficacy of PCT was found to be somewhat weaker than that reported in previous reviews. It was also found that traditional self-report and behavioral observation measures tended to yield larger effects compared to measures that focused on personal meanings and scored content supplied by the client.     

Story stem responses of preschoolers with mood disturbances

Observing the young child's affect regulation and thought processes during a clinic assessment visit is of critical importance although challenging for children referred for mood disturbance. In this study, parents reported symptoms using standardized clinical interviews and story stems narratives were administered to 20 referred and 12 typically developing preschool age children. Comparison of the referred and typically developing children in our sample showed that specific story contexts varied in eliciting responses reflecting disorganization and thought disturbance from the referred children. The experience of using story stem narratives in the clinical assessment process suggests it provides a valuable complement to parent report for children referred for mood disturbance and mania symptoms but additional development and study of the method is necessary.     

结构式团体治疗对住院男性慢性精神分裂症患者孤独感的疗效

目的:探讨结构式团体治疗对住院男性慢性精神分裂症患者孤独感的疗效。方法:选取符合中国精神疾病诊断与分类标准第三版(Chinese Classification and Diagnostic Criteria of Mental Disease,the rdversion,CCMD-3)慢性精神分裂症诊断标准,以阴性症状为主的住院男性患者共106例,随机分为研究组和对照组,每组各53例。研究组实施团体治疗,疗程3个月,对照组不做干预。于治疗前、治疗结束时及治疗结束后3个月分别采用情绪-社交孤独量表(Emotional-Social Loneliness Inventory,ESLI)、阴性症状量表(Scale for the Assessment of Negative Symptoms,SANS)和阳性症状量表(Scale for Assessment of Posi-tive Symptoms,SAPS)对两组进行总分及因子分评定。结果:治疗前两组ESLI、SANS、SAPS总分及各因子评分差异均无统计学意义;治疗结束时研究组ESLI总分及各因子分[如总分,(30.15±12.58)vs.(43.32±16.77)],SAPS总分[(0.42±0.82)vs.(0.96±1.67)]、SANS中情感平淡、兴趣-社交缺乏、注意障碍3项因子评分[(6.72±3.33)vs.(8.47±3.85),(15.00±3.49)vs.(17.06±3.26),(6.91±2.26)vs.(8.13±2.70)],均明显低于对照组(Ps0.05);治疗结束后3个月治疗组ESLI总分及各因子分[如总分,(26.87±15.32)vs.(41.60±16.36)]及SANS中注意障碍因子[6.70±2.19)vs.(8.27±2.43)]评分降低明显,仍低于对照组(Ps0.05)。结论:结构式团体治疗对改善住院男性慢性精神分裂症患者孤独感有明显疗效。     

Diversity in adjustment of maltreated children: factors associated with resilient functioning

Many decades of research indicate that physical abuse and neglect are associated with substantial risk for maladaptation across many developmental tasks of childhood, adolescence, and adulthood. Recent investigations, however, indicate that in spite of elevated risk for negative outcomes, some abused and neglected children demonstrate relatively positive adjustment and success in developmental tasks. An overview of studies of resilient functioning among maltreated children is provided, and results indicate that although a proportion of maltreated children do appear to be resilient to harsh and inadequate caretaking, resilient functioning might be short-lived and/or limited to single areas of functioning. A summary of factors associated with resilient functioning among abused and neglected children is provided. Such factors include individual child characteristics (e.g., self-regulatory processes), features of the child's family context (e.g., supportive parenting), and experiences in the broader environment (e.g., close friendships). Methodological considerations and recommendations for further research are provided, and implications of this literature for clinical and policy applications are presented.     

Diverse patterns of neuroendocrine activity in maltreated children

Cortisol regulation was investigated in a sample of school-aged maltreated (n = 175) and demographically comparable low-income nonmaltreated (n = 209) children in the context of a day camp research program. Overall group differences between maltreated and nonmaltreated children were not found for average morning or average afternoon cortisol levels. However, significant variations were found that were based on the subtypes of maltreatment that the children had experienced. Maltreated children who had been both physically and sexually abused (as well as neglected or emotionally maltreated) exhibited substantial elevations in morning cortisol levels; children who had high (>1 SD) cortisol levels in both the morning and afternoon were also overrepresented in the multiple abuse group. Developmental timing of maltreatment did not account for these group differences, whereas the severity of sexual abuse was implicated. In contrast to the multiple abuse group, a subgroup of physically abused children showed evidence of a trend toward lower morning cortisol relative to nonmaltreated children with a significantly smaller decrease in cortisol levels from morning to afternoon. The findings are discussed in terms of the diversity of atypical cortisol regulation patterns that are exhibited among maltreated children.     

The efficacy of enrofloxacin,alone or combined with metronidazole,in the therapy of canine leishmaniasis

We evaluated the efficacy of enrofloxacin, alone or combined with metronidazole, against Leishmania infantum. The in vitro activity of this fluoroquinolone was assessed using two different methods: a direct test aimed at assessing the drug activity on the parasite, and an indirect test aimed at evaluating the drug effect on macrophage killing, lymphomonocyte activation and nitric oxide production. An in vivo test was also performed on 36 dogs with leishmaniasis, subdivided into three groups, one treated with enrofloxacin, another with enrofloxacin plus metronidazole, and a control group with meglumine antimoniate. The direct test did not show any action of enrofloxacin on the parasite, while the indirect testing showed an enhancement of macrophage killing and an increase in nitric oxide production. These findings show that enrofloxacin does not exert a direct anti-leishmanial activity in vitro. However, on the basis of the positive immunostimulation results shown in vitro and the clinical improvement, particularly of the cutaneous lesions, obtained in several dogs in the in vivo trial, the use of enrofloxacin in association with a specific anti-leishmanial drug can be proposed in the therapeutic protocol of canine leishmaniasis.     

Parent-child interaction therapy: a comparison of standard and abbreviated treatments for oppositional defiant preschoolers

Families of 54 behaviorally disturbed preschool-aged children (3 to 5 years) were randomly assigned to 1 of 3 treatment conditions: standard parent-child interaction therapy (PCIT; STD); modified PCIT that used didactic videotapes, telephone consultations, and face-to-face sessions to abbreviate treatment; and a no-treatment waitlist control group (WL). Twenty-one nondisturbed preschoolers were recruited as a social validation comparison condition. Posttreatment assessment indicated significant differences in parent-reported externalizing behavior in children, and parental stress and discipline practices from both treatment groups on most measures compared with the WL group. Clinical significance testing suggested a superior effect for the STD immediately after intervention, but by 6-month follow-up, the two groups were comparable. The findings indicate that abbreviated PCIT may be of benefit for families with young conduct problem children.     

The efficacy of cognitive-behavioral therapy on the core symptoms of bulimia nervosa

Cognitive behavioral therapy (CBT) is widely regarded as the treatment of choice for bulimia nervosa (BN), with previous reviews of the CBT outcome literature claiming an approximate 40%-50% recovery rate. Most of these reviews have focused on reductions of binge eating and purging; however, the cognitive model of BN that underlies the CBT approach identifies three additional symptoms as central to the disorder: restrictive eating, concerns with shape and weight, and self-esteem. The purpose of this review was to determine the effect of CBT on the five core symptoms of BN, particularly those neglected in previous reviews. This review found that while most studies provided outcome data on binge eating, purgative behavior, and concern with shape and weight, fewer studies provided data on restraint and self-esteem. While generally favorable, evidence for the efficacy of CBT on the core symptoms of BN was mixed, depending on the outcome measures used. Shortcomings in the literature are identified and suggestions to correct these shortcomings are provided.