Dissertations / Theses on the topic 'Compulsive behavior – Treatment'

The purpose of this study was to compare the impact of twelve weeks of instruction in two university-level educational approaches to self management (hatha yoga (EXSCI 119) and the current fitness/wellness core course (PEFWL 101) ) on the problematic behaviors of excessive smoking, dysfunctional eating and excessive alcohol consumption. Some theories of addiction, notably those of Peele and Clemmens, suggest that increased awareness, such as that promoted by hatha yoga, may be valuable to the alteration of the addictive process. The quantitative analysis utilized the stages and processes of change questionnaires developed by many researchers associated with the University of Rhode Island team led by James 0. Prochaska. Analysis of the data did not show any statistical difference between the two approaches. A secondary qualitative analysis suggests that hatha yoga students thought differently about themselves and their experience following their yoga class.
Fisher Institute for Wellness

Problem gambling is best understood from a biopsychosocial perspective, whereby multifaceted biological, psychological, and socio-environmental factors interact in ways that may lead to individual risk. Reinforcement contingencies and operant conditioning appear to play particularly important etiological roles. Theoretically, operant conditioning approaches should therefore comprise particularly effective treatment strategies. While operant conditioning in the form of contingency management is known to be an effective treatment for alcohol and substance abuse, it has never been applied by clinical practitioners in community-based treatment for problem gambling. The present pilot study explored the utility of adding concrete reward contingencies to community outpatient treatment, from the perspectives of clinical effectiveness and client/counsellor experiences. At 3-month follow-up, clinical outcomes compared well to typical treatment outcomes, and treatment retention appeared to be superior. Participating clients perceived concrete rewards to be moderately effective in the change process, while active therapist acceptance of this technique appeared to be limited.
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The purpose of this thesis was to investigate the feasibility of a treatment for hypersexual disorder (HD) by calculating and reporting the results with pre-collected data from a research project at ANOVA/Karolinska Universitetssjukhuset. The treatment was a cognitive behavioral group therapy (CBGT) developed for HD administered in a 7-session group setting with a sample of HD-diagnosed women (n = 16). Feasibility was explored through symptom change of hypersexuality, sexual compulsivity, psychological distress, and depression. Symptom change in relationship to treatment attendance was also explored. In this thesis, the results are considered in a broader context, discussing theoretical issues concerning women’s sexuality in relation to hypersexual problems and medicalization of hypersexual behaviors.   The treatment was shown to be feasible. Significant decrease was found on all measures. Attendance rate significantly correlated with a decrease in depressive symptoms, but not on other measures. Women’s sexuality might differ from men’s, but the treatment, which was first evaluated for men, is still feasible for women. Treatment for hypersexual problems in women and hypersexual problems in women in general have been understudied, which makes this study an important contribution to the research field. Further treatment studies could potentially investigate whether specific alterations based on gender and sexual orientation could be needed for further development of the treatment. There are issues concerning medicalization of hypersexual behaviors which should be considered when addressing the phenomenon, such as the influence of moral and cultural factors on the understanding of hypersexuality. Still, there is need for treatment for hypersexual behaviors experienced as problematic, and having these problems addressed within the medical and scientific field has potential for being beneficial and is preferred to having them left to alternative, unregulated health care providers.

The purpose of this study was to determine what influence scheduled phone contacts would have on the extent of follow-through of continuing care recommednations by participants after treatment. Continuing care recommendations associated with ongoing sobriety include going to another level of care (individual therapy, group therapy, outpatient treatment), attending twelve-step meetings and communicating with a sponsor. Continuing care recommendations are typically written and referred to as a continuing care plan.

The present scoping review of the literature was conducted to analyze all studies of assessment and treatment approaches for individuals diagnosed with obsessive compulsive disorder (OCD) and intellectual disabilities (ID). Search terms were used to identify articles published in behavioral journals. The criteria for the articles reviewed included articles that were peer-reviewed and empirical articles. Online search engines used contained information from the Journal of Applied Behavior Analysis, Journal of Experimental Analysis, The Psychological Record, Behavior Analysis in Practice, The Analysis of Verbal Behavior, and The Behavior Analysis. Key words used in the procedural method of searching for information included obsessive compulsive disorder, OCD, obsessions, compulsions, obsessive hand washing, ordering, checking, praying, counting, repetition, delusional beliefs, grandiose thoughts, controlled thoughts, hoarding, anxiety, panic, fears, germs, look feel sound just right, contamination, and excessive worries. The findings included total of 13,785 articles. After screening for duplication and relevant citations, 13 scoping reviews were identified as meeting eligibility criteria. The present paper reviewed what articles were available with respect to assessments and treatments among individuals with obsessive compulsive disorders and individuals with intellectual disabilities. The result of this study was that one article was found meeting the criteria of assessments and treatments among individuals with obsessive compulsive disorder and intellectual disabilities. The indication, as a result of this study, is that the current literature for assessments and treatments of the symptoms of obsessive compulsive disorders and intellectual disabilities is lacking, and future research is indicated.

O transtorno obsessivo-compulsivo (TOC) possui freqüentemente curso crônico, incapacitando cerca de 10% dos seus portadores. Os sintomas interferem de forma acentuada na vida do paciente, alterando suas rotinas e causando incompreensão dos familiares e daqueles que convivem com ele. A terapia cognitivo-comportamental em grupo (TCCG) é um tratamento eficaz, reduzindo os sintomas do TOC em mais de 70% dos portadores, sendo que ao redor de 27% obtêm remissão completa dos sintomas. Entretanto, cerca de 30% não obtêm nenhuma melhora. Conhecer as razões pelas quais esses pacientes não melhoram e identificar os fatores preditores associados ao aproveitamento ou não da terapia poderia auxiliar em uma melhor compreensão do TOC, numa melhor indicação do tratamento e no desenvolvimento de estratégias que incrementem sua eficácia. O presente estudo foi realizado com 181 pacientes com TOC, que cumpriram um programa de TCCG de 12 sessões semanais de 2 horas, entre outubro de 1999 e dezembro de 2006, no Programa de Transtornos de Ansiedade (PROTAN) do Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS) e tinha como objetivo verificar, em pacientes portadores de TOC, a existência de fatores preditores da resposta à TCCG.Os pacientes foram avaliados antes, durante e ao final do tratamento com os seguintes instrumentos: Y-BOCS, Y-BOCS chek-list, CGI, WHOQOL-BREF. Foi utilizada uma entrevista clínica estruturada com a finalidade de colher dados sobre os sintomas do paciente, histórico da doença, tratamentos anteriores e estabelecimento do diagnóstico do TOC de acordo com o DSM-IV-TR. Também foram coletados dados demográficos, socioeconômicos, status ocupacional, uso de medicação e critérios deinclusão na pesquisa. A entrevista foi complementada pelo MINI (International Neuropsychiatric Interview) para verificar a presença de comorbidades. Considerou-se como “resposta” a redução no mínimo de 35% nos escores da Y-BOCS e uma pontuação na CGI “normal” ou “limítrofe para doença” do pós para o pré-tratamento. O estudo pretende verificar se as seguintes variáveis: sexo, idade do paciente no início do tratamento, tempo de duração da doença, idade de início da doença, situação conjugal, nível de instrução, situação ocupacional, tipo de início da doença, curso, intensidade dos sintomas do TOC no início do tratamento, juízo crítico, história familiar, tipos de sintomas, uso de medicação específica para o TOC concomitante à TCCG estão associadas ou não com a resposta ao tratamento. Para avaliar a associação entre as variáveis categóricas à resposta ao tratamento, foi utilizado o teste qui-quadrado de Pearson. Nas variáveis dicotômicas foi aplicada a correção de Yates. Para avaliar as variáveis quantitativas em relação às categorias de resposta ao tratamento, foi utilizado o teste t de Student para amostras independentes. As variáveis que obtiveram um nível descritivo amostral (valor p) menor do que 0,25 foram inseridas no modelo de regressão logística múltipla.Fatores associados com uma melhor resposta à TCCG: sexo feminino (p=0,074); melhor juízo crítico acerca dos sintomas da doença (p=0,017); melhor qualidade de vida antes do início do tratamento: domínio físico (p=0,039), domínio psicológico (p<0,001), domínio ambiental (p=0,038), domínio social (p=0,053). Fatores associados com piores resultados: maior gravidade global da doença no início do tratamento, avaliada pela CGI (p=0,007); maior número de comorbidades associadas ao TOC (p=0,063); presença de fobia social (p=0,044) e distimia (p=0,072); presença de compulsão de repetição (p=0,104).Numa segunda etapa da análise estatística, incluiu-se no modelo todas as variáveis que na primeira fase haviam apresentado associação com os resultados. As variáveis que na análise de regressão logística múltipla permaneceram associadas significativamente foram: sexo feminino (ORAjustado=2,58; p=0,021); domínio psicológico da WHOQOLBREF (ORAjustado=1,05; p=0,011); juízo crítico (ORAjustado=2,67; p=0,042) e CGI-gravidade antes do inicio da terapia (ORAjustado=0,62; p=0,045). Embora alguns fatores relacionados com a resposta ao tratamento tenham sido identificados, poder prever quais os pacientes irão aproveitar a terapia e quais não irão se beneficiar é uma questão em aberto e está longe de ser esclarecida. As razões para essas dificuldades podem estar relacionadas à heterogeneidade do TOC e das amostras utilizadas nos diferentes estudos, além da falta de padronização das técnicas psicoterápicas utilizadas. Por fim, é possível que fatores não-específicos relacionados com a pessoa do terapeuta, com a qualidade da relação terapêutica, além da motivação e capacidade de tolerar frustração por parte do paciente possam exercer um papel importante que não tem sido avaliado pelas pesquisas.
Obsessive-compulsive disorder (OCD) frequently is a chronic disorder that incapacitates about 10% of patients. Symptoms severety affect the life of patients, change their routines and cause misunderstandings with family and all those that have contact with the patient. Group cognitive-behavioral therapy (GCBT) in 12 two-hour weekly sessions is an efficient treatment that reduces OCD symptoms in over 70% of the patients and results in complete remission of symptoms in 27%. However, about 30% of the patients do not show any improvement. The knowledge of reasons why these patients do not improve and the identification of factors associated with these different therapy outcomes may help to understand OCD better, and may inform treatment indications and the development of strategies to increase its efficacy. This study included 181 patients with OCD treated with 12 session of GCBT from October 1991 to December 2006 at the Anxiety Disorders Program (Programa dos Transtornos de Ansiedade – PROTAN) of Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. The purpose of this study was to investigate predictors of response to GCBT.The following instruments were used to evaluate patients before and at the end of the treatment: Y-BOCS, Y-BOCS checklist, CGI, WHOQOL-BREF. Evaluation was conducted by means of a structured clinical interview to collect data about the patient’s symptoms, disease history, previous treatments, and OCD diagnosis according to DSM-IVTR (APA, 2002). Demographic and socioeconomic data, occupational status, use of medication and criteria for inclusion in the study were also recorded. The interview wascomplemented with the MINI (International Neuropsychiatric Interview) to investigate comorbidities. Response criteria were: >35% reduction in Y-BOCS scores and normal or borderline CGI scores at post-treatment evaluation. The study investigated the possible association of the following variables with response to treatment: sex, age at beginning of treatment, disease duration, age at onset, marital status, education, occupation, type of disease onset, disease course, intensity of OCD symptoms at beginning of treatment, insight, family history, types of symptoms, and use of antiobsessional medications during GCBT. The Pearson chi-square test was used to evaluate the association between categorical variables and response to treatment. Yates correction was performed for dichotomous variables. The Student t test for independent samples was used to evaluate quantitative variables in relation to categories of response to treatment. Variables that achieved a p value lower than 0.25 were included in the initial logistic regression model, which evaluated the predictors of response to treatment and also controlled for possible confounding variables. The following factors showed associations with response to GCBT: women had greater odds of responding to treatment (p=0.074); better insight into disease symptoms was associated with better results (p=0.017); better quality of life before the beginning of treatment was also associated with better results (physical domain: p=0.039; psychological domain: p<0.001; environmental domain: p=0.038; social domain: p=0.053); patients with greater global severity of disease according to CGI had worse results (p=0.007); a greater number of associated comorbidities (p=0.063), social phobia (p=0.044) and dysthymia (p=0.072) were associated with poorer results; repeating compulsion was also associated with lower odds of responding to treatment (p=0.104).In the second stage of statistical analysis, all variables associated with results in the first analysis were included in the multivariate model, and the variables that retained significance were: female sex (ORAdjusted=2.58; p=0.021); WHOQOL-BREF psychological domain (ORAdjusted=1.05; p=0.011); insight (ORAdjusted=2.67; p=0.042) and CGI-severity before GCBT (ORAdjusted=0.62; p=0.045). Although we identified some factors associated with response to treatment, predicting which patients will benefit from therapy and which will not is still an open question. The reasons for such different outcomes may be associated with the heterogeneity of OCD and of the samples used in different studies, as well as with the lack of standardization of the psychotherapeutic techniques used. Finally, unspecific factors not associated with the person of the therapist, the quality of the therapeutic relationship, and the patient’s motivation and tolerance to frustration may play an important role that remains to be evaluated.

D-cycloserine (DCS), a partial agonist that acts on the N-methyl-D-aspartate (NMDA) receptor of the glutamatergic receptor complex, may enhance fear extinction learning during exposure-based therapy. Clinical studies in adults with obsessive-compulsive disorder (OCD) and non-OCD anxiety disorders - and a recent trial in pediatric OCD - have shown that DCS can improve treatment response to exposure therapy relative to placebo and exposure therapy. Some have hypothesized that improved treatment response is a function of increased compliance and engagement in therapeutic homework tasks, a core component of behavioral treatment. The present study examined the relationship between DCS and homework compliance in a 10-week, double-blind, placebo controlled DCS+CBT treatment trial with 30 children and adolescents with a primary diagnosis of OCD. D-cycloserine was dosed 25 or 50mg (depending on weight) one hour before therapy sessions 4-10. Group status (DCS or placebo) did not predict improved homework compliance over the course of treatment. However, significant group differences in homework compliance were found at the first exposure session. Additionally, homework compliance mediated the relationship between DCS and treatment outcome. When groups were collapsed, homework compliance was directly associated with treatment outcome. These findings suggest that outside the context of DCS, homework compliance is an integral part of OCD treatment.

INTRODUCTION: Initial examination of treatment worries suggest they may represent an important construct; however, previously used measures were limited by their specificity, scale format, and lack of parent report. Therefore the present study sought to examine the initial outcomes and psychometrics of newly developed corresponding measures of treatment worries in youth (Treatment Worries Questionnaire – Child; TWQ-C) and their parents (Treatment Worries Questionnaire – Parent; TWQ-P). METHODS: Participants were 94 youth (7-17-years old) and parent dyads presenting for psychosocial treatment of an anxiety disorder. Prior to initiation of treatment, dyads completed the TWQ-C and TWQ-P along with a host of additional child and parent report measures, and three clinician-rated measures. RESULTS: Treatment worries were endorsed in the mild-moderate range by youth and the TWQ-C demonstrated good-excellent internal consistency and test-retest reliability, a strong three-factor structure, and consistent convergent and divergent relationships. Treatment worries were endorsed in the low mild range by parents and the TWQ-P demonstrated fair-good internal consistency and test-retest reliability, a less empirically, but theoretically, supported four-factor structure, and consistent divergent relationships, but variable (by factor) convergent relationships. DISCUSSION: The results of the present study provide information on the concept of treatment worries and support the use of the TWQ-C and TWQ-P as broad assessments of the concept in a variety of populations. Low endorsement of worries among parents likely relates to the nature of the present sample (treatment-seeking) and may have contributed significantly to the less ideal psychometrics of the TWQ-P in comparison to the TWQ-C. Future investigation of treatment worries using the TWQ-C and TWQ-P in a variety of samples is warranted.

This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.

These British Association for Psychopharmacology guidelines cover the range and aims of treatment for anxiety disorders. They are based explicitly on the available evidence and are presented as recommendations to aid clinical decision making in primary and secondary medical care. They may also serve as a source of information for patients and their carers. The recommendations are presented together with a more detailed review of the available evidence. A consensus meeting involving experts in anxiety disorders reviewed the main subject areas and considered the strength of evidence and its clinical implications. The guidelines were constructed after extensive feedback from participants and interested parties. The strength of supporting evidence for recommendations was rated. The guidelines cover the diagnosis of anxiety disorders and key steps in clinical management, including acute treatment, relapse prevention and approaches for patients who do not respond to first-line treatments.

These British Association for Psychopharmacology guidelines cover the range and aims of treatment for anxiety disorders. They are based explicitly on the available evidence and are presented as recommendations to aid clinical decision making in primary and secondary medical care. They may also serve as a source of information for patients and their carers. The recommendations are presented together with a more detailed review of the available evidence. A consensus meeting involving experts in anxiety disorders reviewed the main subject areas and considered the strength of evidence and its clinical implications. The guidelines were constructed after extensive feedback from participants and interested parties. The strength of supporting evidence for recommendations was rated. The guidelines cover the diagnosis of anxiety disorders and key steps in clinical management, including acute treatment, relapse prevention and approaches for patients who do not respond to first-line treatments.

The aim of this study is to demonstrate how the complementary concepts of stability and change could manifest during the therapeutic process, specifically with clients showing the symptom of dependency. The study is guided by a literature study on systems/cybernetic theory with a focus on the cybernetic complementarity of stability and change. A brief description is provided of the symptom of dependency from a more traditional lineal perspective as well as a non-lineal (systemic) perspective. A single case study is utilized to describe how both stability and change could manifest in the therapeutic process. From this description the relevance and usefulness of addressing both stability and change during the therapeutic process emerge and are outlined.
Social Work
M. A. (Social Science Mental Health)

This study explores the possible efficacy of a low carbohydrate and high fat nutritional intervention (LCHF) as a treatment possibility aiming to improve the ability of self-control and regulation in the context of carbohydrate-addiction. The study first outlines why increased simple carbohydrate consumption has been implicated as a risk-factor in numerous chronic conditions, and then explores the possibility that a reduction of such consumption could lower general medical expenditure in the healthcare sector of already overburdened institutions, especially in developing countries like South Africa. Since the neurobiological evidence for food addiction is compelling, this study investigates the impact of a low carbohydrate and high fat eating (LCHF) regimen by measuring the change in the severity of addictive behaviour in relation to a reduced carbohydrate consumption. Results indicate that a LCHF nutritional intervention lessened addictive behaviour after just 30 days, resulting in a statistically significant decrease in addiction symptoms from day 1 to day 30. The weight and BMI values of the participants recorded at the end of the study showed a reduction from those obtained during the pre- treatment stage, and the self-perceived ‘feeling in control’ also improved in all participants after the intervention. The introduction of a LCHF nutritional intervention presents a relatively cost-effective treatment and preventative measure to combat carbohydrate over-consumption and its numerous health complications, and it is therefore hoped that the positive findings of this study will foster further research, using larger samples, into this type of nutritional intervention against addictive eating behaviour.
Psychology
M.A. (Psychology)

Text in English
The rationale for the study was to investigate the symbiotic connection of trauma and addiction. The focus is on childhood trauma and the turn to addictive practices to quell the memories and experiences endured as children. Chapter One discusses the methodology regarding the approach of the study and includes an introductory literature review of the phenomena. Additional literature is included in the ensuing chapters. A personal account of the motivation behind the research is chronicled in Chapter Two. In this chapter, I share with the readers my personal experiences around trauma and addiction in my family of origin. The notion of the blending of trauma and addiction is the focus of Chapter Three. It includes the approach to treatment of trauma and addiction as well as addiction counsellor training in the South African context. The storied lives of the participants and their experiences of trauma and addiction are encapsulated in Chapter Four. Finally, Chapter Five rounds off the study with the analyses of the narratives of the unique individuals who contributed to this research undertaking.
Psychology
M.A. (Psychology)

The study sought to explore the influence of gastrointestinal symptoms in female respondents with emetophobia disorder, panic disorder with agoraphobia and obsessive compulsive disorder. The research assessed a sample of sixty respondents which formed part of three groups which were recruited from clinical and online support groups. The age ranged from twenty to forty-five years. Non-probability quota sampling was employed. A non-experimental research design was implemented in order to make comparisons between these groups’ association of gastrointestinal symptoms and the occurrence of possible vomiting. The differential research strategy determined whether a statistically significant difference existed. The groups were assessed on the Gastrointestinal Symptom Score (2005) and the Patient Assessment of Upper Gastrointestinal Symptom Severity Index (2004). The research aimed to determine whether empirical support exists for the Cognitive Behavioural Model of Emetophobia by Boschen (2007).
Psychology
M.A. (Psychology)

The objectives of this study were to provide a detailed biopsychosocial description of the characteristics of a sample of 100 individuals screened and referred by the National Responsible Gaming Programme helpline for their outpatient treatment programme over an eighteen month period, and, importantly, to measure the success of this specific treatment programme at set intervals, up to a one year follow-up period. While 80% of the sample did not relapse during the six-week treatment programme, the number of treatment seekers without any gambling relapses during each follow-up period declined, and those falling back into gambling increased as time went on. After one year 47% of treatment seekers managed not to revert back to gambling – total abstinence. A further 28% reported having relapsed once or twice or that their gambling was controlled. 25% of treatment seekers reported that they reverted back to gambling fulltime which leaves the success rate of the treatment at 75%. Treatment seekers reported an overall reduction in gambling participation, debt and expenditure and an overall improvement in social and vocational functioning. There is evidence in this study to support the perspective that pathological gambling is a multidimensional disorder and that certain sub-groups of gamblers have distinct gambling behaviour.
Psychology
M.Soc.Sc.