• A controlled trial comparing family therapy with individual supportive therapy in anorexia nervosa and bulimia nervosa was undertaken. Eighty patients (57 with anorexia nervosa; 23 with bulimia nervosa) were first admitted to a specialized unit to restore their weight to normal. Before discharge, they were randomly allocated to family therapy or the control treatment (individual supportive therapy). After one year of psychological treatment, they were reassessed, using body weight, menstrual function, and ratings on the Morgan and Russell scales. Family therapy was found to be more effective than individual therapy in patients whose illness was not chronic and had begun before the age of 19 years. A more tentative finding was the greater value of individual supportive therapy in older patients. To our knowledge, this is the first controlled trial of family therapy in anorexia nervosa and clarifies the specific indications for this treatment.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/494181/archpsyc_44_12_004.pdf

An Evaluation of Family Therapy in Anorexia Nervosa and Bulimia Nervosa

In a prospective (controlled) trial, the result in 18 patients receiving eight, weekly half-hour sessions of brief problem-oriented dynamic psychotherapy was compared with the result in an equal number receiving eight, weekly half-hour sessions of family practitioner therapy and in another 20 receiving no additional therapy. The subjects were drawn from patients at ten suburban family practices in Sydney. They had had psychological complaints for at least six months. No differences between the three treatment groups were found in the final outcome, either in a symptom severity and social dysfunction factor or in a physical disability and medication factor.

Brief psychotherapy in family practice. A controlled prospective intervention trial.

This paper reports an investigation into the efficacy of flexible dosage amitriptyline (AMI) and brief psychotherapy individually and together in the treatment of chronic 'psychogenic' pain. The patients included in the study were drawn from those referred to a pain clinic and were randomly assigned to 1 of 4 groups: (1) AMI + psychotherapy (N = 26), twelve 45 min weekly sessions; (2) AMI + support (N = 26), six 15 min fortnightly sessions; (3) placebo tablet + psychotherapy (N = 26), twelve 45 min weekly sessions; (4) placebo tablet + support (N = 24), six 15 min fortnightly sessions. Outcome was assessed on categorical and continuous variables administered immediately post treatment. The results indicate that amitriptyline is effective in increasing the patients' activity level and the reduction of pain intensity. Psychotherapy increases pain intensity, but tends to improve productivity. There also appears to be a role for the use of amitriptyline in combination with psychotherapy, but their interaction is a complex one. Baseline factors associated with withdrawal from treatment are reported, as well as those associated with a positive response to amitriptyline and psychotherapy respectively. Our findings offer tentative guidelines for choosing between therapies and also underline the importance of assessing more than one outcome variable in evaluating outcome. The importance of carrying treatments out in the context of a multidisciplinary pain clinic is emphasised.

A controlled study of psychotherapy and amitriptyline used individually and in combination in the treatment of chronic intractable, 'psychogenic' pain.

The need for a focus for brief interpretive psychotherapy is considered and a new approach is suggested. In this method, the ways in which the patient's construction of himself and his relationships are related to his problems are identified and expressed in the form of dilemmas, traps and snags. It is suggested that these formulations represent an appropriate level of abstraction, allowing patient and therapist to share provisional hypotheses about the goals of therapy and offering the basis for a method of measuring how far these goals are achieved.

The focus in brief interpretive psychotherapy: dilemmas, traps and snags as target problems.

Goldberg's 28-item General Health Questionnaire (GHQ) and the Student Vulnerability Inventory (SVI) were administered to 1,279 first-year undergraduates at the time of registration. The relationship between three sets of data was examined: GHQ scores, vulnerability factors, and withdrawal from university. Positive associations were found between high GHQ scores and an unsatisfactory relationship with parents, previous psychological investigation or help, and a family history of psychiatric disorder. Withdrawal from university was found to be related to high GHQ scores, an unsatisfactory relationship with parents, and previous psychological investigation or help. The implications of these findings are discussed.

General health, psychiatric vulnerability and withdrawal from university in first-year undergraduates

A feasibility study for a controlled trial of a certain type of formal psychotherapy is described. Patients referred by consultant psychiatrists in the Inner London Area were carefully selected and fully assessed before random allocation to one of three treatment procedures. The results indicate that the trial as initially envisaged is not feasible. The reasons for this conclusion are discussed.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0033291700045165

H. P. Hildebrand

Papers

A feasibility study for a controlled trial of formal psychotherapy