An orienting response model of eye movement desensitization.

Dyck's (Journal of Behavior Therapy and Experimental Psychiatry, 1993) conditioning model of EMD provides a useful description of failure of habituation in post-traumatic stress disorder, but may not account for some common EMD phenomena. An alternative model proposes that the therapist's waving hand--in the presence of a trauma-related cortical set--triggers an intense orienting response (OR). Intrinsic effects of the OR facilitate continuing attention to the memory without avoidance, and provide for effective input of new trauma-related information. The person's neuronal model of the trauma alters to reflect his survival and current safety--as true outcome of the trauma--and associated conditioned responses extinguish. Proposals for experimental evaluation of the model are described.

A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in post-traumatic stress disorder.

Thirty-six patients with PTSD were randomly allocated to individual treatment with imaginal exposure (image habituation training -- IHT), or applied muscle relaxation (AMR) or eye movement desensitization (EMD). Assessment by a blind independent rater and self-report instruments applied pre and posttreatment and at 3-month follow-up indicated that all groups improved significantly compared with a waiting list and that treatment benefits were maintained at follow-up. Despite a failure to demonstrate differences among groups, there was some suggestion that immediately after treatment EMD was superior for intrusive memories.

Resistance to treatment of adolescent sex offenders.

Little information is available concerning adolescent sexual offenders and their response to treatment. Of 45 sex offenders treated in two studies, 6 were adolescents and 21 of the 39 adults reported that their deviant behavior had commenced before or during adolescence. All 6 adolescents presented for treatment only following detection of their offenses, which in 3 led to legal charges. Of the 39 adults, 12 sought treatment voluntarily. Subjects were randomly allocated to receive covert sensitization, imaginal desensitization, medroxyprogesterone, or imaginal desensitization plus medroxyprogesterone. The response of the adults was equivalent to the best reported in the literature. Seven of the 39 required additional treatment, 3 being charged for further sexual offenses. Four of the 6 adolescents required additional treatment, 3 being charged with further sexual offenses. These differences were statistically significant. Adolescent sexual offenders may be more resistant to treatment because their sexual urges are under more direct hormonal control whereas in adults sexual urges are in part under the control of behavior completion mechanisms. Sexual offenses in adolescence need to be considered as at least as significant as those of adults, and more intensive follow-up treatment appears indicated in their management.

A survey of practising psychiatrists' views on treatment of the depressions.

The views of practising psychiatrists on treatment of the depressions were investigated as part of a Quality Assurance Project. A one in six random sample of all Australian psychiatrists was mailed a questionnaire. This asked for treatment recommendations for each of five case descriptions of patients with depression. Respondents were asked to code their treatment plans from a glossary listing possible treatments for depression: 85% of the sample responded. Tricyclic antidepressants were the treatment of choice for two cases of endogenous depression, electroconvulsive therapy (ECT) being recommended when psychotic features were present or when drug therapy had failed. Psychotherapies were the treatment of choice for cases with neurotic features, drugs being recommended when improvement with psychotherapy did not occur.

Reduced P200 latency and allusive thinking: an auditory evoked potential index of a cognitive predisposition to schizophrenia?

Auditory evoked potentials were recorded in healthy medical students who were grouped according to whether they obtained a high or low score on an Object Sorting Test (OST), on which schizophrenics also obtain high scores. High-OST scoring male students compared to Low-OST scoring male students showed reduced P200 latency. This finding was replicated in a second study of medical students. The authors believe these results support the hypothesis that schizophrenic thought disorder and an equivalent loosening of thinking in nonschizophrenic populations (allusive thinking) have a neurophysiological basis in common, namely a relative weakness of inhibition operating on cortical and subcortical structures.

Expectancy, covert sensitization and imaginal desensitization in compulsive sexuality.

Twenty subjects were randomly allocated to receive either imaginal desensitization (ID) or covert sensitization (CS) to reduce compulsive anomalous sexual behaviours. It was predicted from a behavioural completion model of compulsive urges, that patients' response to ID would be at least as good as their response to CS and would correlate with reduction in their general levels of tension following treatment. These predictions were supported. Correlations between patients' expectancies of treatment success and their response were of moderate strength for expectancy measures taken following the first session of both treatments, but much stronger for expectancy measures following the last session of ID. It was suggested that patients experienced a specific response during the further sessions of ID, which enabled them to improve their prediction of response. As aversive therapies remain the standard behavioural therapy for sexual paraphilias, the finding of the present study that imaginal desensitization without traumatic imagery or aversive physical stimuli is at least as effective would seem to require urgent replication, if only on ethical grounds.

Sexual orientation and consistency of sexual identity.

The semantic confusion in the use of the terms sexual and gender identity and role is discussed. Theories concerning the development of the sense of sexual identity in normals have been based largely on the sense of sexual identity in sexually deviant subjects. It is suggested that such subjects may have a stronger and more consistent sense of sexual identity than subjects unaware of sexually deviant impulses. Male medical students in two consecutive years anonymously completed a questionnaire concerning their sexual orientation, preference, role, and identity. In both years, students aware of a homosexual component answered the items investigating their sexual identity with greater consistency than did the students unaware of a homosexual component.

Controlled comparison of aversive therapy and imaginal desensitization in compulsive gambling.

Twenty compulsive gamblers were randomly allocated, half to receive aversion-relief therapy and half to receive imaginal desensitization; both groups were followed-up for one year. Compared with those who received aversion-relief, gamblers who received imaginal desensitization reported a significantly greater reduction of gambling urge and behaviour; they also showed a significant reduction in trait anxiety at one year and in state anxiety at one month and one year following treatment. A high level of state anxiety at one month following treatment predicted failure to respond to treatment at one year in the subjects who received imaginal desensitization, but not in those who received aversion-relief. The relationship between reduction in anxiety and in gambling urge in response to imaginal desensitization was predicted from the theory that compulsive gambling is driven by aversive tension.

Bisexual feelings and opposite-sex behavior in male Malaysian medical students.

The sexual identity of 65 Malaysian male medical students was investigated by anonymous questionnaire. Of these students, 40% were aware of homosexual feelings prior to age 15 years, and 16% were so aware currently. There were correlations between current homosexual feelings and feminine sex dimorphic behavior during childhood and between current homosexual feelings and feminine gender identity. The results are discussed in light of results of a similar questionnaire completed by 138 male medical students in Sydney, Australia.

Auditory hallucinations and the Verbal Transformation Effect.

In an attempt to replicate findings reported by Slade (1976), 12 hallucinating and 12 non-hallucinating shcizophrenic subjects were compared on tests of verbal ability, personality and mental imagery variables and the Verbal Transformation Effect. No significant differences between the groups was demonstrated. When the data from both groups of schizophrenics were combined, a significant correlation was found between 2 measures of the Verbal Transformation Effect and the P-score of the Eysenck Personality Questionnaire.

Dichotic listening and allusive thinking.

Previous work suggests that allusive thinkers have a broader attentional process associated with weak central inhibition. The method of dichotic stimulation was used to investigate this concept. Sixty-three university students completed a battery of tests including 2 dichotic listening tasks. The Object Sorting Test was used as a measure of allusive thinking. Allusive thinkers showed a trend towards impaired shadowing performance. Mislabelling of shadow as distractor words and vice versa, on recall and recognition tasks, showed the strongest correlation with allusive thinking. Such mislabelling was considered to reflect impaired discrimination learning, and provides further support for a hypothesis relating allusive thinking to weak Pavlovaian central inhibition.

Allusive thinking, the Word Halo and verbosity.

The concept of allusive thinking is briefly reviewed and a Pavlovian model of thinking advanced. It is hypothesized that allusive, as compared with non-allusive thinkers, have a broader but less intense attention process associated with weaker inhibition. From this model it was predicted that on word tests which require judgements of similarity of meaning, allusive thinkers would tend to choose more remote or unusual words as similar in meaning. The Word Halo Test and the Word Sorting Test were administered to 63 university students using the Object Sorting Test as a measure of allusive thinking. The prediction that allusive thinkers would choose more unusual words as similar in meaning was supported. A tendency for allusive thinkers to be more verbose than non-allusive thinkers was also noted.