Systematic desensitization as an alternative exposure strategy for PTSD.
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Adult↗
Biomedical subjects
S M Turner
Publications and source records attributed to S M Turner.
Stability of anxious symptomatology in children.
The stability of anxiety states and symptoms was assessed in a sample of 150 anxious and nonanxious children. A number of assessment methods including a semistructured interview, self-report instruments, psychophysiological measures, and parental reports were used initially and at intervals up to 6 months later. The majority of children with a diagnosed anxiety disorder at the initial assessment still manifested significant symptomatology at the 6 month follow-up. However, stability of specific anxiety symptoms when assessed by self- and parental reports was mixed. With respect to psychophysiological assessment, stability of responses was evident at 2 weeks but not after 6 months. Results are discussed in terms of the stability of diagnoses and symptomatology, and the need for thematically relevant self-reports and behavioral assessment tasks. Recommendations are made for the development of a reliable, multimethod strategy to assess the multiple domains of childhood anxiety.
Anxiety Disorders↗
Trauma management therapy: a preliminary evaluation of a multicomponent behavioral treatment for chronic combat-related PTSD.
The development and initial evaluation of a new, comprehensive and multicomponent behavioral treatment (Trauma Management Therapy, or TMT) for chronic combat-related Post-Traumatic Stress Disorder (PTSD) is described. The program utilizes elements of intensive exposure therapy, programmed practice, and structured social and emotional skills training to target the multiple aspects of chronic combat-related PTSD. The treatment was found to be effective in alleviating a broad spectrum of difficulties in combat veterans with chronic PTSD, most of whom had co-occurring Axis I and/or Axis II disorders. The results are discussed with respect to the implementation of the new treatment and the general need for a comprehensive approach to treating combat-related PTSD. Implications for the potential cost-effectiveness of the treatment program also are discussed.
Adult↗
Clinical features affecting treatment outcome in social phobia.
Characteristics of social phobics were examined to determine their effect on treatment acceptance, drop-out rate and amount of improvement at post-treatment. The rate of treatment non-acceptance was low and those who entered treatment differed from those who did not only on ratings of social phobia severity. The drop-out rate also was relatively low, and there were no differences between those who dropped out and those who completed treatment. When patients were divided on the specific versus generalized subtype dichotomy, a number of interesting findings emerged. Response to treatment was similar, but the specific subtype was significantly more improved at post-treatment than the generalized subtype. When compared on composite indexes of overall improvement and endstate functioning, there was no difference between the number of specific and generalized social phobics achieving significant or moderate improvement. However, a greater number of the specific subtype were judged to have high or moderate endstate status than the generalized subtype. A similar outcome was found when social phobics with comorbid disorders were compared with those who were non-comorbid. The results are discussed in terms of factors affecting outcome in social phobia treatment.
Adult↗
Panic, agoraphobia, and vestibular dysfunction.
OBJECTIVE: Otoneurological abnormalities have been reported in panic disorder. The purpose of this investigation was to determine the prevalence of such findings in panic disorder with and without agoraphobia and to discern whether vestibular dysfunction was associated with specific symptoms. METHOD: Clinical audiological and vestibular tests were administered to 30 patients with uncomplicated panic disorder (without agoraphobia or with only mild agoraphobia), 29 patients with panic disorder with moderate to severe agoraphobia, 27 patients with anxiety but no history of panic attacks, 13 patients with depressive disorders but no history of anxiety or panic attacks, and 45 normal comparison subjects. Evaluators were blind to subjects' diagnostic group. Quantitative measures of subjects' discomfort with space and motion and of the frequency of certain symptoms between and during panic attacks were obtained. Anxiety state levels were measured during the vestibular tests. RESULTS: Vestibular abnormalities were common in all the groups but most prevalent in the patients with panic disorder with moderate to severe agoraphobia. Vestibular dysfunction was associated with space and motion discomfort and with frequency of vestibular symptoms between, but not during, panic attacks. There were no major differences between the two panic groups in anxiety levels during vestibular testing. There were no significant differences between groups on the audiological component of the test battery. Exploratory data analysis indicated that the constellation of vestibular tests most specific for agoraphobia was one indicating compensated peripheral vestibular dysfunction. CONCLUSIONS: Subclinical vestibular dysfunction, as identified by clinical tests, may contribute to the phenomenology of panic disorder, particularly to the development of agoraphobia in panic disorder patients.
Adult↗
Lung function in bronchiectasis: the influence of Pseudomonas aeruginosa.
Sputum isolation of Pseudomonas aeruginosa (PA) is associated with extensive disease in bronchiectasis. It is not known, however, whether infection with P. aeruginosa is the result or the cause of severe disease. We compared spirometry in patients with bronchiectasis before and after infection with P. aeruginosa, with that of patients infected by other organisms. All patients (n=12) with chronic colonization by P. aeruginosa (PA group) were studied. These were compared with other patients with bronchiectasis with no isolations of P. aeruginosa (n=37, non-PA group). In the PA group, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were lower than in the non-PA group. The PA group, however, also had lower values at the time of initial colonization with P. aeruginosa than the current values for the non-PA group. Change in FEV1 and FVC over time was faster in the PA group than in the non-PA group. Reduction of FEV1 and FVC over time in the PA group prior to P. aeruginosa colonization was intermediate, not being statistically different from either value above. Our results confirm the association of chronic P. aeruginosa colonization with poor lung function, but conclude that patients with bronchiectasis who become colonized by P. aeruginosa have poorer lung function when first colonized than those colonized by other organisms. Decline in lung function is faster in those chronically colonized by P. aeruginosa than in those colonized by other organisms. It is not clear whether chronic P. aeruginosa colonization causes an accelerated decline in lung function or whether it is simply a marker of those whose lung function is already declining rapidly.
Aged↗
Inventory management system reaps savings for department. Case study: devising a system to order, track, and stock intraocular lenses.
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Feasibility Studies↗
Socioecological and sociocultural variables in psychopharmacological research: methodological considerations.
Although a relatively small amount of work has been done, available evidence suggests that a host of variables, some of which are environmental, influence drug kinetics and likely dynamics as well. Recent evidence suggests that there are considerable differences in interethnic and racial responsiveness (including side effects) to various psychotropic drugs, and that understanding of differences is important for clinical and research studies as well as patient welfare. Some of the parameters of potential importance are presented, and strategies for controlling these variables in research studies are discussed.
Cultural Characteristics↗
Two-year follow-up of social phobias treated with Social Effectiveness Therapy.
A 2-yr follow-up assessment was conducted with patients treated with Social Effectiveness Therapy (SET), a multi-component treatment for social phobia. Eight of the 13 patients who completed the treatment study were available for the follow-up. The results indicated that treatment gains were maintained over the 2-yr follow-up interval, and there was some indication of further improvement over that attained at posttreatment. The findings are discussed in terms of the efficacy of SET and the durability of behavioral treatment of social phobia.
Adult↗
Social phobia: an analysis of possible developmental factors.
Sixty-eight individuals with specific or generalized social phobia and 25 normal controls were assessed for presence of a family history of anxiety, childhood shyness, traumatic conditioning experiences, neuroticism, and extraversion. Subtype differences emerged, including significantly greater neuroticism and a more frequent history of shyness in the generalized subtype. Those with the generalized subtype also had significantly lower extraversion scores, and those with the specific subtype had a significantly higher frequency of traumatic conditioning episodes. Together, traumatic conditioning and childhood shyness predicted the presence of social phobia, although other unidentified factors also appeared to be relevant. The results are discussed in terms of potentially different modes of onset for the subtypes of social phobia and the role of neuroticism and introversion in the development of the disorder.
Adult↗
Assessing community violence: the children's report of exposure to violence.
OBJECTIVE: To describe the development and initial psychometric features of a brief self-report instrument for assessing exposure to community violence, the Children's Report of Exposure to Violence (CREV). METHOD: The CREV was administered to 228 schoolchildren between the ages of 9 and 15 years. A subset (n = 42) was retested 2 weeks later. RESULTS: The CREV has good test-retest reliability, internal consistency, and construct validity. Analyses performed by race and gender revealed no differences in frequency of exposure to community violence as assessed by the CREV. CONCLUSIONS: This initial report suggests that the CREV has promise as a self-report questionnaire, and its construction represents a significant advance in the development of psychometrically sound instruments for use in community violence research.
Adolescent↗
Emotional impact of children's exposure to community violence: a preliminary study.
OBJECTIVE: To use multiple methods and measures to investigate preliminarily the emotional impact of children's exposure to community violence. METHOD: Thirty-seven schoolchildren between the ages of 7 and 12 years were categorized into groups with "high" or "low" frequency of exposure. RESULTS: Differing levels of exposure to community violence did not appear to have an impact on DSM-III-R diagnoses. Exposure to high levels of community violence was not related to internalizing behavior and disorders, but rather was associated with externalizing behavior. CONCLUSIONS: There appears to be an adverse relationship between high levels of exposure to community violence and emotional and conduct problems. Vicarious learning serves as an explanatory construct for these findings.
Child↗
A multicomponent behavioral treatment for social phobia: social effectiveness therapy.
The development of a new, comprehensive and multicomponent treatment for social phobia is described. Initial results of a pilot study with the new treatment also are reported. The treatment was found to be effective with severe (generalized) social phobics, most of whom had co-occurring Axis I and/or II conditions. In addition to significant change on a host of outcome variables, a normative-based endstate functioning index was used to determine treatment efficacy. The results are discussed with respect to the implementation of the treatment and in terms of the need for a comprehensive approach to treating social phobia.
Adult↗
A composite measure to determine improvement following treatment for social phobia: the Index of Social Phobia Improvement.
This article describes the development of a composite index to determine improvement in treatment outcome research with social phobia. The index is comprised of 5 individual outcome measures that tap various domains of social phobia and assess the disorder via multiple methods (e.g. self-report, clinical ratings, behavioral performance). The ability of the index to determine improvement over treatment, and its initial concurrent validity are discussed.
Adult↗
Social phobia: a comparison of behavior therapy and atenolol.
Seventy-two social phobics were randomly assigned to behavioral (flooding) or drug treatment with atenolol or placebo. Treatment was administered over a 3-month period of time, and duration of treatment effects was determined at a 6-month follow-up assessment. Multiple measures of outcome were used, including self-report, clinician ratings (including assessment by independent evaluators), behavioral assessment, and performance on composite indexes. The results indicated that flooding consistently was superior to placebo, whereas atenolol was not. Flooding also was superior to atenolol on behavioral measures and composite indexes. Those subjects who improved during treatment maintained gains at the 6-month follow-up regardless of whether they received flooding or atenolol. The variability of outcome on different measures in social phobia research is discussed, and the need for broad-based treatment strategies to address the pervasive deficits associated with social phobia is noted.
Adolescent↗
Assessing reliable and clinically significant change in social phobia: validity of the social phobia and anxiety inventory.
The ability of the Social Phobia and Anxiety Inventory (SPAI) to measure change as a function of treatment for social phobia was assessed. In addition to determining treatment sensitivity of the SPAI, changes over the course of treatment were examined to determine if they were reliable and clinically significant. The results indicated that although a number of measures showed statistically significant change, only on the SPAI was that change reliable and clinically significant. The use of outcome measures that are reliable and clinically significant for social phobia as well as other disorders is discussed.
Adult↗
Social phobia: a comparison of specific and generalized subtypes and avoidant personality disorder.
The validity of the social phobia subtype distinction was examined in a large sample of carefully diagnosed social phobics (N = 89). Generalized and specific subtypes were diagnosed reliably, and the generalized subtype showed a consistent pattern of greater symptom severity than did the specific subtype. In addition, generalized social phobics with and without avoidant personality disorder were compared, and a difference was found for only 1 of 4 parameters. The results are discussed in terms of the validity of subtyping in social phobia and the diagnostic boundary between social phobia and avoidant personality disorder.
Adult↗
Perceptual deprivation in the acute phase of spinal injury rehabilitation.
Patients in intensive care units are often reported to experience psychological disturbances which may be attributable to a number of well-researched causes. However, it is suggested that the total lack of proprioceptive and motor feedback after spinal trauma may be a significant factor in the genesis of these disturbances which are unique to this group of patients. All cases admitted to the Regional Spinal Injuries Centre in Southport from January 1987 through December 1990 were assessed (n = 187) and the conditions surrounding the occurrence of behavioural disturbances (n = 23, 12.3%) established. The level of interaction with relatives and significant others was established for all acute admissions, and low frequency was found to correlate significantly with the development of perceptual deprivation experiences. The effects of inadequate somatosensory input, lesion level, increasing age, and visitor variability for spinal patients is discussed and an algorithm presented to highlight the potential factors associated with aetiology and treatment of the problem. The implications of these findings for the future management of acute spinal trauma are discussed.
Adult↗