The effectiveness of Stress Inoculation Training with Prolonged Exposure (SITPE) was compared to Eye Movement Desensitization and Reprocessing (EMDR). Twenty-four participants who had a diagnosis of Post Traumatic Stress Disorder (PTSD) were randomly assigned to one of the treatment conditions. Participants were also their own wait-list control. Outcome measures included self-report and observer-rated measures of PTSD, and self-report measures of depression. On global PTSD measures, there were no significant differences between the treatments at the end of therapy. However on the subscale measures of the degree of intrusion symptoms, EMDR did significantly better than SITPE. At follow-up EMDR was found to lead to greater gains on all measures.

Since the brain neurotransmitter changes characterising panic disorder remain uncertain, we quantified brain noradrenaline and serotonin turnover in patients with panic disorder, in the absence of a panic attack. Thirty-four untreated patients with panic disorder and 24 matched healthy volunteers were studied. A novel method utilising internal jugular venous sampling, with thermodilution measurement of jugular blood flow, was used to directly quantify brain monoamine turnover, by measuring the overflow of noradrenaline and serotonin metabolites from the brain. Radiographic depiction of brain venous sinuses allowed differential venous sampling from cortical and subcortical regions. The relation of brain serotonin turnover to serotonin transporter genotype and panic disorder severity were evaluated, and the influence of an SSRI drug, citalopram, on serotonin turnover investigated. Brain noradrenaline turnover in panic disorder patients was similar to that in healthy subjects. In contrast, brain serotonin turnover, estimated from jugular venous overflow of the metabolite, 5-hydroxyindole acetic acid, was increased approximately 4-fold in subcortical brain regions and in the cerebral cortex (P < 0.01). Serotonin turnover was highest in patients with the most severe disease, was unrelated to serotonin transporter genotype, and was reduced by citalopram (P < 0.01). Normal brain noradrenaline turnover in panic disorder patients argues against primary importance of the locus coeruleus in this condition. The marked increase in serotonin turnover, in the absence of a panic attack, possibly represents an important underlying neurotransmitter substrate for the disorder, although this point remains uncertain. Support for this interpretation comes from the direct relationship which existed between serotonin turnover and illness severity, and the finding that SSRI administration reduced serotonin turnover. Serotonin transporter genotyping suggested that increased whole brain serotonin turnover most likely derived not from impaired serotonin reuptake, but from increased firing in serotonergic midbrain raphe neurons projecting to both subcortical brain regions and the cerebral cortex.

The comparable rates of symptomatic distress, functional impairment, and prior psychiatric illness and treatment suggest that patients with subsyndromal anxiety and depressive symptoms warrant clinical recognition and possibly specific treatment.

This study describes the development of the Tinnitus Stages of Change Questionnaire (TSOCQ), which aims to assess the readiness of tinnitus patients to change their behaviors and attitudes in relation to tinnitus. Its ability to predict treatment outcome was also investigated. One hundred and fifty-one patients with tinnitus completed the questionnaire. Through repeated principal component analyses, together with judgments of the factors' theoretical relevance, empirically and clinically meaningful scales were derived. A factor solution in accordance with the transtheoretical model (TTM) and with acceptable psychometric properties was found with the five scales of the TSOCQ labeled Precontemplation (Medical Solution), Precontemplation (Helplessness), Contemplation, Preparation and Action/Maintenance. Participants scoring high on Precontemplation (Helplessness) and low on Action/Maintenance had better treatment outcomes. In conclusion, the TSOCQ had some ability to predict treatment success, but further research is required into the utility of the TTM for understanding the rehabilitation process in tinnitus patients.

ames (1994) describes one of the central dilemmas facing professional health psychologists. Should they J become increasingly involved in training other health professionals to implement psychological procedures? What are the ultimate implications for their profession if they do so? This paper argues that James is basically correct in his overall recommendations but that an appropriate model for t h e transfer of psychological skills is required. A model is proposed which involves the recognition that because of their training, psychologists possess a thorough understanding of psychological theory and should therefore assume responsibility for its application. The ultimate well-being of health-care consumers may best be served by professional psychologists occupying consultant roles within the health-care system.