RESUMEN
The transportability of cognitive-behavioral therapy (CBT) for panic disorder to a community mental health center (CMHC) setting at 1-year follow-up was examined by comparing CMHC treatment outcome data with results obtained in controlled efficacy studies. Participants were 81 CMHC clients with a primary diagnosis of panic disorder with or without agoraphobia who completed CBT for panic disorder. Despite differences in settings, clients, and treatment providers, both the magnitude of change from pretreatment to follow-up and the maintenance of change from posttreatment to follow-up in the CMHC sample were comparable with the parallel findings in the efficacy studies. At follow-up, 89% of the CMHC clients were panic free and a substantial proportion of the sample successfully discontinued benzodiazepine use.
Asunto(s)
Terapia Cognitivo-Conductual/métodos , Trastorno de Pánico/terapia , Adulto , Ansiolíticos/uso terapéutico , Benchmarking , Benzodiazepinas , Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Trastorno de Pánico/tratamiento farmacológico , Rhode Island , Prevención Secundaria , Resultado del TratamientoRESUMEN
A. Holtzworth-Munroe and G. L. Stuart (1994) proposed that 3 subtypes (family only [FO], borderline-dysphoric [BD], and generally violent-antisocial [GVA]) would be identified using 3 descriptive dimensions (i.e., severity of marital violence, generality of violence, psychopathology) and would differ on distal and proximal correlates of violence. Maritally violent men (n = 102) and their wives were recruited from the community, as were 2 comparison groups of nonviolent couples (i.e., maritally distressed and nondistressed). Four clusters of violent men were identified. Three resembled the predicted subtypes and generally differed in the manner predicted (e.g., FO men resembled nonviolent groups: BD men scored highest on measures of dependency and jealousy; GVA men had the most involvement with delinquent peers, substance abuse, and criminal behavior; and both BD and GVA men were impulsive, accepted violence, were hostile toward women, and lacked social skills). The 4th cluster (i.e., low-level antisocial) fell between the FO and GVA clusters on many measures.
Asunto(s)
Trastorno de Personalidad Antisocial/psicología , Determinación de la Personalidad/estadística & datos numéricos , Maltrato Conyugal/psicología , Violencia/psicología , Trastorno de Personalidad Antisocial/diagnóstico , Dependencia Psicológica , Trastornos Disruptivos, del Control de Impulso y de la Conducta/diagnóstico , Trastornos Disruptivos, del Control de Impulso y de la Conducta/psicología , Femenino , Humanos , Celos , Masculino , Persona de Mediana Edad , Psicometría , Reproducibilidad de los ResultadosRESUMEN
Two studies compared marital communication behaviors of violent and nonviolent couples. In Study 1, violent distressed (VD) men reported more husband demand-wife withdraw than did nonviolent men. Distressed men reported less mutual constructive communication and more mutual blame and avoidance than did nondistressed men. Interactions of VD, violent nondistressed (VND), nonviolent distressed (NVD), and nonviolent nondistressed couples were coded in Study 2. VD spouses tended to engage in the most demand and withdraw and the least positive behavior; violent couples had the highest levels of contempt. On some codes, VND couples resembled NVD couples, suggesting that violence without distress may correlate differently with marital communication than violence in combination with distress and that severity of violence is important to consider.
Asunto(s)
Comunicación , Maltrato Conyugal/psicología , Esposos/psicología , Adulto , Análisis de Varianza , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Salud de la Familia , Femenino , Humanos , MasculinoRESUMEN
This work examines the transportability of cognitive-behavioral therapy (CBT) for panic disorder to a community mental health center (CMHC) setting by comparing CMHC treatment outcome data with the results obtained in two controlled efficacy trials. Participants were 110 clients with a primary diagnosis of panic disorder with or without agoraphobia; clients were not excluded on the basis of medication use or changes, severity or frequency of panic attacks, age, or the presence of agoraphobia. Clients completed a 15-session CBT protocol. Despite differences in settings, clients, and treatment providers, the treatment outcomes for clients completing treatment in the CMHC and the efficacy studies were comparable: Of the CMHC clients who completed treatment, 87% were panic-free at the end of treatment, and clients showed significant reductions in anticipatory anxiety, agoraphobic avoidance, generalized anxiety, and symptoms of depression. The present study suggests that panic control treatment can be transported to a CMHC. Challenges facing the transportability of research-based treatment to CMHC clients, settings, and treatment providers are discussed.
Asunto(s)
Agorafobia/terapia , Benchmarking , Terapia Cognitivo-Conductual , Centros Comunitarios de Salud Mental , Trastorno de Pánico/terapia , Adulto , Agorafobia/diagnóstico , Agorafobia/psicología , Empirismo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastorno de Pánico/diagnóstico , Trastorno de Pánico/psicología , Resultado del TratamientoRESUMEN
Marital violence researchers have generally used the terms anger and hostility interchangeably. However, there are important differences between anger and hostility that may be vital to understanding the relationship between these constructs and marital violence. The present manuscript highlights the advantages of distinguishing between anger and hostility. In order to investigate the role of anger and hostility in marital violence, we provide a comprehensive review of 26 empirical studies in addition to critically examining researchers' definitions of anger and hostility and the methods of assessment utilized in this body of research. While many researchers have presented data suggesting that maritally violent men are higher in anger and hostility than maritally nonviolent men, the findings are not consistent and vary in accordance with the construct assessed and the assessment strategy used.
Asunto(s)
Ira , Hostilidad , Psicología Clínica/normas , Maltrato Conyugal/psicología , Terminología como Asunto , Adulto , Ira/clasificación , Ira/fisiología , Causalidad , Cognición/clasificación , Cognición/fisiología , Emociones/clasificación , Emociones/fisiología , Humanos , Masculino , Psicometría/métodos , Psicometría/normas , Proyectos de Investigación/normasRESUMEN
Previous typologies of male batterers, including typologies developed by means of rational-deductive and empirical-inductive strategies, are reviewed. On the basis of this review, 3 descriptive dimensions (i.e., severity of marital violence, generality of the violence [toward the wife or toward others], and psychopathology/personality disorders) that consistently have been found to distinguish among subtypes of batterers are identified. These dimensions are used to propose a typology consisting of 3 subtypes of batterers (i.e., family only, dysphoric/borderline, and generally violent/antisocial). A developmental model of marital violence is then presented, and the previous literature is reviewed to examine how each batterer subtype might differ on variables of theoretical interest. Finally, some of the methodological limitations of previous typology research are reviewed, and suggestions for future work are offered.