Post-treatment Contact Research Articles

A controlled comparison trial of the Collaborative Assessment and Management of Suicidality (CAMS) in an inpatient setting: Outcomes at discharge and six-month follow-up

This controlled comparison trial evaluated a suicide-specific intervention, the Collaborative Assessment and Management of Suicidality (CAMS), in an extended-stay psychiatric inpatient setting. Multiple outcomes were examined for 104 patients, half of whom received individual therapy from therapists trained in CAMS. The comparison group was selected from a larger pool through Propensity Score Matching to ensure comparability on age, sex, treatment program, number of prior suicide attempts, and severity of suicidal ideation. Results showed that a) all patients improved significantly across a wide range of measures, including depression, suicidal ideation, functional disability, and well-being; b) these gains were durable over a 6-month post-discharge period; and c) patients treated by a CAMS-trained individual therapist improved significantly more from admission to discharge across all measures. Differences between CAMS and non-CAMS patients were no longer statistically significant at 6-month follow-up, although statistical power was compromised due to attrition. Although replication studies are needed, these findings suggest that interventions specifically tailored for suicidal patients may have advantages compared to usual, intensive inpatient treatment, perhaps by addressing psychological vulnerabilities specific to the population. The lack of significant differences at follow-up suggest that post-treatment contact may be needed to maintain advantages associated with this and similar interventions.

Beating biology and buying time: an update survey of womens’ experiences after oocyte cropreservation (OC) for deferred reproduction

To further understanding of how women who pursue OC for deferred reproduction think and act relative to reproduction and dating. 2016 anonymous 39-question survey with comparison to our prior OC patient survey completed in 2012. From 2005-15, 1817 women underwent >1 OC treatment cycle at our facility; 866 (48%) agreed to post-treatment contact, and our survey was distributed to these patients. There were 224 survey responses (rate: 26%). From 2012 to 2016, the percentage of women that froze at 33-35y increased (13 to 24%) while those 39-41y decreased (39 to 23%); 44% froze between 36-38y consistent with our clinical data also demonstrating a decrease in age at time of OC. 53% underwent OC in the last 2 years. As in 2012, 80% of respondents were Caucasian, and >70% were never married, reported lack of partner as the no. 1 reason for not yet having children and wished they had undergone OC earlier. The majority now feel the ideal age for egg freezing is 29-34y, with only 16% choosing >35y and <1% choosing >38y. Of note, more (25 vs. 16%) were in a relationship at time of OC with ½ stating the relationship was <1y. 77% reported difficulty finding someone with whom to co-parent at the time of OC. >80% currently report a desire to have children while <20% remain unsure as to whether they definitely want children in the future. Cost was the greatest obstacle to pursuing OC. 1/3 received financial support, mostly from family, with parents being the most common source. After OC, 30% admitted an attitude change toward parenting, mostly in a positive way (i.e. made it a priority or increased openness to alternative family-creating options). >60% also felt lessening of biological-clock pressure when dating and were more open to using donor sperm if still lacking a suitable partner by age 43 (average; range 35-50y). 1/4 said OC changed their dating habits: feeling more relaxed, focused, less desperate and with more time to find the right partner. >60% admitted discussing OC while dating and 90% with family/friends. They were most often met with positive/ supportive reception. 96% would recommend OC to another. After undergoing OC, 22% got pregnant or had children without resorting to their frozen eggs (2/3 naturally; 1/3 ART; 4% adoption). 13% of respondents thawed eggs resulting in a 32% live birth rate. Of those not yet thawing, 1/2 cited lacking a suitable co-parent as the obstacle; 90% reported future intent to thaw. Women are pursuing OC at younger ages, with the primary indication being lack of a suitable co-parenting partner; the latter was also the most common reason cited for not returning to use eggs sooner. Cost was prohibitive for many, with some relying on family finances. Most reported OC as a positive experience, improving views of parenting, inciting healthier dating practices, enhancing hope for future family and expanding acceptable options for achieving that goal.

How Psychoanalysis is Like a Roach Motel: Better Termination Through Better Metaphors

In this article I explore how experiences I had with a former analyst are shaping my views about termination and posttreatment contact with patients. Borrowing metaphors from contemporary physics that corroborate and extend some current views of termination, I suggest ways to think about the future of an analysis. I contrast models of termination in the psychoanalytic canon and, using the lens of relational psychoanalysis, I suggest ways to think about how one might work flexibly with patients at termination, keeping in mind the relational future of the analytic dyad.

“Would You Speak to Me if We Saw Each Other on the Street?”: Reflections on Extra- and Post-Analytic Contact

It has become a commonplace in psychoanalytic theory, and the technique that has evolved from it, for an analyst to avoid extra- and post-analytic contact with current and former patients. However, with the advent of new influences on psychoanalysis—particularly attachment theory—it is necessary to reconsider these prohibitions against contact outside the consultation room. In this article, I discuss my experiences both as a former patient and an analyst with extra- and post-treatment contact with patients, and discuss handling these situations that inevitably occur.

Incidence of open gingival embrasures after mandibular incisor extractions: A clinical photographic evaluation

The purposes of this study were to determine the incidence of open gingival embrasures after a single mandibular incisor extraction and to investigate whether age, sex, interproximal pretreatment and posttreatment contact location, or the type of mandibular incisor were predictors of the incidence and magnitude of open gingival embrasures. Pretreatment and posttreatment intraoral frontal photos of 51 adults who had 1 mandibular incisor extracted were evaluated to determine the incidence and magnitude of open gingival embrasures. The incidence of open gingival embrasures was 68%; the embrasures were moderately noticeable to very noticeable in 52% of those patients. Age, sex, incisor type, and location of interproximal contact before treatment were not predictors of open gingival embrasures after mandibular incisor extractions. An interproximal contact in the incisal third at the end of treatment was associated with the formation of an open gingival embrasure. Open gingival embrasures are a common finding after the extraction of a mandibular incisor, and the magnitude of this embrasure is clinically noticeable.

A new method of evaluating posterior occlusion and its relation to posttreatment occlusal changes.

The purpose of this study was to assess the relationship between posterior occlusion and posttreatment changes in other occlusal variables. Pretreatment (T1), posttreatment (T2), and postretention (T3) records were obtained for 49 Class I (n = 23) and Class II (n = 26) extraction cases. Overbite, overjet, mandibular incisor irregularity, right and left molar deviations, midline deviation, and mandibular arch length were measured, and occlusal registrations were made of each set of dental casts. The proximity of posterior occlusal surfaces was measured as the contact or near-contact areas at or below 300 microm thickness, based on the optical densities of scanned images of the posterior occlusal registrations. The treatment changes for overbite, overjet, right and left molar deviation, and arch length were significantly greater in the Class II group, and the reductions in incisor irregularity were greater in the Class I group. No other class differences were found. Overbite, overjet, and incisor irregularity increased after treatment, and arch length continued to decrease, with no significant class differences. Contact and near-contact areas at or below 300 microm constituted 7% of the functional occlusal table for both classes at the end of treatment, having decreased significantly in both groups (21% in Class I and 29% in Class II) during treatment. Because contact and near-contact areas increased in some patients and decreased in others, there were no significant posttreatment changes. Negative correlations were found between contact and near-contact areas at T2 and changes in overjet from T2 to T3, and between contact and near-contact areas at T3 and changes in overbite from T2 to T3. No relationships were found between posterior contact and near-contact area and incisor irregularity. We concluded that (1) the area of actual and near contacts at or below 300 microm decreased significantly with treatment, indicating that, despite excellent treatment results by conventional standards, the proximity of posterior occlusal surfaces lessened; (2) the proximity of the posterior occlusal surfaces should not be expected to increase posttreatment; (3) posttreatment contact and near-contact areas may be factors in overbite and overjet stability; and (4) posttreatment contact and near-contact areas are not related to incisor irregularity.

Implementing long-term EAP follow-up with clients and family members to help prevent relapse—With implications for primary prevention

This paper reports on a study in progress which involves (a) regular post-treatment contact by employee assistance program (EAP) staff with employees who seek help through the EAP, and (b) contact with a family member or other support person designated by the employee. The contacts are designed to provide support for maintenance of therapeutic gains, assistance in adjusting to current life situations, and early identification and prevention of relapse. The study will evaluate the process of initiating these contacts and will examine their effectiveness at reducing relapse. Factors associated with implementing these services in an EAP context are discussed.

Maintenance strategies for the treatment of obesity: An evaluation of relapse prevention training and posttreatment contact by mail and telephone.

Maintenance strategies for the treatment of obesity: An evaluation of relapse prevention training and posttreatment contact by mail and telephone.

Physiological, behavioural and cognitive changes resulting from flooding in a monosymptomatic phobia

A detailed study of a flooding treatment of a specific phobia suggests that flooding is an effective procedure for instituting behavioural change. The study supports the observations of desynchrony and measure of fear (Hodgson and Rachman. 1974) and suggests the need for post-treatment contact with phobic situations to help to extinguish cognitive avoidance responses.