A randomized controlled trial of guided imagery in bulimia nervosa.

BACKGROUND: The objective of this study was to test a guided imagery therapy designed to enhance self-comforting in bulimia nervosa. METHODS: A randomized controlled trial compared 6 weeks of individual guided imagery therapy with a control group. Fifty participants who met DSM-III-R criteria for bulimia nervosa completed the study. Measures of eating disorder symptoms, psychological functioning and the experience of guided imagery therapy were administered. RESULTS: The guided imagery treatment had substantial effects on the reduction of bingeing and purging episodes; the imagery group had a mean reduction of binges of 74% and of vomiting of 73%. The imagery treatment also demonstrated improvement on measures of attitudes concerning eating, dieting and body weight in comparison to the control group. In addition, the guided imagery demonstrated improvement on psychological measures of aloneness and the ability for self-comforting. CONCLUSIONS: Evidence from this study suggests that guided imagery was an effective treatment for bulimia nervosa, at least in the short-term.

Childhood sexual and physical abuse and adult self-harm and suicidal behaviour: a literature review.

This article reviews the link between childhood sexual and/or physical abuse and adult self-harm, suicidal ideation, and suicidal attempt from 1988 to 1998 in the clinical literature. Despite the methodological and definitional concerns, empirical studies have generally demonstrated more reports of self-harm, suicidal ideation, and suicidal behaviour in clinical and community populations of adults who report sexual and/or physical abuse in childhood than in comparison groups who do not report abuse. Implications for practice include the identification of populations at risk for self-harm or suicide and routine inquiry of abuse histories on admission. Further research into universal definitions of the key terms, standardized measurements of the variables, and longitudinal studies is required.

Recurrent themes of concern in groups for health care professionals.

This paper reports of recurrent themes of concern about AIDS expressed by health care professionals participating in small group sessions. Three dominant themes emerged: fear of contagion, homophobia, and attachment and loss. For each of these themes the possible meanings are explored. Fear of contagion was the dominant theme and is discussed as both a possible expression of displaced homophobia and a 'catastrophic' risk factor (extreme negative consequence). The need of health care professionals to see themselves as 'different' from the person with AIDS is also discussed. Professionals also discussed the emotional burden of caring for young patients often similar in age to themselves. It is suggested that hospital policy makers need to accept the reality of staff concerns and provide adequate forums for expression of concerns since without an opportunity for thoughtful discussion, health care professionals may espouse the 'correct' position and attitude, but believe and practise something else.

Fear of contagion and AIDS: nurses' perception of risk.

Nurses' fear of contagion when caring for persons with AIDS remains high despite increased levels of knowledge. This paper examines the multiple factors that contribute to nurses' perception of risk within the workplace. The authors suggests that constructs from theories such as decision making, psychoanalysis and cognitive psychology can provide insight into the assessment of risk. Findings from a recent survey of nurses are used to illustrate the complex nature of fear of contagion. Understanding this complexity may be an essential first step in order to provide opportunities for resolution of fears and modification of behaviors.

A randomized trial of group interventions for hospital staff caring for persons with AIDS.

The purpose of this study was to develop an educational package for health care providers. Findings from a survey conducted by investigators were used to direct intervention content. All subjects received a 1 hour educational package. Since this type of intervention was not expected to be sufficient to modify attitudes and concerns, 75% of the subjects received an additional 1 hour group discussion intervention (n = 118). In a subgroup of those receiving group interventions, the discussion was preceded by the presence of a person with AIDS (PWA) (in person or on video) discussing his personal experience with the illness and health care workers. It was demonstrated that in order to modify change attitudes, concerns, and affective response, groups were necessary. Furthermore, fear of risk of contagion and homophobia required the presence of a PWA (in person or on video) in order for change to occur.

The knowledge, attitudes and concerns of hospital staff about AIDS.

Staff from 3 Toronto hospitals were surveyed for knowledge, attitudes and concerns about AIDS. 70% of the 1,366 respondents had direct clinical experience with persons with AIDS. Data were analyzed according to hospital setting and professional group: physicians, nurses, technologists and supervisory staff. No setting difference was observed and although statistically significant differences (at the .001 level) were observed between professional groups, these differences are small and have little practical importance. In general, subjects answered 68% of the knowledge questions correctly. All attitudes and concerns were inversely associated to knowledge (Pearson r range was -.31 to -.20). Multivariate analysis demonstrated that knowledge and concern about contagion are important mediating variables (multiple r = .40) for other attitudes and concerns.