Assisted bibliotherapy: effective, efficient treatment for moderate anxiety problems. (1/29)

Specific psychological treatments of proven effectiveness for moderate anxiety disorders are not often easily accessible in general practice. In this study, selected patients were supported in learning skills to manage their symptoms. This approach was efficient, acceptable, and led to clinically significant symptom reduction for a high proportion of patients. This improvement was well sustained at three-month follow-up.  (+info)

Bereaved children. (2/29)

OBJECTIVE: To describe the unique aspects of childhood grief. To provide a framework for family physicians to use in assisting children to grieve. QUALITY OF EVIDENCE: A MEDLINE search from 1966 to 1999 using the key words children, childhood, grief, mourning, and bereavement revealed mainly expert opinion articles, some non-randomized observational studies, and retrospective case-control studies. MAIN MESSAGE: Although children are influenced by similar factors and need to work through the same tasks of grief as adults, their unique psychological defences and evolving cognitive and emotional development make their grieving different from adults'. Understanding these unique childhood features will allow family physicians to more effectively help children through the tasks of acknowledging a death, working through the pain of that death, and accommodating it. CONCLUSIONS: With a framework for grief counseling that incorporates unique features of children's mourning, family physicians will be in a better position to assist their young bereaved patients.  (+info)

Reducing therapist contact in cognitive behaviour therapy for panic disorder and agoraphobia in primary care: global measures of outcome in a randomised controlled trial. (3/29)

BACKGROUND: Panic disorder, with and without agoraphobia, is a prevalent condition presenting in general practice. Psychological treatments are effective but are limited by restricted availability. Interest has grown in methods by which the efficiency and thus availability of psychological treatments can be improved, with particular emphasis on reduced therapist contact formats. AIM: To evaluate the relative efficacy in a primary care setting of a cognitive behaviour therapy (CBT) delivered at three levels of therapist contact: standard contact, minimum contact, and bibliotherapy. METHOD: A total of 104 patients were randomly allocated to receive standard therapist contact, minimum therapist contact or bibliotherapy, with 91 patients completing treatment. All patients received an identical treatment manual and were seen by the same psychologist therapist. Outcome was reported in terms of brief global ratings of severity of illness, change in symptoms, and levels of social disruption. These brief measures were chosen to be suitable for use in general practice and were used at treatment entry and endpoint. RESULTS: The standard therapist contact group had the strongest and most comprehensive treatment response, showing significant differences from the bibliotherapy group on all, and the minimum therapist contact group on some, endpoint measures. Some reduction in efficacy was therefore found for the reduced therapist contact groups. CONCLUSION: The standard therapist contact group showed the greatest treatment efficacy in the present study. As it was of notably shorter duration than many other current formulations of CBT, it represents a useful and efficient treatment for panic disorder and agoraphobia in primary care.  (+info)

Bibliotherapy: the therapeutic use of didactic and literary texts in treatment, diagnosis, prevention, and training. (4/29)

The term bibliotherapy has been defined by Russell and Shrodes as "a process of dynamic interaction between the personality of the reader and literature--an interaction which may be used for personality assessment, adjustment, and growth." In the clinical setting, the dynamics that promote change in a patient-reader can include identification, projection, introjection, catharsis, and insight. Clinicians may use bibliotherapy as a tool for patient treatment, medical diagnosis, and the prevention of illness related to psychosocial dysfunction, allowing for gradual and mutual insight into patient complaints over time. Bibliotherapy may display efficacy on intellectual, psychosocial, interpersonal, emotional, and behavioral levels. The author identifies two basic types of resources that are useful to clinicians administering bibliotherapy: didactic texts, which are instructive, and imaginative literature, which can be a literary text, biography, or autobiography and fosters an imaginative response from the patient-reader. The author identifies the advantages and risks of using bibliotherapy and explores its possible applications in osteopathic medical education, encouraging osteopathic medical educators to familiarize themselves with this treatment modality.  (+info)

Brief report: a "storybook" ending to children's bedtime problems--the use of a rewarding social story to reduce bedtime resistance and frequent night waking. (5/29)

OBJECTIVE: To evaluate the efficacy and acceptability of a social story with tangible rewards to reduce children's disruptive bedtime behavior and frequent night waking. METHOD: Four children (ages 2 to 7), with clinically significant disruptive bedtime behavior, received the intervention, which consisted of a social story (The Sleep Fairy) that sets forth (a) parental expectations for appropriate bedtime behavior and (b) rewards for meeting those expectations. RESULTS: Parent sleep diaries indicated that children had a 78% average decrease in frequency of disruptive bedtime behaviors from baseline to intervention, with another 7% decrease at 3-month follow-up. Night wakings, a problem for 2 children during baseline, were not a problem during intervention and follow-up. Parents reported improved daytime behavior for 3 of the 4 children. Parents gave the intervention high acceptability ratings and maintained a high level of treatment fidelity. CONCLUSIONS: Use of a social story helped parents implement a multicomponent intervention using a familiar bedtime routine, thereby increasing the likelihood that implementation and effects occurred. The book format makes this intervention widely available to parents and professionals, with minimal costs and inconvenience.  (+info)

Medicus Deus: a review of factors affecting hospital library services to patients between 1790-1950. (6/29)

QUESTION: What are some of the historical societal, medical, and public health trends leading to today's provision of hospital library services to patients? DATA SOURCES: Literature from the archives of the Bulletin of the Medical Library Association and other library sources, medical journals, primary historical documents, and texts from the history of medicine form the core of this review. STUDY SELECTION: The period of review extends from about 1790 through 1950 and focuses solely on trends in the United States. Of primary concern are explicitly documented examples that appear to illustrate the patient-physician relationship and those between librarians and their patient-patrons during the earliest years of the profession's development. DATA EXTRACTION: An historical timeline was created to allow the identification of major trends that may have affected library services. Multiple literature searches were conducted using library, medical, and health anthropology resources. When possible, primary sources were preferred over reviews. MAIN RESULTS: Juxtapositioning historical events allows the reader to obtain an overview of the roots of consumer health services in medical libraries and to consider their potential legacy in today's health care libraries. CONCLUSION: This review article highlights early developments in hospital library service to patients. Further research is needed to verify a preliminary conclusion that in some medical library settings, services to the general public are shaped by the broader health care environment as it has evolved.  (+info)

Randomized trial of a brief depression prevention program: an elusive search for a psychosocial placebo control condition. (7/29)

This trial compared a brief group cognitive-behavioral (CBT) depression prevention program to a waitlist control condition and four placebo or alternative interventions. High-risk adolescents with elevated depressive symptoms (N=225, M age=18, 70% female) were randomized to CBT, supportive-expressive group intervention, bibliotherapy, expressive writing, journaling, or waitlist conditions and completed assessments at baseline, termination, and 1- and 6-month follow-up. All five active interventions showed significantly greater reductions in depressive symptoms at termination than waitlist controls; effects for CBT and bibliotherapy persisted into follow-up. CBT, supportive-expressive, and bibliotherapy participants also showed significantly greater decreases in depressive symptoms than expressive writing and journaling participants at certain follow-up points. Findings suggest there may be multiple ways to reduce depressive symptoms in high-risk adolescents, although expectancies, demand characteristics, and attention may have contributed to the observed effects.  (+info)

Treatment of social phobia through pure self-help and therapist-augmented self-help. (8/29)

BACKGROUND: Self-help for social phobia has not received controlled empirical evaluation. AIMS: To evaluate the efficacy of pure self-help through written materials for severe social phobia and self-help augmented by five group sessions with a therapist. These conditions were compared with a waiting-list control and standard, therapist-led group therapy. METHOD: Participants with severe generalised social phobia (n=224) were randomised to one of four conditions. Assessment included diagnoses, symptoms and life interference at pretreatment, 12 weeks and at 24 weeks. RESULTS: A larger percentage of patients no longer had a diagnosis of social phobia at post-intervention in the pure self-help group than in the waiting-list group, although this percentage decreased slightly over the next 3 months. Symptoms of social anxiety and life interference did not differ significantly between these groups. Augmented self-help was better than waiting list on all measures and did not differ significantly from group treatment. CONCLUSIONS: Self-help augmented by therapist assistance shows promise as a less resource-intensive method for the management of social phobia. Pure self-help shows limited efficacy for this disorder.  (+info)

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