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[Behavior therapy self control in chronic compulsive organismic defective habit development].

Patients with chronic compulsive organismic mishabituations, which are rather difficult to treat, can be helped by self-control methods of behavioural therapy combined with suggestive measures. The author currently regards this therapeutic approach to be superior to aversion therapy, which was occasionally used for such cases in the past. The contribution presents a scheme of therapy which can be generalized and is based on the work of Meichenbaum and Leonhard. The scheme consists of two parts containing four phases each. The actual approach and the modification necessary to tailor it to the individual case is explained by means of an example involving the treatment of psychogenic polydipsia.

Adult↗

Development of hand-eye dominance in relation to verbal self-regulation of motor behavior.

The development of the relation between hand-eye dominance and verbal self-control of motor behavior was examined with 4- and 5-year-olds. Performances of subjects falling into either crossed or consistent hand-eye dominance categories were compared on a two-choice button-pushing task. Children performed this with their dominant hand in one of two conditions: verbalizing and not verbalizing their button-pushing activity. Results showed that crossed hand-eye dominant children gave significantly poorer performances than consistent hand-eye dominant children and that the former used their self-instructions in a motoric manner. These findings were interpreted as supporting the view that the functions of cerebral hemispheres in children with crossed dominance are more immature than those in children with consistent dominance.

Child↗

Human development and intervention in childhood psychopathology.

Changes sought by interventionists can be influenced by the classes of changes labeled "development." We argue there are several features of the child's developing physical, psychological, and behavioral characteristics that suggest the sorts of interventions that may be efficacious and the ones that may be less efficient or counterproductive. Illustrations are drawn from the literatures pertinent to such topics as systematic desensitization, cognitive-behavioral self-control therapy, interventions for social isolates, and parent training programs, and involve preventive as well as remedial/therapeutic interventions. The combined efforts of developmentalists and interventionists may contribute to clarifying one of the major issues in human development today, that of constancy and change over the life course.

Behavior Therapy↗

Relaxation/mental imagery (self-hypnosis) and pelvic examinations in adolescents.

A first pelvic examination in a teenage woman is often an anxiety-producing and/or a terrifying event. The anxiety of this first examination, coupled with the inherent stresses of adolescence, creates important crucial expectations for future examinations. Self-hypnosis, i.e., relaxation/mental imagery has been extremely useful as an adjunct in achieving comfort and relaxation for the adolescent during the examination. In addition, it assists in developing an increased sense of self-control. Approaches and techniques of relaxation/mental imagery are illustrated in four representative case reports. Current theories and applications of clinical hypnosis are briefly discussed.

Adolescent↗

[Diabetes and Pregnancy (author's transl)].

UNLABELLED: The article reports on the experiences collected during treatment and delivery of 316 pregnant diabetic women hospitalized in the municipal hospital of Vienna-Lainz. 1. Close co-operation between diabetologist, obstetricians and pediatricians in imperative. 2. Early diagnosis and recording - as far as possible before conception -, accurate control and intensive care by the diabetologist and obstetrician right from the beginning is most essential; the aim should be to attain normoglycaemic levels preferably during the first 3 months of pregnancy. 3. In the case of diabetic patients requiring insulin who are difficult to stabilize, it would be desirable to effect stabilization in the hospital, followed by self-control of blood sugar levels with self-adjusted insulin variation. Above all, overweight should be avoided. 4. Obstetric intensive care can be effected only in a department with modern equipment. 5. In case of complications, it will always be necessary to provide for additional hospitalization over and above the routine cases; such hospitalization must always consist of combined obstetric and internistic medical care. 6. Prognostically Bad Signs of Pregnancy (PBSP) groups must be kept as small as possible. 7. Childbirth should be approximated as closely as possible to the calculated date of birth (in While A cases up to the 40th week of pregnancy, with the other patients at least up to the 38th week of pregnancy). The necessary controls which can justify postponing the time of birth, are explained. The approximation to the calculated data of birth depends largely on optimal stabilization of the diabetes to normoglycaemic levels during the entire pregnancy period. This is documented, inter alia, by normal weight of the newborn at the time of birth, corresponding to the duration of pregnancy. 8. Vaginal delivery should be aimed at. 9. Newborn are always high-risk infants; the first few minutes of live are absolutely decisive. The infants should be placed in the care of a team of pediatricians as early as possible, combined with transfer to a children's hospital with intensive-care ward, using an intensive-care ambulance for effecting the transfer. 10. RESULTS: These measures led to a reduction of the mortality rate (reduced to the corrected values), the average of which had been 12.5% during 1970-1971, to 1.85% during 1972-1979. The proportion of PBSP groups, which was originally 32.42%, dropped during the same period to 20.79%, the perinatal mortality in this group being reduced from 50% to 17.24%.

Blood Glucose↗

Treatment of diabetes mellitus and pregnancy.

The pregnancy of woman with diabetes mellitus poses a high risk. During the pre-insulin era the newborn had a 40% chance of survival and there was high mortality in the mothers. Only in recent years has it been possible to decrease perinatal mortality to 2-4% due to the cooperation of diabetologists, obstetricians, and pediatricians in centers with much experience in supervision of mother and child. In the foreground of treatment are the following prerequisites: (1) close metabolic supervision of the mother allowing blood-glucose values between 60-120 mg/dl and mean blood glucose per day around 85 mg/dl during the course of pregnancy; (2) intensive supervision of the fetus; (3) early recognition and adequate treatment of complications. Close metabolic supervision succeeds only by way of blood-glucose self-control. To decrease the rate of deformities, the close metabolic supervision apparently has to commence before conception. This management no longer requires delivery according to the White scheme.

Congenital Abnormalities↗

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↗

Metabolic comfort and motivation of preference for ethanol.

Rats with preference for ethanol or water were selected by the method based on the minimal contact of the animals with the tested fluids (selection was made twice for 48 hours at two-week intervals). Over four days the selected groups of animals were given 5% (v/v) ethanol as their only source of fluid. The amount of some lipid fractions in various tissues and 14C-acetate incorporation into them were measured. The levels of free amino acids and their derivatives were studied in liver, blood plasma and urine. Twenty-four hours before sacrifice, ethanol was replaced by water. The animals with preference for water or ethanol were distinguished by content of various amino acids, lipid fractions and incorporation of 14C-acetate into the latter. The differences disappeared after ingestion of small amounts of ethanol. The data obtained indicate that preference for ethanol may be regarded as a mode of optimization of metabolic self-control in the organism.

Alcohol Drinking↗

[Psychotherapy of neurotic disorders in older adults: a new doorway to life].

The general concept of neurosis in old age includes the classical forms as well as the ones specific to this particular community and, also, the reactions to social circumstances. This point of view practically covers the greatest part of the behavior that the ones we call "elders" usually show and almost drives us to give a psychological definition of this state. Etiology of these disorders is plural. It involves the role of the emotional past, of the medicosocial implications of ageing, especially regarding affectivity. Psychotherapeutic intervention needs a great pliancy allowing to interfere both on the pragmatic and the interpretative levels. The freudian prejudice build up on the impediment of psycho-affective rigidity hides the unconscious fears of the therapist towards his own old age as well as the fear of being questioned about his efficiency. A restriction in the means as well as in the therapeutic ambition is not underrating but rather valorizing his action in which he must show self-control and suppleness. This psychotherapy must catalyze the energy that the elderly displays in his quest of unity. It trends to give back the individual an unlimited opening on life.

Aged↗

[Psychohygienic aspects of behavioural methods in preparation for childbirth (author's transl)].

The main sources of conflict in pregnancy and labour are depicted in the introduction. Then the psychohygienic possibilities of preparation for childbirth are pointed out and discussed in the light of a program for preparation for childbirth by the author, oriented on behavioural, learning-theoretical and group-psychological principles. All interventions of this program are designed to consider continually the cognitive and emotional capacity of information processing of each group-member. This is realised by problemsolving-training and self-control strategies, administered to actual tasks and problems. By this means important ego-functions are strengthened, which counteract emotions of helplessness and depression. These assumptions are supported by the results of an empirical investigation of this program.

Adaptation, Psychological↗

Obesity: psychological aspects and management.

The failure of psychological treatments to produce consistent long-term weight loss in obese subjects has led directly to a re-examination of the nature of their eating behaviour and, as stated above, to the development of new theoretical models of obesity. While behavioural therapy techniques have succeeded in producing weight losses in the region of 5 kg on average, and in the short term may be more cost-effective than drug therapy when the patients are seen in groups and by paraprofessionals, many of these subjects regain the weight lost. The majority of treatment methods involve a reduction in food intake most commonly by self-control procedures. Since recent evidence implies that the use of these techniques may derive from false assumptions, a return to individually designed treatments is perhaps the optimum strategy to maximize long-term weight loss (Wooley et al, 1979). It may be necessary to focus on relevant areas involving the wider application of behavioural therapy methods such as anxiety-management training including cue exposure and response prevention. As is most commonly suggested, a change of responses leading inevitably to overeating can be identified. The development of innovative treatment methods for obesity will require an increased understanding by therapists of the role of physiological factors in weight during and following weight loss towards a greater understanding of the factors that for him are likely to be associated with weight gain. Self-reinforcement for maintaining weight and the role of the family in promoting, facilitating, and maintaining weight loss may also be useful. However, the acknowledgement of the role of cognitive factors may eventually lead towards the development of more sophisticated treatment methodologies encompassing physiological aspects of obesity and based on social psychological theories of attitude change.

Arousal↗

Smoking cessation programs in occupational settings.

For reasons of health and economics, the business community is displaying a growing interest in providing smoking cessation programs for employees. An examination of the current research on smoking cessation methods has revealed a number of promising directions that smoking cessation programs can take, for example, aversive smoking approaches combined with self-control strategies. A review of current smoking cessation programs in occupational settings revealed some emphasis on physician counseling, but a relatively greater emphasis on use of consultants (especially in proprietary programs) or of contingency programs to encourage nonsmoking.The smoking cessation programs in businesses can move in a number of innovative directions, including (a) increased use of inhouse programs with a variety of smoking cessation strategies; (b) greater emphasis on the training of program participants in nonsmoking behavioral skills, combined with contingency or incentive programs for smoking control; (c) vastly improved research methods, including complete followup assessments of program participants and chemical tests to validate their self-reported abstinence; (d) greater concern about the need for empirically tested procedures for recruitment of participants for the programs; and (e) expanded interchange among behavioral scientists (especially behavioral psychologists), health professionals in occupational health and medicine, union and employee groups, and management.

Behavior Therapy↗

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↗

Task performance in spinal cord injury: effect of helplessness training.

The effects of failure or helplessness training on the task performance of recently injured spinal cord patients were assessed using the learned helplessness theory as a model. The theory states that individuals who experience uncontrollable failure become depressed and feel helpless, while those who experience self-controlled success develop a sense of competence and feel industrious. To provide validation of the learned helplessness theory, 24 recently injured spinal cord patients were interviewed and then tested for helplessness effects and depression on 2 standard learned helplessness tasks. Results suggest that it may be possible to immunize spinal cord injured patients against debilitating emotional reactions to paralysis with a success-oriented rehabilitation regime during the initial stages of recovery.

Attitude↗

On bringing up children.

Parents should strive for two objectives in bringing up children: that their children should be happy and brought up prepared to face and deal with adult life. Happiness requires love, which is incomplete without respect, and much respect derives from discipline. For adulthood children need to be taught self-control, have a sense of responsibility and service, and recognize that you can't go through life doing just what you like.

Adolescent↗

[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↗