Showing papers on "Psychological intervention published in 1997"

"Mental health literacy": a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment.

Abstract: Objectives To assess the public's recognition of mental disorders and their beliefs about the effectiveness of various treatments ("mental health literacy") Design A cross-sectional survey, in 1995, with structured interviews using vignettes of a person with either depression or schizophrenia Participants A representative national sample of 2031 individuals aged 18-74 years; 1010 participants were questioned about the depression vignette and 1021 about the schizophrenia vignette Results Most of the participants recognised the presence of some sort of mental disorder: 72% for the depression vignette (correctly labelled as depression by 39%) and 84% for the schizophrenia vignette (correctly labelled by 27%) When various people were rated as likely to be helpful or harmful for the person described in the vignette for depression, general practitioners (83%) and counsellors (74%) were most often rated as helpful, with psychiatrists (51%) and psychologists (49%) less so Corresponding data for the schizophrenia vignette were: counsellors (81%), GPs (74%), psychiatrists (71%) and psychologists (62%) Many standard psychiatric treatments (antidepressants, antipsychotics, electroconvulsive therapy, admission to a psychiatric ward) were more often rated as harmful than helpful, and some nonstandard treatments were rated highly (increased physical or social activity, relaxation and stress management, reading about people with similar problems) Vitamins and special diets were more often rated as helpful than were antidepressants and antipsychotics Conclusion If mental disorders are to be recognised early in the community and appropriate intervention sought, the level of mental health literacy needs to be raised Further, public understanding of psychiatric treatments can be considerably improved

Determinants of Medication Compliance in Schizophrenia: Empirical and Clinical Findings

Abstract: Advances in psychopharmacology have produced medications with substantial efficacy in the treatment of positive and negative symptoms of schizophrenia and the prevention of relapse or symptom exacerbation after an acute episode. In the clinical setting, the individual patient's acceptance or rejection of prescribed pharmacological regimens is often the single greatest determinant of these treatments' effectiveness. For this reason, an understanding of factors that impede and promote patient collaboration with prescribed acute and maintenance treatment should inform both pharmacological and psychosocial treatment planning. We review the substantive literature on medication adherence in schizophrenia and describe a modified health belief model within which empirical findings can be understood. In addition to factors intrinsic to schizophrenia psychopathology, medication-related factors, available social support, substance abuse comorbidity, and the quality of the therapeutic alliance each affect adherence and offer potential points of intervention to improve the likelihood of collaboration. Because noncompliance as a clinical problem is multidetermined, an individualized approach to assessment and treatment, which is often best developed in the context of an ongoing physician-patient relationship, is optimal. The differential diagnosis of noncompliance should lead to interventions that target specific causal factors thought to be operative in the individual patient.

A Spiritual Strategy for Counseling and Psychotherapy

Abstract: The Alienation Between Religion and Psychology The New Zeitgeist Western and Eastern Spiritual World Views A Theistic Spiritual View of Personality and Mental Health A Theistic Spiritual View of Psychotherapy Ethical Issues and Guidelines Religious and Spiritual Assessment Religious and Spiritual Practices as Therapeutic Interventions Spiritual Interventions Used by Contemporary Psychotherapists Case Reports of Spiritual Issues and Interventions in Psychotherapy A Theistic Spiritual View of Science and Research Methods Directions for the Future.

Labeling mental illness : The effects of received services and perceived stigma on life satisfaction

Abstract: Labeling theory proponents and the theory's critics have different views of stigma and thus differ on the consequences of labeling for people with mental illness. The labeling perspective posits that because of stigma, official labeling through treatment contact has negative consequences for mental patients. In contrast, critics of labeling theory claim that stigma is relatively inconsequential. Instead, they argue that because labeling results in receiving needed services, it provides significant benefits for mental patients. Thus far, no study has tested the relative positive and negative effects of labeling. The author examines these views by comparing the importance of perceived stigma versus the receipt of services for the quality of life of persons with chronic mental illness. Results show that both stigma and services received are significantly associated with quality of life but in opposite ways. These findings have important implications for interventions for mental illness

Cost-effectiveness of the Clinical Practice Recommendations in the AHCPR Guideline for Smoking Cessation

Abstract: Context. —The Agency for Health Care Policy and Research (AHCPR) published the Smoking Cessation: Clinical Practice Guideline in 1996. Based on the results of meta-analyses and expert opinion, the guideline identifies efficacious interventions for primary care clinicians and smoking cessation specialty providers. Objective. —To determine the cost-effectiveness of clinical recommendations in AHCPR's guideline. Design. —The guideline's 15 recommended smoking cessation interventions were analyzed to determine their relative cost-effectiveness. Then, using decision probabilities, the interventions were combined into a global model of the guideline's overall cost-effectiveness. Patients. —The analysis assumes that primary care clinicians screen all presenting adults for smoking status and advise and motivate all smokers to quit during the course of a routine office visit or hospitalization. Smoking cessation interventions are provided to 75% of US smokers 18 years and older who are assumed to be willing to make a quit attempt during a year's time. Intervention. —Three counseling interventions for primary care clinicians and 2 counseling interventions for smoking cessation specialists were modeled with and without transdermal nicotine and nicotine gum. Main Outcome Measure. —Cost (1995 dollars) per life-year or quality-adjusted life-year (QALY) saved, at a discount of 3%. Results. —The guideline would cost $6.3 billion to implement in its first year. As a result, society could expect to gain 1.7 million new quitters at an average cost of $3779 per quitter, $2587 per life-year saved, and $1915 for every QALY saved. Costs per QALY saved ranged from $1108 to $4542, with more intensive interventions being more cost-effective. Group intensive cessation counseling exhibited the lowest cost per QALY saved, but only 5% of smokers appear willing to undertake this type of intervention. Conclusions. —Compared with other preventive interventions, smoking cessation is extremely cost-effective. The more intensive the intervention, the lower the cost per QALY saved, which suggests that greater spending on interventions yields more net benefit. While all these clinically delivered interventions seem a reasonable societal investment, those involving more intensive counseling and the nicotine patch as adjuvant therapy are particularly meritorious.

A Meta-Analysis of Interventions To Decrease Disruptive Classroom Behavior in Public Education Settings.

Abstract: We conducted a meta-analysis of 99 studies that used interventions to decrease disruptive classroom behavior in public education settings. Due to the predominance of single-subject studies, we used...

The Caregiver Strain Questionnaire: Measuring the Impact on the Family of Living with a Child with Serious Emotional Disturbance.

Abstract: The impact on the family of having a family member with serious emotional problems has been an area of concern as deinstitutionalitation and managed care have shifted treatment to the community and primary caregiving to the family. Measures are needed to assess caregiver strain in a way that can lead to a better understanding of the phenomena, improve clinical interventions, and examine the outcomes of new treatment modalities on the client's family. In order to study the effects of this treatment shift, the Caregiver Strain Questionnaire (formerly the Burden of Care Questionnaire) was developed for use with families of children and adolescents with emotional and behavioral disorders. Findings from exploratory and confirmatory factor analyses support the existence of three related but unique dimensions of strain experienced by parents of this population. This study adds to the current body of knowledge by suggesting that subjective caregiver strain has two components, and not the single form claimed in pr...

Relating Parent and Family Functioning to the Psychological Adjustment of Children with Chronic Health Conditions: What Have We Learned? What Do We Need To Know?

Abstract: Reviewed research concerning the relationship of parent and family functioning to the psychological adjustment of children with chronic health conditions. More adaptive family relationships and parental psychological adjustment were associated with positive psychological adjustment while less adaptive family relationships (e.g., greater conflict and maternal psychological distress) consistently predicted problematic adjustment. Conclusions were limited by small, site-specific samples, reliance on self-report measures generally obtained from one parent, and general measures. Research progress would be enhanced by (a) more representative data sets; (b) process-oriented, illness-specific, and clinically relevant measures; (c) prospective analyses that clarify specific causal pathways between family functioning and children's adjustment; and (d) tests of interventions that modify risk and/or resistance factors.

Perceived benefit and mental health after three types of disaster.

Abstract: The study of growth and perceived benefit after traumatic events has been hailed as one of the most promising directions for stress research. This research, however, has been limited by several methodological limitations. These limitations are addressed in this prospective study, which examines perceived benefit and mental health adjustment after 3 different types of disaster. Survivors of a tornado in Madison, Florida, had the highest rates of perceived benefit, followed by survivors of a mass killing in Killeen, Texas, and survivors of a plane crash in Indianapolis, Indiana. Perceived benefit 4-6 weeks postdisaster predicted posttraumatic stress disorder 3 years later. Perceived benefit moderated the effect of severity of disaster exposure on mental health diagnosis change over time. Without perceived benefit, as exposure severity increased, the amount of recovery decreased. If benefit was perceived, as exposure severity increased, the amount of recovery increased. Implications for clinical interventions and future research are discussed.

Outcome of Psychotherapy Among Early Adolescents After Trauma

Abstract: Objective: The authors evaluated the effectiveness of brief trauma/grief-focused psychotherapy among early adolescents exposed to the 1988 earthquake in Armenia. Method: Posttraumatic stress and depressive reactions among treated and not treated subjects were evaluated pre- and postintervention, at 1 1 ∕2 and 3 years after the earthquake, respectively. Results: Severity of posttraumatic stress symptoms significantly decreased among the subjects given psychotherapy, while severity of these symptoms increased significantly among the subjects not treated with psychotherapy. The improvement in posttraumatic stress symptoms was attributable to improvement in all three symptom categories (intrusion, avoidance, and arousal) of posttraumatic stress disorder (PTSD). There was no change in severity of depressive symptoms among subjects given psychotherapy. However, depressive symptoms among subjects not treated with psychotherapy significantly worsened over time. The changes in severity of posttraumatic stress and depressive symptoms were positively correlated within both groups. Conclusions: The findings demonstrate the efficacy of trauma/grief-focused brief psychotherapy in alleviating PTSD symptoms and preventing the worsening of comorbid depression among early adolescents after a catastrophic disaster. The results support the broad use of such schoolbased interventions after major disasters and demonstrate the cross-cultural applicability of Western psychotherapeutic approaches. (Am J Psychiatry 1997; 154:536‐542)

A randomized trial of a consultation service to reduce falls in nursing homes.

Abstract: Context. —Falls are a major health problem in nursing homes, but no interventions have been shown to prevent falls in nursing home residents. Objective. —To evaluate an intervention program designed to prevent falls and associated injuries in high-risk nursing home residents. Design. —Randomized controlled trial. Setting and Participatnts. —Seven pairs of middle Tennessee nursing homes with 1 facility in each pair randomly assigned to the intervention. Facilities had 482 (261 control, 221 intervention) residents who qualified for the study because they had high risk of falls and a potential safety problem that could be addressed by the intervention. Intervention. —Comprehensive structured individual assessment with specific safety recommendations that targeted suboptimal practices for environmental and personal safety, wheelchair use, psychotropic drug use, and transferring and ambulation. Facility staff were encouraged to implement the individual recommendations and to improve overall facility safety. Main Outcome Measures. —The mean proportion of recurrent fallers and incidence rate of injurious falls in the facility in the year following the intervention. Results. —The mean proportion of recurrent fallers in intervention facilities (43.8%) was 19.1% (95% confidence interval, 2.4%-35.8%) lower than that in control facilities (54.1%, P =.03). Intervention facilities had a nonsignificant trend toward a lower mean rate of injurious falls (13.7 vs 19.9 per 100 person-years, reduction of 31.2%, P =.22). Subgroup analyses suggested greatest benefits for residents for whom the recommended interventions were carried out or who had 3 or more falls in the preceding year. Conclusion. —The high rate of falls and related injuries in nursing homes should not be viewed as inevitable, but as outcomes that can be substantially improved through structured safety programs.

Compliance with cardiovascular disease prevention strategies: A review of the research

Abstract: The efficacy of cardiovascular risk-reduction programs has been established. However, the extent to which risk-reduction interventions are effective may depend on adherence. Non-compliance, or non-adherence, may occur with any of the recommended or prescribed regimens and may vary across the treatment course. Compliance problems, whether occurring early or late in the treatment course, are clinically significant, as adherence is one mediator of the clinical outcome. This article, which is based on a review of the empirical literature of the past 20 years, addresses compliance across four regimens of cardiovascular risk reduction: pharmacological therapy, exercise, nutrition, and smoking cessation. The criteria for inclusion of a study in this review were: (a) focus on cardiovascular disease risk reduction; (b) report of a quantitative measure of compliance behavior; and (c) use of a randomized controlled design. Forty-six studies meeting these criteria were identified. A variety of self-report, objective, and electronic measurement methods were used across these studies. The interventions employed diverse combinations of cognitive, educational, and behavioral strategies to improve compliance in an array of settings. The strategies demonstrated to be successful in improving compliance included behavioral skill training, self-monitoring, telephone/mail contact, self-efficacy enhancement, and external cognitive aids. A series of tables summarize the intervention strategies, compliance measures, and findings, as well as the interventions demonstrated to be successful. This review reflects the progress made over two decades in compliance measurement and research and further, advances made in the application of behavioral strategies to the promotion of cardiovascular risk reduction.

The Unavoidable Intervention of Educational Research: A Framework for Reconsidering Researcher-Practitioner Cooperation

Abstract: As a framework for stimulating further, empirical investigation, I describe three different forms of direct researcher practitioner cooperation: data-extraction agreements, clinical partnerships, and co-learning agreements. Each form reflects different social arrangements, inquiry and reporting strategies, and operating assumptions, and each form also has different implications for supporting educational research and reform. Distinctions between these three forms illustrate some of the unavoidable ways in which educational research projects are social interventions in the lives of project participants. This prospect raises questions about how researchers and practitioners could be better prepared to design them as such.

A systematic review of the effectiveness of promoting lifestyle change in general practice.

Abstract: BACKGROUND There is increasing evidence that particular lifestyle behaviours increase the risk of disease and it is widely argued that GPs are ideally placed to encourage patients to modify their behaviour in these areas and thereby reduce their disease risk. There is therefore a need for evidence that GP-based lifestyle interventions are effective in eliciting behaviour change. As there has been no comprehensive attempt to review the literature on this subject, we chose to conduct a systematic review, incorporating meta-analytic techniques where possible, to address this need. OBJECTIVES This study aimed to examine how effective lifestyle advice provided by GPs is in changing patient behaviour. The following four areas of behaviour were examined: smoking, alcohol consumption, diet, and exercise. METHOD The review was restricted to English-language reports of trials which investigated the effectiveness of lifestyle advice provided in a general practice setting. Studies were included where it could be established that subjects were randomly allocated to experimental groups and where a comparison was made between either a "no intervention' or "usual care' control group, or between advice of differing intensities. Six electronic databases were searched and a total of 37 trials were selected for inclusion in the review. Meta-analytic techniques were employed to analyse the data from the smoking advice trials. The results form the trials concerned with the other three behaviours did not lend themselves to this form of analysis. Outcome data were extracted from these trials and summarized in tabular form. RESULTS The results of this review suggest that whilst many of the general practice-based lifestyle interventions show promise in effecting small changes in behaviour, none appears to produce substantial changes. CONCLUSION There is a need for more extensive and rigorous research in this area before substantial public funds are committed to general practice-based health promotion. Furthermore, it is clear that if general practice-based interventions are to be effective in a public health sense, a greater number of GPs will need to become involved in promoting behaviour change than the literature suggests is currently occurring.

Practice Parameters for the Assessment and Treatment of Children and Adolescents with Anxiety Disorders

Abstract: Anxiety disorders comprise one of the most prevalent categories of psychopathology in children and adolescents. These revised practice parameters highlight the DSM-IV changes for anxiety disorders and review the literature related to the assessment and treatment of anxiety disorders in children and adolescents. Up-to-date information on longitudinal outcome data, assessment of anxiety, parent-child interventions, and use of selective serotonin reuptake inhibitors has been added to the previous parameters, published in September 1993. Recommendations for evaluation and multimodal approaches to treatment are presented.

Helpfulness of interventions for mental disorders : beliefs of health professionals compared with the general public

Abstract: BACKGROUND The study aimed to compare the beliefs of health professionals about the potential helpfulness of various mental health interventions with those of the general public. METHOD Surveys were carried out in Australia of 872 general practitioners, 1128 psychiatrists, 454 clinical psychologists and 2031 members of the public. Respondents were presented with a case vignette describing either a person with depression or one with schizophrenia. Respondents were asked to rate the likely helpfulness of various types of professional and non-professional help and of pharmacological and non-pharmacological interventions. RESULTS The professionals gave much high ratings than the public to the helpfulness of antidepressants for depression, and of antipsychotics and admission to a psychiatric ward for schizophrenia. Conversely, the public tended to give much more favourable ratings to vitamins and minerals and special diets for both depression and schizophrenia, and to reading self-help books for schizophrenia. CONCLUSION The beliefs that health practitioners hold about mental disorders differ greatly from those of the general public. There is a need for mental health education campaigns to help close the gap between professional and public beliefs.

A cross-national trial of brief interventions with heavy drinkers

Abstract: OBJECTIVES The relative effects of simple advice and brief counseling were evaluated with heavy drinkers identified in primary care and other health settings in eight countries. METHODS Subjects (1260 men, 299 women) with no prior history of alcohol dependence were selected if they consumed alcohol with sufficient frequency or intensity to be considered at risk of alcohol-related problems. Subjects were randomly assigned to a control group, a simple advice group, or a group receiving brief counseling. Seventy-five percent of subjects were evaluated 9 months later. RESULTS Male patients exposed to the interventions reported approximately 17% lower average daily alcohol consumption than those in the control group. Reductions in the intensity of drinking were approximately 10%. For women, significant reductions were observed in both the control and the intervention groups. Five minutes of simple advice were as effective as 20 minutes of brief counseling. CONCLUSIONS Brief interventions are consistently robust across health care settings and sociocultural groups and can make a significant contribution to the secondary prevention of alcohol-related problems if they are widely used in primary care.

Effectiveness of school-based mental health services for children: a 10-year research review

Abstract: A review of the literature from 1985 to 1995 on school-based mental health services for children was conducted using a computerized data-base search Of the 5,046 references initially identified, 228 were program evaluations Three inclusion criteria were applied to those studies: use of random assignment to the intervention; inclusion of a control group; and use of standardized outcome measures Only 16 studies met these criteria Three types of interventions were found to have empirical support for their effectiveness, although some of the evidence was mixed: cognitive-behavioral therapy, social skills training, and teacher consultation The studies are discussed with reference to the sample, targeted problem, implementation, and types of outcomes assessed, using a comprehensive model of outcome domains, called the SFCES model Future studies of school-based mental health services should (a) investigate the effectiveness of these interventions with a wider range of children's psychiatric disorders; (b) broaden the range of outcomes to include variables related to service placements and family perspectives; (c) examine the combined effectiveness of these empirically-validated interventions; and (d) evaluate the impact of these services when linked to home-based interventions

Behavioral Support for Students with Severe Disabilities Functional Assessment and Comprehensive Intervention

Abstract: Behavioral support for students with severe disabilities has undergone dramatic advances in the past 15 years. The goals of effective behavioral support, as well as the procedures for reaching those goals, have broadened. Two central advances have been procedures for conducting functional assessment and the design of comprehensive interventions. The research foundation for these advances, implications for clinicians, and future research directions are presented.

Are two interventions worse than none? Joint primary and secondary prevention of eating disorders in college females

Abstract: Prevention programs for eating disorders attempt to simultaneously prevent new cases from arising (primary prevention) and encourage students who already have symptoms to seek early treatment (secondary prevention), even though ideal strategies for these 2 types of prevention may be incompatible with each other. In the present study, an eating disorder prevention program was evaluated in a simple of female college freshmen. In the intervention, classmates who had recovered from eating disorders described their experiences and provided information about eating disorders. At follow-up, intervention participants had slightly more symptoms of eating disorders than did controls. The program may have been ineffective in preventing eating disorders because by reducing the stigma of these disorders (to encourage students with problems to seek help), the program may have inadvertently normalized them.

Psychodynamic psychotherapy for cancer patients.

Abstract: Psychodynamic psychotherapy is effective as an approach to understanding the psychological conflicts and the psychiatric symptoms of cancer patients as well as to planning useful psychological interventions. The author recommends that the psychotherapist who treats cancer patients be familiar with the following: 1) the natural course and treatment of the illness, 2) a flexible approach in accord with the medical status of the patient, 3) a common sense approach to defenses, 4) a concern with quality-of-life issues, and 5) counter-transference issues as they relate to the treatment of very sick patients. Case reports illustrate the unique problems facing psychotherapists who are treating cancer patients. Further, these cases show the effective use of psychodynamic principles to inform the therapist of successful psychotherapeutic interventions.

Impact of HIV and sexual health education on the sexual behaviour of young people: a review update

Abstract: This report provides a review of the empirical literature on the effects of HIV/AIDS and sexual and health education on adolescent sex behavior. The review was commissioned by the UNAIDS Policy Strategy and Research Department and the Joint UN Program on HIV/AIDS. This review includes 53 studies that evaluated specific interventions: controlled and other intervention studies cross sectional surveys and international or national comparison studies. Four specific issues were discussed: methodological limitations education issues features of successful programs and the gender social context. Seven basic points were raised by the studies: 1) Education on sexual health and/or HIV/AIDS does not encourage sex activity; 2) good quality programs help delay first intercourse and provide the means to protect adolescents from HIV sexually transmitted diseases and from unwanted pregnancy; 3) adolescents can learn responsible safe sex behavior; 4) sexual health education should begin before the onset of sexual activity; 5) education should be gender-sensitive for both genders; 6) adolescents learn about sexual health issues from multiple sources; and 7) adolescents are a heterogeneous group and should be reached with multiple strategies. Effective education programs were found to be grounded in Social Learning Theory and to have a focused curriculum attention to social influences practice in communication and negotiation skills and openness in communicating about sex. Effective programs help adolescents with skills in decoding mass media messages. Program evaluation should have a solid study design and valid appropriate statistical techniques.

Integrated Treatment for Dually Diagnosed Homeless Adults

Abstract: This study examined the effects of integrating mental health, substance abuse, and housing interventions for homeless persons with co-occurring severe mental illness and substance use disorder. With the use of a quasi-experimental design, integrated treatment was compared with standard treatment for 217 homeless, dually diagnosed adults over an 18-month period. The integrated treatment group had fewer institutional days and more days in stable housing, made more progress toward recovery from substance abuse, and showed greater improvement of alcohol use disorders than the standard treatment group. Abuse of drugs other than alcohol (primarily cocaine) improved similarly for both groups. Secondary outcomes, such as psychiatric symptoms, functional status, and quality of life, also improved for both groups, with minimal group differences favoring integrated treatment.