Integrative psychotherapy: From Chile with love.

Psychotherapy today is facing a challenge of growing within a new framework. Outcomes are becoming critical and integrative psychotherapy should provide good results. Chilean experience--with integrative psychotherapy--is described. The Chilean approach involves a theoretical background (an integrative model) and a clinical branch (integrative psychotherapy). This article shows how Chilean experience looks healthy today, and why it is too soon to say victory has arrived. So, a new approach involves a new reading of the existing data, giving a new framework to these data and having a self-critical attitude in terms of the new developments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopharmacotherapy for addictive and comorbid disorders: current studies

Proper diagnosis of comorbid disorders is crucial in treatment planning for the dually diagnosed. Since psychoactive substance use can obfuscate the diagnosis, special care must be taken to exclude organically based syndromes. Adequate periods of abstinence should first be achieved and subsequently the patient re-examined for residual symptoms compatible with a nonaddictive, nonsubstance-induced psychiatric disorder. The integration of concurrent treatment of both the mental and the addictive disorders appears to be the best approach for treatment of comorbid psychiatric and addictive disorders. An abstinence-based model that typically utilizes a 12-step group therapy is often employed for the addictive illnesses. Other forms of psychosocial therapies such as case managers are being used as well. Presently, physicians' prescribing practices for comorbid addicted patients are based on traditional approaches to use of medications in psychiatric patients, and their attitudes towards addictive disorders may play a significant role in determining the overall success of treatment.     

An introduction to using structural equation models in rehabilitation psychology.

Objective: To provide an overview of structural equation modeling (SEM) using an example drawn from the rehabilitation psychology literature. Design: To illustrate the 5 steps in SEM (model specification, identification, estimation methods, interpretation of results, and model modification), an example is presented, with details on determining whether alternative models result in a significant improvement to fit to the observed data. Data are from a sample of 274 people with spinal cord injury. Issues commonly encountered in preparing data for SEM analyses (e.g., missing data, nonnormality) are reviewed, as is the debate surrounding some aspects of SEM (e.g., acceptable sample size). Conclusion: SEM can be a powerful procedure for empirically representing complex and sophisticated theoretical models of interest to rehabilitation psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The choose-get-keep model of psychiatric rehabilitation: A synopsis of recent studies.

Objective: Comprehensive review of studies using the choose-get-keep (CGK) process model of psychiatric rehabilitation. Also, other studies are identified that have demonstrated methodologies useful in future research on the CGK model. Intervention Model: The CGK process is conceptualized as the phases through which people with psychiatric disabilities proceed as they engage in psychiatric rehabilitation. Conclusion: The CGK model is a potentially useful psychiatric rehabilitation intervention that can be implemented in a variety of service settings and that focuses on the activities of the practitioner and the service recipient. The CGK model warrants further empirical study to examine its effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relapse as a nonlinear dynamic system: Application to patients with alcohol use disorders.

Understanding the relapse process is one of the most important issues in addictive behaviors research. To date, most studies have taken a linear approach toward predicting relapse based on risk factors. Nonlinear dynamical systems theory can be used to describe processes that are not adequately modeled using a linear approach. In particular, the authors propose that catastrophe theory, a subset of nonlinear dynamical systems theory, can be used to describe the relapse process in addictive behaviors. Two small prospective studies using 6-month follow-ups of patients with alcohol use disorders (inpatient, n=51; outpatient, n=43) illustrate how cusp catastrophe theory may be used to predict relapse. Results from these preliminary studies indicate that a cusp catastrophe model has more predictive utility than traditional linear models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Rehabilitation psychology: A comprehensive textbook.

Reviews the book, Rehabilitation psychology: A comprehensive textbook by David W. Krueger (1983). In this volume, David W. Krueger has developed a new blueprint for constructing an edited volume in rehabilitation. Unique in the present design is the attempt, within a single volume of reasonable size, to cover the rehabilitation field from both a type-of-disability approach and an issue-oriented approach. To achieve this objective, the editor has recruited well-known and highly respected authors to write short chapters in their areas of expertise. In all, there are 42 chapters, which range in length between 4 and 14 pages. Each chapter is written by a different author, with the exception of two chapters written by the editor. No uniformity of style or standard outline for presentation has been followed. Instead, each chapter stands on its own. As a result, the effect is more that of a carefully selected book of readings than that of an integrated textbook. This book stands as an impressive attempt to provide the reader with a broad overview of the field of rehabilitation. As such, it serves as a fine introduction to the field of rehabilitation by providing a good sampling of the diversity of issues that surround rehabilitation and having these issues discussed by recognized experts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuroticism as a common feature of the depressive and anxiety disorders: A test of the revised integrative hierarchical model in a national sample.

The revised integrative hierarchical model of depression and anxiety (S. Mineka, D. Watson, & L. A. Clark, 1998) proposes that high levels of neuroticism are shared between the depressive and anxiety disorders. This perspective was evaluated with data from the National Comorbidity Survey (N = 5,847), a population-based community sample. Analyses were based on both a broadband (i.e., diagnostic class) and a narrowband (i.e., specific disorder) approach. Results supported the model insofar as high neuroticism was shared across the depressive and anxiety disorders and was particularly elevated in people with comorbid depression and anxiety. Results are discussed in terms of their implications for understanding the association between personality and the depressive and anxiety disorders in a community sample and for the revised integrative hierarchical perspective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An open trial of integrative therapy for generalized anxiety disorder.

Cognitive-behavioral therapy (CBT), although effective, has the lowest average effect size for generalized anxiety disorder (GAD), when compared to effect sizes of CBT for other anxiety disorders. Additional basic and applied research suggests that although interpersonal processes and emotional avoidance may be maintaining GAD symptomatology, CBT has not sufficiently addressed interpersonal issues or emotion avoidance. This study aimed to test the feasibility and preliminary efficacy of an integrative psychotherapy, combining CBT with techniques to address interpersonal problems and emotional avoidance. Eighteen participants received 14 sessions of CBT plus interpersonal emotional processing therapy and three participants (for training and feasibility purposes) received 14 sessions of CBT plus supportive listening. Results showed that the integrative therapy significantly decreased GAD symptomatology, with maintenance of gains up to 1 year following treatment. In addition, comparisons with extant literature suggested that the effect size for this new GAD treatment was higher than the average effect size of CBT for GAD. Results also showed clinically significant change in GAD symptomatology and interpersonal problems with continued gains during the 1-year follow-up. Implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivation for treatment: A review with special emphasis on alcoholism.

Provides an integrative review of research relating motivational variables and interventions to treatment entry, compliance, and outcome, emphasizing alcoholism and other addictive behaviors. Disadvantages of a trait model of motivation and perceptions of motivation, including agreement, self-label, desire for help, distress, and compliance/dependence, are discussed. Empirical evidence is considered regarding motivational interventions, including advice, feedback, goal setting, role playing, modeling, contingencies, continuity of care, voluntary choice, and modification of behavior attractiveness. Nonspecific aspects of motivation are addressed, including client characteristics (distress, self-esteem, locus of control, severity, conceptual level), environmental variables, and therapist characteristics (hostility, expectancy, empathy). A dynamic conceptualization of treatment motivation is proposed as an alternative to a trait model. (7 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Issues in personality conceptualizations of addictive behaviors.

This article describes the issues and implications associated with personality conceptualizations of addictive behaviors. Attention is directed toward characterizing the sociopolitical climate as it affects the identification, evaluation, and management of substance-abuse disorders. Arguments spawned by unnecessarily simplistic formulations of addiction-proneness hypotheses and by their behavioral antitheses are also reviewed within a historical perspective. In this discussion, the sometimes myopic focus of both personality and behavioral researchers is underscored. Overall, alcohol and drug use phenomena are explored in a conceptual schemata that encompasses multifactorial, reciprocal, and integrative explanations of the etiology, natural history, and progression of addictive disorders and their comorbidities. The methodological limitations of research in the areas are examined, and multidisciplinary, longitudinal research sufficiently comprehensive to target a range of drug and alcohol use types and use frequencies is encouraged. Emphasis is directed toward the understanding of possible commonalities among seemingly excessive behaviors and the implementation of treatment strategies consonant with practical endorsement of multivariate theoretical models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inpatient rehabilitation diabetes consult service: A rehabilitation psychology approach to assessment and intervention.

Problem: Diabetes clinical practice recommendations call for assessment and intervention on diabetes self-management during inpatient hospitalization. Although diabetes is prevalent in inpatient rehabilitation settings, diabetes self-management has not traditionally been a focus of inpatient rehabilitation psychology care. This is because diabetes is often a secondary diagnosis when an individual is admitted to rehabilitation for an acute event. Objectives: The authors provide a rationale for a role for rehabilitation psychologists in assessing and intervening on the psychosocial, behavioral, and functional self-management needs of individuals with diabetes within the rehabilitation setting. The development of a rehabilitation psychology Inpatient Rehabilitation Diabetes Consultation Service is described. Theoretical and empirical bases for compilation of the assessment and intervention materials are provided. Format and implementation of the service on a university-affiliated inpatient rehabilitation unit is described, with special consideration given to professional issues faced by rehabilitation psychologists and teams. Results: A flexible consultation model was implemented using a guided diabetes psychosocial assessment with brief educational handouts addressing selected key topics (i.e., hyperglycemia, hypoglycemia, blood sugar monitoring, nutrition, physical activity, medication, and, A1C and average blood sugar). The consultation service was feasible and well-accepted by treated individuals and the rehabilitation team. Conclusions: Rehabilitation psychologists are uniquely positioned to address the functional, psychosocial, and behavioral needs of individuals with diabetes. With further research to assess clinical outcomes, this approach may further address practice recommendations for inpatient diabetes care. Moreover, such a diabetes consultation model may be useful on an outpatient rehabilitation basis as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors affecting depression among people with chronic musculoskeletal pain: A structural equation model.

Objective: To adapt and test P. M. Lewinsohn, H. M. Hoberman, L. Teri, and M. Hautzinger's (1985) integrative model of depression for individuals with chronic musculoskeletal pain. Design: Structural equation modeling. Participants: Individuals with chronic pain (N = 171), recruited from 6 outpatient rehabilitation facilities in Canada. Outcome Measures: Two measures of the latent variable, depression (the Center for Epidemiologic Studies-Depression Scale and the Zung Self-Rating Depression Scale), along with multiple measures of each of 5 latent predictors (pain, interferences, stress, coping, and social and family support) and 2 measured predictors (preinjury psychopathology and catastrophizing). Results: The normed fit index, comparative fit index, and parsimony ratio indicated an adequate fit for the model, suggesting that stress, perceived severity of pain, activity interferences, and catastrophizing contributed to increased depression (vulnerabilities), whereas pain coping skills and social and family support contributed to decreased depression (immunities). Conclusions: Empirical support was found for the proposed model of depression for people with chronic musculoskeletal pain, and the model appears to provide useful information for clinical rehabilitation interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Statistical Process Control and Rehabilitation Outcome: The Single-Subject Design Reconsidered.

Rehabilitation psychology embraces the scientist-practitioner model as its professional philosophy. This model's original intent was that the diagnosis and treatment of each individual case was to be regarded as a single and well-controlled experiment. Executing this ideal in rehabilitation has been problematic owing to practical, ethical, and technical concerns. Statistical process control (SPC), a robust, graphical analytic strategy developed in industry, is offered as a means to deploy single-subject designs on the front lines of rehabilitation. The history and construction of SPC control charts are presented followed by case examples relevant to rehabilitation practice (ambulation, depression, cognitive rehabilitation, agitation). SPC control charts are a time-tested, scientifically validated, and pragmatic tool to achieve and document patient outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of cytosolic calcium balance on cell injury in cultured bovine aortic endothelial cells during hypoxia and reoxygenation]

The integration of pharmacological therapies for comorbid disorders requires an acceptance of independence and interactions of respective addictive and psychiatric disorders. At the same time, alcohol and other drugs induce psychiatric states that are indistinguishable from psychiatric disorders. On the other hand, while psychiatric disorders do not induce addictive use of alcohol and drugs, they do pose vulnerabilities to the development of addictive disorders. Generally, the treatment of comorbid disorders begins with abstinence and evaluation of the effects of alcohol and other drugs in contributing to the psychiatric picture. In the case of comorbid disorders, stabilization and standard treatments can be employed with certain cautions, namely, to avoid the use of addicting medications such as benzodiazepines and opiates beyond the detoxification stage. High potency neuroleptics and antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) can be used to treat continuing psychiatric states after the exclusionary criteria in DSM-IV for substance-related disorders have been applied to the clinical case. If the psychiatric symptoms clear with sustained abstinence, little or no medications may be required. Specific treatment of the addictive disorders will often determine the extent that addictive disorders are responsible for psychiatric symptomatology. Alternatively, treatment of the psychiatric disorder will enhance compliance with addiction treatment.     

Thoughts about journeys to integrative psychotherapy.

What a humbling experience to be invited to offer commentary on the papers of such distinguished contributors to the field of integrative psychotherapy. Even the most junior member of the panel has a record of achievement impressive enough to place him in a competitive position for a tenured faculty position. As we read their stories, we have a wonderful opportunity to get glimpses into two decades of change in the field of psychotherapy as seen through the eyes of four colleagues who have been tremendously influential. In my effort to tie together these moving pieces I have looked for the "common factors" that have played out in the stories of these four clinician-scholars. In the pages that follow, I will review these commonalities, which include the following: (a) the role of personal life experiences on the development of an integrative approach; (b) the critical role of a mentor; (c) the challenge of defining one's approach; (d) views about the essential factors in effective psychotherapy; (e) an appreciation for the relationship between research and clinical practice; (f) a commitment to teaching and supervision; and (g) the significance of SEPI in the past, present, and future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Electromyographic biofeedback and neuromuscular rehabilitation.

Electromyographic biofeedback has now been used with apparent success, although most often in an uncontrolled fashion, in the rehabilitation treatment of a wide range of neuromuscular disorders. These have included peripheral nerve-muscle damage, spasmodic torticollis, the stroke hemiplegias, and cerebral palsy. Studies of these applications are reviewed, and some specific problems that should be the topic of further controlled research are outlined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Readiness to adopt a self-management approach to cardiac health: Predicting outcomes from cardiac rehabilitation.

Purpose/Objective: To examine whether initial attitudes toward a self-management approach to cardiac health and early-treatment changes in those attitudes predict outcomes in cardiac rehabilitation. Research Method/Design: One hundred eighteen participants took part in a 12-week Phase II cardiac rehabilitation program. Questionnaires to assess readiness to engage in a self-management approach, mood, activity level, and diet were completed at pretreatment and at Weeks 3, 6, 9, and 12. Results: Repeated-measures regressions showed that participants with higher pretreatment levels of readiness to engage in a self-management approach showed more pronounced improvements in mood, activity level, and diet than did those with lower levels of readiness. Those who reported significant shifts in self-management attitudes during the first 3 weeks of the program finished treatment with greater improvements on measures of mood, cardiorespiratory fitness, activity level, and weight than did participants who reported smaller shifts. Conclusions/Implications: Results suggest that pretreatment acceptance of a self-management orientation, as well as early shifts toward such a stance, predicted treatment gains. This information may be used to improve outcomes from cardiac rehabilitation by intervening to enhance readiness in those that start at low levels or fail to engage in the initial stages of 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)     

Review of Generalized anxiety disorders across the lifespan: An integrative approach.

Reviews the book Generalized anxiety disorder across the lifespan: An integrative approach (see record 2009-04840-000) by Michael E. Portman. Generalized Anxiety Disorder (GAD) perhaps might be construed to be the overlooked and neglected stepchild of the various anxiety disorders within the current psychopathological and psychotherapeutic literatures. Portman’s book is an important and largely successful attempt to fill this gap in the literature. In it, the author describes the clinical presentation and phenomenology of the disorder, considers the history of the anxiety disorders that were precursors to the current diagnostic category, reviews the process of, and criteria for, accurate diagnosis of GAD, and concisely summarizes the most important theoretical explanations of the etiology, structure, and reviews the most important and frequently cited treatments for GAD. This book would be a useful and important addition to the library of any graduate student or established researcher who is considering conducting research on any facet of GAD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)