Psychoeducation Research Articles

Evaluation of the Effectiveness of a Psychoeducational Intervention in Treatment-Naïve Patients with Antidepressant Medication in Primary Care: A Randomized Controlled Trial.

Background. There is evidence supporting the effectiveness of psychoeducation (PE) in patients with symptoms of depression in primary care (PC), but very few studies have assessed this intervention in antidepressant-naïve patients. The aim of this study is to assess the effectiveness of a PE program in these patients, since the use of antidepressant (AD) medication may interfere with the effects of the intervention. Methods. 106 participants were included, 50 from the PE program (12 weekly 1.5-hour sessions) and 56 from the control group (CG) that received the usual care. Patients were assessed at baseline and at 3, 6, and 9 months. The main outcome measures were the Beck Depression Inventory (BDI) and remission based on the BDI. The analysis was carried out on an intention-to-treat basis. Results. The PE program group showed remission of symptoms of 40% (P = 0.001) posttreatment and 42% (P = 0.012) at 6 months. The analysis only showed significant differences in the BDI score posttreatment (P = 0.008; effect size Cohen's d′ = 0.55). Conclusions. The PE intervention is an effective treatment in the depressive population not treated with AD medication. Before taking an AD, psychoeducational intervention should be considered.

Effectiveness of Psycho-education on Emotional Maturity of Adolescents

Adolescence is the stage where extreme emotions are expressed with the intensity of adulthood but devoid of adult perspective. Literature reports that 55%-63% of adolescents are at low level of emotional maturity. Considering this high prevalence and lack of standard intervention to manage emotional immaturity, this experimental study was done to assess the effectiveness of psycho-education on emotional maturity among emotional immature adolescents. Total 307 eligible adolescents were randomly recruited from eight conveniently selected schools of dist Faridkot, Punjab. Schools were randomly assigned to either experimental or control group. From each school, 10–12 emotional immature adolescents were selected randomly (loery method). Finally eighty emotional immature subjects completed the study. Emotional maturity scale and socio demographic data sheet was used to collect data. Five sessions of psycho-education were given for five consecutive days to experimental group for one hour each day. The findings revealed that 57% of adolescents were emotionally immature. Psycho education significantly enhanced the emotional maturity at 0.05 level in experimental group. Hence it can be concluded that psycho-education is effective intervention for emotional immaturity. Adolescents should be early identified if they are emotionally immature and can be managed with help of school health nurse in school setting by providing psycho education.

Dementia Caregiver Interventions: A Systematic Review of CaregiverOutcomes and Instruments in Randomized Controlled Trials

A variety of psychosocial interventions have been developed to support dementia caregivers. Compar- ing positive effects on caregivers across these intervention studies are difficult because of the diverse endpoints. The objectives of this review were: (1) to show what types of interventions were conducted in international randomized controlled trails with dementia caregivers; (2) to provide an overview of what main caregiver outcome dimensions can be categorized; and (3) what validated instruments are most frequently used to assess these outcomes. A sys- tematic, computerized literature search was conducted using the electronic databases PubMed, Medline, EBSCO, and PsycINFO. Records of interest were randomized controlled trials for informal caregivers of home dwelling care recipients with any type of dementia. In the 69 identified studies 82 different validated assessments were used, which were categorized in 15 dimensions. About two out of three studies examined psychoeducational interventions. The five most prevalent outcomes were: depressive symptoms (N = 34); burden (N = 33); self-efficacy/coping/mastery (N = 19); emotional distress (N = 19); and quality of life (N = 17). These outcomes were mostly assessed with: the Center for Epidemiologic Studies Depression Scale (N = 23); the Zarit Burden Interview (N = 24); the Revised Scale for Caregiving Self-Efficacy (N = 4); the Cohen Perceived Stress Scale (N = 7); and the WHO Quality of Life (N = 5). This literature review serves as the first step to identify outcomes and assessments which have actually been used. An important next step to improve comparability between studies could be the development of taxonomy to classify and describe the key influential components of interventions in this research field.

Case Report of Secondary Narcolepsy Presenting as Self-Inflicted Genital Injury

Primary Narcolepsy is a sleep disorder with classical presentation showing symptoms of cataplexy, excessive daytime sleepiness, sleep paralysis, and Hypnogogic hallucinations. A rare case of secondary narcolepsy was seen in a patient with self-inflicted genital injury. A 30 year old male was referred to Psychiatry from Surgery for a self-inflicted incised wound on hydrocoele. Since last 1 year, he had multiple episodes of -- 1. Sudden falls while working 2. Sleep during daytime often at unusual places 3. Periods of unresponsiveness during which he was aware but unable to move. During hospital stay, all symptoms of Narcolepsy were noted several times, but prominent hallucinations were not consistently reported. Patient’s EEG was normal. MRI brain showed Gliosis at cervicomedullary junction.MRI spine was advised to examine the cervico-vertebral junction but patient was lost to follow-up. But from historyand investigations, based on DSM-IV-TR, Narcolepsy was diagnosed. It was concluded that he had secondary narcolepsy due to traumatic brain injury. As Self Inflicted Genital injury was done after hallucinations and sleep attack, it was considered to be part of Narcolepsy -a rare presentation. Narcolepsy typically begins in young adulthood mainly 2nd decades of life and causes adverse effects on quality of life of patients. Diagnosis relies on history of patient and objective details obtained from polysomnography and multiple sleep latency testing. Main treatment is symptomatic relief through medication, psycho education, and behavioural modification.

A Cognitive Behavioural Intervention for Case Managed Clients.

This paper outlines a cognitive behavioural therapy (CBT) based psychosocial intervention for case managed clients in a community mental health setting. The aim of the study was to design a CBT based psycho-educational program which addressed stress management and supported self-management skills for case managed clients with chronic and serious mental illness. It was anticipated that the CBT intervention group would have improved post study levels of functioning, and decreased levels of distress, as compared to the control group. Twenty-four clients volunteered for the study, eight females and 16 males. They ranged in ages from 20 to 69 years, with an average age of 43.5 years. There was no specific diagnostic group targeted. Outcome measures used were the Health of the Nation Outcomes Scale and the Mental Health Inventory. The CBT intervention was run for 2 hours a week over 8 weeks using a group format. There was an improvement in behavioural problems, indicating an improvement in functioning and a decrease in anxiety levels. It was concluded that CBT based psycho education programs can improve outcomes for community mental health clients.

Psychoeducation: the dual advantage!

Psychoeducation: the dual advantage!

Psychosocial groupwork for older adults having substance use and mental health issues

Community Outreach Programs in Addictions (COPA) is a Canadian organization that assists older adults who live with substance misuse and mental health issues. COPA College, a psycho educational mutual aide support group consists of weekly group sessions. The program uses a Solution Focussed approach (De Jong, Insoo Kimberg, 2008) which provides support to socially disadvantaged older adults with substance and mental health issues through a group format.This article sets out to evaluate participant reactions and determine if participants decrease substance use following completion of the group. One-on-one semi-structured interviews with ten participants were conducted. Participants were asked to rate the importance of different aspects of the program and discuss alcohol intake following involvement in the group. Aspects of the program rated highly by all the participants included learning new information, the breadth of topics discussed and the harm reduction approach taken by the program. Finally, the general atmosphere of the group was considered very important, especially being comfortable in the group and combining humour with learning, and an opportunity for reflective, sharing peer support.

The Effectiveness of a Culturally Sensitive Cognitive Behavioral Group Intervention for Latino Alzheimer's Caregivers.

Demographic projections suggest that the older Latino population will experience the fastest growth among all racial/ethnic groups; and by 2050 will constitute 20% of the nation's seniors. Yet, Latino Alzheimer's elders and their families remain underrepresented in the health care system and caregiver intervention studies. To address this gap, this study tested the effectiveness of Circulo de Cuidado, a culturally-sensitive, cognitive behavioral (CBT) group intervention, in supporting Latino families' ability to manage the disease's neuropsychiatric symptoms and improve caregiver well-being. Using a randomized controlled trial design, 67 caregivers were assigned to the CBT experimental condition or the psychoeducational (PED) control condition and interviewed at baseline, post-group, and 3 months follow-up. The 2 manualized interventions had the same structure: 5 weekly 90-minute group sessions, followed by telephone coaching at 3, 6, 9 and 12 weeks post-group. Repeated measures analysis of covariance revealed significant group by time interaction effects. Compared with the PED participants, CBT participants reported lower neuropsychiatric symptoms in their relative, less caregiver distress about neuropsychiatric symptoms, a greater sense of caregiver self-efficacy, and less depressive symptoms over time. Our findings offer preliminary evidence that a culturally tailored, CBT group intervention targeted toward neuropsychiatric symptom management has positive psychological benefits for Latino caregivers.

Psycho-educational Approaches in Long-term Care Homes: Direct Care Workers and Managers’ Perspectives

The majority of the Direct Care Workers (DCWs) in long-term care (LTC) facilities have no formal qualifications or training on dementia and experience high levels of stress and burnout as a result of dementia-related symptoms and behaviours. Psycho- educational (PE) approaches can be effective in supporting DCWs, yet, they are underdeveloped within the context of formal care. Therefore, this study aimed to explore the expectations and concerns of care home managers (service managers and top- level managers) and DCWs about PE interventions. A qualitative, cross-sectional study was conducted. Individual interviews with 8 managers (75% female; mean age 45.5 ± 10.26) and 8 focus-group interviews with a total of 58 DCWs (female; mean age of 44.72 ± 9.06) of 4 LTC facilities were performed. All interviews were recorded, transcribed and analysed through thematic analysis by 2 independent judges. Managers’ main expectations were related to the opportunity to improve DCWs’: understanding and attitudes towards dementia; ability to interact with residents; motivation and job satisfaction. DCWs expected to: acquire knowledge and practical skills to deal with dementia; develop their knowledge about resident's biography; enhance their ability to deal with job strain; share experiences and improve group cohesion. Lack of time and support to translate learning into practice and sustain potential benefits over time were anticipated as the main barriers by both elements. There were coincident expectations and concerns among both managers and DCWs. Findings underscore the importance of targeting both DCWs-level and manager-levels perspectives to the planning of a sustainable PE intervention for DCWs.

THEORETICAL APPROACH ABOUT THE ADAPTIVE RESPONSES IN DISASTER PSYCHIATRY

Understanding disaster psychiatry involved changing several paradigms: • The first major change involves the focus of care on those that have not yet changes of illness • In disaster situations, the diagnosis of a mental disorder arises carefully after preliminary examination. • In the acute phase psychiatrist has a duty to make psycho-education and encourage natural recovery, spontaneous rather than treat. • In terms of disaster, the physician should treat the person on site. Studies of psychiatric disorders resulting from disasters belong to a broader range of research on stress. Developed theories propose the following model: external needs (represented by the traumatic event that is the primary stressor) require a response that is based on internal or external resources. Loss or reduction of these resources, either specific (social, financial) or symbolic (beliefs, expectations) are considered as secondary stressors and can have severe impact on recovery. The incidence of PTSD and functional impairment in the general population following a disaster is significantly lower than that evidenced in the directly exposed population. CONCLUSION. Disaster psychiatry, a newer but very important branch of psychiatry has a decisive role in prevention, response and psychic recovery of people in a disaster case. It is a new way of working in psychiatry, often held to the spot of a traumatic event and which requires multiple approaches - short and long term approaches, in order to eliminate any negative consequences on the human psychic Keywords: Disaster psychiatry, stress, posttraumatic stress disorder (PTSD)

Use of a Diagnostic Errors Framework to Classify Mistakes in an Assessment of a Bilingual Child.

This study applies a diagnostic errors framework to identify and classify mistakes that were made in a psychoeducational assessment of a bilingual student who was misidentified as a person with autism. Findings of diagnostic errors were categorized under four domains — faulty knowledge, faulty data gathering, faulty data processing, and faulty verification. This article contributes to the literature by applying a model to understanding the mistakes that could occur during an assessment of special education eligibility. It concludes with considerations for practice and research.

Psycho Educational Conditions of the Development of Safe and Remediation of Dangerous Behaviors of A Child

The article studies psychologo-educational conditions of the development of dangerous (victimization) and safe forms of child’s behavior at different stages of ontogenesis. A concept of victim and safe behavioris given here, as well as their characteristics. The basic paradigm of security is considered, too. A hierarchy of influence exerted by family, personal and social factors on the development of dangerous forms of child behavior is identified. Here are the results of experimental studies conducted on adolescents in Novosibirsk and Novosibirsk region. We consider the system of psychologo-educational remediation of dangerous forms of victim behavior of adolescents. There are identified and described the conditions under which the work of transformation non adaptive forms of victim behavior of adolescents can be effective.

Development and Effectiveness of Positive Psycho-educational Intervention Program in Enhancement of Student Engagement, Motivation and Alleviation of Depressive Symptoms of Selected School Dropouts

India with more than a billion residents has the second largest education system in the world. But it is alarming that the dropout problem is very pervasive in the Indian educational contexts. Many children who enter school are unable to complete their education and multiple factors are responsible for children dropping out of school. Therefore, this study is aimed to develop and assess the effectiveness of the positive psycho-educational intervention (PPEI) in enhancing student engagement, motivation and alleviation of depressive symptoms among the dropouts in West Bengal, India. The study was conducted in two phases: Phase 1 focused on the development of the intervention program: The positive psycho-educational intervention (PPEI) based on the positive psychology and Broaden and Build theory, utilizing the descriptive research method. Phase II involved the assessment of the effectiveness of the newly developed intervention program (PPEI) in enhancing student engagement, motivation and alleviation of depressive symptoms of dropouts employing the true experimental research design particularly Between-Subjects: Two Independent Group Design. Three psychological tests (motivation and engagement scale (MES-HS), student engagement instrument (SEI) and Beck depression inventory (BDI) were administered to the participants before and after the program implementation. A total of 68 dropout boys from urban areas were randomly assigned both in control and experimental groups. The data analysis was done utilizing mean scores, paired samples statistics, t-test for independent samples and Cohen's d. The null hypothesis was tested at 0.05 level of significance. The statistical analysis between the pre-test and post-test scores of the experimental group showed significant difference (p=.000) and its post-test scores indicated significant increase in student engagement and motivation and significant decrease in the depressive symptoms. It indicates that the Psycho-education focused positive intervention Program (PPEI) was effective for the participants.

Douleur chronique : la place du psychiatre

ObjectivesChronic pain affects nineteen percent of the European adult population and its impact on morbidity is major. Considering psychosocial factors allows improving functional re-establishment. Psychiatric comorbidities are under-diagnosed and worsen the prognosis. The psychiatrist has an important role to play in the assessment and treatment of these subjects. MethodsWe will detail the relationship between chronic pain and some psychiatric diseases as well as their psychological and biological correlation. Then, we will discuss the therapeutic implements available to the psychiatrist. ResultsWe have to distinguish the psychosomatic disorders, which is a somatic disorder closely intertwined with a psychic disorder, from the somatoform disorder which is a body complaint to indicate a psychosocial distress. These disorders induce huge medico-economic costs: high prevalence and wrong care pathways, rarely using the psychiatrist expertise. The subjects with post-traumatic disorder combined with chronic pain have more severe post-traumatic symptoms with greater functional impairment. Twenty to fifty percent of subjects suffering of chronic pain have a depressive syndrome and fifty percent of the depressed subjects complain about chronic pain. Their symptoms are more numerous, more intense and longer lasting. Regardless of the used assessment tools, there are more pathological personality traits in chronic pain subjects with heterogeneous profiles than in general population which is useful for offering more targeted therapeutic strategies. Neurobiological integration of painful experience is based on two components : A somatosensory component (S1 and S2 areas) and an affective component with a central role of the anterior cingulate cortex. Functional dysfunctions involved in chronic pain affects the affective component of the pain experience and this component can be modulated. The psychiatrist should definitely avoid psychological explanation for the pain. He should focus on a multidisciplinary approach with partnership and complementarity. Its assessment identifies involved psychosocial factors, not for disqualifying the complaint but for considering all its aspects. Among drug treatments, antidepressants have a specific analgesic action particularly for IRS and MAOIs. Among non-drug treatments, reconditioning through physical activity combined or not with behavioral experiments can be associated with psycho education. Mindfulness, therapy of acceptance and commitment are used to promote voluntary consciousness of the body, of the pain and of thoughts. In some situations, transcranial magnetic stimulation can provide a useful aid. Analytical inspired therapies allow the subjects who are questioning about the meaning of the pain, better understanding a broader suffering. ConclusionChronic pain is closely linked to some psychiatric disorders. We should propose specific therapeutic strategies to each patient and the psychiatrist should be involved in assessment and treatment of chronic pain. In particular, the fear related to pain should be always assessed and supported. There are drug and non-drug strategies available for the psychiatrist to help taking care of these patients.

Mapping the evidence for the prevention and treatment of eating disorders in young people.

Eating disorders often develop during adolescence and young adulthood, and are associated with significant psychological and physical burden. Identifying evidence-based interventions is critical and there is need to take stock of the extant literature, to inform clinical practice regarding well-researched interventions and to direct future research agendas by identifying gaps in the evidence base.AimTo investigate and quantify the nature and distribution of existing high-quality research on the prevention and treatment of eating disorders in young people using evidence mapping methodology.MethodA systematic search for prevention and treatment intervention studies in adolescents and young adults (12–25 years) was conducted using EMBASE, PSYCINFO and MEDLINE. Studies were screened and mapped according to disorder, intervention modality, stage of eating disorder and study design. Included studies were restricted to controlled trials and systematic reviews published since 1980.ResultsThe eating disorders evidence map included 197 trials and 22 systematic reviews. Prevention research was dominated by trials of psychoeducation (PE). Bulimia nervosa (BN) received the most attention in the treatment literature, with cognitive behavioural therapy (CBT) and antidepressants the most common interventions. For anorexia nervosa (AN), family based therapy (FBT) was the most studied. Lacking were trials exploring treatments for binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS). Relapse prevention strategies were notably absent across the eating disorders.ConclusionsDespite substantial literature devoted to the prevention and treatment of eating disorders in young people, the evidence base is not well established and significant gaps remain. For those identified as being at-risk, there is need for prevention research exploring strategies other than passive PE. Treatment interventions targeting BED and EDNOS are required, as are systematic reviews synthesising BN treatment trials (e.g., CBT, antidepressants). FBTs for AN require investigation against other validated psychological interventions, and the development of relapse prevention strategies is urgently required. By systematically identifying existing interventions for young people with eating disorders and exposing gaps in the current literature, the evidence map can inform researchers, funding bodies and policy makers as to the opportunities for future research.

EPA-0492 - Functional remediation in bipolar II patients: improvement of functioning and subsyndromal symptoms

Introduction Recently, Functional Remediation (FR) has proven to be effective in improving the functional outcome of euthymic bipolar patients. Objective Our objective was to test the efficacy of FR programme in a subsample of euthymic bipolar II patients (BPII). Aims The main aim was improve the functional outcome in these patients. Method Post-hoc analyses were undertaken using data of 53 DSM-IV diagnosed BPII outpatients who had participated in a multicentre, rater blind, randomized, controlled trial (RCT) exploring the efficacy of FR (n=17) as compared with a Psychoeducation (PSY) (n=19) and a control (n=17) groups which only treatment as usual (TAU). The primary outcome variable was a functional improvement measured as the mean change in the Functioning Assessment Short Test (FAST) from baseline to endpoint after intervention. Results Data revealed a significant functional improvement from baseline to endpoint (Pillai's Trace =0.164; F =3.619; p =0.037), suggestive for an interaction between program pertinence and time (pre-post). Nevertheless, Tukey's post-hoc test only revealed a trend in favour of a better outcome for FR when compared to the TAU (p =0.058) and to the PSY group (p =0.062). We also found an interaction between program pertinence and time when analysing the subdepressive symptoms (Pillai's Trace =0.157; F =3.635; p =0.036), so that patients in FR showed a significant reduction in subdepressive symptomatology when compared to the PSY group (p= 0.041). Conclusions The FR program appears to be effective in improving the overall functional outcome in BPII patients, as well as in reducing subdepressive symptoms.

A randomized clinical trial to test the efficacy of a family-focused, culturally informed therapy for schizophrenia.

Research strongly suggests that family interventions can benefit patients with schizophrenia, yet current interventions often fail to consider the cultural context and spiritual practices that may make them more effective and relevant to ethnic minority populations. We have developed a family focused, culturally informed treatment for schizophrenia (CIT-S) patients and their caregivers to address this gap. Sixty-nine families were randomized to either 15 sessions of CIT-S or to a 3-session psychoeducation (PSY-ED) control condition. Forty-six families (66.7%) completed the study. The primary aim was to test whether CIT-S would outperform PSY-ED in reducing posttreatment symptom severity (controlling for baseline symptoms) on the Brief Psychiatric Rating Scale. Secondary analyses were conducted to test whether treatment efficacy would be moderated by ethnicity and whether patient-therapist ethnic match would relate to efficacy and patient satisfaction with treatment. Patients included 40 Hispanic/Latinos, 14 Whites, 11 Blacks, and 4 patients who identified as "other." In line with expectations, results from an ANCOVA indicated that patients assigned to the CIT-S condition had significantly less severe psychiatric symptoms at treatment termination than did patients assigned to the PSY-ED condition. Patient ethnicity and patient-therapist ethnic match (vs. mismatch) did not relate to treatment efficacy or satisfaction with the intervention. Results suggest that schizophrenia may respond to culturally informed psychosocial interventions. The treatment appears to work equally well for Whites and minorities alike. Follow-up research with a matched length control condition is needed. Further investigation is also needed to pinpoint specific mechanisms of change.

EPA-0272 - An oriental culture bound syndrome ('dhat' syndrome) in an adolescent 2nd generation immigrant male in australia

Introduction Culture-bound syndromes are defined as 'episodic and dramatic reactions specific to a particular community'. 'Dhat' syndrome or 'loss of semen' leading to weakness, is a culture bound sex neurosis in the Indian subcontinent not common in rest of the world. Aims and Objective To highlight how Culture Bound Syndromes can transcend geographical boundaries. Method A detailed history of the presenting complaints, past and family history and use of ICD 10 (WHO) for diagnosis/excluding other major mental illness. ResulT 15 year old unmarried, Afghani male whose family migrated to Australia before his birth (never went back to Afghanistan), presented with anxiety, difficulty in falling asleep, poor appetite, and weakness for 6 months. His symptoms started after being introduced to pornographic films by friends. He began masturbating 3-4 times everyday which soon became a concern to him, believing it to be 'excessive and harmful' (masturbatory guilt). For the next 3 months, he tried to abstain from masturbation, leading to problems like passage of 'whitish' discharge in urine (?precome) and nocturnal emissions, leading to more anxiety and low mood. He did not fulfil ICD 10 criteria for depression. Fluoxetine 20 mgs daily was started with sexual counselling,(psycho education about masturbation). He showed improvement within 6 weeks and at follow-up 6 months showed complete resolution. Conclusion 'Dhat Syndrome' a Culture Bound Syndrome, not normally reported in Modern Western world may still present in 2nd generation immigrants, with no overt contact with their original culture, possibly due to deep rooted trans-generational cultural ties.

EPA-0465 – Effective prevention through promoting healthy lifestyles among psychiatric patients.

Effective prevention through promoting healthy lifestyles among psychiatric patients. People with mental illnesses often have an unhealthy lifestyle, including poor diet, nicotine consumption, physical inactivity and drug use. Sometimes medication reinforces unhealthy behavioral patterns. This is the case with patients who make prolonged use of for example antipsychotics. Those patients are twice as likely to be obese as the average person end are more suffering from metabolic syndrome, and putting them at substantially higher risk of diabetes and cardiovasculair disease. Somatic screening in combination with lifestyle intervention can help control the prevalence of somatic complications for these patients To ensure mental health care institutions pay adequate attention to physical health, the Ministry of health care formulated criteria that institutions must meet. These criteria are also known as the building blocks and include policy, training of health care providers, systematic screening of physical health, lifestyle intervention, psycho education and patient record. The Reinier van Arkel Group, a mental healthcare institution in the Netherlands, implemented the building blocks in their hospital through developing a procedure in which attention the physical health is guaranteed. This procedure describes what the health care worker should do and is applied to all patients. Part of the procedure is systematic screening of the physical health care en applying lifestyle interventions. In addition, group therapies such as smoking cessation training are provided. This training is offered to both patients and staff.

Primary Vaginismus and Associated Phobia: Successful Treatment with Behavior Therapy

ABSTRACT Objectives To report two cases of primary vaginismus with associated phobia, successfully treated with behavior therapy. Results In our two reports, we describe the successful treatment of vaginismus with associated phobias using behavioral therapy. The behavioral approach involved psycho education, graded exposure, relaxation therapy and systematic desensitization. Conclusion The report demonstrates a successful approach toward managing vaginismus and associated phobias in a clinical setting. How to cite this article Sahoo MK, Biswas H, Singh V, Padhy SK. Primary Vaginismus and Associated Phobia: Successful Treatment with Behavior Therapy. J Postgrad Med Edu Res 2014;48(3):151-153.