The current status of behavioral psychotherapy: theory and practice.

Pathological gambling was officially defined as a psychiatric illness by APA in 1980. The authors report on the results of a state-wide study in New York that indicated significant differences between problem gamblers in the general population and pathological gamblers entering publicly funded treatment programs. These results, based on telephone interviews using standardized assessment instruments with 1,000 persons, raise serious clinical and programmatic issues regarding the development and organization of appropriate services for pathological gamblers. They also point to the fact that large segments of the general population are not receiving needed services.

The authors report the latest findings from a 32-year longitudinal study of 269 back-ward patients from Vermont State Hospital. This intact cohort participated in a comprehensive rehabilitation program and was released to the community in a planned deinstitutionalization effort during the mid-1950s. At their 10-year follow-up mark, 70% of these patients remained out of the hospital but many were socially isolated and many were recidivists. Twenty to 25 years after their index release, 262 of these subjects were blindly assessed with structured and reliable protocols. One-half to two-thirds of them had achieved considerable improvement or recovery, which corroborates recent findings from Europe and elsewhere.

In order to explore valproate's spectrum of efficacy in rapid-cycling bipolar disorder, 55 patients underwent a prospective, open, 7.8-month trial designed to assess the drug's acute and prophylactic properties. Twenty patients received monotherapy, and 35 received combination therapy. Moderate to marked acute antidepressant responses were seen in 47% of the patients, prophylactic antidepressant responses in 76%, acute antimanic responses in 91%, prophylactic antimanic responses in 94%, acute responses in mixed states in 85%, and prophylactic responses in mixed states in 93%. Consistent with other anticonvulsant literature, these data suggest that valproate has marked antimanic and mixed state efficacy, but minimal to moderate antidepressant properties.

Considerable effort has been directed toward identifying and conceptualizing information-processing deficits in schizophrenia and other psychotic disorders. The impressive gains in this field have made meaningful contributions to our understanding of the etiology and course of these disorders. This article considers whether the time is ripe to move beyond identification of these deficits to remediation of them. This move is far from a simple matter; it requires careful attention to theoretical frameworks and to the criteria for selecting certain cognitive deficits, among many, for remediation. A sparse and somewhat dated literature suggests that certain types of cognitive remediation, at least when defined in a narrow sense, are feasible with schizophrenic patients. This literature can reasonably justify continuing investigations on a modest scale. Specific questions for further studies include the following. 1) Which cognitive models provide a framework to guide cognitive interventions? 2) Which specific functions or levels of information processing should be targeted by cognitive interventions? 3) Are cognitive interventions effective? 4) Does the remediation of basic cognitive deficits generalize? A major strength of this area of investigation is the testability of the questions. Several research designs are tentatively suggested.

The authors investigated the pharmacological treatment of delusional depression by assigning patients on a random double-blind basis to amitriptyline alone, perphenazine alone, or a combination of the two. Fourteen (78%) of the 18 patients assigned to amitriptyline plus perphenazine were responders, compared with seven (41%) of 17 patients treated with amitriptyline alone and three (19%) of the 16 patients treated with perphenazine alone. The combination of amitriptyline and perphenazine was clearly superior (p less than .01).

The authors compared scores on the Toronto Alexithymia Scale and the Anxiety Sensitivity Index of 27 patients with panic disorder and 31 patients with obsessive-compulsive disorder. Results suggest that patients with panic disorder constrict emotional experience, thereby reducing the likelihood of their experiencing physiological symptoms that accompany affect.

This study tested the hypothesis that in a population of adult outpatients with major depression, those with an early onset of depression would have a greater prevalence of personality disorders than those with a late onset of depression. The 404 subjects were patients participating in depression treatment studies at the Massachusetts General Hospital. They were administered the Structured Clinical Interview for DSM-III-R-Patient Version to assess the current presence of major depression and the age at onset of the initial depressive episode. The subjects were then divided into two groups: those with early onset (before 18 years of age) and those with late onset (at age 18 or later). The prevalence of personality disorders was determined through use of the physician-rated Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and the patient-rated Personality Diagnostic Questionnaire-Revised (PDQ-R). The patients with early onset of major depression had a significantly higher prevalence of avoidant, histrionic, narcissistic, and borderline personality disorders according to the SCID-II. The PDQ-R scores indicated that avoidant, dependent, passive-aggressive, histrionic, narcissistic, borderline, and antisocial personality disorders were significantly more prevalent among the patients with early onset of major depression. Overall, the results are consistent with the view that early-onset depressive illness is distinguished from late-onset major depression by more frequent association with persistent disturbances in behaviors and attitudes.

Six patients with seasonal affective disorder showed marked improvement in depressive symptoms after following three different 2-hour schedules of bright artificial light, and they relapsed when the light was withdrawn.

The goal of this study was to determine whether self-mutilators with personality disorders differ from nonmutilators with personality disorders in impulsivity, aggression, and other psychopathology and whether serotonergic dysfunction contributes to self-mutilation. Twenty-six self-mutilators with personality disorders were matched to 26 control subjects with personality disorders for gender, age, education, axis I diagnosis of affective disorder, and axis II diagnosis of personality disorder. Numerous indexes of psychopathology as well as CSF 5-hydroxyindoleacetic acid (5-HIAA) levels and platelet imipramine binding sites (Bmax) and affinity (Kd) were determined. Self-mutilators had significantly more severe character pathology, had greater lifetime aggression, and were more antisocial than the control subjects. The self-mutilators scored higher on the Hamilton Rating Scale for Depression but not on the Beck Depression Inventory or the Beck Hopelessness Scale. The two groups did not differ on the Buss-Durkee Hostility and Guilt Inventory or on the Sensation Seeking Scale. The degree of self-mutilation was significantly correlated with impulsivity, chronic anger, and somatic anxiety. Both self-mutilation and impulsivity showed significant negative correlations with Bmax, although the two groups did not differ in CSF 5-HIAA levels or in platelet imipramine binding. The results demonstrate the contribution of severe character pathology, aggression, impulsivity, anxiety, and anger to self-mutilation and provide preliminary support for the hypothesis of underlying serotonergic dysfunction facilitating self-mutilation.

The decision to change the primary locus of care for chronically ill psychiatric patients from the state mental hospital to the community has often set off a chain reaction of consequences. Notably, reducing the role of institutions has frequently resulted in destroying needed sanctuary for some patients. The author discusses the relationship between deinstitutionalization and the function of asylum and examines the relevance of three planning principles--functional equivalence, cultural relevance, and potential trade-offs--to the need of chronically ill psychiatric patients for asylum.

Although not a new phenomenon, wife-beating has been largely ignored by mental health professionals. The author describes a context in which the physical abuse of women as wives can be understood and suggests alternative theoretical constructs to traditional theories of masochism as explanations of why women stay in violent marital relationships. She discusses the societal attitudes that normalize the use of family violence as well as attitudes about women, men, and sex roles that leave women vulnerable to assault; summarizes the research on abused wives; identifies a specific stress response syndrome caused by violent abuse; and elaborates on the problems posed for clinicians working with abused women.

Back to table of contents Previous article Next article ArticleNo AccessTHE DYNAMICS OF PSYCHOTHERAPY IN THE LIGHT OF LEARNING THEORYFRANZ ALEXANDERFRANZ ALEXANDERSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.120.5.440AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail PDFThis content is only available as a PDF. Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing Psy[email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byLearning to Solve Emotional Problems: A Controlled Study of Short-Term Anxiety-Provoking Psychotherapy30 May 2008European Journal of Psychotherapy & Counselling, Vol. 10, No. 1History of psychologic treatments19 September 2013Psychological Bulletin, Vol. 130, No. 4Back to the Future: F. Alexander (1963) Reconsidered.Journal of Psychotherapy Integration, Vol. 14, No. 4Journal of Clinical Child Psychology, Vol. 28, No. 4Clinical Psychology: Science and Practice, Vol. 3, No. 1Clinical Psychology: Science and Practice, Vol. 2, No. 1Applied and Preventive Psychology, Vol. 3, No. 3Clinical Psychology: Science and Practice, Vol. 1, No. 1Therapeutic impact disclosure: A last taboo in psychoanalytic theory and practiceClinical Psychology & Psychotherapy, Vol. 1, No. 1Clinical Psychology Review, Vol. 13, No. 4Relevance of Ethology to PsychiatryPsychiatry and Clinical Neurosciences, Vol. 46, No. 3A Psychotherapist Engages in Behaviour Therapy1 September 1991 | The Canadian Journal of Psychiatry, Vol. 36, No. 7The Humanistic Psychologist, Vol. 19, No. 3British Journal of Psychotherapy, Vol. 5, No. 4The Journal for Specialists in Group Work, Vol. 12, No. 2A SELF-MANAGEMENT MODEL FOR SUPERVISION8 June 2007 | Journal of Marital and Family Therapy, Vol. 10, No. 3Integration of Psychodynamic and Behavioral PsychotherapiesAmerican Journal of Clinical Hypnosis, Vol. 25, No. 4Behavior Therapy, Vol. 13, No. 5Behavioral Approaches in Adolescent PsychiatryDiscussion of “the learning process in combined psychotherapy”The American Journal of Psychoanalysis, Vol. 39, No. 4, Vol. 1 / 1Psychosomatic illness: A behavioral approachPsychosomatics, Vol. 19, No. 10Psychiatric Clinics of North America, Vol. 1, No. 2Opening Moves and Sequential Strategies in Child Psychotherapy26 April 2017 | Canadian Psychiatric Association Journal, Vol. 21, No. 5Behaviour Research and Therapy, Vol. 14, No. 3Termination of Psychoanalysis of Adults: A Review of the Literature1 July 2016 | Journal of the American Psychoanalytic Association, Vol. 22, No. 4Psychoanalysis and Behavior TherapyLEE BIRK, and $$Word$$ W. BRINKLEY-BIRK9 March 2015 | American Journal of Psychiatry, Vol. 131, No. 5Bridge over Troubled Water: An Interventive Method in Cases of Maternal Deprivation26 June 2016 | Australian & New Zealand Journal of Psychiatry, Vol. 5, No. 3Scientific Status of Technical Eclecticism: A Critical Note1 September 2016 | Psychological Reports, Vol. 28, No. 1Therapist focus on clients' significant others in psychotherapy21 February 2006 | Journal of Clinical Psychology, Vol. 26, No. 4Some Notes on Behavior Theory, Behavior Therapy and Behavioral Counseling3 September 2016 | The Counseling Psychologist, Vol. 1, No. 4Client self-exploration as a function of reference to significant othersJournal of Clinical Psychology, Vol. 25, No. 3Brief Psychotherapy of Psychiatric Reactions to Physical IllnessEDWARD H. STEIN, JESSICA MURDAUGH, and JOHN A. MACLEOD1 April 2006 | American Journal of Psychiatry, Vol. 125, No. 8Psychodynamics in Behaviour Therapies26 April 2017 | Canadian Psychiatric Association Journal, Vol. 13, No. 6Brief Psychotherapies in Child Psychiatry26 April 2017 | Canadian Psychiatric Association Journal, Vol. 13, No. 4Emerging Concepts for Briefer Psychotherapy: A Review31 August 2016 | Psychological Reports, Vol. 22, No. 2Comprehensive Psychiatry, Vol. 9, No. 5Values and Psychotherapy: A Review of the Literature2 November 2016 | Perceptual and Motor Skills, Vol. 25, No. 2Two Different Kinds of Psychotherapy of Short DurationPETER E. SIFNEOS1 April 2006 | American Journal of Psychiatry, Vol. 123, No. 9Journal of Sex Research, Vol. 2, No. 3EDUCATION OF THE GRADUATE PHYSICIAN: ATTEMPTS AT EVALUATIONLUCY ZABARENKO1 April 2006 | American Journal of Psychiatry, Vol. 122, No. 5Communication, Learning and Therapeutic Process in a Children's Psychiatric Hospital26 April 2017 | Canadian Psychiatric Association Journal, Vol. 10, No. 5Behavior therapy, psychology and the psychiatrist: Contributions, evaluation and overview.1 January 1965 | American Journal of Orthopsychiatry, Vol. 35, No. 1 Volume 120Issue 5 November 1963Pages 440-448 Metrics PDF download History Published online 1 April 2006 Published in print 1 November 1963

Pharmacological treatments for certain psychiatric disorders in young people are often ineffective and may cause major side effects; thus, it is important to investigate other treatments. This article reviews the literature on the efficacy and safety of ECT in this age group and examines the evidence for the suggestion that it may be used inappropriately. All studies published in English and other languages on the use of ECT in persons 18 years of age or younger were obtained. The reports were systematically reviewed and rated according to the quality of the information in several domains, yielding an overall quality score for each study. Individual cases from each report were then examined and grouped according to diagnosis and response to ECT. Sixty reports describing ECT in 396 patients were identified; most (63%) were single case reports. The overall quality was poor but improved in the more recent studies. There were no controlled trials. Rates of improvement across studies were 63% for depression, 80% for mania, 42% for schizophrenia, and 80% for catatonia. Serious complications were very rare, whereas minor, transient side effects appeared common. ECT in the young seems similar in effectiveness and side effects to ECT in adults. However, this conclusion is qualified by the lack of systematic evidence. More research and education of professionals and the public are needed. It is suggested that ECT registers be set up, that surveys and controlled trials be conducted, and that seizure thresholds, the optimal anesthetic, effects of concurrent medications, and cognitive consequences of ECT in the young be investigated.

This study sought to determine if rates of childhood sexual, physical, psychological, and multiple abuse (i.e., abuse in more than one form) differed between women with a lifetime history of bulimia nervosa and women with no history of eating disorders. Subjects were 80 women, aged 18-35, with a lifetime history of bulimia nervosa (40 women who had recovered for a year or more and 40 women currently suffering from bulimia nervosa) and 40 women who had never had an eating disorder or related difficulties. The cohort was obtained primarily by newspaper advertisement. Subjects participated in structured diagnostic interviews and completed paper-and-pencil questionnaires related to abusive experiences in childhood. Women in the bulimia nervosa group reported higher levels of childhood physical, psychological, and multiple abuse. Contrary to expectation, rates of sexual abuse did not distinguish the groups, except in combination with other forms of abuse. The higher rates of psychological, physical, and multiple abuse found among women with a lifetime history of bulimia nervosa than among comparison subjects underscore the importance of examining the full range of possible abusive experiences in women with eating disorders, rather than focusing simply on sexual abuse.

The author compared the arrest rates of 301 former state mental hospital patients with those of the local county population and selected U.S. cities. He found that the patients had a markedly higher incidence of arrests for criminal behavior, including violent offenses, than either of the comparison groups. Patients who were female, aged 20-30, and nonwhite had higher arrest rates for violent offenses than the rest of the study group. These findings are at variance with those of earlier studies but are in general agreement with more recent studies. The author suggests the need for further research in order to more completely identify those factors which explain the high crime rate among the mentally ill.