Therapeutic alliance and behavior inhibition

Abstract The study examined whether the quality of the therapeutic alliance is associated with a tendency toward behavior inhibition. Inhibition was measured by the frequency with which the clients used the word "not" and by their verbal productivity. In treatment sessions with low-quality therapeutic alliance, clients tended to use the word "not" more often and speak fewer words. Results suggest that it could be useful for therapists to use indexes of behavior inhibition as problem markers in the therapeutic alliance.     

Morita therapy over history]

At Sansei Hospital in Kyoto we performed Morita Therapy not only for Japanese clients but also foreign clients from several countries, like Germany, Switzerland, U.S.A., China, Korea, India and Indonesia. We could treat those foreign clients using Morita Therapy with good success although they came from various cultural backgrounds. One of the characteristic Approaches of Morita Therapy was that it avoided the conceptualization of self-consciousness and self image as a subjective fiction established by abstract and logical thinking. Secondary Morita Therapy moves clients to deal with activities in real life. These 2 approaches help clients not to be involved in symptom development or fixation mechanisms and break through self-centeredness. At the first stage of Morita Therapy, namely in the bed rest period clients can experience his psychic state as if he were a just born baby. The founder of Gestalt Therapy, Frederick S. Perls experienced by himself Morita Therapy. During bed rest therapy he behaved as if he were a baby. This behavior came out not from conscious abstract and logical thinking but from spontaneous "pre-conscious" state of mind. Morita called this "Jun-na-kokoro" (Pure mind). Morita knew that neurotic symptoms come out from those abstract and logical thinking which could lead to fixation of symptoms so that therapy principle might be the de-centralization of self and the pure mind experience which is found in our daily life and also in daily life of foreign people from various cultural backgrounds.     

A Pilot Evaluation of a Tutorial to Teach Clients and Clinicians About Gambling Game Design

This paper describes the pilot evaluation of an Internet-based intervention, designed to teach counselors and problem gamblers about how electronic gambling machines (EGMs) work. This study evaluated the tutorial using assessment tools, such as rating scales and test of knowledge about EGMs and random chance. The study results are based on a number of samples, including problem gambling counselors (n = 25) and problem gamblers (n = 26). The interactive tutorial was positively rated by both clients and counselors. In addition, we found a significant improvement in scores on a content test about EGM games for both clients and counselors. An analysis of the specific items suggests that the effects of the tutorial were mainly on those items that were most directly related to the content of the tutorial and did not always generalize to other items. This tutorial is available for use with clients and for education counselors. The data also suggest that the tutorial is equally effective in group settings and in individual settings. These results are promising and illustrate that the tool can be used to teach counselors and clients about game design. Furthermore, research is needed to evaluate its impact on gambling behavior.     

The mentally ill substance abuser: challenges for the administrator

Despite a high incidence of dual diagnosis among substance abusers and among the mentally ill, few programs provide the comprehensive services needed to address both problems simultaneously. Dual diagnosis presents a series of challenges for administrators: Which problem should be addressed first? Should admission criteria be altered to exclude such clients? Can more comprehensive services be offered within existing funding? Differences between the two domains of treatment exacerbate their inability to work together. Substance abuse programs often employ "recovering" individuals as treatment staff and offer relatively brief inpatient programs, often using confrontational approaches. Self-help groups are frequent adjuncts to treatment but disdain the use of prescribed medications. In contrast, programs for the chronic mentally ill usually do not employ former clients, have longer lengths of stay, include use of medications to alter behavior, and are more supportive and educational. Overcoming barriers to treatment must involve change in policies related to funding, staff training, admission criteria and differences in philosophy of treatment.     

Agitation and dementia-related problem behaviors and case management in long-term care

Existing data on case management (CM) time were analyzed to investigate the impact of agitation and dementia-related behavior problems on the use of CM time by older clients (N = 242) in a Medicaid waiver-funded home and community-based services program. Among clients with dementia (n = 73), regression analysis revealed that having problem behaviors resulted in increased use of CM time. Among clients with behavior problems, those with greater functional ability consumed greater CM time. Content analysis revealed that most CM activity focused on service coordination rather than on direct attempts to manage problem behaviors. Implications for CM programs include the need to consider case mix when allocating caseload size and provision of specific training on interventions to address behavior problems.     

The dual-diagnosis problem is the case-management problem in disguise

The prevalence of dual-diagnosis among clients of a service system depends more strongly on the internal organization of that system than on the intrinsic prevalence of dual diagnoses in the service population. Clients are most often identified as dual-diagnoses if they carry two diagnoses that cross program lines. For purposes of program planning, a dual-diagnosis client is nearly always a dual-program client. From this point of view, dual-diagnosis clients are produced by service systems with diagnosis-specific program. Instituting a system-wide case-management unit is a more effective solution to the dual-diagnosis problem than creating special programs for clients with two diagnoses.     

Evaluation of an interdisciplinary review committee managing the use of psychotropic medication with people with intellectual disabilities

This paper reports on the first two years of the operation of an Interdisciplinary Review Committee managing the use of psychotropic medication in a training centre for people with intellectual disabilities in Victoria. For 25 clients receiving psychotropic medication in the management of challenging behaviour, daily doses of neuroleptic medication were reduced by an average of 43.9%. Across all psychotropic drugs administered as chemical restraint, daily doses were reduced by an average of 51.2%. Polypharmacy prevalence was reduced from 52.0% to 24.0%. Three of the clients were totally removed from all psychotropic medication with no deleterious outcome. None of the 25 clients had a net medication increase.     

Anxiety modulation by the heart? Aerobic exercise and atrial natriuretic peptide

Exercise has an anxiolytic activity and it increases the concentrations of atrial natriuretic peptide (ANP). Because ANP has an anxiolytic activity, this hormone might contribute to the anxiolytic effects of aerobic exercise. Cholecystokinin-tetrapeptide (CCK-4)-induced panic attacks were studied in 10 healthy subjects after "quiet rest" or 30 min of aerobic exercise. Plasma ANP concentrations were measured before and after exercise or quiet rest using a commercial IRMA kit. Compared to quiet rest, CCK-4-induced anxiety was reduced and plasma ANP concentrations were increased by prior exercise. This anxiolytic activity of exercise was correlated with the increase in plasma ANP concentrations. Our results suggest that besides other mechanisms, ANP might be a physiologically relevant humoral link between the heart and anxiety-related behavior contributing to the acute anxiolytic effects of exercise.     

Exposure and response prevention therapy with cognitive defusion exercises to reduce repetitive and restrictive behaviors displayed by children with autism spectrum disorder

Repetitive and restrictive behaviors are disruptive in children with autism spectrum disorder. Exposure is an evidence-based approach to these problems and is hypothesized to work in part by enabling rule testing that undermines rule control. The present study undermined rule control more directly through cognitive defusion exercises. Experiment 1 used a multiple baseline across participants design to assess the effects of a cognitive defusion exercise in the form of word repetition and exposure on problem behavior associated with repetitive and restrictive behaviors observed in children with autism spectrum disorder. All 3 participants demonstrated a decrease in the percentage of problem behavior following the implementation of treatment which remained at near zero during a 3-month follow-up. Experiment 2 used an alternating treatments design to compare a cognitive defusion exercise and exposure to a control exercise and exposure. All except 1 of the participants displayed larger and quicker decreases in problem behavior during the cognitive defusion exercise condition compared to the control exercise condition. The results suggest that cognitive defusion exercises can enhance the treatment effects of exposure to decrease problem behavior associated with repetitive and restrictive behaviors.     

An analysis of a partial task training strategy for profoundly retarded institutionalized clients

This study investigated the effects of a partial task training strategy on productivity and on-task behavior in three profoundly retarded institutionalized clients in a pre-skills workshop classroom. Partial task training consisted of the presentation of "mini-tasks," with reinforcement for completion of those tasks. Additionally, behavior monitors were used to provide the clients with further positive comments and prompts. The results indicated that this strategy was effective in decreasing high rates of off-task behavior and in substantially increasing the number of pieces completed during the session. However, the effect on other inappropriate behaviors was minimal. This strategy demonstrated that profoundly retarded clients could be taught to increase on-task behavior and productivity in pre-skills workshop classes.     

Effects of social and environmental change on institutionalized mentally retarded persons: the relocation syndrome reconsidered

The "relocation syndrome" in multiply-handicapped, institutionalized mentally retarded residents was examined in an observational study. Weight change and the initiation and duration of constructive and nonconstructive behavior was observed, as well as resident-staff interactions before and after relocation to a new living unit. The hypothesis that there would be an increase in behavior deleterious to the health of clients after relocation, when compared to two premove baseline periods of crowding, was not totally supported. Although relocation did cause significant changes in a variety of behaviors, not all were deleterious (i.e., no mortalities, weight gains). Results were discussed in terms of a social-situational model.     

A Pilot Group Cognitive Behavioural Therapy Program for Problem Gamblers in a Rural Australian Setting

An innovative pilot treatment program was developed for problem gamblers living in rural areas of Australia using cognitive behaviour therapy (CBT) modified from an established specialist therapy service. The standard 12 weekly group program was delivered on site by adapting it to two 1?week blocks with daily group sessions and 1?week of patient practice between the face to face group sessions. The median SOGS score (8) met the cut off for probable pathological gambling at assessment. All 7 who were assessed as suitable for the program completed the treatment with the median SOGS score of 0 at the end of treatment indicating these clients were no longer pathological gamblers. This was maintained at 12?months for 5 clients who provided follow up measures. Participants experienced a clinically significant change in the severity of their gambling and its impacts. This pilot program proved to be acceptable to rural participants and provides preliminary evidence that this intervention can reduce gambling and improved life functioning. Randomised controlled designs are needed to confirm the efficacy of this treatment approach. This program may provide a model for the treatment of gambling clients with complex co-morbidities in other rural settings.     

Health promotion for adolescents: preventive and corrective strategies against problem behavior

This paper, in its first part, gives an overview of research on "problem behavior" in adolescence. Adolescence is considered to be a stage in life characterized by more experimentation, exploration, risk-taking, and rebellion than any other stages. Many health-damaging behaviors (drug consumption, precocious sexual activity, riskful driving, aggressive behavior, etc.) have important psychosocial functions in adolescents' developments. Some of these behaviors can be signals of "stress", defined as a bio-psycho-social state of tension resulting from a variety of stressors which confront adolescents daily in modern industrial societies. In the second part of the paper, the implications of this research for strategies of intervention are discussed. The systematic analysis distinguishes between different stages in the process by which problem behavior emerges and separates "preventive" from "corrective" forms of intervention. Additionally, the analysis differentiates between the dimensions targeted by the measures: interventions addressed toward individual behavior ("personal resources") on the one hand, and living conditions ("social resources") on the other hand. The resulting types of intervention approaches are illustrated with examples and discussed in view of how appropriate they are for health promotion in adolescence. Implications for "social policy for adolescents" are discussed.     

Prevalence of exercise dependence and other behavioral addictions among clients of a Parisian fitness room

Aim of the Study

Exercise dependence is an inadequate pattern of exercise leading to clinically significant negative consequences. Subjects present loss of control of their physical activity, tolerance, and withdrawal symptoms when they do not practice sport. We studied the prevalence of exercise dependence among clients of a Parisian fitness room. We also assessed alcohol and nicotine use disorders, 2 other “socially tolerated” behavioral addictions (compulsive buying and Internet addiction), and 2 disorders related to anxiety focused on the body (bulimia and hypochondria).

Method

All clients of the fitness room 18 years and older were invited to participate in the study. Three hundred subjects were included; 125 (42%) presented diagnostic criteria of exercise dependence. Unsurprisingly, exercise dependents spent more hours each day in the fitness center practicing (2.1 vs 1.5 hours per day). They went to the fitness center more often each week (3.5 vs 2.9 days per week). Exercise addicts smoked less; alcohol consumption was equivalent in both groups. Compulsive buying was significantly more frequent in exercise dependents (63% vs 38%), which means they scored higher in the compulsive buying scale (5.4 vs 4.1). Prevalence of hypochondria was equivalent in both groups, but scores in the Whiteley Index of Hypochondria were higher (4.1 vs 3) in the exercise-dependent group. Bulimia was significantly more frequent among exercise dependents (70% vs 47%), who also presented a higher number of bulimic episodes each week (2.5 vs 1.3). Subjects with exercise dependence spent more time on their computer each day (3.9 vs 2.4 hours per day). We found no difference regarding time spent using Internet, the number of e-mails sent or received, and their time at speaking on a cellular phone.

Conclusion

Our results lead to systematically study the addictive relation to exercise among regular clients of the fitness rooms. Exercise addicts are exposed to negative consequences for their excess of physical activity. Exercise addiction is also associated to compulsive buying, bulimia, and, in a lesser extent, hypochondria.     

Don't ask questions: a psychotherapeutic strategy for treatment of involuntary clients.

This article puts forth the proposition that asking questions is detrimental to successful therapy with unwilling clients. The utility of three commonly used approaches is examined by asking. Does continuing questioning impede therapy with involuntary clients? Are therapists asking questions primarily as a means of coping personally with sullen and silent, or angry and abrasive client behavior? Is it correct to assume that asking "why" is a particularly poor therapy intervention because it brings therapists and clients into a futile search for causation of behaviors? It is recommended that statements, instead of questions, should be introduced as the preferred therapeutic modality with reluctant and unwilling clients.     

Therapeutic alliance and behavior inhibition

Abstract

The study examined whether the quality of the therapeutic alliance is associated with a tendency toward behavior inhibition. Inhibition was measured by the frequency with which the clients used the word “not” and by their verbal productivity. In treatment sessions with low-quality therapeutic alliance, clients tended to use the word “not” more often and speak fewer words. Results suggest that it could be useful for therapists to use indexes of behavior inhibition as problem markers in the therapeutic alliance.     

Enhancing physical activity adherence and well-being in multiple sclerosis: a randomised controlled trial

Individuals with multiple sclerosis (MS) are more sedentary than the general population, increasing their propensity for reduced functional ability, mobility, and activities of daily living. Self-efficacy has been one of the most consistent determinants of physical activity across populations, including those with MS. However, no studies exist that have attempted to influence self-efficacy in MS patients, in an effort to improve physical activity participation. We conducted a three-month randomised, controlled trial (n=26), contrasting the effects of an efficacy-enhancement exercise condition and a control exercise condition on exercise adherence, well-being, and affective responses to exercise. Analyses indicated that individuals in the efficacy enhancement condition attended more exercise sessions, reported greater levels of well-being and exertion, and felt better following exercise than individuals in the standard care condition. Regardless of treatment condition, individuals with a stronger sense of exercise self-efficacy, who reported more enjoyment following the exercise sessions, demonstrated significantly greater adherence with the exercise program. We believe this to be the first empirical attempt to change physical activity behavior in persons with MS using a well-established theoretical framework to drive the intervention. Continued examination of self-efficacy as a determinant of behavior change in individuals with MS is needed.     

The effects of two forms of physical activity on eyeblink classical conditioning

Voluntary exercise, in the form of free access to a running wheel in the home cage, has been shown to improve several forms of learning and memory. Acrobatic training, in the form of learning to traverse an elevated obstacle course, has been shown to induce markers of neural plasticity in the cerebellar cortex in rodents. In three experiments, we examined the effects of these two forms of physical activity on delay eyeblink conditioning in rats. In Experiment 1, exercising rats were given 17 days of free access to a running wheel in their home cage prior to 10 days of delay eyeblink conditioning. Rats that exercised conditioned significantly better and showed a larger reflexive eyeblink unconditioned response to the periocular stimulation unconditioned stimulus than rats that did not exercise. In Experiment 2, exercising rats were given 17 days of free access to a running wheel in their home cage prior to 10 days of explicitly unpaired stimulus presentations. Rats that exercised responded the same to tone, light, and periocular stimulation as rats that did not exercise. In Experiment 3, acrobatic training rats were given 15 days of daily training on an elevated obstacle course prior to 10 days of eyeblink conditioning. Activity control rats underwent 15 days of yoked daily running in an open field. Rats that underwent acrobatic training did not differ in eyeblink conditioning from activity control rats. The ability to measure the learned response precisely, and the well-mapped neural circuitry of eyeblink conditioning offer some advantages for the study of exercise effects on learning and memory.     

Combining Self-Affirmation and Implementation Intentions: Evidence of Detrimental Effects on Behavioral Outcomes

Background

There is limited evidence that self-affirmation manipulations can promote health behavior change.

Purpose

The purpose of this study was to explore whether the efficacy of a self-affirmation manipulation at promoting exercise could be enhanced by an implementation intention intervention.

Methods

Participants (Study 1?N?=?120, Study 2?N?=?116) were allocated to one of four conditions resulting from the two (self-affirmation manipulation: no affirmation, affirmation) by two (implementation intention manipulation: no implementation intention, implementation intention) experimental design. Exercise behavior was assessed 1 week post-intervention.

Results

Contrary to prediction, those participants receiving both manipulations were significantly less likely to increase the amount they exercised compared to those receiving only the self-affirmation manipulation.

Conclusion

Incorporating an implementation intention manipulation alongside a self-affirmation manipulation had a detrimental effect on exercise behavior; participants receiving both manipulations exercised significantly less in the week following the intervention.