Negative outcomes: What is the evidence on self-administered treatments?

D. C. Mohr (see record 1995-30134-001) suggested that high deterioration rates may occur in self-directed treatments. The investigators examined data from 5 studies of self-administered treatment for depression and found in contrast much lower rates (9% vs. 19%) than those cited in Mohr's review. The negative response rates for the self-administered treatments compared favorably with the negative response rates in the therapist-administered treatments provided in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. The findings indicate that it may be the manner in which participants are prepared for self-administered treatment that is critical. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-help books and amount of therapist contact in smoking cessation programs.

Evaluated 2 self-help behavior therapy books (B. G. Danaher and E. Lichtenstein, 1978; O. F. Pomerleau and C. S. Pomerleau, 1977) for stopping smoking against a widely available minimal treatment program. A 3?×?2 factorial design was employed to evaluate the 3 treatments under both self-administered and therapist-administered conditions. 85 chronic cigarette smokers (mean age 37.3 yrs) participated in the 8-wk treatment programs and a 6-mo follow-up. Dependent variables included self-monitored number of cigarettes smoked daily, CO concentrations in expired breath samples, dosage scores based on topographical aspects of smoking behavior, and adherence and cost-effectiveness measures. Under self-administered conditions, the minimal treatment program was at least as effective as the behavior therapy books. On the self-report measures, therapist contact was associated with improved treatment outcome for the behavior therapy programs but not for the control condition. Reliable between-groups differences were not consistently observed on CO levels. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-directed treatment for premature ejaculation.

Tested the effects of self-administered treatment for premature ejaculation vs therapist-administered treatment by assigning 18 couples with premature ejaculation problems to (a) totally self-administered treatment, (b) self-administered treatment in conjunction with minimal therapist (telephone) contact, or (c) standard therapist-administered treatment. All Ss completed the Locke-Wallace Marital Adjustment Test and a sexual background inventory. Ss were successfully treated by therapists or by themselves when they maintained minimal contact with a therapist. Ss working without therapist contact failed to complete treatment successfully. Follow-up data indicate that although there was deterioration in therapeutic gain following the termination of treatment, improvement over pretreatment responses was maintained on all relevant measures. Data also indicate that greatest improvement in ejaculatory control occurred when Ss continued to use the squeeze or pause to delay ejaculation, but significant improvement in latency to ejaculation also occurred when Ss used neither technique to lengthen intercourse. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A controlled study to assess the clinical efficacy of totally self-administered systematic desensitization.

43 highly anxious self-referred snake phobics (mean age, 33.5 yrs) received either therapist-administered desensitization, self-administered desensitization with weekly therapist phone calls, totally self-administered desensitization, a self-administered double-blind placebo control, or no treatment. Pretreatment to posttreatment and follow-up assessments of Ss' reactions and attitudes toward snakes include behavioral approach, self-report, and heart rate period data. The latter 2 measures showed significant differences between desensitization and control Ss. It is concluded that within the context of moderate treatment effects, results support the clinical efficacy of totally self-administered desensitization. Implications for the clinical management of specific fears are discussed. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analysis of bibliotherapy studies

Used meta-analysis to examine the efficacy of bibliotherapy. Bibliotherapy treatments were compared to control groups and therapist-administered treatments. The mean estimated effect size (d) of the 70 samples analyzed was + 0.565. There was no significant differences between the effects of bibliotherapy and therapist-administered treatments, as well as no significant erosion of effect sizes at follow-up. Bibliotherapy did appear more effective for certain problem types (assertion training, anxiety, and sexual dysfunction) than for others (weight loss, impulse control, and studying problems). Overall the amount of therapist contact during bibliotherapy did not seem to relate to effectiveness, but there was evidence that certain problem types (weight loss and anxiety reduction) responded better with increased therapist contact. Recommendations for future research were given, especially for more research on the commonly purchased books and moderator analyses by personality type and reading ability.     

Biofeedback treatment for pediatric migraine: Prediction of treatment outcome.

Despite a growing number of studies showing good effectiveness of nonpharmacological treatments such as thermal biofeedback (TBF) for pediatric migraine, little is known about psychosocial variables that might be predictive of treatment outcome. The identification of predictors appears especially important when children are treated in a home-based treatment format that tends to be somewhat less effective than a therapist-administered treatment. A total of 32 children between the ages 8 and 16 years completed a home-based TBF treatment program with treatment outcome being of similar magnitude as previously reported in the literature. Multiple regression analysis revealed externalizing behavior tendencies, initial level of psychosomatic complaints, and the child's age to be highly predictive of outcome, whereas dimensions of family functioning failed to exert a direct influence. The implications of these findings for the development and evaluation of future treatment programs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-desensitization and meditation in the reduction of public speaking anxiety.

Assigned 38 speech-anxious students to the following self-administered treatment conditions: (a) systematic desensitization, (b) desensitization with meditation replacing progressive relaxation, (c) meditation only, and (d) no treatment. All 3 treatment manuals included coping-skill instructions. The results indicate that the 3 treatments were equally effective in reducing anxiety and produced a greater reduction in self-reported (but not behavioral) anxiety than that found in untreated Ss. Reliable changes in physiological manifestations of anxiety were found only in Ss who rated the treatment rationale as highly credible. High credibility ratings were also associated with significantly greater reductions in self-reported anxiety. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Modification of smoking behavior through self-administered punishment of imagined behavior: A new approach to aversion therapy.

Hypothesized that if imagined behaviors are punished, corresponding overt behaviors will be suppressed. A total of 133 undergraduate smokers were randomly assigned to 1 of 5 experimental groups. In 1 group, self-administered shock was contingent upon actual smoking, while in another it was contingent upon imagined smoking. Additional controls were provided by placebo, delayed treatment, and minimal-contact groups. Inconclusive results were obtained for females. For male moderate smokers, the imagined- and actual-smoking treatments were equally effective. With male heavy smokers, the imagined-smoking treatment was significantly more effective than the placebo (p     

Efficacy of psychosocial treatments for geriatric depression: A quantitative review.

A meta-analysis of 17 studies examined the efficacy of psychosocial treatments for depression among older adults. Studies were included only if a comparison was made to a control condition (no treatment, delayed treatment, or placebo treatment) or another psychosocial intervention. Results indicated that treatments were reliably more effective than no treatment on self-rated and clinician-rated measures of depression. Effect sizes for studies involving participants with major depression disorder were also reliably different from zero, as were effect sizes from studies involving participants with less severe levels of depression. These findings compare favorably with several other quantitative reviews of treatments for depression. Results suggest more balanced presentations of the potential benefits of psychosocial interventions are warranted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of self-administered treatments for depression and anxiety.

Self-administered treatments (SATs) are widely used by the general public and mental health professionals. Previous reviews of the efficacy of SATs have included under this category interventions for nonclinical problems, group interventions, and interventions involving significant amounts of therapist contact. The efficacy of SATs for clinical levels of depression and anxiety with minimal therapeutic contact was examined by meta-analyzing 24 studies. The results show large effects for SATs when compared with no-treatment control groups (d=1.00). However, unlike previous meta-analyses that found nonsignificant differences between SATs and therapist-administered treatments, in this sample SATs resulted in significantly poorer outcomes (d=-0.31). Some differences in effect size were observed between the clinical targets of depression and anxiety. However, there were high correlations between clinical target, methodological quality of the study, and amount of contact. This makes it impossible to determine whether the observed differences could be explained by the nature of the disorders, methodological quality, or the amount of contact with a member of the research team. The implications of the findings for the clinical use of SATs and for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Heart rate feedback and the management of cardiac neurosis.

Describes the treatment of a 55-yr-old male with chronic cardiac neurosis who had failed to respond to several prior medical and psychological interventions. Significant and durable symptomatic response appeared to be correlated with the application of a combination of procedures including heart-rate feedback, patient-administered desensitization, and therapist-administered flooding. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Procarboxypeptidase in rat pancreas. Overall characterization and comparison of the activation processes

In a multicenter open longitudinal clinical trial where 479 patients suffering from migraine with or without aura were recruited, patients treated at home one to three migraine attacks with their customary treatment, and subsequently, over a 3-month period, one to three migraine attacks with 6 mg sumatriptan sc using an autoinjector. The headache response to customary treatment was 19% at 1 h and 30.5% at 2 h, and was not significantly different when only attacks treated "adequately" according to accepted treatment recommendations were considered: 16% at 1 h and 35% at 2 h. In contrast, 69% and 82% of patients treated with 6 mg sumatriptan sc had mild headache or no headache at 1 and 2 h respectively, regardless of migraine type or duration of symptoms prior to treatment. Other migraine symptoms (nausea, vomiting, photo- and phonophobia) were effectively treated with sumatriptan. Recurrence of migraine was observed in 31% of patients and was well controlled by a second injection of sumatriptan. It is concluded that 6 mg sumatriptan sc, self-administered using an autoinjector, is well tolerated and more effective than most currently used acute treatments for migraine in a population of severely affected patients consulting a neurologist.     

Tuberculosis 2000: problems and solutions

The incidence of tuberculosis is expected to increase, from 8.8 million cases in 1995, to 10.2 million cases by the year 2000 and 11.9 million by 2005. Three million deaths due to tuberculosis occurred in 1995, and 3.5 million can be expected in the year 2000. The most important causes of the world-wide increase in tuberculosis are: 1) non-compliance with control programmes; 2) inadequate diagnosis and treatment; 3) migration; 4) endemic human immunodeficiency virus (HIV); 5) ambulatory and self-administered treatment. In the 1970s it was stated that treatment needed to be supervised-a recommendation that went unheeded. A number of fundamental changes should be introduced in order to make treatment effective, to cure patients and thus to arrest the transmission of the disease: 1) supervision during the whole period antituberculosis drugs are taken, and 2) hospitalization during the initial treatment stage for all groups at risk. It is already 50 years since the first antituberculosis drugs were discovered; effective treatments capable of curing all patients in 6 months have been available for the last 25 years, and the result is failure plus a growing mortality curve at the beginning of the twenty-first century. If we wish to alter this trend, we need trained doctors all over the world who possess enough clinical knowledge of tuberculosis; hospitalization for specific groups of tuberculosis patients; true supervision during the whole treatment period; fixed-dose combinations of drugs; and prophylaxis or preventive treatment whenever possible. We also need to take into account other factors such as drug resistance, endemic HIV, and migration.     

Behavioral treatment of problem drinkers: A comparative outcome study of three controlled drinking therapies.

Evaluated and compared 3 therapies designed to reduce the alcohol consumption of problem drinkers. 29 self-referred and 89 court-referred clients were randomly assigned to 1 of 3 treatment groups: (a) aversive counterconditioning (AC) using self-administered electrical stimulation; (b) behavioral self-control training (BT) including self-monitoring and instruction in functional analysis; or (c) a controlled drinking composite (CD) including blood alcohol awareness training, discriminated aversive counterconditioning, self-monitoring, and rate-control training. Prior to treatment, all Ss completed the MMPI, Michigan Alcoholism Screening Test, Rotter's Internal-External Locus of Control Scale, and Profile of Mood States. All therapies were conducted by trained paraprofessionals and consisted of 10 weekly sessions. Results show that all 3 therapies produced significant reduction in weekly alcohol consumption and peak blood alcohol concentration. These gains were largely maintained over 1 yr of follow-up. No significant differences among treatments were found, although AC was initially least effective. CD proved least cost effective, requiring 4 times more therapist contact than either AC or BT. A self-control manual was helpful in maintaining controlled drinking. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of topical ciprofloxacin in the treatment of chronic suppurative otitis media

We conducted a test of the efficacy of ciprofloxacin eardrops in 80 patients (95 ears) with otorrhea due to chronic suppurative otitis media in two treatment settings. One group (n = 40; 47 ears) received daily ciprofloxacin therapy plus aspiration in the clinic. The other group (n = 40; 48 ears) self-administered ciprofloxacin at home. Overall, otorrhea resolved in 88% of all ears within 12 days of the initiation of treatment. The clinic-treated patients tended to respond more rapidly than did the self-treated patients, but there was no statistically significant difference in success rates between the two groups. Side effects were negligible. We conclude that empiric topical ciprofloxacin therapy is an effective, safe and relatively inexpensive treatment for otorrhea in patients with chronic otitis media.     

Effects of biofeedback and psychotherapy on patients with myofascial pain dysfunction who are nonresponsive to conventional treatments.

Assessed the effects of biofeedback (BF) alone or BF with psychotherapy on 18 adult patients with myofascial pain dysfunction syndrome who did not respond to conventional physical treatments. Ss were randomly assigned to 1 of 3 treatment conditions: (1) masseter muscle BF on the symptomatic side of the face, (2) frontalis BF, or (3) frontalis BF plus psychotherapy. Findings indicate that (a) frontalis BF with psychotherapy was more effective than frontalis BF alone, (b) frontalis and masseter BF were about equally effective with these Ss, and (c) frontalis or masseter BF as well as frontalis BF plus psychotherapy, was more effective with these Ss than was escalated treatment or no further treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of structured psychodrama and systematic desensitization in reducing test anxiety.

36 students with examination anxiety took part in a study of the effectiveness of structured psychodrama and systematic desensitization in reducing test anxiety. Ss were randomly assigned to psychodrama, desensitization, or no-treatment control groups. All Ss were tested before and after the treatments on the Suinn Test Anxiety Behavior Scale and the Neuroticism scale of the Eysenck Personality Inventory. Results show that Ss in both treatment groups significantly reduced their test-anxiety scores compared with the controls. This was also congruent with gains as tested in vivo. A comparison between the 2 treatments, however, shows no significant differences. Also, there were no statistical differences among the 3 groups in neuroticism either before or after the treatments. It is concluded that the structured psychodrama method is as effective a mode of counseling as systematic desensitization in treating test anxiety. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive therapy versus systematic desensitization: Is one treatment superior?

Reviews psychotherapy outcome research and reassesses the findings of D. A. Shapiro and D. Shapiro (see record 1983-06160-001) who reported evidence in their review that cognitive therapy was considerably more effective than systematic desensitization. A substantially larger sample of studies is examined that have compared these 2 forms of treatment. Analyses indicated that (a) cognitive and desensitization treatments are roughly equal in efficacy, and (b) Shapiro and Shapiro's earlier finding may have occurred only because most of the studies they examined were conducted by investigators with an allegiance to cognitive therapy. Present results reveal that therapies combining both cognitive and desensitization treatments are no more effective than one of the treatments alone. The comparable level of improvement observed for cognitive, desensitization, and combined treatments has important implications for psychotherapy theory and research. A listing of the 25 studies included in the present review are appended. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Matching stress inoculation's treatment components to client's anxiety mode.

65 speech-anxious undergraduates (determined by the Personal Report of Confidence as a Speaker) were classified as experiencing primarily cognitive or somatic symptoms of anxiety as measured on the Cognitive–Somatic Anxiety Questionnaire. Ss received cognitive restructuring, coping relaxation, a combined cognitive–somatic treatment (stress inoculation), or no treatment. Indices of anxiety (e.g., the Anxiety scale of the Affect Adjective Check List) were obtained. The cognitive indices of anxiety provided the strongest support for the "matching" hypothesis, in that matched treatments resulted in more facilitative patterns of cognitions relevant to the stressor. All treatments were more effective than the no-treatment control in reducing behavioral indicants of anxiety, although a self-report measure of speech anxiety failed to show such treatment effects. Results are discussed in the context of treating focused anxieties by attending to the individual's concerns in the anxiety-arousing situation. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Graft fixation strength with arthroscopic anterior cruciate ligament reconstruction. Two-incision rear entry technique compared with one-incision technique

OBJECTIVES: This study examined how patient acceptability influences the effectiveness of directly observed therapy for tuberculosis. METHODS: Decision and sensitivity analyses were used in assessing influences. RESULTS: If mandatory directly observed therapy discourages 6% of initial tuberculosis patients (range: 4% to 10%) from seeking care, then such therapy will be less effective than self-administered therapy. Directly observed therapy is more effective than repeated self-administered therapy for patients failing to complete initial treatment unless 32% (range: 27% to 38%) of patients avoid seeking care. CONCLUSIONS: Patient acceptability must be taken into consideration before selecting public health strategies.