By W. Sanford. Stetson University.

These are described as creating a sense of empathy or intimacy in social situations inderal 80 mg with amex. Ecstasy has accordingly been additionally referred to as an ‘empathogen’ or ‘entactogen’ discount inderal 40mg on line. The rapid emergence of ecstasy into youth culture in the late 1980s and early 1990s was the spur for a familiar ‘moral panic’ generic inderal 80mg mastercard, which rumbles on sporadically to this day discount inderal 40mg on-line. This panic was accompanied by a growing body of research inderal 80mg otc, assessing the risks and harms associated with the drug’s use in a range of environments. There was a clear dissonance between this research and much of the political and media response to the panic, which tended to misrepresent population harms by focusing obses- sively on individual fatalities. The most recent and comprehensive, independent systematic review of 85 the observational evidence was published in 2009. The study looked at over 4,000 published studies, 422 of which met the review criteria for inclusion. However, fatalities are relatively low given its widespread use, and are substantially lower than those due to some other Class A drugs, particularly heroin and cocaine. These risks can be minimised by following advice such as drinking appropriate amounts of water, although this is no substitute for abstinence. However, there is evidence for some small decline in a variety of domains, including verbal memory, even at low cumulative dose. The magnitude of such deficits appears to be small and their clinical relevance is unclear. However, we do now have a reasonable assessment of the drug’s risks, specifcally relative to other stimulants. Its toxic/acute risks are relatively low, especially if basic risk reduction advice is followed; these include hydration, managing overheating issues in dance club venues/party environments, and being aware of poly-drug use risks. Given this, we propose as a starting point a specialist pharmacist supply model, along the lines described for amphetamine and powder cocaine. At a practical level, an on-site licensed outlet would facilitate informed choice on content and dosage. This informed choice is sacrifced in illicit markets, in which ‘pills’ are of unknown strength, content and purity. Licensed on-site vendors would also be able to assume many of the responsibilities of the pharmacist role. They would be expected to 143 1 2 3 Introduction Five models for regulating drug supply The practical detail of regulation restrict sales on the basis of intoxication, multiple purchase and volume rationing, as well as offering advice on safer use. This would offer a degree of control over access, with removal of membership as sanction for any ‘house rules’ violations. These could include sales to third parties, or supply to indi- viduals who had already been denied club access. Without making any claims for its effcacy, such potentially benefcial research should not be curtailed purely on the basis of unrelated concerns about the drug’s recreational use on the party scene. It is reasonable to propose that any new drugs not covered by existing regulatory frameworks should not be, by default, legally available—as is often the case at present. A default prohibition, certainly on any form of commercial sales, would seem to be the more cautious and responsible course to take (poisons legislation could also come into play to cover 144 86 See for example: www. Such a prohibition would exist until any such drug had been subject to appropriate evaluation and recommendations by the relevant regulatory agencies. Quite how such a prohibition would operate raises a series of potentially tricky questions. Distinctions would have to be made, and sanctions determined, based on the nature of the drug and the motives for its production and supply. Commercial development and sales of unclas- sifed drugs would be the key target of such a restriction. However, it seems likely that the incentive for illicit chemists to develop and market new drugs on an unregulated basis would diminish if licit alternatives were available. Such commercially driven activities would usefully be separated from the, admittedly marginal, activities of ‘psychonauts’— drug chemist/hobbyists. Research into new drugs would ideally take place within an academic or government body under some form of external supervision and scrutiny. Jay, ‘From Soft Drink to Hard Drug; A Snapshot History of Coca, Cocaine and Crack’, Transform Drug Policy Foundation, 2005 * T. Whilst all have their own risk profles, these psychedelics have a number of qualities in common. They are also more toxic than other hallucinogens and often associated with unpleasant physical side effects—and are correspondingly not widely used recreationally (and have mostly never been prohibited), being of interest mostly to historians and a small group of ‘psychonauts’).

We suggest that future studies report on the level of self-guided exposure after the prescribed treatment protocol is over generic inderal 40 mg line, and examine whether those who engaged in self-directed exposure between post-treatment and follow-up continued to improve or maintained gains more than those who did not order 40mg inderal free shipping. We would also like to suggest the need for the experimental investigation of the effects of explicit instructions for self-guided exposure on long-term treatment efficacy purchase 80 mg inderal free shipping. A second limitation of the studies reviewed was the failure of most studies to include drop-outs in the outcome analyses order inderal 40 mg without a prescription. Consequently order 40 mg inderal free shipping, our effect sizes for the comparisons of interest are based on the subset of participants who completed treatment and thus one should not assume our findings generalize to intent-to-treat samples. A related issue is the failure of most studies to report the percentage of those who refused treatment, thus precluding the investigation of possible differences in palatability of various phobia treatments. It is recommended that future studies routinely report refusal rates to address this issue. Third, It should also be noted that the number of studies testing a non-exposure treatment were too few to allow more fine grained-analyses examining the efficacy of exposure treatments vs. Hence, our findings showing exposure treatments outperformed non-exposure alternative treatments should be interpreted with some degree of caution as should our finding showing that non-exposure treatments outperform no treatment. A similar limitation should be noted with respect to our findings on whether cognitive procedures enhance the efficacy of exposure treatments. Because of the small number of studies testing individual cognitive techniques, we were forced to use a lumping approach in which studies of any cognitive augmentation strategy were lumped together. Clearly, more studies are needed that examine alternatives to exposure-based methods. These should be studied in the context of a “stand alone” treatment as well as within the context of an exposure augmentation approach. Finally, our selection of moderator variables was constrained by the type of information supplied consistently across studies. Potentially important moderators, such as trait anxiety, distress tolerance, and psychiatric comorbidity could not be evaluated because either no information was provided for these variables, information was not provided in a way that could be coded for moderator analysis, or there was very little variation across studies on the variable of interest (e. The significant heterogeneity observed for several of the comparisons suggests other variables may be moderating treatment efficacy. Conclusions What conclusions can be drawn from this quantitative review of psychosocial treatments for specific phobia? First, our findings are consistent with other qualitative reviews (Barlow, Moscovitch, & Micco, 2004; Choy et al. Moreover, despite the brief duration of these treatments, the effect sizes relative to no treatment rank them as one of the most potent treatments for any psychiatric condition. Second, contrary to the assertion that one session of exposure treatment is as effective as multiple sessions, the data lead us to conclude that multiple exposure sessions are more effective than one session of exposure particularly at follow-up and suggest that clinicians should deliver treatment in multiple sessions to enhance long-term treatment gains. Third, our findings suggest that overall, non-exposure treatments do outperform no treatment, but the magnitude of this effect is about the same as that for placebo vs. Fourth, our findings suggest that those presenting with specific phobia display a moderate placebo response rate and highlight the importance of controlling for non-specific treatment effects in future efficacy studies. Rather, our moderator analyses found no significant moderator effect of specific phobia subtype on treatment outcome. We conclude that gaps in the existing treatment literature do not allow this question to be answered at this time and further conclude that treatment research in specific phobia will advance considerably by the addition of studies that test multiple treatments with participants presenting with different phobia subtypes. Hopefully, data from studies like these will provide the basis for developing empirically informed treatment matching strategies for the future. Effectiveness of psychological and pharmacological treatments for obsessive–compulsive disorder: A quantitative review. Psychosocial treatments for panic disorders, phobias, and generalized anxiety disorder. Effects of eye movement desensitization versus no treatment on repeated measures of fear of spiders. Emotional processing and fear measurement synchrony as indicators of treatment outcome in fear of flying. Treatment of claustrophobia and snake/spider phobias: Fear of arousal and fear of context.

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Treatment was delivered twice weekly for 45 minutes and addressed the 5 schema modes specifc to borderline personality discount inderal 80 mg mastercard. Participants in both conditions improved signifcantly on all outcomes measures with the exception of one quality of life measure generic inderal 80mg line. No added value of crisis support was found on any outcome measure after 18 months of treatment discount 80mg inderal with amex. Psychodynamic PsychotheraPy title of PaPer A controlled trial of psychodynamic psychotherapy for co-occurring borderline personality disorder and alcohol use disorder authors and journal Gregory generic 80 mg inderal visa, R generic 80mg inderal mastercard. Those in the intervention group received individual, weekly sessions of manualised dynamic deconstructive psychotherapy for 12 to 18 months. Transference-focused psychotherapy consisted of 2 individual weekly sessions and supportive treatment consisted of 1 weekly session, with more available if required. Compared with standard care or other control conditions, family intervention reduced the risk of relapse at treatment end and up to 12 months posttreatment. No evidence for the effectiveness of psychodynamic approaches in terms of symptoms, functioning or quality of life was found. Both treatments were manualised and delivered for 9 months with a planned minimum of 12 sessions and a maximum of 20 sessions. The number of sessions ranged 6 to 16 and treatment length ranged from 6 to 12 weeks. Due to the methodological weaknesses of the studies reviewed, including the absence of an active control group, further research is needed before practice recommendations can be made. Psychoeducation was diffcult to distinguish from the provision of good quality information as required in standard care, and from family intervention, where information is provided to family members. When indirect comparisons were made between single family intervention and multiple family intervention, the data suggest that only the former may be effcacious in reducing hospital admission. No new robust evidence for the effectiveness of psychoeducation on any of the critical outcomes was found. Family intervention may also be effective in improving additional critical outcomes such as social functioning and disorder knowledge. The studies included in the analysis were all conducted before 1983 and interventions were relatively short. Other favourable outcomes include decreased use of medication and improved work and social functioning. Results from the case series and case studies suggest that about two-thirds of those who receive dissociative disorders-focused treatment improve. All studies included in the analysis met Nathan and Gorman’s (2002) criteria for Type 1 or Type 2 studies. The groups did not differ in time to recurrence of depression or mania, however the family-focused therapy group had shorter times to recovery from depression, less time in depressive episodes, and lower depression severity scores during the 2-year study. Most studies met Nathan and Gorman’s (2002) criteria for Type 1 (23), Type 2 (7) or Type 3 (3) studies. Anxiety disorders Panic summary of evidence In the current review, no recent studies were found to indicate the effectiveness of any interventions for this disorder. Posttreatment, in vivo exposure was superior to education support and at the 6-month follow up, those receiving in vivo exposure continued to do better than those in education support. It comprised psychoeducation, skills training, exposure, cognitive restructuring, and relapse prevention. In addition, children in the intervention condition showed greater reductions in parent and laboratory-observed measures of behavioural inhibition. All studies included in the analysis met Nathan and Gorman’s (2002) criteria for Type 1, 2, or 3 studies. For the treatment of substance-use disorders in children, no recent studies were found. However, after 12 months, there was no differential benefcial effect of the intervention on substance use. For alcohol use, all treatments were effective, with therapist-delivery showing the largest effect. A meta-analysis was conducted to determine effect sizes across the selected studies.

Nonetheless buy inderal 80mg with amex, other special features of dialectical behavior therapy order inderal 80mg visa, such as the requirement for all therapists to meet weekly as a group discount inderal 80 mg without a prescription, could contribute to the results discount 80mg inderal amex. The patients with borderline personality disorder exhibited improvement in depression order 80mg inderal mastercard, hopeless- ness, and suicidal ideation, but the improvement was not greater than it was for a control group. In this study, compared with control subjects, patients receiving the dialectical behavior therapy treatment showed a paradoxical increase in parasuicidal acting out during the brief hospitalization (average length of stay was 12. Barley and colleagues (152) compared dialectical behavior therapy received by patients with borderline personality disorder on a specialized personality disorder inpatient unit with treat- ment as usual on a similar-sized inpatient unit. They found that the use of dialectical behavior therapy was associated with reduced parasuicidal behavior. It is unclear whether improvement was due to dialectical behavior therapy per se or to other elements of the specialized unit. Perris (153) reported preliminary findings from a small uncontrolled, naturalistic follow-up study of 13 patients with borderline personality disorder who received cognitive behavior ther- apy similar to dialectical behavior therapy. Twelve patients were evaluated at a 2-year follow-up point, and all patients maintained the normalization of functioning that had been evident at the end of the study treatment. Other controlled studies reported in the literature of cognitive behavior approaches are dif- ficult to interpret because of small patient group sizes or because the studies focused on mixed types of personality disorders without specifying borderline cohorts (154–156). Treatment of Patients With Borderline Personality Disorder 51 Copyright 2010, American Psychiatric Association. In summary, there are a number of studies in the literature suggesting that cognitive behavior therapy approaches may be effective for patients with borderline personality disorder. Most of these studies involved dialectical behavior therapy and were carried out by Linehan and her group. Replication studies by other groups in other centers are needed to confirm the validity and generalizability of these findings. Instead, longer forms of treatment, such as “schema-focused cognitive therapy” (147), “complex cognitive therapy” (144), or dialectical behavior therapy (17), are usually recommended. The standard length of dialectical behavior therapy is approximately 1 year for the most commonly administered phase of the treatment. It involves 1 hour of individual therapy per week, more than 2 hours of group skills training per week (for either 6 or 12 months), and 1 hour of group process for the therapists per week. Other versions of dialectical behavior therapy, such as that administered in a brief inpatient setting (151), may be useful but are not necessarily more effective than other forms of inpatient treatment. For example, as Linehan (17) pointed out, focusing on “therapy-interfering behavior” is similar to the psychodynamic emphasis on trans- ference behaviors. Beck and Freeman (19) noted that cognitive therapists and psychoanalysts have the common goal of identifying and modifying “core” personality disorder problems. However, psychodynamic therapists view these core problems as having important unconscious roots that are not available to the patient, whereas cognitive therapists view them as largely in the realm of awareness. It is not clear how successfully psychiatrists who have not been trained in cognitive behavior therapy can imple- ment manual-based cognitive behavior approaches. Although dialectical behavior therapy has been well described in the literature for many years, it is not clear how difficult it is to teach to new therapists in settings other than that where it was developed. Variable results in other settings could be due to a number of factors, such as less enthusiasm for the method among therapists, differences in therapist training in dialectical behavior therapy, and different patient populations. Although the Linehan group has developed training programs for therapists, certain characteristics recommended in dialectical behavior therapy (e. Group therapy a) Goals The goals of group therapy are consistent with those of individual psychotherapy and include stabilization of the patient, management of impulsiveness and other symptoms, and examina- tion and management of transference and countertransference reactions. Groups provide special opportunities for provision of additional social support, interpersonal learning, and diffusion of the intensity of transference issues through interaction with other group members and the ther- apists. In addition, the presence of other patients provides opportunities for patient-based lim- it-setting and for altruistic interactions in which patients can consolidate their gains in the process of helping others. However, these studies had no true control condition, and the efficacy of the group treatment is unclear, given the complexity of the treatment received. Another small chart review study of an “incest group” for patients with borderline personality disorder (159) suggested shorter subsequent inpatient stays and fewer outpatient visits for treated patients than for control subjects. A randomized trial (160) involving patients with borderline person- ality disorder showed equivalent results with group versus individual dynamically oriented psy- chotherapy, but the small sample size and high dropout rate make the results inconclusive. This quasi-experimental, nonrandomized study showed that patients with borderline personality disorder discharged from a day program with continuing outpa- tient group therapy (N=12) did better than those who did not have group therapy (N=31).

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