Cognitive-behavioural approaches to treatment have become an important part of the clinical management of chronic pain. More recent developments in cognitive-behavioural theory, based on recent developments in the understanding and treatment of health anxiety, have emphasized the importance of catastrophizing appraisals, which drive both attentional processes and behavioural responses, which in turn are believed to be crucial for the maintenance of chronic pain. The experiment conducted here investigated the responses of pain patients (n=39) and controls (n=71) to a behavioural task (prolonged squeezing a dynamometer). Subsequently, the impact of a cognitive task, which fully engaged participants' attention (dichotic listening) was examined. Participants were asked, firstly, to sustain an isometric muscle contraction task (squeezing); secondly, to learn an attentional demanding task (dichotic listening); thirdly, to recall the discomfort experienced in the squeezing task and lastly, to perform both squeezing and dichotic listening at the same time. The squeezing tasks were experimentally manipulated by attaching a more or less negative label ("pain tolerance test" vs. "muscle stamina and strength test"). Patients were found to be less able to sustain prolonged muscle tension than controls, but the effect was not evident once the distracting task was introduced; similar effects were found for discomfort. All participants subsequently recalled the squeezing task as being longer and associated with less discomfort than they had actually recorded it at the time. In the dichotic listening tasks, although patients detected the same number of words overall as controls did, they were less able to focus on the target channel (i.e. they detected more of the words included as distractors on the unattended channel).
This study aimed to examine the effect on anxiety about health of a self-referent health questionnaire, in which people were asked to respond to questions about personal risk factors. Participants were randomly allocated into one of two experimental conditions (completing a self-referential assessment of their current health, or personality), with dependent variables measured before and after the experimental manipulation. Dependent variables included general and disease-specific (CHD, Stroke and Diabetes) anxiety and need for reassurance. Analysis of covariance suggested that participants who completed the health-focused questionnaire significantly increased in their anxiety ratings about Heart Disease, Stroke and Diabetes relative to those who completed the personality-focused assessment. There was no effect on general anxiety ratings. The results have important implications for measurement procedures commonly employed in health psychology, as they suggest that asking participants to rate factors related to health risk may lead to other psychological changes. It is important that subsequent research identify the duration of such effects.
The article provides an overview of published treatment manuals for psychotherapy in bipolar disorders and discusses content and structure of manualized programs. This is followed by a more detailed description of an elaborated psycho-educative program which have successfully been applied in individual as well as in group settings for the education of inpatients, outpatients and patients' relatives. Future research needs to further evaluate existing programs in terms of treatment efficacy.
The article provides an overview of clinical self-rating scales for manic symptoms, aiming to promote its use in clinical practice. Of the four identified scales available in German language, the Manie-Selbstbeurteilungs-Skala MSS by Bräunig et al., which is a translation of the Self-Rating Manic Inventory SRMI by Shugar et al., is the best validated instrument both for diagnostic purposes and for measuring symptom severity during the course of illness. This overview is followed by a brief discussion of newer developments in the bipolar spectrum, temperament and hypomania research. In addition, options of using mania scales for measuring hypomania according to DSM-IV and/or ICD-10 criteria for bipolar disorders are suggested.
On the basis of a vulnerability-stress-model psycho-educative, cognitive-behavioural, family-oriented and interpersonal approaches of psychotherapy for bipolar disorders are described. This is followed by a review of randomised controlled trials investigating the treatment efficacy of psychotherapeutic interventions. These studies show positive results particularly for psychoeducation, cognitive-behavioural therapy and family-oriented therapy. Finally, it is discussed in which respects evidence for the successful implementation of psychotherapy is still missing and why it is so important to move towards manualized psychotherapeutic programs.
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