Internet‐based treatment for social phobia: a randomized controlled trial

In this study conducted in the French‐speaking part of Switzerland, 52 individuals with social phobia were randomly assigned either to an Internet‐based cognitive–behavioral treatment with minimal contact with therapists via e‐mail or to a waiting‐list control group. Significant differences between the two groups were found at posttreatment on all primary outcome measures (social anxiety measures) and on two of the secondary outcome measures (general symptomatology, therapy goal attainment). On average, within‐groups effect sizes were large for the primary outcomes (Cohen's d=0.82) and for secondary outcomes (Cohen's d=1.04). Moreover, subjects in the treatment group fulfilled the criteria of clinically significant improvement significantly more often than subjects in the control group on all measured dimensions (58% vs. 20%). Users' acceptance of the program was high. The results from the present study lend further support to the hypothesis that Internet‐delivered interventions with minimal therapist contact are a promising treatment approach to social phobia. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65:1–15, 2009.     

Comparative efficacy of biofeedback and stress inoculation for stress reduction

Evaluated the comparative effectiveness of frontalis electromyographic (EMG) biofeedback, a primarily somatic intervention, and stress inoculation, a self-instructional form of cognitive-behavior therapy. Both treatments were compared with a waiting list control group on systolic and diastolic blood pressure, the Taylor Manifest Anxiety Scale, and the Teaching Anxiety Scale (N = 24). Multivariate assessment on all four dependent measures indicated that both the frontalis feedback and stress inoculation groups improved significantly more than the no treatment control, but did not differ overall from one another. The stress inoculation group showed more improvement in self-reported anxiety than the EMG group, while the EMG group tended to do better than the stress inoculation group on blood pressure measures. The untreated control group regressed somewhat across all measures. It was proposed that each treatment may have specific effects that might suggest which treatment would be indicated for a particular client.     

A comparison of the efficacy and acceptability of group versus individual cognitive behaviour therapy in the treatment of panic disorder and agoraphobia in primary care

Panic disorder and agoraphobia is a prevalent clinical condition which places heavy demands on treatment resources in primary care. The efficient delivery of evidence‐based psychological treatment for this disorder is therefore important. Previous research has investigated both individual and group treatment formats for cognitive behaviour therapy (CBT) for panic disorder and agoraphobia. These two modalities of treatment delivery are, however, rarely compared within the same study format. Also little is known of patients' preferences regarding treatment delivery formats. The present study investigated the relative efficacy of a group treatment CBT and an individual treatment CBT in comparison with a waiting list control group in the treatment of panic disorder with or without agoraphobia in primary care. Ninety‐seven patients suffering from DSM‐IV panic disorder with or without agoraphobia were randomly allocated to receive either group CBT, individual CBT, or waiting list control. All patients were seen by the same therapist and all received an identical treatment manual. Treatment response was measured by blind assessor, therapist and patient‐rated measures of anxiety, depression, and agoraphobic avoidance, and was analysed in terms of both traditional statistical significance and clinical significance of outcome. At treatment end‐point, in terms of traditional statistical significance, both the group and individual CBT were significantly superior to waiting list control but did not differ significantly from each other. When clinical significance of outcome at treatment end‐point was considered, individual CBT showed a significant advantage over both group CBT and waiting list control. At 3‐month follow‐up, however, the individual CBT treatment group showed significant superiority to the group CBT treatment on clinical significance of outcome on one outcome measure only. This was principally due to a reduction in the proportion of patients achieving criteria of clinically significant change in the individual CBT treatment group over the 3‐month follow‐up period. When given a free choice of group or individual CBT at the end of the waiting list period, the overwhelming majority (95%) of the waiting list patients chose individual CBT. The implications of these findings for future research and for wider clinical practice are discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

EMDR for panic disorder with agoraphobia: comparison with waiting list and credible attention-placebo control conditions

In a randomized controlled trial, eye movement desensitization and reprocessing (EMDR) for panic disorder with agoraphobia (PDA) was compared with both waiting list and credible attention-placebo control groups. EMDR was significantly better than waiting list for some outcome measures (questionnaire, diary, and interview measures of severity of anxiety, panic disorder, and agoraphobia) but not for others (panic attack frequency and anxious cognitions). However, low power and, for panic frequency, floor effects may account for these negative results. Differences between EMDR and the attention-placebo control condition were not statistically significant on any measure, and, in this case, the effect sizes were generally small (eta2 = .00-.06), suggesting the poor results for EMDR were not due to lack of power. Because there are established effective treatments such as cognitive-behavior therapy for PDA, these data, unless contradicted by future research, indicate EMDR should not be the first-line treatment for this disorder.     

Predictors of hip joint replacement in new attenders in primary care with hip pain.

BACKGROUND: Studies investigating the factors associated with need for total hip replacement should ideally be based on prospective investigation of new attenders in primary care. AIM: To determine the incidence of listing for total hip replacement, and its predictors, among attenders in primary care with a new episode of hip pain. DESIGN OF STUDY: Prospective multicentre cohort study. SETTING: One hundred and ninety-five patients (mean age = 63 years, 68% female) with new episode of hip pain, attending primary care between November 1994 and October 1997. At the first visit, patients were evaluated for indices of pain and disability, range of hip movement, and radiographic changes of osteoarthritis. METHOD: General practitioner participants were recruited from the membership of the Primary Care Rheumatology Society to recruit all consecutive attenders with a new episode of hip pain. Annual follow-up was carried out to determine which patients were being 'put on a waiting list' for total hip replacement. RESULTS: Seven per cent of patients were put on a waiting list for total hip replacement within 12 months and 23% of patients within four years. At presentation, pain duration, pain severity, (including the need to use a stick) and restriction of internal rotation were the major clinical predictors of being put on a waiting list. Radiographic predictors of osteoarthritis performed similarly to the clinical measures. A simple scoring system based on both radiographic severity and two of the clinical measures was derived that identified groups at high likelihood of being put on a waiting list (sensitivity = 76%) with a low false-positive rate (specificity = 95%). CONCLUSION: New primary care attenders with pain are frequently accepted for total hip replacement soon after their first attendance--a decision that can be predicted by simple clinical measures.     

Death anxiety: "state" or "trait"?

Investigated relative effects of hypnosis, alpha biofeedback, prestige suggestion, and silence in attenuating experimentally induced increases in death anxiety. Forty female undergraduate Ss at Louisiana State University were tested on four measures of death anxiety: "Emotional" associations to "death" words, association response latencies to "death" vs. "neutral" words, Death Anxiety Scale, and Death Concern Scale. Ss then were assigned to four treatments: (1) Hypnosis, with anxiolytic post-hypnotic relaxation suggestions; (2) Nonhypnotic anxiolytic prestige suggestions; (3) EEG alphacontingent biofeedback; and (4) a 15-minute waiting period. After treatments, Ss viewed a tape-slide presentation that emphasized personal death and overestimated its probability from various causes. Ss then were retested on death anxiety measures, forms of which were counterbalanced within groups. Analysis of variance (at .05 and .01 confidence levels) failed to differentiate groups on either increases or decreases of death anxiety. It was concluded that death anxiety may be a "trait" as opposed to a "state" phenomenon.     

A self‐directed psychosocial intervention with minimal therapist contact for adults with attention deficit hyperactivity disorder

Using a randomized controlled design, the efficacy of a self‐directed psychosocial intervention with minimal therapist contact, aimed at reducing the symptoms of adult ADHD, was examined. Following the intervention, the treatment group reported significantly reduced ADHD symptomatology; improved organizational skills; improved self esteem and better anger control, when compared to waiting list controls. Comorbid anxiety, depression, high levels of stress and learning problems, did not effect treatment outcome. Improvements in ADHD symptomatology and organizational skills were maintained at a 2‐month follow‐up. Although the programme was successful, close adherence to the programme was necessary for optimum treatment gains. These findings build upon an earlier study that used a more intensive form of programme delivery and support the view that psychosocial interventions can enhance daily functioning for adult ADHD. Copyright © 2003 John Wiley & Sons, Ltd.     

A controlled comparison of eye movement desensitization and reprocessing versus exposure plus cognitive restructuring versus waiting list in the treatment of post‐traumatic stress disorder

A total of 105 patients with post‐traumatic stress disorder (PTSD) were randomly allocated to eye‐movement desensitization and reprocessing (EMDR) (n = 39) versus exposure plus cognitive restructuring (E + CR) (n = 37) versus waiting list (WL) (n = 29) in a primary care setting. EMDR and E + CR patients received a maximum of 10 treatment sessions over a 10‐week period. All patients were assessed by blind raters prior to randomization and at end of the 10‐week treatment or waiting list period. EMDR and E + CR patients were also assessed by therapists at the mid‐point of the 10‐week treatment period and on average at 15 months follow‐up. Patients were assessed on a variety of assessor‐rated and self‐report measures of PTSD symptomatology including the Clinician Administered PTSD Scale (CAPS), the Impact of Events Scale (IOE) and a self‐report version of the SI‐PTSD Checklist. Measures of anxiety and depression included the Montgomery Asberg Depression Rating Scale (MADRS), the Hamilton Anxiety Scale (HAM‐A) and the Hospital Anxiety and Depression Scale (HADS). A measure of social function, the Sheehan Disability Scale was also used. Drop‐out rates between the three groups were 12 EMDR, 16 E + CR and five WL. Treatment end‐point analyses were conducted on the remaining 72 patients. Repeated measures analysis of variance of treatment outcome at 10 weeks revealed significant time, interaction and group effects for all the above measures. In general there were significant and substantial pre–post reductions for EMDR and E + CR groups but no change for the WL patients. Both treatments were effective over WL. The only indication of superiority of either active treatment, in relation to measures of clinically significant change, was a greater reduction in patient self‐reported depression ratings and improved social functioning for EMDR in comparison to E + CR at the end of the treatment period and for fewer number of treatment sessions for EMDR (mean 4.2) than E + CR (mean 6.4) patients. At 15 months follow‐up treatment gains were generally well‐maintained with the only difference, in favour of EMDR over E + CR, occurring in relation to assessor‐rated levels of clinically significant change in depression. However, exclusion of patients who had subsequent treatment during the follow‐up period diminished the proportion of patients achieving long‐term clinically significant change. In summary, at end of treatment and at follow‐up, both EMDR and E + CR are effective in the treatment of PTSD with only a slight advantage in favour of EMDR. Copyright © 2002 John Wiley & Sons, Ltd.     

Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant

BACKGROUND AND METHODS: The extent to which renal allotransplantation - as compared with long-term dialysis - improves survival among patients with end-stage renal disease is controversial, because those selected for transplantation may have a lower base-line risk of death. In an attempt to distinguish the effects of patient selection from those of transplantation itself, we conducted a longitudinal study of mortality in 228,552 patients who were receiving long-term dialysis for end-stage renal disease. Of these patients, 46,164 were placed on a waiting list for transplantation, 23,275 of whom received a first cadaveric transplant between 1991 and 1997. The relative risk of death and survival were assessed with time-dependent nonproportional-hazards analysis, with adjustment for age, race, sex, cause of end-stage renal disease, geographic region, time from first treatment for end-stage renal disease to placement on the waiting list, and year of initial placement on the list. RESULTS: Among the various subgroups, the standardized mortality ratio for the patients on dialysis who were awaiting transplantation (annual death rate, 6.3 per 100 patient-years) was 38 to 58 percent lower than that for all patients on dialysis (annual death rate, 16.1 per 100 patient-years). The relative risk of death during the first 2 weeks after transplantation was 2.8 times as high as that for patients on dialysis who had equal lengths of follow-up since placement on the waiting list, but at 18 months the risk was much lower (relative risk, 0.32; 95 percent confidence interval, 0.30 to 0.35; P<0.001). The likelihood of survival became equal in the two groups within 5 to 673 days after transplantation in all the subgroups of patients we examined. The long-term mortality rate was 48 to 82 percent lower among transplant recipients (annual death rate, 3.8 per 100 patient-years) than patients on the waiting list, with relatively larger benefits among patients who were 20 to 39 years old, white patients, and younger patients with diabetes. CONCLUSIONS: Among patients with end-stage renal disease, healthier patients are placed on the waiting list for transplantation, and long-term survival is better among those on the waiting list who eventually undergo transplantation.     

A prospective study of the effectiveness of group and individual psychotherapy for women CSA survivors

Objectives. There is little empirical evidence to guide clinical practice in treating adult patients presenting to adult mental health and primary care services with severe psychological difficulties consequent on childhood sexual abuse. The aim of this study was to determine the effectiveness of a model of short term, focal, integrative psychotherapy with this population of patients and to compare outcomes when the model is delivered on an individual or group basis. Design. This study used a patient preference design with random allocation to one of two treatment modalities (individual or group treatment). There was a waiting list control. Method. A group of 48 women patients were assessed on 4 psychological measures when entering a waiting list condition, immediately before treatment and after completion of 12 sessions of psychotherapy, either in a group or individually. Follow‐up data were collected at 4 months and 8 months. Results. Both individual and group patients showed highly statistically and clinically significant improvements after treatment. These gains were maintained at follow‐up with the exception of one measure that indicated a significant decline from post‐treatment levels for the group patients. Conclusions. This model of psychotherapy is highly effective, when delivered by chartered clinical psychologists to patients whose preferences for individual or group therapy have been met.     

The effectiveness of activity scheduling and relaxation training in the treatment of spasmodic dysmenorrhea

The first purpose of this study was to examine the effectiveness of activity scheduling as a treatment for spasmodic dysmenorrhea, compared to relaxation training (a treatment of demonstrated effectiveness) and to a waitinglist control condition. The second purpose was to examine the differential effectiveness of these treatments on different measures. Forty women suffering from spasmodic dysmenorrhea completed six individualized treatment sessions or remained on the waiting list. Results showed that both activity scheduling and relaxation training were effective treatments for spasmodic dysmenorrhea, with both treatments producing improvements on general measures of dysmenorrhea, a symptom severity measure, and an activity measure.     

The effect of two types of memory training on subjective and objective memory performance in healthy individuals aged 55 years and older: a randomized controlled trial

The objective of the study was to examine the effectiveness of two types of memory training (collective and individual), compared to control (waiting list), on memory performance. Participants were 139 community-dwelling older individuals recruited through media advertisements asking for people with subjective memory complaints to participate in a study. Data were collected at baseline, and at 1 week and 4 months after the intervention. Training efficacy was assessed using measures of subjective and objective memory performance. After the intervention, participants in the collective training group reported more stability in memory functioning and had fewer feelings of anxiety and stress about memory functioning. In addition, positive effects were found on objective memory functioning. Compared with the other two groups, the collective training group participants had an improved recall of a previously learned word list. Compared to controls, participants in the individual training group reported fewer feelings of anxiety and stress in relation to memory functioning.     

Symptom monitoring in childhood asthma: a randomized clinical trial comparing peak expiratory flow rate with symptom monitoring.

BACKGROUND: Accurate symptom evaluation is a critical component of asthma management. Limited data are available about the accuracy of symptom evaluation by children with asthma and their parents, or the impact of various symptom-monitoring strategies on asthma morbidity outcomes. OBJECTIVE: The purpose of this randomized clinical trial was to evaluate the effect of three different intensities of symptom monitoring on asthma morbidity outcomes. METHODS: One hundred sixty-eight children (ages 6 to 19) of diverse racial, geographic, and socioeconomic backgrounds were randomized to 1 of 3 treatment groups (subjective symptom evaluation, symptom-time peak expiratory flow rate (PEFR) monitoring, daily PEFR monitoring) in this longitudinal, clinical trial. Outcome measures included a summary asthma severity score, forced expiratory volume in 1 second, symptom days, and health care utilization. RESULTS: Children who used PEFR meters (PFMs) when symptomatic had a lower asthma severity score, fewer symptom days, and less health care utilization than children in the other two treatment groups. Minority and poor children had the greatest amount of improvement using PFMs when symptomatic. Results were much less striking in white families. Thirty percent of families in the PFM treatment groups discontinued use entirely by 1 year postexit, whereas the majority of families who continued use (94%) used them only when symptomatic to inform symptom interpretation and management decisions. CONCLUSIONS: Not every child with asthma needs a PFM. Children and families facing extra challenges as a result of illness severity, sociodemographic, or health care system characteristics clearly benefited most from PFM use.     

A psychophysiological evaluation of female urethral syndrome: Evidence for a muscular abnormality

This is a preliminary investigation into a recently defined urological disorder occurring in a subgroup of women with urethral syndrome suggestive of pelvic floor muscular (PFM) dysfunction. Symptoms include straining to void, urgency, frequency, hesitation, incontinence and/or retention, and subpubic pain. Finding neither bladder nor urological abnormalities, urologists may consider these women emotionally unstable without organic cause for their symptoms. However, their distress may be a consequence rather than a cause of their voiding problems. Sixteen female urological patients were matched with 16 asymptomatic controls to investigate PFM functioning, psychological status, and symptomatology. Results showed heterogeneity of symptomatology and little elevation of depression or anxiety when comparing patients with controls. Hypotheses of muscular abnormality were confirmed. Patients evidenced poor control over tensing and relaxing PFM, elevations of PFM activity under various conditions, and chronic pain as a prominent symptom. Treatment approaches specifically designed to address PFM dysfunction are discussed.     

Treatment of generalized anxiety disorder in older adults

Older adults with generalized anxiety disorder (GAD; N = 75; M age = 67.1 years) were randomly assigned to cognitive-behavioral therapy (CBT), a discussion group (DG) organized around worry-provoking topics, or a waiting period. Participants in both active conditions improved relative to the waiting list. Although CBT participants improved on more measures than DG participants, the authors found only I significant difference immediately after treatment and no differences at 6-month follow-up. Effect sizes were smaller than in younger samples, but CBT showed large effects and DG showed medium-sized effects Overall, results indicate that brief treatment of late-life GAD is beneficial, but they provide only limited support for the superiority of CBT to a credible comparison intervention.     

Performance Changes Following the Revision of Organ Allocation System of Lung Transplant: Analysis of Korean Network for Organ Sharing Data

BackgroundThere is currently a lack of data on the impact of the recent revision of the domestic lung allocation system on transplant performance.MethodsWe conducted a retrospective analysis of transplant candidates and transplant patients registered in Korean Network for Organ Sharing between July 2015 and July 2019. Study periods were classified according to the introduction of the revised lung allocation system as follows: period 1 from July 2015 to June 2017 and period 2 from August 2017 to July 2019.ResultsDuring the study period, a total of 627 patients were on the waiting list, of which 398 lung transplantations were performed. Total waiting list size increased by 98.6%, from 210 in period 1 to 417 in period 2. The number of transplant patients also increased by 32.7%, from 171 in period 1 to 227 in period 2. The number of donors decreased from 1,042 to 878, whereas the usage rate, i.e., the number of lung donors used for transplantation among the total number of reported lung donors, increased from 16.4% to 25.9%. The proportion of patients with high urgent status at transplantation increased from 45% to 60.4%, whereas those with urgent status decreased from 46.8% to 35.7% (P = 0.006). The use of marginal donor lungs increased from 29.8% to 53.7% (P < 0.001). To adjust urgency status and marginal donor usage between two groups, we conducted a propensity score matching analysis. No significant differences were detected in 1-year survival rates between the two periods after propensity score matching. As well, no significant difference was observed in mortality on the waiting list between the two periods.ConclusionThe recent revision of the lung allocation system in Korea did not change the performance of lung transplant in terms of waiting list mortality and 1-year survival. The rapid increase in the volume of waiting list between the two periods increased the waiting time, transplantation of high-urgency patients, and use of marginal lung donors.     

Treatment-independent pregnancy rate in patients with severe reproductive disorders

A long waiting list for in-vitro fertilization (IVF) offers the possibility to study treatment-independent pregnancy rates in patients with severe reproductive disorders. We performed a retrospective cohort study with a nested case-control design in which the cases achieved a spontaneous pregnancy while on the waiting list for IVF, or for IVF with intracytoplasmic sperm injection (ICSI), and the controls did not become pregnant while on the waiting list. Spontaneous pregnancies occurred in 76 of 1391 patients on the waiting list. Significant differences between pregnant and non-pregnant patients were found for duration of subfertility (couples on the IVF waiting list), and for progressive sperm motility and basal 17beta-oestradiol (couples on the ICSI waiting list). The 12 months cumulative pregnancy rate for patients on the waiting list was 2.4% (95% CI 1.2-3.9%) for tubal subfertility patients, 5.9 % (3.7-8.7%) for longstanding unexplained subfertility patients, and 6.6% (4.5-9.3%) for male subfertility patients. Of the 76 control patients, 21% of tubal subfertility patients, 18% of unexplained subfertility patients, and 17% of male subfertility patients achieved a pregnancy in their first IVF or ICSI treatment cycle. We confirm that the treatment-independent pregnancy rate in patients with severe reproductive disorders is low. More than 75% of the spontaneous pregnancies in the tubal subfertility and unexplained subfertility couples occurred during their first three months on the waiting list, whereas spontaneous pregnancy rate in male subfertility couples showed a more gradual but persisting increase. We conclude that one cycle of IVF or ICSI is superior to 12 months of expectant management in patients with severely impaired fertility due to tubal, unexplained or male factors.      

Long-term efficacy of biobehavioral treatment of temporomandibular disorders

This study evaluated the relative long-term efficacy of biofeedback, cognitive–behavioral skills training (CBST), combined biofeedback and CBST (Combined), and no-treatment comparison groups in 108 patients suffering from chronic temporomandibular disorder (TMD). After an initial evaluation, patients were assigned to one of the four treatment conditions. The three biobehavioral treatment interventions consisted of 12 standardized sessions. Patients were reevaluated 1 year after completing treatment. Results demonstrated that patients who received the biobehavioral treatments reported significant improvement in subjective pain, pain-related disability, and mandibular functioning 1 year after receiving treatment. The no-treatment comparison group did not demonstrate such improvements. The combined biofeedback and CBST treatment produced the most comprehensive improvements across all outcome measures. These results again demonstrate the heuristic value of adopting a biopsychosocial perspective to the assessment and treatment of chronic medical/dental disorders such as TMD.     

Semantic desensitization: a paradigmatic intervention approach to anxiety disorders

Studied the effectiveness of semantic desensitization in alleviating public speaking anxiety. Thirty speech-anxious clients, matched on the severity of their problem, were assigned randomly to one of the following treatment conditions: (a) semantic desensitization; (b) attention placebo; and (c) waiting list control. The semantic desensitization group received a self-instructional, anticipatory-anxiety hierarchy paired with visually induced, relaxing, pleasant scenes. Semantic desensitization therapy resulted in significant reductions of both the affective and behavioral components of anxiety as compared to the two controls. The placebo control also showed improvement in several indices of subjective anxiety as compared to the no-treatment waiting list control. The beneficial effects of semantic desensitization therapy were maintained on follow-up.     

表面肌电生物反馈疗法结合吞咽训练治疗脑卒中患者吞咽障碍的疗效

目的:观察表面肌电生物反馈治疗结合吞咽训练治疗脑卒中患者吞咽障碍的效果.方法:选择2018年2月至2019年12月在广州市第一人民医院康复医学科和神经科接受治疗的65例脑卒中后吞咽障碍患者,根据患者意愿分为吞咽训练组33例和肌电生物反馈组32例.吞咽训练组采用吞咽训练,肌电生物反馈组在吞咽训练的基础上采用表面肌电生物反...