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Biofeedback and the behavioral treatment of disorders of disregulation.

This paper reviews biofeedback research from the perspective of cybernetic/feedback theory and applies the theory to the behavioral treatment of psychosomatic disorders. The concept of disregulation is used to elucidate how environmental factors can modulate the central nervous system and effect homeostatic, self-regulatory control of peripheral organs. When feedback from peripheral organs is disrupted, it is hypothesized that disregulation occurs, leading to physiological instability and functional disease. Within this framework, biofeedback provides a new feedback loop that can help individuals regain physiological self-control. Basic research using biofeedback to enhance self-regulation of cardiovascular responses is reviewed. The use of biofeedback in the behavioral treatment of disorders such as tension and migraine headache, hypertension, and epilepsy are selectively reviewed and critically evaluated. The need to consider feedback mechanisms in behavioral and biomedical approaches to treatment is highlighted. Predictions regarding the potential inadvertent perpetuation of disregulation and disease through inappropriate biomedical intervention is also considered.

Behavior Therapy↗

[Behavior therapy of cardiac phobia--a clinical report of experiences in the training of cognitive anxiety management].

We report about a psychotherapeutic approach of intervention with patients suffering of severe cardiac neurosis. The patients treated had panic attacks almost every night. The patients learned cognitive strategies in combination with a self-controlled stimulus exposition. In addition an analysis of the individual learning history was made. We found an anxious, dominant mother in 8 of 10 cases. Two patients had a foster-mother. Six married patients had a tendency of separation and a fear of separation as well. In these cases we recommended a marital therapy or an individual therapy after our hospital treatment. All treated patients lost the panic attacks; agoraphobic tendencies were reduced as well--no longer impairing their every day life. In five cases all clinical symptoms had disappeared completely. In all cases we found the improvements persisting 6 months after treatment.

Adaptation, Psychological↗

Reinterpretative cognitive strategies in chronic pain management.

This preliminary study was conducted to test the effectiveness of cognitive treatment of clinical pain. Chronic pain patients were trained in a self-control cognitive strategy procedure. Specifically, they were provided with a conceptualization of their pain, instructed in an awareness of their thoughts prior to and during their experience of pain, and trained in the use of several cognitive strategies to replace these thoughts and relabel their pain experience. Training was provided in a group setting to further consolidate the use of the instructions by enabling patients to roleplay the instructions to one another. Patients were also encouraged to verbally reinforce themselves each time they used the procedure. The experience of pain was measured by the McGill pain questionnaire, a behavioral checklist and staff reports. Results suggest that cognitive strategies can effectively alter the experience of clinical pain. Moreover, pain as a cognitive label for a nonspecific state of arousal is suggested.

Cognition↗

[Self control developing function of self verbalization in children in experimental situations].

80 children received 5 different instructions which the children were supposed to repeat when exposed to classical tempting situations. As one result it could be shown that children of the middle class under the treatment conditions of verbalizing positive consequences were significantly better concerning the time of latency than those of other groups. In contrast to the expectations there were no differences according to factors like class, intelligence and latency. Results are discussed in terms of the development of self-control, relations between verbal and nonverbal behavior, cognitive behavior modification, and in the relation to a similar experiment by Hartig and Kanfer (1973).

Achievement↗

An eclectic approach to parent group education.

Many factors contribute to a need for parent education today. Parent education has changed over the past centuries as a result of our changing values, our increasing knowledge base, and changes in family structure. The parent education group attempts to meet the parents' need to validate their concerns and offer them process and skills that promote mental health in children. Two popular models of parent education, the reflective model and the behavioral model, stem from two schools of psychologic thought-the phenomenologic school and the behavioral school. Because of the weaknesses and strengths of each model, an eclectic model of parent education is proposed which facilitates an authoritative patern of parenting correlated with self-reliant, explorative, and self-controlled children. This eclectic model of parent education is perceived as being within the role description of the generalist nurse who has access to back-up specialists in the health care system. Many opportunities exist for the nurse to offer this type of health education.

Female↗

Low back pain comprehensive rehabilitation program: a follow-up study.

The outcome of the management of chronic low back pain in 42 men and 36 women by a comprehensive rehabilitation program consisting of biofeedback training, counseling in self-control techniques, self-regulated medication reduction, physical therapy, vocational rehabilitation services and education conducted in a therapeutic milieu was examined at 6 months and 12 months after discharge. The mean age of the subjects was 43.4 years: the mean highest school grade completed, 12.6; and the mean full scale WAIS IQ, 106.7. On admission 72 were unemployed and had been disabled and unemployed for a median time for 3 years. Almost two-thirds were involved in litigation. Thirty-three were working or accepted for employment t 6 months after discharge and 35 at 12 months (p less than 0.001). Success rates are higher when only those who stayed in the program for more than 4 weeks are considered. The employed patients rated their pain lower, used less medication and relied less on attention from physicians. They did not seem to differ in their use of relaxation skills or exercise. A similar study has been initiated of patients randomly assigned to treatment and waiting list control groups.

Adult↗

Behavior rating inventory for moderately, severely, and profoundly retarded persons.

The reliability and validity of the behavior of a sample of institutionalized mentally retarded children, with total IQs between 2 and 53, were assessed by a new scale measuring the following areas; communication, self-help, physical skills, self-control, and social behavior. Clinically and statistically acceptable levels of interrater agreement were found. With respect to validity: (a) several factors loaded very highly on items consistent with the a priori labeling of subscales; (b) two of the factors (cognitive and psychomotor development) could account for about 75% of the explained variance in ward placement levels (multiple R = .86); and (c) individual items on the Behavior Rating Inventory for the Retarded correlated highly with independently derived measures of the actual behavior these items represented. The major advantages of this scale over existing ones include its clearly demonstrated validity and relative ease of administration and scoring.

Adolescent↗

Moral and humane: patients' libraries in early nineteenth-century American mental hospitals.

"Moral treatment" designates a period in American psychiatry in the first half of the nineteenth century when retreats and asylums, following the example of the York Retreat in England, began to offer humane care to the mentally ill. Patients had a close and personal relationship with the hospital superintendent or the resident physician; positive behavior was rewarded and patients were expected to exercise self-control. Moral treatment was marked by a well-ordered daily routine in which patients followed a therapeutic regimen of work and leisure activities. Reading was regarded as both therapeutic and recreational, and was highly recommended. For this reason, retreats and asylums maintained book collections and considered library services an important aspect of the patients' therapeutic program. This paper examines patients' library activities in eight early nineteenth-century mental hospitals where moral treatment was practiced.

Books↗

[Diabetes mellitus].

Some of the most outstanding features of Juvenile Diabetes Mellitus in adolescence are revised in this paper and have been established in a group of 38 affected children controlled in the Department in the past years. The relationship between determined epidemiologic and etiopathogenic factors, as the age in which the disease appears, the sex or the presence of concrete HLA antigens with the clinical expression, evolution and prognosis of the Diabetes Mellitus is underlined. Likewise, some problems about acceptance of the disease, fulfillment of the diet or the self-control that are usually manifested during adolescence are commented.

Adolescent↗

Pain center follow-up study of treated and untreated patients.

To investigate the outcome of patients treated in a multidisciplinary pain clinic, patients previously treated in the center and patients who had been eligible for, but did not desire such treatment, were contacted by phone. Their current life and pain status were assessed using a structured interview format. Fourteen individuals in each group agreed to participate in the study. The groups did not differ significantly on variables of sex, age, time since referral, marital status, premorbid income, and type of pain. Analysis of differences in discomfort level for the treated group revealed a 47% decrease from a mean of 7.02 to 3.67 (10-point scale). The telephone contact occurred approximately 2 1/2 years following initial referral. There were no statistical differences in current pain levels, number of pain-related visits to health professionals, pain-related expenses, employment status, disability status, history of pain-related litigation, use of medications, or frequency of pain-related surgeries since referral. Patients treated in the pain clinic were significantly more likely to use active, self-control strategies to manage pain than were individuals in the control group. Use of such strategies, however, was limited. The data suggest that outcome studies of pain patients should include control groups treated by other modalities or who receive no treatment; that maintenance of treatment goals is compromised by compliance problems; and that more comprehensive cost effectiveness studies of chronic pain treatment are needed.

Chronic Disease↗

[Combined modality therapeutic program for the control of smoking].

This investigation presents the results of a multimodal therapeutic programme for the cessation of smoking. The programme included the following elements: self-control techniques, education on a variety of issues on tobacco effects, group dynamic techniques, medical check up and pharmacological support. There were two treatment conditions, one included twelve sessions, and the other eight sessions. All groups received four follow-up sessions in a six month period. Ninety four subjects initiated treatment and 69 (73.4%) completed it. Twenty one subjects (22.3%) stopped smoking and remained abstinent after six months, eleven (11.7%) stopped smoking and relapsed and fourteen (14.7%) stopped smoking but did not attend the last follow-up sessions. Twenty three subjects (24.5%) did not stop smoking but reduced their smoking rate in 50% from initial report. These results were considered as satisfactory when compared with others obtained in similar studies.

Adult↗

[Autogenic training in psychophysiological preparation for parachute jumps].

The efficiency of specific psychophysiological preparation--autogenic training--to parachute jumps was measured in two groups of cadets (test subjects and controls). Hetero- and autogenic training was carried out according to a scheme specially developed for this type of activity. The study of questionnaires and physiological data demonstrated that the specific psychophysiological preparation by means of autogenic training for a certain type of activity helped to develop active self-control over one's own state and emotions, alleviated tension, arrested adverse neurotic manifestations (sleep disturbances, depression, anxiety), contributed to the feeling of confidence in the successful completion of the jump and promoted positive tuning towards subsequent jumps.

Anxiety Disorders↗

Diver adaptability during a nitrox saturation dive at 7 ATA.

The major objective of this study was to demonstrate the advantages of transforming raw scores to ipsative form (deviation scores calculated around each subject's mean), particularly in diver research characteristically involving small subject samples in a self-control design. Measures of reaction time, response accuracy, anxiety, hostility, and depression were obtained from three U.S. Navy divers (Ss) during a nitrox saturation dive at 7 ATA (bottom time 7 days). It was argued and to some extent demonstrated that normative (interindividual) statistics obscure individual differences which are clearly delineated with the scores in ipsative form. Further, this score transformation allowed for meaningful between-Ss (same measure) and between-measures (same S) comparisons. These relationships could not be demonstrated with the scores in normative form. Application of P-technique of factor analysis within each S's arrays of data suggested that the characteristic adaptive patterns of two Ss in this study reacted to the pressure-stress by directing affect inward; for the third S, affect was directed outward. However, none of the 20 scales from the Minnesota Multiphasic Personality Inventory clearly discriminated among the three adaptive types.

Adult↗

Oedipal grief: mourning or melancholia?

A discussion of "Oedipal Grief" by Robert May, Ph.D. A clinical syndrome seen in late adolescent men, oedipal grief refers to a depressive state sustained by a vengeful conscience and a pattern of self-punitive acting out. The psychopathology of this syndrome is clarified and differentiated sharply from the normal developmental process of grieving the loss of an idealized oedipal father. As a form of developmental melancholia, the repressed ambivalence and weakening of the ego in this syndrome is highlighted. May's reconceptualization of the structural-instinctual model of the superego and ego ideal is then critically reviewed; his tendency to reduce oedipal to preoedipal developmental phenomena is noted. A more developmentally differentiated theoretical model is suggested in terms of the incomplete internalization of the functions of self-control and self-esteem in the type of adolescent personality organization which underlies, and is perpetuated by, the psychopathology in the oedipal grief syndrome. The main task of brief psychotherapy is thus to promote the ego's capacity to tolerate increased inner conflict so that a developmental shift toward greater internalization can take place. The skillful treatment conducted by May is reinterpreted in these terms; and the therapeutic facilitation of adolescent grieving is placed in the context of structural-developmental change.

Child Development↗

[The "ideal" pacemaker (author's transl)].

The therapeutic role of chronic cardiac pacing in cardiology has significantly altered for two fundamental reasons: a) on the one hand, there has been a widespread increase in the indications for cardiac stimulation, and consequently, today, approximately 50% of the patients with pacing do not suffer from advanced atrioventricular (A-V) block or syncopal attacks, but are frequently suffering from other pathological conditions: episodes of paroxysmal arrhythmia, atrial disease, depression of the habitual pacemaker by drugs or in the course of cardiomyopathy; b) on the other hand, through technological progress the life of the generator has been lengthened (lithium, plutonium), more variable frequencies within relatively high limits are available, electrodes, wiring, circuits etc. have improved. This extended use of the pacemaker, however, creates in itself a series of problems: it is now possible to envisage the characteristics of the "ideal" pacemaker, in other words, a stimulation unit endowed with resistance, modulation, self-control, innocuosness.

Cardiac Pacing, Artificial↗

[Intensive care for newborns. Evaluation of questionaires (author's transl)].

This report contains three sections: A general definition of aims and tasks of neonatal intensive care is followed by the description of four regions and four neonatal units of different structure with some relevant statistics. According to this inquiry about 1.5 cots for maximum neonatal care and 4 cots for intermediate care per 1000 live births are needed. Considering efficiency and effectivity the smallest independent intensive care unit should "cover an area" of 4000 deliveries per year; it should be closely connected to a least one obstetrical unit. Where and how this neonatal unit may be integrated into a childrens hospital can be derived from the four examples given. It should be recognized that 1) high quality intensive care depends on the availability of additional pediatric services, 2) comprehensive care of newborn infants necessitates regional organization including a newborn ambulance system. Thus, close contacts with obstetrical, but also with pediatric units offering better facilities should be established. In yearly intervals results are to be self-controlled by statistical means. The following incidences of normal survival of infants referred to childrens hospitals can be gained currently [2]: Birth weights below 1000 g: above 20%; 1000--1499 g: above 85%; above 1500 g: better than 95%. Less favorable figures call for analyses of reasons and measures to abolish them.

Austria↗

[Hygiene in medical practice (author's transl)].

Ideas and suggestions for hygiene in medical practice ought to be a stimulus for colleagues in active practice in town and country and also for specialists. Within the scope of a reviw, neither rules, standards nor checklists should be given, because self-determination and self-control- with the help of these stimuli too-are preferable to bureaucratic control. Order and cleanliness are part of the picture of a good doctor. The aspects of hygiene in their many branches, not only for defense against infection, ought to contribute in fact and psychologically to the benefit of the patient.

Communicable Disease Control↗

On Kibarashi-gui (binge eating).

The authors presented 16 cases that displayed episodes of pathological over-eating, i.e. kibarashi-gui (binge eating). The cases were divided into three groups, and symptomatology of the eating bouts and associated psychiatric symptoms were described. Constellations of symptoms differed from group to group. The first group, Group A, was concluded as the pure kibarashi-gui (binge eaters), and Group B can be regarded as a variant of anorexia nervosa. Discussion was focused on the similarities and differences between kibarashi-gui and anorexia nervosa. Kibarashi-gui is explained as a defeat of self-control or competition. Discussions on the origin of the sex difference of eating disorder were done. And, the concept of slimness or beauty in women was assumed as the most important factor in eating disorders.

Adolescent↗