Relaxation and muscular tension: A biobehavioristic explanation.

Relaxation and muscular tension are commonly ascribed to cohere to metaphorical principles of stimulus-response (S-R) that presumably are isomorphic with neurally based reflexive mechanisms that are not modifiable by learning. However, purely S-R principles have been progressively replaced in modern learning theory with expectancy or discrepancy models of learning that do not recognize separate neural processes that subserve operant (R-S) and respondent (S-R) conditioning. An alternative explanation for the relaxation response and muscular tension is provided that is derived from principles of modern learning theory. It is demonstrated theoretically and through practical procedure that muscular relaxation is a homeostatic resting state and muscular tension is a function of simple biopsychologic processes of incentive motivation or learning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Play therapy with the elderly: A case study.

This article reviews a project conducted with nursing home residents using child-centered play therapy. Play therapy was chosen as a therapeutic modality in order to reach this population more creatively. Three case studies are presented. Therapeutic changes were reported by the social worker, staff members, the elderly participants, and the author. Observed outcomes of therapy reported were decreased depression, heighten self-esteem, improved socialization skills, and what appeared to be resolution of difficult issues. A discussion of limitations, selection of clients, and suggestions for future use of play therapy with this population are included. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Opioid therapy for chronic noncancer back pain. A randomized prospective study

STUDY DESIGN: A randomized, open, long-term, repeated-dose comparison of an anti-inflammatory drug and two opioid regimens in 36 patients with back pain. OBJECTIVES: To examine the long-term safety and efficacy of chronic opioid therapy in a randomized trial of patients with back pain. METHODS: All participants underwent a 4-week washout period of no opioid medication before being randomly assigned to one of three treatment regimens for 16 weeks: 1) naproxen only, 2) set-dose oxycodone, or 3) titrated-dose oxycodone and sustained-release morphine sulfate. All patients then were assigned to a titrated dose of opioids for 16 weeks and then gradually tapered off their medication for 12 weeks. Finally, all participants were monitored for a 1-month posttreatment washout period. Each patient was called once a week for a report on pain, activity, mood, medication, hours awake, and adverse effects and was monitored carefully for signs of abuse and noncompliance. RESULTS: Weekly reports during the experimental phase showed the titrated-dose group to have less pain (P < 0.001) and less emotional distress (P < 0.001) than the other two groups. Both opioid groups were significantly different from the naproxen-only group. During the titration phase, patients also reported significantly less pain and improved mood. Few differences were found in activity or hours asleep, or between average pretreatment and posttreatment phone-interview and questionnaire variables. No adverse events occurred, and only one participant showed signs of abuse behavior. CONCLUSIONS: The results suggest that opioid therapy has a positive effect on pain and mood but little effect on activity and sleep. Opioid therapy for chronic back pain was used without significant risk of abuse. However, tapered-off opioid treatment is palliative and without long-term benefit.     

Coping and the self-control of chronic tension headache.

Assigned 39 community residents, mean age 35.2 yrs, with chronic tension headache to 1 of 2 self-control treatment groups, a headache discussion group, or a symptom-monitoring control group. Ss in the 2 self-control treatment groups and in the headache discussion group were provided similar rationales for treatment and were taught to monitor their cognitive responses to stress-eliciting situations. Ss in the 2 self-control treatment groups were also taught either cognitive or both cognitive and relaxation coping skills for controlling tension headache. Ss in the headache discussion group were not provided with specific skills for controlling their headaches but were led in a discussion of the historical roots of their symptoms. Both the self-control treatments and the headache discussion procedure produced substantial reductions in headache that were maintained at a 6-wk follow-up. The symptom-monitoring control group showed no change in headache symptoms. These findings provide additional evidence of the effectiveness of cognitively oriented therapeutic procedures for the treatment of tension headache but raise questions concerning the active ingredients of these treatments. (41 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Time and false electromyographic feedback: Effect on tension headache.

Measured frontalis EMG amplitude in 20 19–38 yr old Ss with tension headaches. Of these, 10 were given auditory feedback that accurately reflected EMG levels, and the other 10 received false feedback. Ss receiving relevant feedback significantly decreased both EMG and number of headaches as compared to controls. Controls did, however, show decreasing trends in the 2 variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alprazolam in chronic tension type headache

Alprazolam was evaluated in the treatment of 62 patients of chronic tension type headache using a double blind cross over design with random allocation to drug or placebo. The duration of the trial was 4 months with a 2 week run in period and 2 week washout period separating two treatment periods of 4 weeks each. The patients were followed up for 4 weeks at the completion of the trial. 48 patients completed the trial. There was no significant difference in the overall response rate based in terms of percentage reduction in headache frequency per week, however a significant decrease in headache index was observed during treatment with alprazolam as compared to placebo (P < 0.05). The mean analgesic intake per week was also significantly lower during treatment with alprazolam as compared to the run in period. Side effects were seen in 16.67% patients. In none of the patients was it significant enough to require withdrawal from the study.     

Radioiodine I-31 therapy in the management of thyroid cancer. A prospective study

The therapeutic value of I-131 ablation therapy following thyroidectomy for thyroid cancer was evaluated in 54 patients in a prospective study of 25 years. Thirteen (24%) patients had follicular, 24 (44%) papillary, 13 (24%) mixed papillary-follicular, two (4%) Hurthle cell and two (4%) had undifferentiated cell type tumor. Twenty-four (44.5%) patients had metastases at the time of I-131 therapy mainly to cervical and mediastinal lymph nodes, and less frequently to bone, brain, lung, and liver. After surgical thyroidectomy, the mean cumulative dose of I-131 required to achieve therapeutic ablation of functioning post-surgical remnants or tumor metastases was 163.4 mCi. The recurrence rate for patients with metastases was 56% and those without metastases was 25%. Ten patients showed recurrence of I-131 accumulating tissue five to 10 years after initial total ablation. The total mean cumulative dose of I-131 administered for both followup diagnostic studies, and initial and follow-up therapy was 245.3 mCi. Seven deaths were attributable to thyroid cancer, five with differentiated and two with anaplastic cell type tumors. Three of the four patients with differentiated cell type tumors had metastases to brain or bone. Their response to therapy was similar to those patients with anaplastic cell type tumors. In contrast, there were no deaths due to thyroid cancer when total ablation was achieved and maintained. After ablation, all patients were maintained on maximum tolerated doses of thyroid extract or thyroxin. No significant complications attributable to the therapeutic doses of I-131 employed in this series were noted.     

Chronic daily headache in children and adolescents: a 2-year prospective study

The newer generation of antifungal agents such as itraconazole and terbinafine are more effective than the older therapies, griseofulvin and ketoconazole, in the treatment of dermatophyte pedal onychomycosis. Itraconazole can be administered as continuous dosing, 200 mg per day for 3 months, or in the form of pulse therapy, 200 mg twice a day for 1 week per month for 3 consecutive months. Terbinafine is given as continuous dosing, 250 mg per day for 3 months.     

Self-schemas and risk for depression: A prospective study.

Two longitudinal experiments with 375 undergraduates investigated the role of depressive self-schemas in vulnerability to depression. Ss were divided into 5 groups hypothesized to be at differential risk for depression according to a schema model: depressed schematic, depressed nonschematic, nondepressed schematic, nondepressed nonschematic, and psychopathology control. In Exp I, Ss were followed regularly for 4 mo with self-report and clinical interview measures of depression (e.g., Beck Depression Inventory). There was no evidence of risk for depression associated with schema status apart from initial mood and no interaction of life stress events and schemas. In Exp II, links among self-schemas, information processing, and mood status were investigated. It was shown that depressive self-schemas did not exert an ongoing, active influence on everyday information processing; instead, current mood affected information processing. Remitted depressed Ss resembled nondepressed rather than depressed Ss. Findings support the distinction between concomitant and vulnerability schemas noted by N. Kuiper et al (in press) and help to clarify differences between cognitions that are symptoms of depression and those that may play a causal role under certain conditions. (41 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Specific and nonspecific effects in the biofeedback treatment of tension headache: 3-Year follow-up.

In a previous study by the present authors (see record 1980-32946-001), 39 tension headache sufferers were assigned either to no treatment, standard biofeedback, or 1 of 2 biofeedback control procedures to test factors mediating the effectiveness of biofeedback. No differences were found between the 3 biofeedback conditions, indicating that learned reductions of frontal EMG activity had little to do with the observed treatment effect. Three-year follow-up collected from 28 of the 39 original Ss revealed high levels of maintenance for all biofeedback groups but again showed that reductions in EMG activity were unrelated to long-term maintenance. Results are consistent with the hypothesis that cognitive and behavioral factors may underlie biofeedback's treatment effect. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hardiness and health: A prospective study.

Hypothesized that hardiness—commitment, control, and challenge—functions to decrease the effect of stressful life events to producing illness symptoms. 259 upper- and middle-level male managers (mean age 48 yrs) were administered a battery of tests (including Rotter's Internal–External Locus of Control Scale, the Schedule of Life Events, and the Seriousness of Illness Survey) covering a 5-yr period. Results support the hypothesis by showing main effects on illness for both stressful life events and hardiness and an interaction effect for these independent variables. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chrysotherapy. A prospective study

A 4-year prospective clinical study of chrysotherapy was designed to reexamine old beliefs and traditions, and to test potentially new approaches to chrysotherapy. The standard weekly dosage of 50 mg was compared to that based on 1 mg/kg body weight; no significant differences were found. The rapidly absorbed aqueous thiomalate was compared to the slowly absorbed oil repository thioglucose; the latter produced significantly less side effects and an appreciably higher percentage of improvement. Almost half (43%) of nonresponders on standard regimen had a satisfactory clinical response at higher dosage levels without increase in toxicity. Some of these findings vary so much with traditional beliefs and practices that the authors urge caution in their interpretation. But generally speaking these problems are technical and do not detract from the conviction that chrysotherapy is valuable and comparatively safe in the management of rheumatoid arthritis and that it deserves more widespread application in clinical practice.     

Change mechanisms in EMG biofeedback training: Cognitive changes underlying improvements in tension headache.

43 college students suffering from recurrent tension headache were randomly assigned to 1 of 4 EMG biofeedback training conditions. Although all Ss were led to believe they were learning to decrease frontal EMG activity, actual feedback was contingent on decreased EMG activity for half of the Ss and increased EMG activity for the other half. Within these 2 groups, Ss also viewed bogus video displays designed to convince them they were achieving large (high success) or small (moderate success) reductions in EMG activity. Results show that regardless of actual changes in EMG activity, Ss receiving high-success feedback had substantially greater improvement in headache activity (53%) than Ss receiving moderate success feedback (26%). Performance feedback was also related to score changes in locus of control and self-efficacy measures administered pre- and posttreatment. Changes in these 2 cognitive variables during biofeedback training were correlated with reductions in headache activity following treatment, while changes in EMG activity exhibited during training were uncorrelated with outcome. (54 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Placebo-controlled evaluation of abbreviated progressive muscle relaxation and of relaxation combined with cognitive therapy in the treatment of tension headache.

Sixty-six tension headache patients were randomly assigned to one of four conditions for 8 weeks: (a) progressive muscle relaxation (PMR) alone; (b) PMR plus cognitive therapy (PMR?+?Cog); (c) pseudomedication, a credible attention-placebo control; or (d) continued headache monitoring. A comparison of overall headache activity (headache index), derived from a daily headache diary, for 4 weeks before treatment to 4 weeks after treatment revealed that active treatment (PMR and PMR?+?Cog) was superior to either control condition. Moreover, level of headache medication consumption decreased significantly for the active treatment groups. Although headache-index comparisons of the two active treatments showed no advantage for adding cognitive therapy to PMR, a measure of clinically significant change showed a trend for PMR?+?Cog to be superior to PMR alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relaxation treatment for insomnia: A component analysis.

Compared 4 relaxation treatments—progressive relaxation, progressive relaxation without tension release, imagery with tension release, and imagery without tension release—for sleep onset insomnia with a waiting-list control (no treatment). Analysis of data from 44 19–71 yr old insomniacs recruited from the community showed all treatment conditions to be superior to no treatment in reducing latency of sleep onset and ratings of fatigue. The presence of muscle-tension release was unrelated to outcome. There was a nonsignificant trend for visual imagery treatments to be superior to somatic-focusing treatments in reducing sleep onset latencies. Treatments using visual focusing were superior to somatic-focusing treatments in reducing the number of nocturnal awakenings. At 6 mo follow-up, only the imagery treatments showed significant improvement over pretreatment levels on latency of sleep onset. Visual-focusing treatments produced significantly greater reductions in sleep onset latency at follow-up than did the somatic-focusing treatments. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acute therapy for cluster headache with sumatriptan: findings of a one-year long-term study

The efficacy, safety, and tolerability of subcutaneous sumatriptan in the acute treatment of cluster headache were investigated in a multicenter study over a period of up to 1 year. A total of 2,031 attacks were evaluated in 52 patients. Therapy was successful in 88% of all attacks. Freedom from pain within 15 minutes in more than 90% of all attacks treated was reported by 42% of the patients, and no decline in efficacy occurred during the course of the study. Adverse events were reported by 62% of the patients.     

Time of first intercourse: A prospective study.

Longitudinal psychosocial data were used to predict the transition from virginity to nonvirginity among 430 7th–9th graders, all of whom were virgins at the initial testing in 1970. By the most recent follow-up in 1979, 93% reported having had sexual intercourse. Variation in time of onset of initial intercourse was categorized into 6 time periods and served as the main criterion variable in the study. Bivariate and multivariate analyses showed that antecedent measures of personality, the perceived environment, and behavior were predictive of variation in time of onset and, taken together, accounted for approximately 30% of the criterion variance. Results support the utility of the problem-behavior-theory framework and show onset of sexual intercourse to be a systematic aspect of psychosocial development in adolescence. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Suicide among gifted women: A prospective study.

The longitudinal data from the Terman Genetic Studies of Genius (L. M. Terman, 1925; Terman and M. Oden, 1947, 1959) were used to predict suicide in 40 women: 8 suicides, 15 Ss who were matched with the suicides on age of death, and 17 Ss who were still living in 1964. The Terman studies covered 60 yrs and followed 1,528 gifted individuals (IQs over 135) from childhood into the retirement years. Seven variables from the Ss' files were assessed as possible predictors of suicide: S's physical health, early loss of the father, stress in the family of origin, problems with alcohol, and 3 indices of mental health ("signatures" [e.g., suicide attempts, alcohol abuse, depression]; self-reports of temperament; and a cumulative mental health rating developed by Terman). A discriminant function analysis was able to differentiate the women who committed suicide from the 2 control groups. A 7-variable function predicted 100% of the suicides. A 4-variable function predicted 75% of the suicides. It is concluded that suicide risk factors can be identified in women and that certain signatures of suicide are as useful in predicting female suicide as male suicide. (49 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuropsychiatric function and dehydroepiandrosterone sulfate in elderly women: a prospective study

BACKGROUND: Though among the most abundant human steroid hormones, the physiologic role of dehydroepiandrosterone and its sulfate (DHEAS) is not known. Our goal was to determine if DHEAS is associated with cognition and mood in older women, and if baseline DHEAS levels are predictive of cognitive decline. METHODS: In a prospective cohort, we studied 394 randomly selected community-dwelling women, aged 65 years or older, currently enrolled in the Study of Osteoporotic Fractures. Subjects were administered a modified Mini-Mental State Exam, Trials B, Digit Symbol, and the Geriatric Depression Scale-Shortened (GDSS), at study onset and 4-6 years later. Serum was obtained at study initiation for DHEAS analysis. RESULTS: DHEAS levels declined with age, as expected. There was no consistent association of DHEAS quartile or log DHEAS with any of the four outcomes, even after multivariate adjustment. Change in cognitive performance overtime was not associated with DHEAS levels. Analysis of the 32 women without any detectable DHEAS compared to those with detectable levels revealed higher measures on the GDSS (mean score 3.4 +/- 3.6 compared with 1.6 +/- 2.3, p = .028) and a higher percentage with depression (21.7% compared with 4.6%, p = .001). CONCLUSIONS: Serum DHEAS is not a sensitive predictor of cognitive performance or decline on a selected neuropsychological battery in elderly community women; however, nondetectable levels may be associated with depression.