A Psychotherapy process study of therapist in session self-awareness

Abstract

Therapist self-awareness has been hailed as a critical component of clinical practice. Yet initial evidence suggests that momentary states of in-session self-awareness in therapists may be distracting. To test the relationships among therapist in-session self-awareness, its affective and behavioral manifestations, therapist management strategies, and client perceptions of the therapy process, therapist and client dyads participated in process recall of a therapy session. Results suggest that therapist self-awareness was helpful and related to more positive client ratings of the therapy process. In addition, therapists were most likely to use basic techniques (e.g., asking a question, using paraphrase) as a way to manage distracting self-awareness, yet no one management strategy was seen as most effective. Implications of the findings are discussed.     

Low doses of apomorphine transiently reduce locomotor activity in MPTP-treated mice

Parkinson's disease patients sometimes experience deterioration of motor function to below their baseline "off" state, termed the "super-off" state. We used low subthreshold (0.05 mg/kg) to threshold (0.10 and 0.20 mg/kg) doses of apomorphine to demonstrate the "super-off" state in MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine)-lesioned mice. Twenty-four mice were randomized to receive apomorphine or vehicle. Within 20 min of administration, 0.10 and 0.20 mg/kg apomorphine-treated mice had less locomotion than controls. At the 100 min time point, 0.10 mg/kg apomorphine-treated mice had greater locomotion than controls. One week of suprathreshold levodopa pretreatment did not alter the response to these low apomorphine doses. Our results suggest that low doses of apomorphine can initially depress locomotion and subsequently stimulate locomotion, in a manner similar to what is seen in Parkinson's disease patients.     

The effect of 1-(4,5-dihydro-1H-imidazol-2-yl) isoquinoline on monoamine release and turnover in the rat frontal cortex

Imidazoline-(2) binding sites (I(2)-BS) are widely distributed in rat brain and our studies have shown that drugs selective for these sites regulate central extrasynaptic monoamine concentrations. Radioligand binding studies have recently shown that BU98008 (1-[4,5-dihydro-1H-imidazol-2-yl] isoquinoline) displays high affinity at I(2)-binding sites. The aim of this study was set to assess the pharmacological actions of BU98008 in a functional in vivo model using the technique of in vivo brain microdialysis. Systemic injection of 20 mg/kg BU98008 produced an 85% rise in extracellular noradrenaline levels compared with basal values in the rat frontal cortex. Further experiments demonstrated that peripheral administration of 10 and 20 mg/kg BU98008 elicited a transient 25% elevation in dopamine overflow compared with basal values and simultaneously produced an 18% decrease in extracellular DOPAC (3-4-dihydroxyphenylacetic acid) levels compared to basal values. In addition, BU98008 did not appear to affect serotonergic neurotransmission in the frontal cortex. In conclusion, the present study demonstrates that BU98008 shares some functional similarities with known selective I(2)-BS ligands.     

In vivo molecular imaging biomarkers: clinical pharmacology's new "PET"?

Medicine, including the pharmaceutical and biotechnology industries as well as many clinical practitioners, has recognized the importance of using molecular imaging biomarkers, including those labeled in such a way as to be imaged by positron emission tomography (PET), as tools for predicting outcomes in drug development and creating opportunities for "personalized" medicine, for diagnosing early-stage disease, and for the follow-up of the effectiveness of treatment.(1) However, only one important and widely used PET biomarker is currently approved by the Food and Drug Administration (FDA). If the technology is so important, we can ask why there is such a limitation to the availability of these biomarkers.     

Using mobile technology to overcome language barriers in medicine

Australia has a large migrant population with variable fluency in English. Interpreting services help ensure that healthcare services are delivered appropriately to these populations. However, the use of professional interpreters in hospitals is expensive. There are also issues with service availability and convenience. Mobile devices containing software with translating abilities have promising potential to improve communication between patients and hospital staff as an adjunct to professional interpreters. It is highly convenient and inexpensive. There are concerns about the accuracy of the interpretation done with such software and more research needs to be carried out to support or allay these concerns. For now, clinically important and medicolegal related interpretation should be undertaken by professional interpreters whereas less crucial tasks may be performed with the help of interpreting software on mobile devices.     

In Vivo Imaging of Cerebral Dopamine D3 Receptors in Alcoholism

Animal studies support the role of the dopamine D3 receptor (DRD3) in alcohol reinforcement or liking. Sustained voluntary alcohol drinking in rats has been associated with an upregulation of striatal DRD3 gene expression and selective blockade of DRD3 reduces ethanol preference, consumption, and cue-induced reinstatement. In vivo measurement of DRD3 in the living human brain has not been possible until recently owing to a lack of suitable tools. In this study, DRD3 status was assessed for the first time in human alcohol addiction. Brain DRD3 availability was compared between 16 male abstinent alcohol-dependent patients and 13 healthy non-dependent age-matched males using the DRD3-preferring agonist positron emission tomography (PET) radioligand [¹¹C]PHNO with and without blockade with a selective DRD3 antagonist (GSK598809 60 mg p.o.). In striatal regions of interest, where the [¹¹C]PHNO PET signal represents primarily DRD2 binding, no differences were seen in [¹¹C]PHNO binding between the groups at baseline. However, baseline [¹¹C]PHNO binding was higher in alcohol-dependent patients in hypothalamus (V_T: 16.5±4 vs 13.7±2.9, p=0.040), a region in which the [¹¹C]PHNO signal almost entirely reflects DRD3 availability. The reductions in regional receptor binding (V_T) following a single oral dose of GSK598809 (60 mg) were consistent with those observed in previous studies across all regions. There were no differences in regional changes in V_T following DRD3 blockade between the two groups, indicating that the regional fractions of DRD3 are similar in the two groups, and the increased [¹¹C]PHNO binding in the hypothalamus in alcohol-dependent patients is explained by elevated DRD3 in this group. Although we found no difference between alcohol-dependent patients and controls in striatal DRD3 levels, increased DRD3 binding in the hypothalamus of alcohol-dependent patients was observed. This may be relevant to the development of future therapeutic strategies to treat alcohol abuse.     

Understanding access to drug and alcohol treatment services in Europe: A multi-country service users’ perspective

Aims: The IATPAD (Improvement in Access to Treatment for People with Alcohol and Drug Related Problems) study explored barriers and facilitators to accessing alcohol and drug treatment services in eight European countries.

Methods: Results from individual interviews and focus group discussions with 246 service users who had experienced alcohol and drug treatment in Bulgaria, Greece, Italy, Poland, Slovakia, Slovenia, Spain and Scotland are described. Thematic analysis was used to interpret the data.

Results: The study identified a number of consistent facilitating factors and barriers across all eight European countries, despite different health care systems. The results suggest that five main factors were implicated in the help-seeking behaviour of the service users interviewed. These were: information, service organisation, staff attitudes, significant others and personal disposition. All these factors could be viewed as both facilitators and barriers.

Conclusions: To enhance access to alcohol and drug treatment, local, non-stigmatising and available services are required alongside support from significant others which should increase motivation and skills of potential service users.