Effectiveness of cotherapists versus single therapists and immediate versus delayed treatment in behavioral marital therapy.

Evaluated the overall effectiveness of behavioral marital therapy (BMT) in aiding distressed couples, and explored the relative effectiveness of (a) cotherapists vs single therapists and (b) immediate treatment vs delayed treatment, which resulted from placing couples on a waiting list. 30 maritally distressed couples (aged 19–59 yrs) were randomly assigned to 1 of 6 treatment conditions, with 5 couples per condition: (a) immediate treatment by Therapist A; (b) immediate treatment by Therapist B; (c) immediate treatment by Therapists A and B as a cotherapy team; (d) delayed treatment by Therapist A; (e) delayed treatment by Therapist B; or (f) delayed treatment by Therapists A and B as a cotherapy team. Ss were administered a battery of tests that included the Marital Adjustment Test and Areas-of-Change Questionnaire. Results indicate that BMT was more effective than no treatment on both self-report measures and 1 of 2 behavioral measures, thus affirming the overall effectiveness of the treatment. A cotherapy team and single therapists were equally effective in producing treatment changes. In addition, overall there were no significant differences between couples receiving therapy immediately and couples treated after a 10-wk waiting period. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Facilitating outpatient treatment entry following detoxification for injection drug use: A multisite test of three interventions.

A multisite, randomized trial within the National Drug Abuse Treatment Clinical Trials Network (CTN) was conducted to test 3 interventions to enhance treatment initiation following detoxification: (a) a single session, therapeutic alliance intervention (TA) added to usual treatment; (b) a 2-session, counseling and education, HIV/HCV risk reduction intervention (C&E), added to usual treatment; and (c) treatment as usual (TAU) only. Injection drug users (n = 632) enrolled in residential detoxification at 8 community treatment programs were randomized to 1 of the 3 study conditions. TA participants reported entering outpatient treatment sooner and in greater numbers than TAU participants. Reported treatment entry for C&E fell between TA and TAU with no significant differences between C&E and the other conditions. There were no differences among the interventions in retention, as measured by weeks of outpatient treatment for all participants who reported treatment entry. Alliance building interventions appear to be effective in facilitating transfer from detoxification to outpatient treatment, but additional treatment engagement interventions may be necessary to improve retention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family experience of barriers to treatment and premature termination from child therapy.

Barriers to participation in treatment were proposed as a basis for dropping out of treatment among children seen in outpatient therapy. Families (N?=? 242) of children referred for treatment for oppositional, aggressive, and antisocial behavior participated. The main findings were that (a) barriers to participation in treatment contributed significantly to dropping out of therapy; (b) perceived barriers to treatment were not explained by family, parent, and child characteristics that also predicted dropping out; and (c) among families at high risk for dropping out of treatment, the perception of few barriers attenuated risk. Parent perceptions of the difficulties of participating in treatment (including stressors and obstacles associated with treatment, perceptions that treatment is not very relevant, and a poor relationship with the therapist) influenced who dropped out. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment Utility of Psychological Assessment.

This article focuses on treatment utility. A definition of treatment utility was provided by S. C. Hayes, R. O. Nelson, and R. B. Jarrett (1987): "We propose to use the phrase the treatment utility of assessment to refer to the degree to which assessment is shown to contribute to beneficial treatment outcome" (p. 963). Various methodologies to examine the treatment utility of assessment are summarized. Treatment utility studies using various assessment procedures (i.e., diagnosis and functional analysis) and various disorders (i.e., unipolar depression, social or interpersonal problems, and phobic disorders) are described. Suggestions are made as to when elaborated assessment and/or treatment utility studies are needed. Limitations on the generalizability of results of any particular treatment utility study are presented. Despite progress, for most assessment procedures and devices, the treatment utility question remains: What is the degree to which assessment is shown to contribute to beneficial treatment outcome? (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hot water irrigation in the treatment of posterior epistaxis

Tamponade treatment in epistaxis is painful and the patient needs hospitalisation. Irrigation with hot water was introduced as a treatment of epistaxis 100 years ago. This study compares the two treatments with respect to effect, recurrence, pain, and length of hospital stay. Forty-four consecutive patients with posterior epistaxis were randomized to receive treatment with either hot water (HWI) or tamponade. In the group of patients treated with HWI, the treatment had to be stopped in seven patients (33%) because of lack of cooperation; nine patients (43%) could be discharged from hospital with no need for further treatment, whereas five patients (24%) had recurrent epistaxis requiring additional tamponade treatment. Among patients treated with tamponade, 14 patients (61%) could be discharged from hospital with no need for further treatment, while nine patients (39%) had recurrent epistaxis requiring additional tamponade treatment. Compared with the tamponade treatment, HWI is almost as effective, the hospital stay is shorter, and the treatment is significantly less painful.     

MMPI evaluation of 5-year methadone treatment status.

Evaluated treatment outcome over a 5-yr period for 148 1st admissions (mean age, 27.14 yrs) to a methadone treatment program. Eleven Ss (7%) were successful treatment completions, 16 Ss (11%) transferred to other methadone programs, 38 Ss (26%) remained in continuous treatment, and 83 Ss (56%) were unsuccessful treatment terminations. Discriminant analysis using the MMPI suggested that the more stable Ss at admission had the best treatment outcome. For the patients in continuous treatment, MMPIs administered at 6-wk, 6-mo, and 5-yr intervals indicated that this group of Ss did not change on the personality dimension. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of supplemental phonics-based instruction for low-skilled kindergarteners in the context of language minority status and classroom phonics instruction.

This study tested the efficacy of supplemental phonics instruction for 84 low-skilled language minority (LM) kindergarteners and 64 non-LM kindergarteners at 10 urban public schools. Paraeducators were trained to provide the 18-week (January–May) intervention. Students performing in the bottom half of their classroom language group (LM and non-LM) were randomly assigned either to individual supplemental instruction (treatment) or to classroom instruction only (control). Irrespective of their language status, treatment students (n = 67) significantly outperformed controls (n = 81) at posttest in alphabetics, word reading, spelling, passage reading fluency, and comprehension (average treatment d = 0.83); nevertheless, LM students tended to have lower posttest performance than non-LM students (average LM d = ?0.30) and were significantly less responsive to treatment on word reading. When we examined the contribution of classroom phonics time to student outcomes, we found that the treatment effect on spelling was greater for students in lower phonics classrooms, whereas the treatment effect on comprehension was greater for those in higher phonics classrooms. Finally, when we examined LM students alone, we found that pretest English receptive vocabulary positively predicted most posttests and interacted with treatment only on phonological awareness. In general, pretest vocabulary did not moderate kindergarten LM treatment response. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term effects of behavioral versus insight-oriented therapy with inpatient alcoholics.

Assessed the relative effects of behavioral treatment involving both covert sensitization and relaxation training vs insight-oriented treatment consisting of transactional analysis (TA) with 113 male and female alcoholic inpatients (21–73 yrs). Ss were assigned in randomized blocks to 1 of 4 groups: (a) milieu treatment control group or 1 of 3 experimental groups, each of which included the milieu treatment, (b) behavioral group, (c) TA group, (d) combined group, involving both TA and behavioral treatment. Four-year follow-up interviews yielded data on the Quantity Frequency Index scale, abstinence, and an overall clinical adjustment scale for 5 posttreatment periods. Differences between behavioral and TA treatment were significant or approached significance at 6 mo and 1? yrs after treatment, but not thereafter. Strong and consistent trends were evident favoring the behavioral approach on all 3 measures across all 5 follow-up periods. The strength of the milieu treatment was also supported, and the need for long-term follow-up studies beyond 6 mo is stressed. (70 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of attributional processes concerning medication taking on return of fear.

In this investigation, the authors examined the effect of attributional processes concerning medication taking on return of fear following exposure-based treatment. Participants (87% undergraduate students and 13% community volunteers) displaying marked claustrophobic fear (N = 95) were randomly allocated to a waitlist condition, a psychological placebo condition, a 1-session exposure-based treatment, or the same exposure treatment given in conjunction with an inactive pill. Attributions concerning medication taking were manipulated by further randomly assigning participants in the exposure-based treatment plus pill condition to 1 of 3 instructional sets immediately following treatment completion and posttreatment assessment: (1) The pill was described as a sedating herb that likely made exposure treatment easier; (2) the pill was described as a stimulating herb that likely made exposure treatment more difficult; or (3) the pill was described as a placebo that had no effect on exposure treatment. Return of fear rates for the 3 conditions were 39%, 0%, and 0%, respectively. Moreover, the deleterious effects of the sedation instructions were mediated by reduced self-efficacy. These findings highlight the importance of assessing patient attributions regarding the improvements achieved with combined exposure-based and pharmacological treatments for anxiety disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of a motivation enhancement intervention on veterans’ engagement in PTSD treatment.

This study is the first randomized controlled trial of the posttraumatic stress disorder (PTSD) motivation enhancement (PME) Group, a brief intervention based on Motivational Interviewing and designed to enhance combat veterans’ engagement in PTSD treatment by increasing awareness of the need to change PTSD-related problems. Outpatients in a year-long, group- and cognitive–behavioral therapy (CBT)–oriented Veterans Affairs PTSD treatment program were randomly assigned to 4 sessions of the PME Group (n = 60) or a Psychoeducation Group (n = 54) in the 2nd month of treatment. Hypotheses about the proposed impact of the PME Group on PTSD treatment engagement (i.e., readiness to change, perceived treatment relevance, and PTSD program attendance) were all supported, although predicted differences were not found on all measures. These results support the need to address readiness to change in combat-related PTSD treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Computer-assisted cognitive rehabilitation for the treatment of patients with substance use disorders: A randomized clinical trial.

The purpose of this study was to examine the comparative efficacy of cognitive rehabilitation as an intervention for substance misuse. Patients with substance use disorders entering long-term residential care (N = 160) were randomly assigned to one of two conditions: (a) standard treatment plus computer-assisted cognitive rehabilitation (CACR), which was designed to improve cognitive performance in areas such as problem solving, attention, memory, and information processing speed; and (b) an equally intensive attention control condition consisting of standard treatment plus a computer-assisted typing tutorial (CATT). Participants were assessed at baseline, during treatment, at treatment completion, and 3-, 6-, 9-, and 12-month follow-up. Intent-to-treat analyses showed that, compared with those randomized to CATT, patients who received CACR were significantly more engaged in treatment (e.g., higher ratings of positive participation by treatment staff, higher ratings of therapeutic alliance), more committed to treatment (e.g., longer stays in residence) and reported better long-term outcomes (e.g., higher percentage of days abstinent after treatment). Mediational analyses revealed the positive comparative effect of CACR on abstinence during the year after treatment was mediated by treatment engagement and length of stay in residence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Features of spondyloarthritis around the world

The pressing need to document treatment efficacy for young children who stutter is discussed. Guidelines for such documentation are suggested and illustrated. Measures for verifying treatment effects in four realms are delineated: (a) conditions of documentation, (b) dependent variables to be measured, (c) establishment of treatment integrity, and (d) verification of the relationship between treatment and outcome. Illustrations of the application of the suggested guidelines are presented for 2 children.     

Ratings of Therapist Dynamic Activities and Alliance Early and Late in Psychotherapy.

The present study examines the concurrent and predictive relationships between therapist psychodynamic-interpersonal activity and therapist-rated alliance. Ratings from 45 patient and therapist dyads engaged in short term psychodynamic psychotherapy from a point early (3rd or 4th session) and late (the session at which 90% of the treatment was completed) in treatment were used. The results suggest that therapists who have positive views of the alliance early in treatment also have positive views of the alliance later in treatment. Therapists who used psychodynamic-interpersonal activities early in treatment also made use of psychodynamic-interpersonal activities later in treatment. Moreover, the use of psychodynamic-interpersonal activities early in treatment was positively related to both global and specific aspects of therapist-rated alliance late in treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Rural american indians' perspectives of obstacles in the mental health treatment process in three treatment sectors.

This study sought to identify obstacles associated with alcohol, drug, and mental (ADM) health care utilization in three treatment sectors for residents on three reservations in the United States. Participants (N = 224) disclosed that they had sought treatment for ADM problems in the past year and identified obstacles they faced during this process. Four obstacles were identified: (a) self-reliance, (b) privacy issues, (c) quality of care, and (d) communication/trust. A vast majority (71%) of participants reported at least one of these obstacles during treatment, and 61% faced two or more obstacles. There were no differences in the type or number of obstacles by treatment sector. Privacy and communication/trust obstacles were more likely to occur in emotional treatment compared to alcohol/drug treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An open trial of brief supportive-expressive psychotherapy in the treatment of generalized anxiety disorder.

Conducted a treatment development study applying brief supportive-expressive psychodynamic psychotherapy (P. Crits-Christoph et al; see record 95-195001-002) to the treatment of generalized anxiety disorder (GAD). Background and rationale for the development of this therapy are presented, along with the project's methods and results. Project goals were to develop a treatment manual, train therapists, and assess the treatment's integrity and efficacy. Outcome data on 26 patients (aged 22–64 yrs) with a Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnosis of GAD indicate that the treatment is promising. Patients revealed significant change in anxiety, depression, worry, and interpersonal problems. Ratings of therapist adherence and competence indicate that the treatment manual can be implemented with fidelity and can be discriminated from other treatments. Methodological issues in the planning of treatment research on GAD, particularly the problem of comorbidity, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of duration of treatment on treatment outcome and cost of treatment for Wilms' tumor: a report from the National Wilms' Tumor Study Group

PURPOSE: National Wilms' Tumor Study (NWTS)-4 was designed to evaluate the efficacy, toxicity, and cost of the administration of different regimens for the treatment of Wilms' tumor (WT). PATIENTS AND METHODS: Between August 6, 1986 and September 1, 1994, 905 previously untreated children aged younger than 16 years with stage II favorable histology (FH) WT (low-risk [LR]), stages III to IV FH WT, or stages I to IV clear-cell sarcoma of the kidney (high-risk[HR]) were randomized after the completion of 6 months of chemotherapy to discontinue (short) or continue for 9 additional months (long) treatment with chemotherapy regimens that included vincristine and either divided-dose (standard [STD]) courses (5 days) or single-dose (pulse-intensive [PI]) treatment with dactinomycin. HR patients also received either divided-dose (STD) courses (3 days) or single-dose (PI) treatment with doxorubicin. RESULTS: The 4-year relapse-free survival (RFS) rates after the second randomization for LR patients were 83.7% for the 190 patients treated with short and 88.2% for the 187 patients treated with long chemotherapy (P = .11). The 4-year RFS rates after the second randomization for HR FH patients were 89.7% for the 256 patients treated with short and 88.8% for the 246 patients treated with long chemotherapy (P = .87). The charge for treatment with the short PI treatment regimens for all children with stages I through IV FH WT was approximately one half of that with the long STD treatment regimens. CONCLUSION: The short administration schedule for the treatment of children with WT is no less effective than the long administration schedule and can be administered at a substantially lower total treatment cost.     

Use of Veterans Affairs Health Care Services by Veterans Receiving Addiction Treatment in Washington State.

The authors describe characteristics of treatment use among veterans who had addiction treatment in non-Veterans Affairs (VA) facilities in Washington state and who used health care services, including addiction treatment, in VA facilities. From 1996 through 2000, 2,649 VA patients received addiction treatment in Washington state facilities, with 56% (n = 1,489) also receiving some VA specialty addiction treatment and the remaining 44% (n = 1,160) receiving VA health care services unrelated to addiction treatment. Among all veterans receiving addiction treatment in VA facilities in Washington state (n = 11,663), 11% also had treatment in non-VA centers. Over the more than 4-year period, female veterans seen in both systems were less likely to receive VA specialty addiction treatment than were male veterans (40% vs. 58%). This article shows that a significant number of veterans received addiction treatment in both VA and non-VA facilities in Washington state. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of blood culture reporting and clinical liaison on the empiric treatment of bacteraemia

AIMS: To assess the impact of blood culture results and early clinical liaison on the treatment of patients with bacteraemia. METHODS: 123 patients with significant positive blood cultures were followed over a nine month period in a 620 bed teaching hospital. The impact of early blood culture reporting and clinical liaison on the cost and appropriateness of treatment was assessed. RESULTS: Empiric treatment was started before the Gram stain result in 107 (87%) patients. Treatment was altered on the basis of the Gram stain result in 39 (36%) of these patients, and on culture and sensitivity results in 53 (50%). The spectrum of antibiotic treatment was narrowed in 58 (54%) of these; 20 (19%) on Gram stain result alone. This resulted in a 42% reduction in daily antibiotic costs in patients who had received empiric treatment. Empiric treatment did not follow the hospital antibiotic policy in 49 (46%) of the patients treated. In patients where empiric treatment was not in accordance with hospital policy, 21 (44%) had an isolate resistant to the empiric treatment used; while in patients who received agents in accordance with hospital policy only one (1.7%) had a resistant isolate (p < 0.05). Patients who died (11 (9%)) were less likely to have received empiric treatment in accordance with the antibiotic policy, although this did not reach statistical significance (p = 0.1). CONCLUSION: Early reporting of Gram stain results from blood cultures, combined with early clinical liaison, results in more rational and cost effective treatment.     

A clinical and microbiological evaluation of systemic and local metronidazole delivery in adult periodontitis patients

The present study describes results on selected clinical and microbiological parameters obtained by treatment with local (Elyzol) and systemic (Flagyl) use of metronidazole alone and/or mechanical subgingival debridement in adult periodontitis. Patients were randomly divided into local and systemic treatment groups each comprising 5 individuals in each of whom 4 sites (one site/ quadrant) with a probing depth of > or = 5 mm were selected and treated with separate treatment modalities. The overall treatment design provided 6 different test groups. Groups of quadrants received: (1) scaling and root planing; (2) local metronidazole treatment; (3) systemic metronidazole treatment; (4) local metronidazole combined with scaling and root planing; (5) systemic metronidazole combined with scaling and root planing; (6) no treatment. The microbiological and clinical effects of treatment modalities were monitored over a period of 42 days. All treatments resulted in clinical improvements (gingivitis, probing pocket depth, attachment level) except for the untreated group. Parallel to the clinical changes, all treatments reduced the number of total bacteria and proportions of obligately anaerobic microorganisms. Although both of the combined treatment groups responded to therapy with better resolution of infection that the pure mechanical and pure metronidazole treatments, local metronidazole in combination with scaling and root planing seems to be more effective in terms of producing both clinical and microbial improvements.     

Long-term outcomes of treatment of Mycobacterium avium complex bacteremia using a clarithromycin-containing regimen

OBJECTIVES: To describe the long-term outcomes of treatment of AIDS-related Mycobacterium avium complex (MAC) bacteremia using a standard clarithromycin-based regimen. DESIGN: Retrospective study of patients with MAC bacteremia diagnosed between April 1992 and April 1995. SETTING: An urban AIDS clinic SUBJECTS: One hundred seventy-six consecutive patients with MAC bacteremia. INTERVENTIONS: Clarithromycin 500 mg twice daily, ethambutol 800 or 1200 mg daily, and clofazimine 100 mg daily. MAIN OUTCOME MEASURES: Late treatment failure (defined as a positive blood culture more than 90 days after starting treatment), clarithromycin susceptibility of initial and treatment-failure isolates, DNA fingerprinting of isolates from treatment failures. RESULTS: Two out of 176 (1.1%) baseline isolates were resistant to clarithromycin. One hundred and fifty-one patients were treated for MAC bacteremia, 144 (95%) with the standard regimen. Of the 117 patients who survived > 90 days after starting therapy, 25 (21%) met the criteria for late treatment failure. Of the 22 treatment-failure isolates available for susceptibility testing, 19 (86%) were resistant to clarithromycin. Therefore, 13% of patients treated using the standard regimen (19 out of 144) had treatment failure associated with the emergence of clarithromycin resistance. Using logistic regression, non-compliance was associated with treatment failure (P = 0.02). Fourteen out of the 17 (82%) evaluable paired isolates had identical DNA fingerprint patterns, whereas three pairs showed that a different strain of MAC was present at the time of treatment failure. CONCLUSIONS: Initial resistance to clarithromycin was rare during this period. However, late treatment failure associated with the emergence of clarithromycin resistance was relatively common during long-term follow-up. Most late treatment failures represented emergence of clarithromycin resistance in the initial strain.