Clinical psychology

The aim of this study was to explore how former psychotherapy patients characterize "good outcome" after having completed treatment that they described as successful, in the sense that therapy had changed their lives in ways that made a difference. Semi structured qualitative depth interviews were conducted with 10 former psychotherapy patients. A hermeneutical-phenomenological approach was used to analyse interview transcripts. The former patients' descriptions of good outcome clustered around four themes: establishing new ways of relating to others; less symptomatic distress, or changes in behavioural patterns contributing to suffering; better self-understanding and insight; and accepting and valuing oneself. Interrelationships between the four components of good outcome, along with limitations and implications of the study, are discussed.

Affect consciousness refers to the ability to adequately perceive, reflect upon and express affect. The concept is used in clinical work with adults, but lacks an equivalent for children's experience of affect. This paper examines the developmental prerequisites for affect consciousness, as well as the concept's applicability to work with children. The main focus is on the development of affect regulation throughout the first 6 years of life. Special emphasis is put on the role of attachment and the unfolding of mentalization ability in this development. The role of play as an organizing factor for affective experience is discussed. Observation of play is highlighted as a strong indicator of affect consciousness in children.

Objective: Obsessive-compulsive disorder (OCD) is a disabling anxiety disorder. The established treatment of choice is exposure and response prevention (ERP) and it has been demonstrated that ERP is effective across a range of different treatment formats. The aim of the present pilot study was to evaluate the effectiveness and patients' acceptability of individually delivered ERP in a group setting. In the current paper we describe the main features of this novel approach as compared to standard individual ERP and other group approaches.

A comprehensive cancer care project was carried out in Uppsala with the aim of improving the overall situation for patients treated with intensive chemotherapy with curative intent. This report gives the results in 58 patients with small cell lung cancer (SCLC), focusing on the nutritional aspects of the care and chemotherapy-related adverse effects. Responses, survival and simple nutritional parameters were compared with a historical control group (n = 81), and quality-of-life parameters with a pre-project group (n = 22). Groups were comparable with respect to pre-treatment characteristics. In contrast to the historical control group, weight, body mass index and S-albumin did not decrease during treatment in patients diagnosed during the project period. Yet, food intake in the study group was low, and for most patients below what is recommended, Survival, proportion of responses and response duration did not differ from those of the control group. Compared with the pre-project quality-of-life controls, a number of scores were more favourable for study patients (n = 36) interviewed in association with the 8th treatment course by a Swedish version of the Cancer Inventory of Problem Situations (CIPS). The global score was lower in the study group than in the pre-project group (0.80 vs 1.20, p < 0.001). Significant differences in a favourable direction were also seen in several higher order factors and miscellaneous subscales constituting the CIPS. On individual items, the study group expressed less problems with appetite/food taste in hospital, nervousness before chemotherapy and worry about adverse effects. The greatest differences in positive direction for the study group were seen within areas where the project focused on caring activities. We therefore conclude that a cancer care project with the present goals and means of intervention can improve the quality of life in patients with SCLC treated with intensive chemotherapy.

We set out to investigate whether potential relatives want to be informed about the existence of hereditary conditions within their family and under which conditions they want healthcare providers to breach confidentiality to inform them. We hypothesized that the willingness to be informed about a hereditary condition in the family would be influenced by characteristics of the disease and by individual characteristics. Surveys were administered to a Norwegian random sample (N = 2,400) to a Swedish random sample (N = 1,200), and to a Norwegian student sample (n = 607). Eight different disease scenarios were constructed, systematically varying three disease characteristics: fatality, penetrance, and availability of treatment. Results show that a majority of participants wished to be informed about the existence of a hereditary disease within their family. The desire to be informed and the acceptability of breaches of confidentiality were predicted by the treatability of the disease, uncertainty avoidance, and age, but not by self-efficacy or worry. © 2006 Wiley-Liss, Inc.

Sixty insomniacs, aged 60 years or over, fulfilling the DSM-IV criteria for primary insomnia, completed a set of questionnaires measuring psychological distress. These included the Sleep Impairment Index (SIM), the Symptom Check List 90 -Revised (SCL-90-R), the Penn State Worry Questionnaire (PSWQ), the Toronto Alexithymia Scale -20 (TAS-20) and the Elders Life Stress Inventory (ELSI). The insomniacs were compared on these measures with two contrast groups, one of elderly good sleepers and one an elderly community sample. As norms were developed for the SCL-90-R and PSWQ, insomniacs were also contrasted with the norm groups on these measures. In general, the results indicated a higher level of psychological distress among insomniacs than among the good sleepers, while there were negligible differences between insomniacs and the community sample on most measures. Overall, elderly insomniacs scored higher on measures of worry compared with the other groups, followed by measures of somatization, obsessive-compulsion and depression. It is concluded that excessive worrying was the most characteristic feature of elderly insomniacs.

The aim of the present study was to evaluate the prevalence of self-reported problems (fear, pain, unpleasantness, fainting) of dental and medical injections, and the extent to which such problems may lead to avoidance of necessary treatment. The study included a representative sample (n = 1385) of 18-yr-old students attending high schools in the county of Hordaland, Norway. Data were collected by use of questionnaires completed in the classrooms. More problems were reported during dental than medical injections. About 17% and 15% of participants reported high fear during their last dental and medical injection, respectively. Fainting had been experienced by 2% during a dental injection and by 7% during a medical injection. Avoidance of treatment when an injection is needed was 6.7% for dental treatment and 5.2% for medical treatment. In multiple regression analyses, fear was the only explanatory factor for the avoidance of dental treatment. It is concluded that self-reported problems of injections are prevalent in this age group, particularly among girls, and that it may lead to the avoidance of necessary treatment in 5–7% of the adolescent population.

Twenty patients with dental anxiety were investigated while seated in a dental chair in a dental clinic. Heart rate (HR), heart rate variability (HRV), and skin conductance level (SCL) were recorded while the patients were exposed to scenes of dental treatment as well as a Stroop attentional task. Results showed an attentional bias with longer manual reaction times (RT's) to the incongruent compared to the congruent color words as well as the threat compared to the neutral words. Longer RT's to the incongruent and the threat words were found in the low HRV patients compared to the high HRV patients. Furthermore, all patients showed an increase in HR during exposure and the Stroop task compared to baseline. The HRV showed a decrease during the exposure and the Stroop task compared to baseline. HR and HRV did not differ between exposure and the Stroop task. Moreover, HR and HRV did not return to baseline levels during the recovery period. The SCL showed an increase from baseline to exposure, from exposure to the Stroop task and a decrease in the recovery phase. Results showed the importance of vagal cardiac control in attentional, emotional, and physiological processes in patients suffering from dental fear. #

Fifty-five insomniacs, 60 years or above, participated in a behavioral treatment program, comparing two interventions (sleep hygiene+stimulus control vs sleep hygiene+relaxation tape). Half of the subjects were randomized to a waiting-list condition prior to treatment. No significant changes were observed during the waiting-list period. During the treatment period however, the subjects improved on several sleep parameters, and treatment gains were maintained at a 6-month follow-up. The effects of treatment were greater for nocturnal measures (e.g. sleep onset latency and total sleep time) as compared to daytime measures (e.g. life satisfaction, daytime alertness) and not-targeted behavior (medication use). There were no differences in treatment effects for the two interventions. 

Although several qualitative reviews on pharmacological interventions for pathological gambling have been published, no quantitative review of this field has been conducted. Methods: Studies of pharmacological interventions of pathological gambling were identified by computer searches in the PsychINFO and MEDLINE databases covering the period from 1966 to July 2006, as well as from relevant reference lists. The inclusion criteria were as follows: the target problem had to be pathological gambling, the interventions were pharmacological, the study was written in English, and the study reported outcomes particularly pertaining to gambling. A total of 130 potential studies were identified of which 16 met the inclusion criteria. A total of 597 subjects were included in the outcome analyses of these studies. The grand mean age was 43.3 years. The overall proportion of men was 62.8%. The included studies were coded for outcome measures of pathological gambling. For each condition, means and SDs for gambling-related outcome measures were compiled at 2 points in time: baseline and posttreatment. Results: At posttreatment, the analysis showed that the pharmacological interventions were more effective than no treatment/placebo, yielding an overall effect size of 0.78 (95% confidence interval, 0.64-0.92). A multiple regression analysis showed that the magnitude of effect sizes at posttreatment was lower in studies using a placebo-control condition compared with studies using a predesign/postdesign without any control condition. Effect sizes were also negatively related to the proportion of male participants in the included studies. No differences in outcome between the 3 main classes of pharmacological interventions (antidepressants, opiate antagonists, mood stabilizers) were detected. Conclusion: Pharmacological interventions for pathological gambling may be an adequate treatment alternative in pathological gambling.