Services for Schizophrenic Patients and Their Families: What They Say They Need

The effects of education and stress reduction groups for the relatives of schizophrenic patients and their perception of services available to them is presented. 76% of relatives refused invitation to groups because they were overburdened. Those attending the groups said that they found them beneficial but measurable improvements were slight. Relatives' perception of the shortfalls of the services and the difficulties faced differed from that of patients. As the majority of patients turn to their relatives for help and support, rather than approaching hospital services directly, relatives were better able to identify service shortfalls. Patients' perceived needs included employment and increased income, which are not amenable to direct hospital intervention. Relatives were able to express needs that could be addressed by services. Both patients and relatives were able to identify the main difficulties faced, though there was a difference in emphasis.

Cerebral Circulation During Treatment of Blood-Injury Phobia: A Case Study

A case of blood-injury phobia complicated by fainting is described. Measures of cerebral blood flow velocity (CBFV) and heart rate (HR) indicated that phobic exposure reliably precipitated a marked drop in CBFV, simultaneous with an increase in HR and onset of dizziness. It is suggested that hyperventilation was a factor exacerbating fainting in this case. Muscle tensing produced small increases in cerebral blood flow velocity but these were not of sufficient magnitude to prevent onset of dizziness. The patient improved with treatment involving graded exposure, respiratory control and muscle tensing. At seven months follow-up the patient maintained improvements in anxiety and avoidance but again became faint during exposure.

Adapting Behavioural Marital Therapy to the Needs of a Secondary Marriage: A Case Evaluation

This paper describes and evaluates the adaption of Behavioural Marital Therapy (BMT) to the needs of a couple in a secondary marriage (the husband was in his second marriage and brought three dependent children to this marriage). The couple presented with specific difficulties in negotiating parenting roles within the reconstituted family. BMT focused on promoting adaptive cognitions, affect and communication when discussing this specific issue. Evaluation used a multiple probe design assessing self-monitored stressful interactions about parenting, and daily marital satisfaction. Results showed significant reductions in the intensity and frequency of arguments from pre- to post-therapy, and increases in marital satisfaction. These gains were maintained at follow-up. Discussion focuses on future directions for adapting BMT to problems particular to secondary marriages.

Social Support and Treatment Outcome of Obsessive Compulsive Disorder at 9-Month Follow-up

The present study investigated whether social support and family members' reactions to clients with obsessive compulsive disorder played a significant role in the follow-up outcome of an intensive behavioral treatment program. The roles OCD symptoms, moodstate, social functioning and life events were also assessed. General social support did not predict relapse, but significant others' empathy and positive interactions were associated with maintenance of gains. Negative family interactions (especially criticism and anger) and belief that clients could control their symptoms predicted relapse. Higher levels of post-treatment anxiety and depression and poorer functioning were related to negative outcome, as was distress from life events during follow-up. Results are discussed with respect to possible mechanisms of action and future research needs.

“Subconscious Retraining”: A Placebo Strategy for Generalized Anxiety Disorder

This report describes a placebo strategy which engendered a reasonable degree of positive expectation in 10 Generalized Anxiety Disorder patients and was perceived by them as being credible, sensible and appropriate at pre- and post-therapy and at six month follow-up. The significant improvement noted on a range of measures suggests that the strategy is not inert.

Problem Solving Training to Enhance Dietary Self-management in a Diabetic Patient

A central aspect of self-management of diabetes involves patients regulating the timing and intake of dietary carbohydrates. A 20 year old female diabetic patient was taught to identify deviations from appropriate dietary self-management, and a problem solving intervention was used to train new behavior in settings associated with such deviations. Dietary behavior and blood glucose levels were monitored in a diary and electronically, and treatment effects were evaluated in a multiple baseline across settings design. Treatment resulted in clear improvement in dietary management, and a substantial gain in blood glucose control at the end of intervention. At follow-up dietary change was maintained. Long term effects on blood glucose levels were confounded by a reduction in insulin dosage between treatment and follow-up.