Relaxation therapy in Tourette syndrome: a pilot study.

To evaluate the feasibility and efficacy of behavioral relaxation therapy as treatment for Tourette syndrome, 23 patients were recruited from a university-based pediatric Tourette syndrome referral clinic. Individuals were randomized and stratified according to initial tic severity and the presence of attention-deficit hyperactivity disorder into either relaxation therapy or a minimal therapy (control) group. Sixteen patients, mean age 11.8 years (S.D. 2.8 years), completed the 3-month study, which included weekly, hour-long, individual training sessions for 6 weeks. Individuals (n = 7) in the relaxation therapy group demonstrated a significantly increased ability to relax, compared with the minimal therapy (awareness and quiet time training) group. At 6 weeks, tic findings, based on five established tic severity scales, revealed greater improvement in the relaxation treatment group, but values failed to reach statistical significance. No difference between therapy groups was apparent at the 3-month evaluation. The acquired ability to relax did not significantly affect behavioral measures on the Child Behavioral Checklist. On the basis of this pilot study, relaxation therapy appears to have a limited role in the treatment of tics in Tourette syndrome.

Development of an inventory for dizziness and related factors.

Dizziness is an extremely common complaint of patients, yet often goes unexplained after medical evaluation, which can lead to inappropriate treatment. There is a lack of psychometrically sound self-report instruments that measure dizziness and related factors. This study describes the application of factor analytic procedures with 184 dizzy patients' responses to develop the Dizzy Factor Inventory (DFI), a 44-item inventory divided into three sections and modeled after the Multidimensional Pain Inventory. The first section consists of symptom factors, the second concerns responses of significant others to the dizzy patient, and the third section assesses activity level. This inventory groups symptoms into empirically distinct factors that could be related in clinical and research applications to physiological and psychological processes, and could be useful for treatment planning and measuring treatment progress. Factors derived with dizzy patients are compared to factors found with chronic pain patients.

Compliance to nicotine gum recommendations in a multicomponent group smoking cessation program: an exploratory study.

This is an exploratory study of compliance to nicotine chewing gum in a multicomponent group smoking cessation program where usage was optional. Two-thirds (24 out of 36) of the participants across three group sessions complied with the recommendation to use nicotine chewing gum. All subjects received standard instructions. Demographic characteristics (age, sex, site of employment) and smoking variables (number of years smoked, pretreatment number of cigarettes smoked per day, and nicotine dependence) failed to predict compliance, but complaint participants reported significantly greater confidence at their ability to not smoke in various challenging situations as measured by the Smoking Self Efficacy Questionnaire. Those who did comply mostly failed to chew the gum in the way instructed. Reduced craving was cited as the most positive feature of gum use.

Evaluation of a multicomponent group smoking cessation program.

BACKGROUND: Participants who had completed a multicomponent group smoking cessation program were interviewed to determine their smoking status and satisfaction with the program. METHODS: The follow-up interviews occurred an average of 20 months after entry to the program, with a response rate of 80% (89 out of 111 enrollees). Most individuals interviewed (82%) were able to quit for at least 24 hr; 25% were able to maintain nonsmoking status for 1 year or longer. RESULTS: Initial quit rates were comparable for both men and women, but women were more than twice as likely to have relapsed by the time of the follow-up interview. Participants rated self-monitoring as the most helpful of 10 program components, including nicotine fading, nicotine gum, group support, health information, and talks by ex-smokers. Ratings for the program overall were higher than the rating of any individual component. CONCLUSIONS: Since earlier studies have found that successful quitters use more coping strategies than relapsers, multicomponent programs offer participants an opportunity to learn a variety of techniques and choose the combination that works best for them.

Ending smoking at the Johns Hopkins Medical Institutions. An evaluation of smoking prevalence and indoor air pollution.

An empiric evaluation of a policy ending smoking in a large urban medical center was conducted. The study included a prospective cohort tracking of employees to measure changes in smoking behavior, environmental fires, smoking-related litter, and environmental tobacco pollution exposure. A 25% decrease in employee smoking prevalence was found (21.7% vs 16.2% before vs after policy implementation, respectively). The daily number of cigarettes reportedly smoked by employees who continued smoking and the total number smoked at work decreased across all occupational categories by an average of 25%. Significant reductions were noted in the level of public smoking and the amount of cigarette remnants. Nicotine vapor concentrations decreased significantly in all areas except restrooms. These findings suggest that visible smoking and environmental tobacco smoke exposure can be markedly decreased by instituting a policy eliminating smoking in a large medical center.

The impact of a total ban on smoking in the Johns Hopkins Children's Center.

We report the results of a ban on smoking in The Johns Hopkins Children's Center, Baltimore, Md, beginning in July 1987. A survey 6 months before and 6 months after implementation of the ban showed current smoking prevalences to be 15% and 13.8%, respectively. The percentage of smokers who smoked at work declined from 82% before the ban to 43% after the ban. After the ban, 66% of smokers and 93% of nonsmokers agreed that a hospital should be smoke free, while 43% and 83%, respectively, agreed with this statement before the ban. Systematic observations showed a decline from 53% of visitors and staff smoking in public areas 1 month before the ban to 0% smoking 6 months after the ban. Twenty-four-hour cigarette butt counts in elevator lobbies located well within the center dropped from 940 for an average day to 19 for an average day 6 months after the ban. Finally, measurement of environmental nicotine vapor showed a decline from a weekly average concentration of 13 micrograms/m3 of nicotine 1 month prior to the ban to 0.51 micrograms/m3 of nicotine 6 months after the ban in nine lobby lounges. The results suggest that a total ban on smoking in a hospital is feasible and effective in virtually eliminating public smoking.

Banning smoking in a children's hospital: are employees supportive?

This study surveyed 762 professional and auxiliary employees in a large urban children's hospital to assess readiness for a total ban on smoking. The prevalence of never smokers was 63.1%, former smokers was 21.1%, and current smokers was 15.1%. Among nonsmokers, 83% indicated that a children's hospital should be smoke-free. The attitudes of former smokers were almost identical to those of never smokers. Less than half of current smokers (43%) agreed with a ban on smoking which suggests some support for a smoke-free setting even among smokers. In multivariate analysis, smokers, however, were eight times less likely to agree with such a policy, independent of age, sex, and occupation. This study suggests that the majority of employees are supportive of a total ban on smoking but that special efforts to help smokers stop smoking may enhance the effectiveness of a policy banning smoking in a children's health care facility.

Behavioral treatment of children with recurrent headaches.

The effectiveness of relaxation and biofeedback treatment for adults who suffer from headaches is well documented. By contrast, only several case study reports have been published describing these procedures applied to childhood headaches. This report describes the treatment of 15 children, aged 10-17 years, treated in a behavioral medicine clinic by using relaxation, biofeedback and behavioral counseling. At the end of treatment, 8 of 15 children were headache-free and 5 others exhibited a marked reduction in headache frequency and severity. Improvements were then maintained at follow-up. These results are comparable to results obtained when similar procedures are used to treat chronic adult headache sufferers.

Control of the rat's sniffing behavior by response-independent and dependent schedules of reinforcing brain stimulation.

The rat's sniffing response occurs in continuous bursts, at approximately 5-11 Hz. In the present experiments, the analog signal from a thermo-couple probe in the nasal cavity was digitized to provide a discrete logic pulse, defining a sniff, and permitting on-line presentations of reinforcing brain stimulation contingent on momentary sniffing patterns. Schedules of reinforcer presentation included response-independent fixed interval (temporal conditioning), continuous reinforcement (CRF), and differential reinforcement of low rates (DRL 10 sec). Under temporal conditioning, bursts of sniffing were observed immediately after stimulation, and an acceleration in sniffing developed preceding stimulation. Under CFR, operant rate-intensity functions were found to be similar to traditional bar-press data. Under DRL, sniffs were effectively paced by the criterion interval, and interresponse time analyses revealed evidence of temporal discrimination. The behavioral patterns were interpreted in terms of the interplay of operant and respondent functions.