ABSTRACT
Coercive interventions for psychiatric patients are controversial. Research on different preventive measures has increased over the last years. The present study examined patients' attitudes towards and understanding of previously experienced coercive measures as well as their preferences related to coercive measures and possible alternatives. In total, 213 patients who had experienced coercion and 51 patient controls (patients staying voluntarily on a closed ward with no coercive treatment) from three acute wards were examined via expert interviews and questionnaires in the framework of a naturalistic trial. Assessments included a new self-developed questionnaire as well as instruments measuring psychopathology. Patients who had experienced coercion differed from controls in both symptoms and insight into their illness. As expected, "noninvasive measures" (e.g., the use of a "soft room," observation in seclusion) were better accepted by patients than "invasive measures" (e.g., mechanical restraint, forced medication). Forced medication and mechanical restraint were less well accepted than involuntary hospitalization, seclusion, or video surveillance. The retrospective understanding of coercive measures increased over the course of treatment. In addition, patients rated a number of options for reducing coercion on the wards, particularly music or exercises. A large subgroup indicated they would like to discuss future admissions with the staff.
Subject(s)
Coercion , Health Knowledge, Attitudes, Practice , Mental Disorders/psychology , Mental Disorders/therapy , Patient Acceptance of Health Care/psychology , Psychiatry/methods , Adult , Aggression/psychology , Female , Hospitalization/trends , Hospitals, Psychiatric/trends , Humans , Male , Middle Aged , Restraint, Physical/psychology , Retrospective Studies , Surveys and QuestionnairesABSTRACT
BACKGROUND AND OBJECTIVES: Dual-process models suggest that automatic behavioral tendencies contribute to the development and maintenance of Obsessive Compulsive Disorder (OCD) symptoms. The aim of the present study was to investigate the potential of the Approach-Avoidance Task (AAT) to reduce OCD symptoms and associated distress. METHODS: The study was set up as an online intervention. Participants with OCD symptoms (N = 101) were randomly assigned either to one of two experimental conditions or a waitlist control group upon completion of an online baseline survey. Participants were instructed to respond to contamination-related and neutral pictures by pulling or pushing a computer mouse, respectively. In one AAT condition, contamination-relevant pictures remained on the screen one second after pulling (lock condition), while pictures disappeared immediately after pulling in the standard AAT. Participants completed an online re-assessment four weeks after baseline. RESULTS: For analyses, only data of patients with contamination-related OCD symptoms were analyzed. A significant reduction in distress caused by OCD symptoms was found for both AAT training groups. Furthermore, a reduction in compulsions occurred for the group using the standard AAT. No significant effect was found for the control group. LIMITATIONS: Implicit behavioral tendencies prior to and after training were not assessed. CONCLUSIONS: Findings tentatively suggest that the AAT might be effective in reducing washing-/contamination-related OCD symptoms.
