Showing papers on "Psychological intervention published in 1993"

Recovery from mental illness: The guiding vision of the mental health service system in the 1990s.

Abstract: he implementation of deinstitutionalization in the 1960s and 1970s, and the increasing ascendance of the community support system concept and the practice of psychiatric rehabilitation in the 1980s, have laid the foundation for a new 1990s vision of service delivery for people who have mental illness. Recovery from mental illness is the vision that will guide the mental health system in this decade. This article outlines the fundamental services and assumptions of a recovery-oriented mental health system. As the recovery concept becomes better understood, it could have major implications for how future mental health systems are designed. The seeds of the recovery vision were sown in the aftermath of the era of deinstitutionalization. The failures in the implementation of the policy of deinstitutionalization confronted us with the fact that a person with severe mental illness wants and needs more than just symptom relief. People with severe T CHANGING TOWARD THE FUTURE

Brief interventions for alcohol problems: a review

Abstract: Relatively brief interventions have consistently been found to be effective in reducing alcohol consumption or achieving treatment referral of problem drinkers. To date, the literature includes at least a dozen randomized trials of brief referral or retention procedures, and 32 controlled studies of brief interventions targeting drinking behavior, enrolling over 6000 problem drinkers in both health care and treatment settings across 14 nations. These studies indicate that brief interventions are more effective than no counseling, and often as effective as more extensive treatment. The outcome literature is reviewed, and common motivational elements of effective brief interventions are described. There is encouraging evidence that the course of harmful alcohol use can be effectively altered by well-designed intervention strategies which are feasible within relatively brief-contact contexts such as primary health care settings and employee assistance programs. Implications for future research and practice are considered.

Asian Americans: Personality Patterns, Identity, and Mental Health

Abstract: Foreword. A Diverse Population. Culture and Race. Families. Personality Patterns. Ethnic Identity. Stress. Stress and Refugees. Psychopathology in the "Model Minority". Underuse of Mental Health Services. Psychotherapy. Conclusion. Appendix A: Types of Mental Disorders. Appendix B: Mental Health Delivery Systems.

The illusion of mental health.

Abstract: It is argued that researchers' reliance on "objective" mental health scales and disregard for clinical judgment has led to many mistaken conclusions. Specifically, standard mental health scales appear unable to distinguish between genuine mental health and the facade or illusion of mental health created by psychological defenses. Evidence is presented indicating that (a) many people who look healthy on standard mental health scales are not psychologically healthy, and (b) illusory mental health (based on defensive denial of distress) has physiological costs and may be a risk factor for medical illness. Clinical judges could distinguish genuine from illusory mental health, whereas "objective" mental health scales could not. The findings call into question the conclusions of many previous studies that rest on standard mental health scales. They suggest new ways of understanding how psychological factors may influence health. Finally, they suggest that clinical methods (which researchers often malign) may have an important role to play in meaningful mental health research.

Community coalitions for prevention and health promotion

Abstract: In the last several years, health promotion specialists have stressed the importance of multiple interventions aimed both at individuals who are at health risk, and at risk-producing environments and policies (Milio, 1980; McLeroy et al., 1988; Pentz et al., 1989; Winett et al., 1989). The current emphasis on multiple interventions at multiple levels of the 'social ecology' is a response to the severity and complexity of chronic health conditions that are rooted in a larger social, cultural, political and economic fabric. The current wisdom in health promotion holds that targeting the behavior of individuals, without also intervening at these other social levels that shape behavior, will not have as great an impact on health status (McLeroy et al., 1988; Minkler, 1989; Hawkins and Catalano, 1992; Stokols, 1992). The development of coalitions of community agencies, institutions and concerned citizens to combat chronic health conditions is gaining popularity as an intervention aimed at strengthening the social fabric. Currently, hundreds of millions of dollars are being invested in coalition development as a health promotion intervention. For instance, both the COMMIT and ASSIST community tobacco control programs, funded by the National Institutes for Health, require coalitions of citizens in order to develop local strategies to decrease tobacco use (National Cancer Institute, 1988; Shopland, 1989).

Community violence and children on Chicago's southside

Abstract: This report summarizes a program of study on African-American children and violence conducted by a comprehensive community mental health center on the southside of Chicago. The research, which looked at exposure to violence, self-reports of aggression, and possible interventions, grew out of: (1) an awareness of the enormous amount of familial and extrafamilial violence in the black community; (2) clinical experiences that indicated that victimization and covictimization (i.e., victimization of close others) were often significant factors in the lives of the mentally ill; (3) a growing uneasiness, and indeed curiosity, over the extent to which children were witnessing these events and the impact of this witnessing, particularly on their own levels of aggression; and (4) a belief that the integrity of the black community was being threatened by the violence and that solutions must be sought.

Overcoming resistance to change.

Abstract: The pace of change in health care organizations challenges nursing administrators at all levels of management to be effective change agents. As resistance is an inevitable element in the process of planned change, inclusion of interventions to overcome resistance is critical to the change agent role. The author presents five theoretically-based strategies for reducing the levels of resistance to planned change.

A Sociology of Mental Health and Illness

Abstract: Perspectives on mental health and illness Stigma revisited and lay representations of mental health problems Social class and mental health Women and men Race and ethnicity Age and ageing Mental health work and professions The treatment of people with mental health problems The organization of mental health work Psychiatry and legal control Users of mental health services Public mental health and the pursuit of happiness References

A meta-analysis of adolescent smoking prevention programs.

Abstract: OBJECTIVES. A large number of studies evaluating adolescent smoking prevention programs have been published. Systematic quantitative reviews of this literature are needed to learn what does and does not work. The present meta-analysis focuses on the efficacy of school-based programs. METHODS. Evaluations of 94 separate interventions were included in the meta-analysis. Studies were screened for methodological rigor and those with weaker methodology were segregated from those with more defensible methodology; major analyses focused on the latter. RESULTS. Behavioral effect sizes were found to be largest for interventions with a social reinforcement orientation, moderate for interventions with either a developmental or a social norms orientation, and small for interventions with the traditional rational orientation. Attitude effect sizes followed the same pattern, but knowledge effect sizes were similar across all four orientation categories. CONCLUSIONS. Because behavioral effect represents the fundamental ...

A Meta-analytic Review of Interventions for Caregiver Distress: Recommendations for Future Research

Abstract: This review summarizes articles from 1980 to 1990 on psychosocial interventions and respite care for caregivers. The review was limited to controlled studies that attempted to change emotional distress in caregivers. Cumulatively, they suggest that individual psychosocial interventions and respite programs are moderately effective; psychosocial interventions with groups are less so.

Critical Review of Behavioral Interventions to Preserve the Environment: Research Since 1980

Abstract: This review integrates and evaluates the environmental-preservation research published during the 1980s. The focus is environmental behavior change as targeted by behavior analysts and others designing interventions to encourage environmental-preservation behavior. A modified taxonomy of behavioral interventions, based on a taxonomy presented by Geller et al., categorizes these reported interventions by antecedent and consequence conditions. Fifty-four studies were categorized and evaluated according to which of these taxonomic interventions were reported. The conclusions were that (a) antecedent conditions using commitment, demonstration, and goal-setting strategies were generally most effective in encouraging environmentally responsible behavior, and (b) consequence conditions were effective in producing behavior change during the experiment's duration. However, some other important findings were that (a) much of the research in this field during the 1980s did not directly compare interventions, (b) few...

Violence against women by male partners: Prevalence, outcomes, and policy implications.

Abstract: Violence against women has only recently been addressed in national policy and legislation. Responses by most societal institutions to women assaulted by male partners are still based primarily on a lack of knowledge about the prevalence, severity, and outcomes of violence perpetrated by men against female intimates. Although well suited to make a vital contribution, psychologists still rarely involve themselves in proactive interventions with women victims. This article reviews empirical literature on the physical and sexual assault of women by their male intimates and discusses potential physical and psychological outcomes, with a focus on linking what is known about abused women's reactions with the rich literature on survivors' responses to trauma. Implications for research, treatment interventions, and policy are discussed.

Prevention of conduct disorder before and after school entry: Relating interventions to developmental findings

Abstract: In this paper, both longitudinal and treatment studies relevant to conduct disorder (CD) are reviewed, and a developmental approach to its prevention is presented. Outcome studies for the treatment of CD and antisocial behavior are first reviewed to demonstrate that, although none have been entirely successful, many interventions have powerful effects on various symptoms that comprise the disorder, highly predictive antecedents, and risk factors. Second, the development of CD and the potency and interrelationship among antecedent and mediating variables is traced through the preschool and early elementary school years. Third, an attempt is made to synthesize the developmental and treatment research findings to suggest possible integrations of interventions that are promising for future preventive trials in the preschool and elementary school periods. It is concluded that, whereas before the entry to school preventive interventions targeted entirely in the family setting may prove successful, after the transition to school multisetting interventions will be essential. Finally, three examples of new and multisetting prevention trials are briefly described.

The Psychology of Criminal Conduct: Theory, Research and Practice

Abstract: Crime, Criminology, and Psychology. The Measurement and Distribution of Crime. Classification of Offenders. Social and Environmental Theories of Crime. Individually Oriented and Integrated Theories of Crime. Biological Correlates of Antisocial Behavior. Familial and Social Correlates of Crime. Personal Attributes of Offenders. Aggression and Violent Crime. Crime and Mental Disorder. Sexual Deviation and Sexual Offending. Forensic Psychology and the Offender. Psychological Interventions with Offenders. Treatment of Dangerous Offenders. The Effectiveness and Ethics of Intervention. References. Index.

Development of an intervention to restore attention in cancer patients.

Abstract: Developing interventions to maintain or restore attentional capacity during demanding phases of illness will help promote effective functioning in people with cancer. This study tested the effects of an experimental intervention aimed at maintaining or restoring attentional capacity in 32 women during the 3 months after surgery for localized (Stage I or II) breast cancer. The intervention was designed to minimize or prevent attentional fatigue through regular participation in activities that engage fascination and have other restorative properties. Attentional capacity was assessed using objective and subjective measures at four time points, approximately 3, 18, 60, and 90 days after breast cancer surgery. After the first observation, subjects were randomly assigned to receive the intervention (n = 16) or not to receive intervention (n = 16). Repeated measures ANOVA showed a significant interaction of experimental intervention and time on attentional capacity. Specifically, subjects in the intervention group showed significant improvement in attentional capacity over the four time points, while the nonintervention group showed a pattern of inconsistent performance over time. Findings suggest that nurses can intervene to maintain or restore attentional capacity in women after surgery for localized breast cancer. The theoretical basis for further development of attention-restoring interventions in patients with cancer is discussed.

Screening elders for risk of hospital admission.

Abstract: Objective: To define a set of screening criteria that identifies elders who are at high risk for repeated hospital admission in the future. Design: Longitudinal cohort study. Logistic regression analysis of data from half of the subjects was used to identify risk factors for repeated hospital admission. The ability of these risk factors to identify elders who are at high risk for repeated hospitalization in the future was then tested using data from the other half of the subjects. Setting: United States. Participants: A subsample (n = 5876) of a multistage probability sample of all non-institutionalized U.S. civilians who were 70 years or older in 1984. Measurements: At baseline (1984), elderly subjects were asked about their demographic, socioeconomic, medical, and functional characteristics and about their recent use of health services. Their subsequent hospital admissions and mortality were then monitored through the records of the Medicare program and the National Death Index (1985–88). Results: Among the subjects in the first half of the sample, eight factors emerged as risk factors for repeated admission: older age, male sex, poor self-rated general health, availability of an informal caregiver, having ever had coronary artery disease, and having had, during the previous year, a hospital admission, more than six doctor visits, or diabetes. Based on the presence or absence of these factors in 1984, 7.2% of the subjects in the second half of the sample were estimated to have a high probability of repeated admission (Pra ≥ 0.5) during 1985–1988. In comparison with subjects estimated to have a low risk (Pra < 0.5), this high-risk group's actual experiences during 1985–1988 included a higher cumulative incidence of repeated admission (41.8% vs 26.2%, P < 0.0001), a higher cumulative rate of mortality (44.2% vs 19.0%, P < 0.0001), more hospital days per person-year survived (5.2 vs 2.6), and higher hospital charges per person-year survived ($3731 vs $1841). Conclusion: Eight easily ascertained risk factors affect elders' probability of being hospitalized repeatedly within four years. In the future, brief surveys about the presence of these factors could be used to estimate elders' risk of future hospitalization and, thereby, to identify some of those who may derive the greatest benefit from interventions designed to avert the need for hospitalization.

Journal of Psychotherapy Practice and Research

Abstract: The Journal of Psychotherapy Practice and Research , now in its second year of publication, states as its aim "to address the professional understanding of human behavior and to enhance the psychotherapeutic treatment of mental disorders." In the inaugural issue, the editors further define the journal's goals: to "enhance our appreciation of the conduct of psychotherapy by addressing clinical concerns reflected by single case or small sample reports, as well as by publishing important research initiatives that attempt to deepen our understanding of how different psychotherapies work, and for whom, by studying larger groups of patients." As well as regular articles, the journal has published special articles, clinical and research reports, grand rounds case presentations, reprints of classic articles, editorial commentaries, and book reviews. Fairly diverse topics are covered, including clinical applications of theoretically derived hypotheses, studies of technical interventions, psychotherapeutic approaches to treatment of specific disorders, and others. A few

Adolescent mental health: Prevention and treatment programs.

Abstract: Adolescent mental health represents a neglected area of research. Mental health objectives include the promotion of optimal functioning as well as the prevention and reduction of maladaptive functioning. This article examines behaviors and conditions that place adolescents at risk for adverse outcomes and the urgent need for prevention and treatment to promote adaptive functioning. The current status of prevention and treatment programs is discussed along with critical issues including the interrelation and contribution of both prevention and treatment; the interplay of basic and applied research; and the need to extend existing interventions as well as to devise new models to address underserved, understudied, and high-risk populations. Research on the role of adolescent development, paths toward adjustment and maladjustment, and special opportunities that adolescence presents for intervention are also discussed.

A review of the state of the practice in requirements modeling

Abstract: A field study of ten organizations was conducted to determine their current practices on definition, interpretation, analysis, and use of the requirements for their software systems and products. The field study consisted of a series of in-depth, structured interviews with practitioners of various kinds. The findings of this study are summarized, and the implications for improving practice either by organizational and methodological interventions or by introducing new technology are explained. >

Confidentiality in Health Care: A Survey of Knowledge, Perceptions, and Attitudes Among High School Students

Abstract: Objective. —To assess adolescent knowledge, perceptions, and attitudes about health care confidentiality. Design. —Anonymous self-report survey with 64 items addressing confidentiality issues in health care. Setting. —Rural, suburban, and urban high schools in central Massachusetts. Participants. —Students in ninth through 12th grades from three schools. Results. —A total of 1295 students (87%) completed the survey: 58% had health concerns that they wished to keep private from their parents, and 69% from friends and classmates; 25% reported that they would forgo health care in some situations if their parents might find out. There were differences in response by gender, race, and school. About one third were aware of a right to confidentiality for specific health issues. Of those with a regular source of care, 86% would go to their regular physician for a physical illness, while only 57% would go there for questions about pregnancy, the acquired immunodeficiency syndrome, or substance abuse that they wished to keep private. Sixty-eight percent had concerns about the privacy of a school health center. Conclusion. —A majority of adolescents have concerns they wish to keep confidential and a striking percentage report they would not seek health services because of these concerns. Interventions to address confidentiality issues are thus crucial to effective adolescent health care. ( JAMA . 1993;269:1404-1407)

Separate and combined effects of methylphenidate and behavior modification on boys with attention deficit-hyperactivity disorder in the classroom.

Abstract: This study evaluated the separate and combined effects of behavior modification and 2 doses of methylphenidate (MPH; 0.3 and 0.6 mg/kg) compared with baseline (no behavior modification and a placebo) on the classroom behavior and academic performance of 31 ADHD (attention deficit-hyperactivity disorder) boys attending a summer treatment program. Results revealed significant effects of both interventions, with the mean effect size of medication being more than twice as great as that of behavior modification. Relatively small incremental value was gained by the higher dose of medication or the addition of behavior modification, compared with the effects of the low dose of MPH. In contrast, the addition of either dose of MPH resulted in improvement beyond the effects of behavior modification alone. These group effects reflected those obtained in analyses of individual differences. Furthermore, comparisons of individual responsiveness showed that boys who responded to one treatment also responded to the other.

Rape. Scope, impact, interventions, and public policy responses.

Abstract: There are many ways for women to be victimized by strangers and by people they know, but rape is the crime women fear most. The research on the frequency, psychological aftereffects, somatic consequences, and immediate as well as delayed interventions for rape is reviewed; a brief consensus of the literature within each of these areas is developed; and the implications of the research for public policy are considered. Among the suggested policy responses are improvements in the databases on rape frequency, increased attention to measurement, a higher priority for teaching about rape in the education of health care providers, increased funding and technical assistance to rape crisis centers, and more diversity of interventions and research on their effects.

Adolescent suicide prevention: Current research and social policy implications.

Abstract: The rate of adolescent suicide has increased dramatically in the past few decades, prompting several interventions to curb the increase. Unfortunately, many of the intervention efforts have not benefited from current research findings because the communication between researchers and those who develop the interventions is inadequate. Of specific concern are the increasingly popular curriculum-based suicide prevention programs, which have not demonstrated effectiveness and may contain potentially deleterious components. This article reviews the current epidemiological research in adolescent suicide and suggests how this knowledge could be used more effectively to reduce the rate of adolescent suicide. Recommendations include support for integrated primary prevention efforts; suicide prevention education for professionals; education and policies on firearm management; education for the media about adolescent suicide; more efficient identification and treatment of at-risk youth, including those exposed to suicidal behavior; crisis intervention; and treatment for suicide attempters.

Vision change and quality of life in the elderly. Response to cataract surgery and treatment of other chronic ocular conditions.

Abstract: • Objective. —Evaluation of health care in older populations has increasingly focused on quality of life as a critical outcome of treatment. Vision is assumed to be central to functioning. Data suggest that aging, in itself, is associated with a decline in visual functioning, which, in turn, is related to a decline in physical and mental functioning. Other studies indicate that cataract surgery is followed by significant improvement in vision and visual function. Our objective was to test these assumptions. Design.—Prospective study of 1021 patients, consecutively drawn from 76 randomly selected ophthalmologists' offices in three cities. Structured interviews were completed at baseline, 2 months, and 1 year after entry. Patients. —Six hundred thirteen patients with cataracts and 408 other ophthalmic patients drawn from the same offices but treated for other chronic ocular disorders. All received refractive services as needed. Setting. —Patients from three cities (Baltimore, Md, St Louis, Mo, and San Diego, Calif) were interviewed once in their homes and twice by telephone. Interventions. —The study involved the measurement of the effects of usual treatment for cataracts and other degenerative eye diseases. Major Outcome Measures. —Visual, social, and psychological functioning. Results. —Within 1 year of treatment, change in visual function was accompanied by significant changes, in the same direction, in quality of life functions: nighttime driving, daytime driving, community activities, home activities, mental health, and life satisfaction. In addition, the patients with cataracts showed significantly greater improvement in measures of vision than did the noncataract group. Conclusions. —Regardless of treatment, improvement across quality of life functions occurred when visual function improved. Thus, many types of functional degeneration observed in older populations, attributed to a decline in vision, can be slowed, or evenreversed, when visual function is improved. Cataract surgery was effective in improving vision and quality of life functions.

Psychological interventions to prevent HIV infection are urgently needed. New priorities for behavioral research in the second decade of AIDS.

Abstract: Behavior change remains the only means for primary prevention of HIV disease. Psychology should take a leading role in efforts to curtail the epidemic, but has not contributed to HIV prevention at a level proportionate to the urgency of the crisis. The authors propose an updated agenda for behavioral research on AIDS-HIV prevention implementing accelerated community trials of promising behavior change models, conducting trials of community-level interventions on a large scale and focused on populations most vulnerable to HIV infections, establishing partnerships between HIV research and community service organizations, integrating efforts from across psychology disciplines to advance and refine HIV prevention interventions, and mobilizing interdisciplinary HIV prevention resources and communication mechanisms to rapidly translate research findings to community and public policy arenas.

Treatment of Substance Abuse in Severely Mentally Ill Patients

Abstract: Substance abuse is the most common comorbid complication of severe mental illness. Current clinical research converges on several emerging principles of treatment that address the scope, pace, intensity, and structure of dual-diagnosis programs. They include a) assertive outreach to facilitate engagement and participation in substance abuse treatment, b) close monitoring to provide structure and social reinforcement, c) integrating substance abuse and mental health interventions in the same program, d) comprehensive, broad-based services to address other problems of adjustment, e) safe and protective living environments, f) flexibility of clinicians and programs, g) stage-wise treatment to ensure the appropriate timing of interventions, h) a longitudinal perspective that is congruent with the chronicity of dual disorders, and i) optimism.

Social support and caregiving burden in family caregivers of frail elders.

Abstract: This study assessed the relationships between six different types of social support and five measures of caregiving burden. Two questions were addressed: Are all types of social support equally associated with burden, and do the same types of support correlate with different types of burden? Family caregivers (N = 217) to frail elders composed the sample. Multiple regression analyses demonstrated that all types of social support for caregivers of frail elders are not equal. Engaging in social interaction for fun and recreation appears to be the most important in diminishing the burden of caregiving. These findings are instructive both theoretically and clinically. The theoretical import of greater social participation under a condition of chronic stress is discussed. Further, interventions that focus on caregivers regularly experiencing pleasant activity with friends and other family would seem to go a long way toward managing the burden of caregiving. Language: en

Communication between patients with breast cancer and health care providers determinants and implications

Abstract: Background. This study evaluated the perceptions of patients with breast cancer of their medical interactions with providers. The determinants and psychological consequences of communication problems also were examined. Methods. Ninety-seven patients with Stage I or II breast cancer completed a set of validated questionnaires before initiating postoperative therapy. Data on psychological distress were collected at baseline and 3-month follow-up, and multivariate models were fit to explain the relationship between pretreatment communication problems and subsequent psychological distress. Data on clinical variables were abstracted from medical records. Results. A substantial proportion of patients (84%) reported difficulties communicating with the medical team. Communication problems were more common among patients who were less optimistic about their disease and had less assertive coping styles. Patient-reported communication problems were associated with increased anxiety, depression, anger, and confusion at the 3-month follow-up. The association between communication problems and mood disturbance remained significant, although small, after adjusting for baseline mood disturbance, demographic, clinical, and coping style variables. Conclusion. Interventions that enhance communication between patients with breast cancer and their providers may improve patients' psychological adjustment to treatment. Conversely, interventions that lower distress and modify coping style may enhance communication.

Rural‐Urban Differences in Stigma and the Use of Care for Depressive Disorders

Abstract: Stigma may be a particularly important barrier to mental health care in rural communities where lack of anonymity increases the probability that someone who seeks care will be labeled "crazy." This study examined rural-urban differences in the stigma associated with depressive symptoms and the stigma associated with seeking treatment for depressive disorders. In addition, the study compared how the stigma associated with seeking treatment predicted use of care in rural and urban residents with a history of depressive symptoms. Two hundred subjects from metropolitan and adjacent non-metropolitan counties rated one of four randomly selected vignettes using 14-point semantic differential scales. The findings indicated that rural residents with a history of depressive symptoms labeled people who sought professional help for the disorder somewhat more negatively than their urban counterparts. Logistic models controlling for sociodemographic characteristics demonstrated that the more negative the labeling, the less likely depressed rural residents were to have sought professional help. Labeling was not associated with use of care among urban people with depressive symptoms. We concluded that prospective studies are warranted to inform the development of interventions to decrease the stigma associated with seeking treatment for depressive disorders in rural communities.