Effect of adding systematic desensitization to goal-directed paradigm on risk of falling in patients with stroke: a randomized controlled trial.

Background: Improvement in rehabilitation outcomes for patients suffering from chronic stroke can be attained through systematic desensitization of their fear of falling, which in turn reduces the risk of falling. Purpose: This study aimed to examine the effect of adding systematic desensitization to a goal-directed paradigm on functional performance, balance, risk of falling, and fear of falling among chronic ischemic stroke patients. Methodology: Two equally sized groups, each comprising 40 stroke patients of both sexes, were randomly divided. For 8 weeks, Group A received three sessions per week of combined treatment consisting of systematic desensitization and a goal-directed paradigm, while Group B received only the goal-directed paradigm. The Timed Up and Go (TUG) test and Dynamic Gait Index (DGI) were used to assess function performance; the Berg Balance Scale (BBS) and the Biodex Fall Risk Index (FRI) were used to evaluate balance; and the 16-item Fall Efficacy Scale-International (FES-I) was used to evaluate fear of falling. At baseline and after the treatment, all measurements were obtained. Results: Both groups (A and B) revealed a substantial increase in functional performance through a decrease in TUG scores and an increase in DGI. Additionally, there was a decrease in the risk of falling through an increase in the BBS scores and a decrease in the FRI. Furthermore, there was a decrease in the fear of falling, as measured using the FES-I, after treatment, with superior improvement in Group A with a p-value of <0.001. Conclusion: Systematic desensitization combined with a goal-directed paradigm has a superior effect on improving functional performance and reducing the risk of falling and the fear of falling in patients with stroke compared to a goal-directed paradigm alone.

A study on the impact of systematic desensitization training on competitive anxiety among Latin dance athletes.

Objective: In the domain of competitive events, Latin dance athletes have always suffered competitive anxiety, which is a prevalent and prevailing psychological facet, in pre-, intra-, and post-competitive engagements. Usually, the implementation of systematic desensitization training is an efficacious approach to reduce competitive anxiety levels in routine sports to fortify psychological resilience of athletes (like swimming, volleyball, and basketball). This study focuses on the effect of systematic desensitization training on competition anxiety in the training of Latin dancers to establish good mental ability and promote the competitive ability of athletes. Methodology: The "Sports Competition Anxiety Test Questionnaire" was used to evaluate and classify the competitive anxiety levels of 150 Latin dance athletes. Then, the top 48 participants were selected (24 in the intervention cohort and 24 in the non-intervention cohort) as the study participants after stratifying anxiety score levels from the highest to the lowest. The intervention group was treated with an 8-week psychological intervention by employing systematic desensitization training techniques (encompassing imagery desensitization and in vivo desensitization). The anxiety levels of the subjects were quantified by employing the "Sport Competition Trait Anxiety Inventory" (CCTAI-C) and the "Competitive State Anxiety Inventory" (CSAI-2) to scrutinize the efficacy of systematic desensitization training in regulating competitive anxiety levels among Latin dance athletes. Results: After applying systematic desensitization training, the intervention group displayed a notable reduction in sport cognitive trait anxiety. Specifically, there was a decrease of 29.37% in social evaluation anxiety, 20.31% in competition preparation anxiety, 16.98% in performance anxiety, 25.16% in failure anxiety, 34.47% in opponent's ability anxiety, and 25.16% in injury anxiety. Moreover, for competitive state anxiety, cognitive state anxiety and somatic state anxiety decreased by 39.19 and 21.43%. The state self-confidence increased by 14.42%. Conclusion: The result indicated that systematic desensitization training not only mitigates anxiety but also positively intervenes in sports-related anxiety. Moreover, systematic desensitization training can significantly diminish competitive anxiety among Latin dance athletes to bolster confidence during competitions. Integrating desensitization training into the regular regimen of Latin dance practice has the potential to fortify dancers' psychological resilience against anxiety.

Treating Radiation Anxiety With Systematic Desensitization: Head and Neck Cancer Case Reports.

Introduction: Head and neck cancer patients have high rates of psychological distress, which may be exacerbated by the treatments they receive. Many patients who undergo radiation therapy report significant anxiety associated with the thermoplastic mask required for immobilization during treatment. Case Description: This report presents two examples of head and neck cancer patients reporting high mask anxiety, along with a history of claustrophobia, who expressed concern about their abilities to initiate and adhere to treatment. Both were referred to supportive care psychology before radiation treatment initiation. With counseling and the use of systematic desensitization, they were successfully able to complete their treatments. Discussion: Results of these case reports highlight the value of integrating early supportive care in the treatment of head and neck cancer and support the need for further study in future randomized controlled trials.

Just Right Challenge Feeding Protocol: Case-Report for Guiding Clinical Reasoning and Future Research in Food Selectivity Treatment.

Food selectivity impacts health and quality of life for children with developmental disabilities. Best practice protocols are still in development and use of escape extinction, systematic desensitization and parent education are elements that may be part of effective multi-component treatment. The Just Right Challenge Feeding Protocol (JRCFP) includes each of these elements to drive changes in food acceptance for children with developmental disabilities. This case-report provides detailed information about how a group of children progress through treatment. Children in this case-report had 15 or less foods in their food inventory and profiles indicating the presence of sensory over-responsivity. Every 5-10 weeks, each child moved up one step in the Food Interaction Hierarchy (e.g. touch, taste, eat). Significant increases in vegetable and fruit acceptance and mealtime quality are noted and parent compliance on home program assignments is described. This information is valuable for guiding clinical reasoning and future research of treatment for food selectivity.

Research progress on psychotherapy for dental anxiety / 口腔疾病防治

@#Dental anxiety refers to the unique tension, worry and even fear of dental treatment, which may lead to patients refusing to receive treatment and missing the best time for treatment. With the development of bio-psycho-social medical models, psychotherapy has gradually become the optimal treatment for dental anxiety. This article reviewed the etiology, evaluation and psychotherapy of dental anxiety. Research has shown that uncomfortable dental treatment experience is the main cause of dental anxiety, which is commonly assessed using questionnaires in clinical practice. Psychotherapy for dental anxiety is a noninvasive, widely applicable treatment without side effects, mainly including improving the treatment environment and service attitude, behavior therapy, and cognitive therapy, which has been shown to effectively alleviate dental anxiety in patients. However, psychotherapy for dental anxiety is highly demanding for dentists, which hinders its promotion and application. At the same time, the psychotherapeutic mechanism of dental anxiety is not clear and remains to be further elucidated by large-scale and high-quality randomized controlled studies.

Assessment and Treatment of Noise Hypersensitivity in a Teenager with Autism Spectrum Disorder: A Case Study.

Noise hypersensitivity is a poorly understood symptom of Autism Spectrum Disorder (ASD). For some, problem behaviors co-occur with the aversive noise. Limited literature exists on treating noise hypersensitivity; however, noise hypersensitivity may be related to a specific phobia. This case study utilizes modified Cognitive Behavioral Therapy (CBT) to address anxiety, avoidance, and problem behaviors evoked by noise in a teen with ASD and mild Intellectual Disability (ID). Using multi-method assessment and individualized treatment, problem behaviors reduced, and independent coping strategies use occurred. Successful desensitization supports the efficacy of modified CBT as a treatment for noise-related anxiety and problem behaviors in individuals with ASD and ID. Outcomes are discussed considering intervention difficulties for noise hypersensitivity in a complex and diverse population.

Behavioral and neural processes in counterconditioning: Past and future directions.

Counterconditioning refers both to the technique and putative process by which behavior is modified through a new association with a stimulus of an opposite valence. Similar to extinction, counterconditioning is considered a form of inhibition that interferes with the expression of the originally learned response without erasing it. But whereas interest in extinction continues to rise, counterconditioning has received far less attention. Here, we provide an in-depth review of counterconditioning research and detail whether counterconditioning is any more effective than extinction at preventing relapse of the originally learned behavior. We consider the clinical implications of counterconditioning, describe recent neurobiological and neuroimaging research in this area, and consider future avenues in need of further investigation.

Reducing blood draw phobia in an adult with autism spectrum disorder using low-cost virtual reality exposure therapy.

BACKGROUND: Needle phobias are common in children and adults worldwide. One effective intervention for this phobia is exposure therapy where a participant is gradually exposed to increasing levels of the fear-evoking stimulus while differential reinforcement is applied. This intervention, however, may be difficult to implement with some medical procedures as it may be difficult to obtain unfettered access to medical facilities and equipment for the purposes of exposure. Virtual reality may overcome these obstacles. METHODS: In this investigation, the present authors developed a low-cost virtual reality-based exposure therapy which was used with an adult male with autism spectrum disorder and a history of extreme needle phobia. The effectiveness of this intervention was evaluated using a changing criterions design with generalization probes. RESULTS: The intervention quickly increased the participant's compliance in the analogue training setting and the effects were generalized across settings and behaviours, and maintained over time. CONCLUSIONS: The findings indicate combining virtual reality with exposure therapy may produce an effective intervention for medical phobias. The intervention package may remove barriers associate with traditional exposure therapy and was low-cost which may increase access to the intervention.

Effect of systematic desensitization training on acceptable noise levels in adults with normal hearing sensitivity.

CONTEXT: The willingness of a person to accept noise while listening to speech can be measured using the acceptable noise level (ANL) test. Individuals with poor ANL are unlikely to become successful hearing aid users. Hence, it is important to enhance the individual's ability to accept noise levels. The current study was an attempt to investigate whether systematic desensitization training can improve the ANL in individuals having high ANL. AIMS: To investigate the effect of systematic desensitization training on ANLs in individuals with normal hearing sensitivity. SETTINGS AND DESIGN: Observational study design. MATERIALS AND METHODS: Thirty-eight normally hearing adults within the age range of 18-25 years participated in the study. Initially, baseline ANL was measured for all participants. Based on the baseline ANL, participants were categorized into three groups; low ANL, mid ANL, and high ANL. The participants with high ANL were trained using systematic desensitization procedure whereas, individuals with low and mid ANL did not undergo any training and served as the comparison groups. After the training period, ANL was measured again for all the participants. STATISTICAL ANALYSIS USED: Repeated measures of analysis of variance with follow up paired "t" test. RESULTS: Analysis revealed a significant main effect of systematic desensitization training on ANL. There was a significant improvement in ANL in participants with high ANL. However, there was no significant difference in ANL between baseline and follow-up session in individuals with low and mid ANL. CONCLUSIONS: Systematic desensitization training can facilitate ANL, thereby enhancing the individual's ability to accept the noise levels. This enhanced ANL can facilitate better hearing aid fitting and acceptance.

Benson's Relaxation Effect in Comparing to Systematic Desensitization on Anxiety of Female Nurses: A Randomized Clinical Trial.

INTRODUCTION: Nursing staffs expose to a high level of anxiety. This study aimed to compare the effect of Benson's relaxation and systematic desensitization methods for decreasing the anxiety score of nurses. MATERIALS AND METHODS: In a randomized clinical trial, 72 female nurses were assigned randomly to three different groups. Benson's relaxation and systematic desensitization were used as intervention beside control group. After intervention, the Spielberger state-trait anxiety inventory was used for measuring the anxiety score. Analysis of variance (ANOVA), Tukey test, and paired t-test were applied for comparing three group scores. RESULTS: The ANOVA test showed that a significant difference among three groups regarding scores of posttrait and poststate anxiety (P < 0.05). The Tukey test showed that both Benson's relaxation and systematic desensitization methods were effective in decreasing of the anxiety score of nurses. Moreover, the mean change in trait and state anxiety scores at Benson's relaxation and systematic desensitization groups was more than control group, respectively, and was statistically significant. CONCLUSION: Both Benson's relaxation and systematic desensitization methods are effective in improvement of the state and trait dimensions of anxiety. However, these methods could be applied in stressful situation among medical staffs of students.

A comparison of a modified sequential oral sensory approach to an applied behavior-analytic approach in the treatment of food selectivity in children with autism spectrum disorder.

Treatments of pediatric feeding disorders based on applied behavior analysis (ABA) have the most empirical support in the research literature (Volkert & Piazza, 2012); however, professionals often recommend, and caregivers often use, treatments that have limited empirical support. In the current investigation, we compared a modified sequential oral sensory approach (M-SOS; Benson, Parke, Gannon, & Muñoz, 2013) to an ABA approach for the treatment of the food selectivity of 6 children with autism. We randomly assigned 3 children to ABA and 3 children to M-SOS and compared the effects of treatment in a multiple baseline design across novel, healthy target foods. We used a multielement design to assess treatment generalization. Consumption of target foods increased for children who received ABA, but not for children who received M-SOS. We subsequently implemented ABA with the children for whom M-SOS was not effective and observed a potential treatment generalization effect during ABA when M-SOS preceded ABA.

Using Graduated Exposure and Differential Reinforcement to Increase Food Repertoire in a Child with Autism.

Food selectivity is often seen in children with autism spectrum disorder and can lead to severe nutritional deficiencies. Food selectivity can be specific to food texture, colour, shape, presentation, type, brand or container. Often food selectivity is treated using escape extinction in conjunction with other procedures, which can be challenging to implement for the therapist or caregiver, aversive for the child, and requires adequate supervision from a professional to ensure fidelity of the procedure. A preference assessment, parent interview and food journal determined the child's food repertoire consisted of four different foods in total (pasta, fish crackers, dry cereal and yogurt), and the child was selective by brand, texture, temperature and utensil requirement. A 12-step graduated exposure food hierarchy was constructed, the child was lead through the hierarchy, and parent training was implemented for generalization. After 9 months of treatment, the participant's food repertoire increased from four items to more than 50 items. Additionally, food refusal behaviour decreased to rates of zero during intervention and parents report significant decreases in mealtime behaviour at home. The importance of using an alternative strategy to escape extinction for treating food selectivity in children with autism spectrum disorder will be discussed.

Uso de técnicas de exposición en una clínica de psicología / Use of Exposure Techniques in a Psychology Clinic

El objetivo del artículo es indagar el uso de las técnicas de exposición en la práctica de la psicología clínica asistencial. Se analiza el tipo de técnicas de exposición, su frecuencia de uso, tanto en general como en función del diagnóstico, y su relación con los resultados del tratamiento. De los 880 pacientes de la Clínica Universitaria de Psicología de la Universidad Complutense, con todo tipo de diagnóstico, el 67.2% son mujeres y su edad media es de 32.79 años. Los resultados señalan que el 39.5% de los casos ha utilizado alguna técnica de exposición, siendo la Exposición Gradual la más frecuente (31.6%). Predomina el uso de las técnicas de exposición en trastornos de ansiedad (70.8%), somatomorfos (47.4%) y sexuales (47.1%). Se observa un incremento en el uso de técnicas de exposición en los casos con comorbilidad (55.4% frente a 36.3%). De los casos que han recibido alguna técnica de exposición, el 74.1% ha finalizado con éxito el tratamiento, frente al 61.9% de los que no han utilizado ninguna técnica de exposición. Se discuten los resultados, destacando el valor de usar técnicas de exposición para reducir la evitación o las respuestas de miedo con independencia del diagnóstico.

The aim of this work is to explore the use of exposure techniques at the health care context of a clinical psychology facility. Different modalities of exposure techniques, their frequency of usage - both across the entire sample and considering different diagnostic groups - and their relationship to the treatment results, were analysed. From the 880 patients with diverse diagnosis treated at the University Psychology Clinic of the Universidad Complutense of Madrid, 67.2% were women, with a mean of32.79 years. Results show that exposure techniques were used in 39.5% of total cases, being gradual exposure the most frequent (31.6%). Exposure techniques were employed foremost on anxiety disorders (70.8%), somatoform disorders (47.4%), and sexual disorders (47.1%). Also, it was observed that exposure techniques were used more often in cases with one or more comorbid diagnosis (55.4 vs. 36.3%). 74.1% of the patients treated with exposure techniques received therapeutic discharge, while 61.9% of patients not treated with exposure techniques were discharged. The results are discussed, emphasizing the utility of exposure techniques to treat avoidant or fearful behaviour regardless of the diagnosis.

A non-linear dynamical approach to belief revision in cognitive behavioral therapy.

Belief revision is the key change mechanism underlying the psychological intervention known as cognitive behavioral therapy (CBT). It both motivates and reinforces new behavior. In this review we analyze and apply a novel approach to this process based on AGM theory of belief revision, named after its proponents, Carlos Alchourrón, Peter Gärdenfors and David Makinson. AGM is a set-theoretical model. We reconceptualize it as describing a non-linear, dynamical system that occurs within a semantic space, which can be represented as a phase plane comprising all of the brain's attentional, cognitive, affective and physiological resources. Triggering events, such as anxiety-producing or depressing situations in the real world, or their imaginal equivalents, mobilize these assets so they converge on an equilibrium point. A preference function then evaluates and integrates evidentiary data associated with individual beliefs, selecting some of them and comprising them into a belief set, which is a metastable state. Belief sets evolve in time from one metastable state to another. In the phase space, this evolution creates a heteroclinic channel. AGM regulates this process and characterizes the outcome at each equilibrium point. Its objective is to define the necessary and sufficient conditions for belief revision by simultaneously minimizing the set of new beliefs that have to be adopted, and the set of old beliefs that have to be discarded or reformulated. Using AGM, belief revision can be modeled using three (and only three) fundamental syntactical operations performed on belief sets, which are expansion; revision; and contraction. Expansion is like adding a new belief without changing any old ones. Revision is like adding a new belief and changing old, inconsistent ones. Contraction is like changing an old belief without adding any new ones. We provide operationalized examples of this process in action.

Canine separation anxiety: strategies for treatment and management.

Dogs with separation-related behavior problems engage in unwanted behavior such as destruction of property and excessive vocalization when left alone, causing distress for both the dog and the owner, and often leading to the dog being relinquished or euthanized. I review research on factors likely to predispose dogs to developing separation anxiety and on the treatments available. Although research is equivocal, dogs seem to develop separation-related behavior problems if they are male, sourced from shelters or found, and separated from the litter before they are 60 days old. Protective factors include ensuring a wide range of experiences outside the home and with other people, between the ages of 5-10 months, stable household routines and absences from the dog, and the avoidance of punishment. The most successful treatment for canine separation-related problems may be behavior modification that focuses on systematic desensitization and counterconditioning, which can be supplemented with medication in the initial stages. Where individual therapy from an animal behavior expert is not possible, advice to dog owners should be clear, simple, and contain five or fewer instructions to improve adherence. Advice is given for people seeking to adopt a dog, for new dog owners, and for existing dog owners who wish to treat their dog's separation anxiety.

Consistencia entre el reporte verbal y los efectos psicofisiológicos registrados en el tratamiento de una fobia específica empleando la técnica de la Desensibilización Sistemática (DS) / Consistency between verbal report and psychophysiological effects registered in the treatment of a specific phobia using Systematic Desensitization

En la presente investigación se empleó un diseño cuasi-experimental de caso único AB para evaluar la consistencia del reporte verbal basado en Unidades Subjetivas de Ansiedad (USAS) y los efectos psicofisiológicos registrados en la aplicación de la técnica de la Desensibilización Sistemática, empleando el componente imaginario de ésta en un caso de fobia específica a las aves. Los resultados no mostraron una consistencia entre el informe verbal del sujeto, en el cual reportó, tanto cero USAS para 10 escenas ansiógenas, como una disminución en la activación fisiológica, y las medidas obtenidas en los equipos que registraban el pulso y la RGP. El pulso mostró una tendencia al aumento mientras que la RGP una tendencia a mantener los mismos niveles.

In the present research a quasi- experimental AB single case research design was used to assess the consistency of a verbal report based on Subjective Units of Discomfort (SUDS) and the psycho-physiological measures of pulse and galvanic skin response (GSR) when applying the systematic desensitization technique and using only its imaginary component in the treatment of a specific phobia to birds. The results found didn’t show a consistency between the participant’s verbal report, in which both cero SUDS were reported for 10 ansiogenic scenes and a decrease in the physiological arousal, and the measurements obtained by the equipment that registered pulse and GSR. In contrast, the pulse showed an increasing tendency and the GSR registered a tendency to maintain the same levels.