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Biomedical subjects

R J Hafner

Publications and source records attributed to R J Hafner.

At least 55 records · Page 3Linked to original sources
PubMed1983

Spouse-aided versus individual therapy in persisting psychiatric disorders: a systematic comparison.

Fifty-three married patients with a wide range of severe, persisting psychiatric disorders were randomly allocated to a form of couples therapy (spouse-aided therapy) or to individual therapy. Both were outpatient, goal-oriented therapies, with an overall mean duration of 9.5 hours. Before, during, immediately after, and three months after therapy, patients and spouses completed ratings of target and personal problems, sexual activity and attitudes, psychological symptoms, and marital satisfaction. Ratings were also conducted by independent assessors. Spouse-aided therapy proved superior to individual therapy at a statistically significant level on most outcome measures, with clinically worthwhile improvements in symptoms, problems, and marital satisfaction in both partners. Individual therapy was followed by improvement in some symptoms, but marital dissatisfaction increased and both partners were more depressed at three months follow-up than before treatment.

Adolescent↗
PubMed1983

Marital interaction and adjustment in patients with essential hypertension.

Twenty-five men and twenty-six women with essential hypertension, and their spouses, were compared with normotensive control couples on a questionnaire measure of marital adjustment. The marriages of the hypertensive men showed significantly raised levels of marital dissatisfaction in the spouses, and an abnormal degree of reciprocal dissatisfaction between spouses. The marriages of the female patients showed an abnormal lack of reciprocity between spouses' scores. These findings support anecdotal reports of a relationship between marital disharmony and communication problems and elevated blood pressure. It is suggested that clinicians could routinely assess marital adjustment in patients with essential hypertension, and that in some cases conjoint marital therapy might be an adjunct or alternative to anti-hypertensive medications.

Adult↗
PubMed1982

Psychological treatment of essential hypertension: a controlled comparison of meditation and meditation plus biofeedback.

Twenty-one patients with essential hypertension were randomly allocated to eight 1-hour sessions of meditation training, meditation plus biofeedback-aided relaxation, or a no-treatment control group. Statistically significant falls in systolic and diastolic blood pressure occurred after both training programs, although overall reductions in blood pressure were not significantly greater in either program than in the control group. Meditation plus biofeedback-aided relaxation produced falls in diastolic blood pressure earlier in the training program than did meditation alone. All patients practiced mediation regularly between training sessions: The amount of practice did not correlate with the amount of blood pressure reduction after training. On questionnaire measures of psychological symptoms and personality, sex differences emerged, with females showing significant abnormalities in hostility scores and males showing significantly raised levels of somatopsychic symptoms. In females, outward-directed hostility fell significantly and assertiveness increased after training, but in males, somatopsychic symptoms were unchanged.

Adult↗
PubMed1982

Marital interaction in persisting obsessive-compulsive disorders.

The failure of modern behaviour therapy to relieve usefully more than 50% of severe, persisting obsessive-compulsive disorders is discussed. It is suggested that explanations for the failure of many married patients to respond to behaviour therapy can be found in their marital interaction. Where the development or maintenance of obsessive-compulsive symptoms is an alternative to overt marital conflict, it may often be counterproductive to treat the symptoms alone, since this serves to consolidate them as a displaced focus of marital dissatisfaction. Marital therapy is often unacceptable or ineffective in such cases. Five cases of persisting obsessive-compulsive disorder in married women are used to illustrate this. An innovative treatment model using spouse-aided therapy is outlined, wherein the patient's spouse is invited to take part in therapy as a co-therapist or co-agent of change.

Adult↗
PubMed1981

Biofeedback treatment of intermittent urinary retention.

The treatment of a 29-year-old woman with intermittent urinary retention using biofeedback is described and discussed in the context of the pathophysiology of reflux urethral instability and related disorders of micturition. During attempts to train the patient to raise the pitch of an auditory biofeedback signal, which varied directly with intrinsic bladder pressure, evidence appeared for the involvement of sensory neuronal pathways in the disorder. This and other evidence are incorporated within an explanatory hypothesis.

Adult↗
PubMed1981

The treatment of obsessional neurosis in a family setting.

The limitation of a patient-centered approach to the treatment of obsessive-compulsive disorders are underlined by the failure of modern behaviour therapy techniques to help usefully more than 50 per cent of patients. The concept of family homeostasis is discussed in relation to two cases of obsessive-compulsive neurosis which failed to respond to patient-centred treatment over several years. The successful treatment of these cases in a family context is described. It is suggested that the comparative success of behaviour therapy in treating obsessive-compulsive disorders, which were previously regarded as generally intractable, has encouraged the premature use of patient-orientated behavioural techniques in cases where family therapy may be more appropriate. Although there is evidence that helping the families of obsessive-compulsive patients to verbalise feelings facilitates symptomatic improvement, the precise mechanisms whereby improvement occurs require further elucidation.

Adolescent↗
PubMed1981

Agoraphobia in men.

Twenty male and 20 female agoraphobics, matched for age and marital status, were systematically compared using self-report questionnaire measures of symptoms and hostility, and clinical observations. The males differed significantly from the females as follows: the males were less phobic of social situations but more preoccupied with somatic symptoms and related fears. The females were more phobic of mental illness, more extrapunitive, and reported fewer obsessional symptoms. Two distinct but overlapping clinical sub-groups of males were defined. The sub-group in which separation anxiety, extreme dependence on spouse, denial of hostility and hypochondriasis were prominent, responded poorly to behavioural treatment; the sub-group in which a fear of loss of control of aggressive impulses and generalised anxiety were prominent, responded comparatively well to behaviour therapy.

Adult↗
PubMed1981

Behaviour therapy for the neuroses: some conceptual and practical problems.

Some problems in reconciling behaviourism as pure science with clinical behaviour therapy for complex neurotic and personality disorders are examined. A major problem is the inability of scientific behaviourism to permit motivation, will and choice to be considered from an intrapsychic perspective. Cognitive behaviour therapy and its derivatives have been developed in an attempt to overcome this problem. Although such therapies have retained a paradigmatic attachment to behaviourism, they have more in common with psychodynamic psychotherapy. Conflict among contemporary behaviourists about the relevance of cognitive theory to behaviourism has obscured more fundamental issues such as the role of the patients-therapist relationship. Both classical and cognitive behaviour therapists view a direct examination of the patient-therapist relationship as therapeutically irrelevant, although there is evidence that such a viewpoint may be anti-therapeutic in some severe neurotic disorders. Behaviourists must acknowledge the central importance of examining the patient-therapist relationship in such disorders if they are to continue their successful dialectic with psychodynamic therapists.

Attitude of Health Personnel↗
PubMed1981

Spouse-aided therapy in psychiatry: an introduction.

This paper underlines the failure of contemporary individual and marital psychotherapies to help many married people with persisting psychological disorders. It examines the spouse's contribution to the maintenance of psychological disability, and discusses the problems of constructively involving such spouses in conjoint therapy. Spouse-aided therapy addresses this problem by inviting the patient's spouse to become a co-therapist. It is explicitly not a marriage therapy, and is conducted on a goal-orientated time-limited out-patient basis. During discussion of problems with achieving treatment goals, the focus of therapy shifts from the patient's symptoms to marital interaction. Confrontation of the spouse's contribution to the patient's continuing disability then becomes possible, and is followed by changes in marital interaction which generally facilitate the patient's improvement. Many couples choose to proceed with marital therapy after spouse-aided therapy has allowed them to reconstrue the patient's symptoms in interactional terms.

Ambulatory Care↗
PubMed1979

Agoraphobic women married to abnormally jealous men.

Of 36 married female agoraphobics treated by the author over a period of 3 years, seven were married to men who displayed abnormal jealousy. In all these cases the husbands' jealousy adversely influenced their wives' response to treatment, and improvement in wives was associated with increased morbidity in their husbands.

Adult↗
PubMed1979

Behavior therapy as a test of psychoanalytic theory.

The author describes 4 patients in whom radically new symptoms appeared after intensive behavior therapy. He suggests that fresh symptoms are most likely to develop in a small minority of patients who are unable to learn more adaptive psychological defense mechanisms during or after behavior therapy and that psychoanalytic theory may help predict the nature of such symptoms.

Adaptation, Psychological↗