Symptom Substitution Research Articles

Biofeedback for headache.

Biofeedback has proven effective in treatment of vascular and muscle contraction headache. However, many factors have not yet been explored. Research into personality and psychologic aspects that can predict success or failure with biofeedback is necessary, as is research into the applicability of skills learned in the laboratory to nonlaboratory situations. The possibility of symptom substitution should be investigated, and the problem of using study volunteers who do not adequately represent the headache population must be dealt with. Biofeedback represents a significant step forward in control of migraine and muscle contraction headache. Further experience with biofeedback techniques is necessary, but the future seems to promise continued success with this new method of treatment.

Symptom substitution, generalization, and response covariation: Implications for psychotherapy outcome.

Symptom substitution, generalization, and response covariation: Implications for psychotherapy outcome.

Treatment of Primary Enuresis in a Mentally Retarded Adult: The Need to Supplement The Bell and Pad Procedure

Bell and pad intervention to treat enuresis in a 21 year old mentally retarded male, living in a half-way house for intellectually handicapped people, is reported. Enuresis was not significantly reduced after 22 weeks of standard bell and pad treatment. Therapist involvement in the programme was de-emphasized to offset the possibility that therapist visits were reinforcing wet nights. This de-emphasis was supported by behavioural contracting. These programme supplements were associated with an immediate reduction to no wet nights. A six month Follow-up revealed the subject had wet his bed only very occasionally. No “symptom substitution” was evident.

Symptom substitution, generalization, and response covariation: Implications for psychotherapy outcome.

Symptom substitution, generalization, and response covariation: Implications for psychotherapy outcome.

Psychodynamic and Behavioral Approaches to the Treatment of Sexual Dysfunctions

Sex therapy has emerged as a testing ground for examination of the re lationship between psychodynamic and behavioral approaches to psychotherapy and behavior change . Until the early 1960s psychoanalysis and dynamically oriented psychotherapy represented the maj or approaches to the treatment of psychological disorders in general and sexual dysfunctions in particular . After that time behavior therapy be gan to represent an increasingly important alternative conceptualization and treatment procedure . We have noted (Leiblum & Pervin, 1980) that the ground -breaking work of Masters & Johnson (1970), together with the increasing popularity of behavioral techniques and self-help procedures, has served to reshape thinking concerning the nature of sexual dysfunctions and the potential for rapid, significant modification of sexual functioning. In the early years of these developments, debate focused almost entirely on psychodynamic therapy and behavior therapy as competing, mutually exclusive procedures. Behavioral approaches were viewed by psychoanalysts as superficial and the results as transient, while behavior therapists castigated analysts for mistaken assumptions concerning symptom substitution and presented evidence suggesting that behavior therapy could be both brief and effective, perhaps even more effective than insight therapy. Although these extreme, divergent points of view continue to be held by many analysts and behavior therapists, others have taken to exploring the possible linkages that might be established between

Once more unto the breach dear friends…A reconsideration of the literature on symptom substitution

For over 25 years the question of symptom substitution has been the most heatedly contested theoretical point between the behavioral and psychodynamic schools. The behaviorists have claimed to show empirically that symptom substitution is at worst a negligible phenomenon, while the psychodynamicists have argued that this is a theoretical impossibility. This paper reviews the basic behavioral and psychodynamic positions on this issue. It subsequently argues that the behavioral studies in this area are methodologically and conceptually flawed to the point of neutralizing the claim of “empirical” resolution. Finally, current behavioral and psychodynamic positions on this issue are viewed, as well as their relevance to future research and therapeutic intervention.

The Current Status of Behavior Therapy

This article reviews the current status of behavior therapy, discussing ambiguities, characteristics, myths, and limitations of the field. Ambiguity of "behavior therapy" stems from the different definitions that have been proposed, the historical development of the field, and the diverse conceptual positions and treatment techniques. Myths about behavior therapy related to the role of client-therapist relationship and "symptom substitution" are evaluated in light of contemporary data. Current limitations including the heavy reliance upon outcome research with subclinical populations and the utility of medical treatments are also discussed. Despite the ambiguities of the field and complexities in evaluating the evidence, behavior therapy has contributed substantially to therapy research by placing outcome research on a scientific footing.

Behavioral symptom substitution in children cured of encopresis.

Follow-up data were obtained on 47 children who had been treated for encopresis with an initial catharsis, maintenance laxative therapy, demystification, symptom-related counseling, and close follow-up. Behavioral inventories were used at the beginning of treatment and three years later to determine whether any significant symptom substitution occurred in children cured of encopresis. Little evidence of this was uncovered. There was a comparison of cured and uncured children with respect to behavioral profiles at the start of treatment and three years later. The uncured group showed more aggressive behaviors initially, and also were more socially withdrawn at the start of treatment, although this was not evident three years later. Monitoring of associated behaviors should be an important part of the management of encopresis.

Hysterical conversion: a prognostic study.

This is a study of the symptoms and treatment of 61 patients with hysterical conversion. The incidence rate is high and the clinical picture showed different qualities from that seen in other studies. Treatment by suggestion under various procedures produced favourable results. All symptoms were removed and after twelve months follow-up only 12 patients relapsed. Symptom substitution was minimal. The prognosis is related, among other things, to the duration of the symptoms before treatment.

Therapy of vaginismus by hypnotic desensitization

Fear and anxiety are of tremendous importance in the production and maintenance of a symptom. Vaginismus, as a reaction of avoidance of an anxiety-producing situation, is readily amenable to treatment by systematic desensitization. This may proceed mainly in two ways: “in vitro” or “in vivo.” In order to strengthen and speed up the densensitization process, we used hypnotic techniques in a dynamic approach. The “in vitro” treatment proceeds with imagery, under hypnosis, of an “anxiety hierarchy” of increasingly erotic and sexually intimate situations which will be reproduced at home with the partner, until sexual intercourse is achieved. In the “in vivo” method the patient learns self-hypnosis and then inserts in the vagina first a finger, and then Hegar dilators of gradually increasing sizes. The partner, the patient, and the physician will then successively proceed to insertion, forming a team-referred work situation. This continues until the “female superior position,” practiced first with the largest dilator, is reproduced at home by intercourse. Between 1965 and 1974 we treated 71 women with this method. Good results were obtained in 16 of 18 by the “in vitro” technique and in 53 of 54 by the “in vivo” technique. One patient was referred from the “in vitro” group to the “in vivo” group. In follow-up of 2 to 5 years there was no relapse or symptom substitution.

Biofeedback, migraine headache and new symptom formation.

SYNOPSISIn this retrospective study of 12 migraine patients successfully treated with biofeedback, we find that 67% experienced some form of symptom substitution. This manifested as classical psychosomatic symptoms, clinical depression, or a quasi‐delusional belief in controlling one's own or others' thoughts or feelings.

Behavior Ecology Emerges from Behavior Modification

The position is presented that behavior modification is ready to expand its theoretical and professional base to one which can be described as behavioral ecology. At each level of operation, from individual therapy to broad social applications, behavioral change involves complex rearrangements in the systems surrounding the focal behavior. While symptom substitution in the psychodynamic sense may not be demonstrated, each therapeutic intervention produces a variety of effects both within the person and in his interpersonal network. At the broad social level, behavior modifiers who consider applications of their methods to such problems as population control also need to consider the complex systems effects in any decision to focus on a particular behavior.

Blindisms: Treatment by Punishment and Reward in Laboratory and Natural Settings

Reports on study designed to test the effectiveness of using punishment (pre-recorded sound of chalk screeching on a blackboard) and positive reinforcement to reduce blindisms (stereotypic behaviors) in blind children. The data for six independent experiments indicated a marked decrease in the stereotypic behaviors. There was no evidence that a reduction in one kind of stereotypic behavior produced a corresponding increase in another kind (symptom substitution) and in fact other untreated behaviors also showed a decrease in four of the six experiments. The reduction of the stereotypic behaviors also generalized to other classrooms and this reduction was maintained over a ten day period without further treatment.

Emergent fears during treatment of three obsessive compulsives: Symptom substitution or deconditioning?

The emergence of new fears during treatment by flooding of three obsessive compulsives is described, and its theoretical implications are discussed. Two characteristics which differentiate these patients from others are their initial failure to anticipate disastrous or shameful consequences and the unusually rapid extinction of the originally reported fears. Their initial unawareness of these fears seems to result from conditioned inhibition. The originally reported fears and the emergent ones belonged to the same theme, the former occupying the lower part of the hierarchy and the latter the higher part. Emergence of these fears was facilitated by generalization of deconditioning along the treated dimension.

Hysterical Aphonia: A Case Report

Abstract Out-patient hypnotherapy was used to treat a 55-year-old female who had suffered hysterical aphonia for a year. There were eight sessions at weekly intervals. An age regression was done to ascertain the etiology of the aphonia in order to treat the cause so as to prevent symptom substitution. Speech modeling, assertive training and ego strengthening suggestions were also used. At the end of seven sessions the patient was speaking normally. The eighth and final session merely provided reinforcers for maintenance. Carry-over effects were noted over the subsequent year.

Parental intervention in the treatment of chronic constipation

Chronic constipation was successfully eliminated in a 3-yr-old girl through a regimen combining behavioral and medical treatments. The onset of constipation was at birth. The procedures entailed use of mineral oil to produce reflex defecation concurrent with a token economy established by the parents in the home. After symptom remission, the behavioral- medical interventions were systematically faded. At 39-, 67-, and 93-week follow ups there was no recurrence of constipation and no symptom substitution.

The role of the symptom in psychopathological states.

Abstract.— Four approaches to the role of symptoms in psychopathological states are discussed. These are: Prepsychoanalytic psychiatry, psychoanalysis, family communication theory, and the view that symptoms as a sign of mental illness do not exist. The latter comprises labelling theory and social learning theory. Particular interest is attached to the contentions of symptom substitution and symptomatic treatment. Both are rejected as myths. A theory of action is briefly outlined, and on the basis of this, an alternative interpretationof phenomena ordinarily conceptualized as mental pathology is suggested. The concepts of “psychopathology” and “symptoms” are redefined in accordance with present knowledge, and the importance of formulating human action in an ethical frame of reference is pointed out.

Behavioral Treatment of Hysterical Neurosis: Symptom Substitution and Symptom Return Reconsidered.

One of the major areas of disagreement between therapists working within the psychodynamic and behavioral frameworks involves the issues of symptom substitution and symptom return, the psychodynamicists holding that treatment of symptoms alone cannot result in permanent improvement, and the behavioral therapists arguing that it can. However, a reexamination of the data indicates that psychoanalysts base their conclusions primarily on cases of hysterical neurosis whereas the behaviorists base their conclusions primarily on the treatment of phobia. Heeding the call of the recent American Psychiatric Association Task Force on Behavior Therapy (1973), in this paper we seek to reconcile the apparently contradictory data, illustrating our arguments with case reports. Moreover, we will attempt to obtain a greater degree of rapprochement and cross-fertilization between the dynamic and behavioral schools of thought.

Look carefully; a short note on symptom substitution

Look carefully; a short note on symptom substitution

Symptom substitution in a male hysteric.

Symptom substitution in a male hysteric.