Therapeutic Sessions Research Articles

Collected Stories: Play in Four Acts

ABSTRACTThis article evolved from a group process where members of a psychoanalytic institute were faced with planning workshops for a professional weekend around the theme of “play.” The workshop that evolved consisted of four vignettes of play taking place in the therapeutic sessions of a child, an adolescent, an adult, and an elderly woman. The discussion of these vignettes that began at the conference and then was developed for this article focuses on tracing the development of play from childhood into adulthood (Mayes & Cohen, 1996; Russ, 2004) and on the relationship between play and the development of reflective functioning (Fonagy & Target, 1996). One area of particular interest that was focused upon was the use of play with adults who are described as “concrete,” people who function, at times, at a level of differentiation more typical of a young child. Play is described as being particularly helpful in facilitating a more differentiated and, thus, more reflective mode of psychic functioning for this group of individuals as well as for people at all levels of development.

Effects of pulsed therapeutic ultrasound on the treatment of people with knee osteoarthritis.

[Purpose] The aim was to evaluate the effect of therapeutic ultrasound on the pain, joint mobility, muscle strength, physical function, and quality of life of people with knee OA. [Subjects and Methods] One-site, one-arm, before-after study that included people with Grade II or III tibiofemoral osteoarthritis. Ten therapeutic ultrasound sessions (duty cycle=20%, ERA=10 cm2, BNR=6:1, SATP=2.2 W/cm2, SATA=0.44 W/cm2, frequency=1 MHz, time=4 minutes) were applied. Assessments of primary outcome variables: pain intensity and function, and secondary variables: joint mobility, muscle strength and quality of life, were performed at onset and end of therapy; an additional intermediate evaluation was included for the primary variables. [Results] Means of repeated measurements of pain intensity (pain at rest, pain on palpation and pain after functional activities) and function showed significant differences. There was a significant reduction in pain intensity at the end of functional activities as well as a significant increase in function and in quadriceps muscle strength. [Conclusion] Therapeutic ultrasound applied in accordance with the parameters used, could be recommended during the treatment of individuals with knee osteoarthritis, because it significantly decreased the intensity of pain after the 5th session, and this reduction was maintained until the end of the intervention.

High short-term rebleeding rate in patients undergoing a second endoscopic therapy for small-bowel angioectasias after recurrent bleeding.

Angioectasias represents the most frequently found lesion in the small bowel by device-assisted enteroscopy for obscure gastrointestinal bleeding in Western countries. Recurrence of gastrointestinal bleeding after angioectasias therapy remains unclear and data regarding the efficacy of additional endoscopic therapeutic sessions to reduce the rebleeding rate is limited. To evaluate the rebleeding rate in small bowel angioectasias after a second endoscopic treatment with balloon-assisted enteroscopy after an initial bleed during the first endoscopic treatment. A retrospective double-center study of patients with small-bowel angioectasias undergoing a second enteroscopy treatment due to a first rebleeding episode. The endpoint was rebleeding, defined as the need for a blood transfusion, the presence of overt bleeding or a decrease in hemoglobin ≥ 2 g/dL. Fifteen of 37 (40.5%) patients with small-bowel angioectasias that underwent a second endoscopic therapy after a first rebleeding episode (n = 15) experienced a second rebleeding episode. Kaplan-Meier curve analysis showed that most rebleeding episodes occurred within the first 12 months of follow-up, resulting in a rebleeding rate of 33.1% at 6 months, 39.1% at 12 months and 52.6% at 24 months. Despite the high absolute short-term rebleeding rate, further endoscopic treatments may be beneficial due to the effective reduction of rebleeding in a subset of patients.

Computer Based Psychological Interventions

The digital world and technology have remained a very fascinating precinct in human life. This paper contains empirical evidence on the acceptance and efficacy of computer and internet-based interventions for mental disorders has increased. Despite growing evidence of effectiveness of digital interventions, it is still unclear how the practice of interventions should be measured, how this is associated with benefits, and how much interventions should be used in order to get health benefits. Guided computer-based interventions combined with face to face therapeutic sessions give a very prolific result in a long run. More empirical and research-based support is required to compare the benefits and drawbacks between computer-based and face-to-face assessment and therapeutic interventions. This article focuses on the various aspects of computer-based intervention and how these upcoming digital interventions are subject to the efficacy of traditional face-to-face therapeutic approaches.

Особенности чувственных образов в процессе имаготерапии

The article presents the results of the study performed on 27 adults who have completed five imago therapeutic sessions. The subjects were split in two groups: problem-solving group and problem-analysis group. The peculiarities of sensory images that arise during the sessions by Glezer grounded theory method were studied. It turned out that the subject sensual tissue of the psychosemiological tetrahedron (the term of F. Vasiljuk) of the imago therapeutic image is represented mainly by sensory imaginary events and less frequently by sensual objects and recalled events. The pole and sensory tissue of meaning are least expressed in the imago therapeutic image. The pole and sensory tissue of personal meaning are significantly expressed by the imago therapeutic image. Not only elements relating to the imagination are woven into the imago therapeutic image but also elements reflecting the process of imaginative psychotherapy as a whole, a separate session, the process of imagination. These elements are closely related to the elements of imaginary and remembered events, their feelings and comprehension.

Effectiveness of aerobic exercise and balanced diet for motor and functional recovery of stroke survivors with and without diabetics and post stroke diabetics

Background: Diabetes is a strong risk factor for stroke, it is unsettled stroke is different in patients with and without diabetes. Hyperglycemia has been observed after an acute stroke and is associated with poor prognosis. Stroke patients with diabetes mellitus appear to have a worse prognosis in term of both mortality and residual disability. Aims and Objective: The study aims to prospectively characterize stroke in the diabetic patients in stroke population. To determine the time course of recovery and prognosis in stroke patients with diabetes and the relation between non-diabetes, pre diabetes, and post diabetes. Materials and Methods: A total of 65 subjects were enrolled for the study from the Outpatient Department of ACS Medical College and Hospital. 30 patients after exclusion were subjected for the therapeutic session under 3 groups of 10 each, such as non-diabetic, diabetic before stroke and diabetic after the stroke, and each group comprising males and females. The treatment session of 3 months comprised aerobic exercises, neurological rehabilitation, and prescribed diet. Pre- and post-test using, Scandinavian stroke scale (SSS), Barthel’s Index (BI), and random blood glucose level. Data were analyzed using twotailed t-tests, delineated as a mean ±standard deviation and the level of significance was set at P < 0.01 for SSS, P < 0.005 for BI, and P < 0.005 for random glucose level (RGL). Results: Pre- and post-intervention data of SSS and BI of all the three groups of subjects recorded significant increase at P < 0.01 and P < 0.05, respectively, indicating the positive impact of the treatment session on mitigation of disabilities. The RGL data of both diabetic groups recorded a significant reduction in the post-treatment estimation, confirming the effectiveness of the treatment regimen in regulating the blood glucose level as well. Conclusion: This study has demonstrated the positive impact of physical activity; particularly the aerobic exercise and nutritional alterations in successful intervention of the disabilities of stroke survivors with and without diabetes.

The Effects of Hallucinogens on Gene Expression.

The classic serotonergic hallucinogens, or psychedelics, have the ability to profoundly alter perception and behavior. These can include visual distortions, hallucinations, detachment from reality, and mystical experiences. Some psychedelics, like LSD, are able to produce these effects with remarkably low doses of drug. Others, like psilocybin, have recently been demonstrated to have significant clinical efficacy in the treatment of depression, anxiety, and addiction that persist for at least several months after only a single therapeutic session. How does this occur? Much work has recently been published from imaging studies showing that psychedelics alter brain network connectivity. They facilitate a disintegration of the default mode network, producing a hyperconnectivity between brain regions that allow centers that do not normally communicate with each other to do so. The immediate and acute effects on both behaviors and network connectivity are likely mediated by effector pathways downstream of serotonin 5-HT2A receptor activation. These acute molecular processes also influence gene expression changes, which likely influence synaptic plasticity and facilitate more long-term changes in brain neurochemistry ultimately underlying the therapeutic efficacy of a single administration to achieve long-lasting effects. In this review, we summarize what is currently known about the molecular genetic responses to psychedelics within the brain and discuss how gene expression changes may contribute to altered cellular physiology and behaviors.

Who are the female smokers who seek treatment for smoking cessation: A Brazilian cohort study

ABSTRACTAim: To describe the sociodemographic, clinical, and behavioral characteristics of women who seek treatment for smoking cessation and to investigate the relationship between these characteristics and the nicotine dependence level and treatment duration. Methods: Data were collected using questionnaires that were administered to 655 women. Regression of generalized linear model and regression logistic ordinal were used to assess the correlation between the variables being studied. Findings: The average age of women in the study was 49 years. Among them were those who were employed (54.9%), who had high levels of nicotine dependence (78.5%), and whose primary reason for seeking treatment was related to health concerns (62%). The treatment duration was positively correlated with depression (p = 0.04), hypertension (p < 0.01), and with seeking treatment due to health concerns (p = 0.02). Conclusions: Our study indicates that adherence in women can be increased by providing treatment that is accessible to the lower class. It also indicates the need to reconceptualize the way therapeutic group sessions are conducted. We hypothesize that the reason for the high dropout rate after 6 months of treatment could be related to the way that group sessions operate.

A therapeutic education tool in paediatric dentistry

Therapeutic education for children is developing in the treatment of dental caries. The Elmy pathway, a pedagogical game aiming to improve children's oral health skills, has been designed. The qualitative assessment of this tool seems to confirm its benefit for use in therapeutic education sessions.

Repeated sessions of transcranial direct current stimulation evaluation on fatigue and daytime sleepiness in Parkinson's disease.

Parkinson is a common and disabling disease that affects patient's and career's quality of life. Unfortunately, medications, such as dopaminergic and sedative-hypnotic drugs, as an effective treatment have unwilling side effects. Recently, Transcranial Direct Current Stimulation (tDCS) in conjunction with medication becomes popular as a complementary safe treatment and several studies have proved its effectiveness on controlling motor and specially non-motor aspects of Parkinson's disease. In this randomized double-blind parallel study, 23 patients with Parkinson's disease divided into two groups of real tDCS plus occupational therapy and sham tDCS plus occupational therapy and the effects of therapeutic sessions (eight sessions tDCS with 0.06mA/cm2 current, 20min on dorsolateral prefrontal cortex) were evaluated on fatigue and daytime sleepiness just after therapeutic course and in 3-month follow-up. tDCS had a significant effect on fatigue and no effect on daytime sleepiness reduction in patients with Parkinson's disease. tDCS is an effective and safe complementary treatment on fatigue reduction in Parkinson's disease.

The feasibility and acceptability of short-term, individual existential behavioural therapy for informal caregivers of patients recruited in a specialist palliative care unit.

BackgroundExistential behavioural therapy (EBT) is a recently developed intervention to support informal caregivers of patients in a specialist palliative care unit and was initially established as a six-session group programme. This pilot study aimed to test the feasibility and acceptability of an adapted short-term, individual approach of EBT in preparation for a randomized controlled trial (RCT).MethodsThe study was conducted in a prospective, mixed methods design including four quantitiative assessments with embedded qualitative interviews at one assessment.The intervention offered two one-hour therapeutic sessions focusing on (1) mindfulness and (2) existential meaning-in-life as a source of strength provided by a trained psychotherapist. To test the feasibility of the intervention, doubling of the participation rate, compared to the previous group study (13,6 %) as well as an attrition rate of less than 30 % were set as thresholds. To test the acceptability of the intervention, self-rated usefulness of individual aspects of the intervention and the frequency of implementing therapeutic elements by the carers were set as criteria. Acceptability testing also included the number of participants who completed both sessions, where we expected more than 75 % as a criterion for acceptability. Return rates of quantitative questionnaires were set as criteria for the feasibility of data collection (<33 % loss expected within the study period). Qualitative interviews were used to collect additional data on feasibililty and acceptability and to explore potential harms and benefits of the intervention.Results44/102 (43,1 %) of eligible informal caregivers agreed to participate in the study. Due to attrition of 13 caregivers (attrition rate: 29,5 %), 31 caregivers were included in the trial. Self-rated usefulness showed sufficiant results for all but one individual aspect. Frequency of implementing therapeutic elements showed wide inter-item as well as inter-participant ranges and decreased over the study period. All participants completed both sessions. Return rates of the questionnaires were within the expected range. According to the interviews, the intervention was associated with several participant-identified benefits. No severe adverse effects were observed.ConclusionsFindings suggest that the short-term, individual EBT proved feasible and mostly acceptable.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-016-0160-1) contains supplementary material, which is available to authorized users.

How many physical therapy sessions are required to reach a good outcome in symptomatic lumbar spondylolisthesis? A retrospective study

BackgroundThere is a lack of conclusive information about the optimal dosage of physical therapy treatments in Spondylolisthesis (SPL) patients. PurposeThe present study attempted to evaluate the comparative effectiveness of two different doses in reaching similar clinical outcomes. MethodsA retrospective cohort study of 64 consecutive patients admitted for physical therapy with symptomatic lumbar grade I SPL (42 ± 15years, 57% female) was conducted. At the end of the treatment, all participants were retrospectively assigned to one of two groups, receiving either 5–8 or 9–12 sessions (experimental or control group, respectively) of physical therapy treatments. The Prone Bridge Test (PBT) and the Supine Bridge Test (SBT) were used to measure muscular endurance. ResultsThe area under the ROC curve for the PBT was 0.64 (95% CI 0.45–0.83) and for the SBT was 0.57 (95% CI 0.33–0.80). The optimal cutoff points were 25.5s for the PBT and 55.0s for the SBT. Logistic regression revealed that PBT (OR = 1.062) was associated with SPL. The final regression model explained 77.4% (R2 = 0.341; p = 0.024) of the variability. ConclusionsIn this sample, the number of sessions required to achieve satisfactory outcomes ranged from 5 to 12. The clinical results of the subjects in the 5–8 sessions group were similar to the 9–12 sessions group. Individual's coping mechanisms could be considered in future studies to understand which patients will require more therapeutic sessions.

POEM AS A TOOL FOR SELF COGNITION AND SELF-CREATION

Author of this article explains, how to use poem (Two suns, written by Vincas Mykolaitis- Putinas) for Self Cognition and Self Creation, presents creative poetry therapy method (techniques), and evaluates therapeutic impact on emotional, cognitive, social and personal growth. Clients' responses to poem's reading are explored in the beginning and in the end of poetry therapy session, changes are evaluated, personally important meanings of creative activities were disclosed during session, benefit of dialog, based on clients‘personal meanings, and its impact on Self Cognition and Self Creation was evaluated in therapeutic session. Author emphasizes, that, deep reading has benefit on Self Creation, reduces emotional tension and promotes positive thinking, liberates from low Self evaluation; advocates for poetry therapy techniques to promote deep reading. KEY WORDS: Poetry therapy. Self cognition, self- creation, adults, reading. DOI: http://dx.doi.org/ 10.15181/atee.v1i0.1314

The Links: What is Produced in the Space Between Others

Argentine psychoanalysts have been working on a link approach to psychoanalysis for more than forty years, inspired by Isidoro Berenstein's and Janine Puget's theoretical–clinical developments. It proposed an additional perspective of psychoanalytic theory with ideas that had not been previously developed or included. Bridges were built with other disciplines such as philosophy, anthropology, and the history of contemporary subjectivity. This task has required the deconstruction, rethinking, and invention of some conceptualisations, not only of family and couple bonds or links, but of what was called "lo vincular" (the link) itself. The term lo vincular describes the work carried out by subjects in the context of links, for in order to create a link with others we must do something with the changes brought about by their presence. Such "doing" cannot be anticipated; it is always about to happen despite having happened often before. The same is true of each therapeutic session, no matter whether it is the first, second, or third. We cannot foresee what will happen in this session or in the next, or even what our patient's next idea might be.

Brinquedo terapêutico na administração de medicação endovenosa em crianças: estudo exploratório

Aim: To identify the reactions of children during intravenous drug administration before and after the use of a therapeutic play technique and to analyse their companions’ perceptions regarding the technique’s effects on the child’s preparation for intravenous drug administration. Method: An exploratory study with a qualitative approach conducted through observations of intravenous drug administration and therapeutic play sessions with children and semi-structured interviews with their companions. The data were subjected to thematic analysis. Results: Children who had difficulty accepting intravenous medication, especially those between 4 and 6 years, presented positive behavioural changes after the use of therapeutic play. The children’s companions recommended the use of this technique to improve care and reduce stress during drug administration. Conclusion: Therapeutic play is a relevant nursing intervention for minimizing children’s reactions during intravenous drug administration, and the training of nurses and the promotion of technique are important for improving care.

The effectiveness of communication skills and effective dialogue on marital satisfaction and commitment of young couples

The purpose of this study is analyzing the effectiveness of communication skills and effective dialogue on marital satisfaction and commitment of young couples. The research plan was the trueexperiment pre-test, post-test experimental and control groups. The statistical population was consisted of all couples (married less than 5 years) attending ARAMESH counseling clinic in the city of Gorgan in the second half of 2015. The research sample was selected among those couples, who volunteered to participate in educational and therapeutic sessions and randomly divided into two groups; experiment group (10 couples) and control group (10 couples). The effective training communication skills for the experimental group was conducted in 8 sessions of group counseling for 90 minutes and no training for control group. The research questionnaires were Afrooz Marital Satisfaction Scale (AMSS) and marital Dimensions of Commitment Inventory (DCI) of Adams and Jones (1977). The findings showed that training communication skills and effective dialogue have effect on marital commitment and satisfaction. On the other hand, according to Chi Eta contribution, it can be stated that training communication skills and effective dialogue explained 97% of the variance of couples marital commitment and satisfaction. Other findings showed that trainingcommunication skills and effective dialogue have effect on couples' satisfaction. On the other hand, according to Chi Eta contribution, it can be said that training communication skills and effective dialogue can explain 95% of the variance in satisfaction of couples. Other findings showed that training communication skills and effective dialogue have effect on marital commitment. On the other hand, according to Chi Eta contribution, it can be stated that training communication skills and effective dialogue explained 92% of the variance of couple’s marital commitment. Since training communication skills and effective dialogue was desirable and effective for marital satisfaction and commitment, we recommend the implementation of this method in other samples to improve couple relations and develop new strategies in other words, encouraging families to provide new measures to improve family performance.

Trauma-Focused Cognitive Behavior Therapy

Repeated retelling of trauma narratives within Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) assists participants to habituate to experiences that have precipitated symptoms of post-traumatic stress. In this study, the narratives produced by children and adolescents, who developed post-traumatic stress disorder following a natural disaster, and who were treated with a manualized TF-CBT intervention, were examined. The first author developed a coding system utilizing three major concepts (coherence, elaboration, and evaluation) to identify changes in the narratives as they were retold at each therapeutic session. Analysis using this coding system identified that the internal logic of the stories was maintained as the detail diminished, and that the level of evaluation increased. Compression emerged as a major pattern, alongside the reduction in participant distress over the course of the treatment. Although requiring replication, these trial concepts, developed by the coding system, have potential analyzing trauma narratives and enhancing clinician observations.

Efeitos da atividade física terapêutica sobre o perfil glicêmico, composição corpórea e capacidade física funcional em diabéticos tipo II

Introdução: pouco se sabe dos efeitos de uma única sessão semanal de atividade física terapêutica supervisionada aos diabéticos, portanto, resolveu-se analisar a possibilidade de ganho com essa prática. Objetivo: avaliar os efeitos de exercícios supervisionados ao perfil glicêmico, composição corpórea e capacidade funcional. Métodos: 28 diabéticos tipo II na primeira sessão foram avaliados por glicemia capilar, composição corpórea (IMC e percentual de gordura) e capacidade física (Time Up and Go, Sit-To-Stand e Step Test). Sendo reavaliados após oito sessões semanais de exercícios. Utilizou-se o T-Student para variáveis dependentes (p

فعالية العلاج الواقعي في التخفيف من السلوک العدواني لدى طالبات المرحلة الثانوية في دولة الکويت

هدفت هذه الدراسة إلى معرفة السلوکيات العدوانية الأکثر انتشارا بين أفراد العينة، والکشف عن فعالية برنامج علاجي قائم على أسلوب العلاج بالواقع للتخفيف من هذا السلوک. تکونت عينة الدراسة من (40) طالبة من المرحلة الثانوية بدولة الکويت تم اختيارهن بترشيح من الأخصائيات الاجتماعيات والنفسيات بالمدرسة . تراوحت أعمارهن بين (15-17 سنه). تم تقسيمهن إلى مجموعتين (تجريبية وضابطة)، کل مجموعة اشتملت على (20) طالبة. استخدم مقياس السلوک العدواني ذا الأربعة أبعاد: 1-عدوان موجه نحو الآخرين 2- عدوان موجه نحو الذات 3- عدوان موجه نحو الممتلکات 4- الخروج عن المعايير والقيم . أسفرت النتائج عن أن العدوان الموجه نحو الآخرين هو السلوک الأکثر انتشارا. اشتمل البرنامج العلاجي على (12) جلسة، وذلک خلال الفصل الأول للعام الدراسي 2013/ 2014. أشارت النتائج إلى فعالية البرنامج في تخفيف السلوک العدواني، ووجود فروق ذات دلالة إحصائية بين أفراد المجموعتين لصالح المجموعة التجريبية. في ضوء تلک النتائج تم تقديم عدة توصيات منها: تقديم دورات تدريبية للأخصائيات الاجتماعيات والنفسيات والمعلمات تشرح أسلوب العلاج بالواقع وکيفية استخدامه للتعامل من خلاله مع الطالبات العدوانيات، إضافة إلى برامج توعوية للطالبات. The aim of this study was to find the most aggressive behavior prevalent among members of the sample and, to reveal the effectiveness of reality therapy treatment in decreasing this act. The sample consisted of (40) female students studying at secondary school level in Kuwait ,they were nominated by school social workers and, school psychologists depending on their experience with the students and, by reference to the academic records of students , their age ranged between (15-17). They were divided In two groups K experimental and, controlled group , each group consist of 20 students The researchers applied (scale of aggressive behavior) which consist of four dimensions:1-Aggression directed towards others, 2-Aggression directed towards Self, 3-Aggression directed towards public properties, 4-Violation of norms and, values. Results have shown that aggression towards others was the most prevalent behavior. Therapy program consisted of 12 therapeutic sessions, and that was during the first semester of the academic year 2013/2014. Results indicated that the program was effective in reducing aggressive behavior of experimental group members. In light of these results a number of recommendations were presented including: providing training programs for school social workers, psychologists and, teachers to explain methods of Reality therapy treatment and, how to use it, as well as awareness programs for students.

USING ASSISTIVE TECHNOLOGY TO SUPPORT THERAPEUTIC INTERVENTIONS WITH PEOPLE WITH DEMENTIA: FINDINGS FROM THE DEM@CARE INTERVENTION STUDIES IN IRELAND

With expected increases in dementia prevalence figures as our population ages, there is a great need to find acceptable, efficient, and cost-effective solutions that enable people with dementia to live well at home and to remain integrated with their communities for longer. Technology-based approaches have been suggested as a potential means of meeting these needs, but attitudes to, and lack of familiarity with technology can reduce their effectiveness in the home environment without sufficient support. The “Dementia Ambient Care” (Dem@Care) project piloted a psychosocial intervention to reduce excess disability and increase subjective quality of life while introducing assistive technologies with direct therapist support. Five participants (3 female, mean age 77) living at home with early to moderate stage dementia took part. Four therapists delivered the intervention; each participant had one therapist working with them. Prominent every-day difficulties were first identified, and then the therapist, person with dementia, and caregiver set therapeutic goals relating to these difficulties, and selected strategies and appropriate Dem@Care sensors to address these goals. Each participant subsequently took part in 12-14 therapeutic sessions at home (90-120 minutes each). A rolling consent process was used throughout. Periodic multidisciplinary meetings were also held to facilitate therapist interaction and feedback. In all cases the intervention had a positive impact and all participants felt they achieved their primary goals. Therapists found it difficult at times to introduce technology and to successfully integrate it into goal strategies, in part due to the nature of some of the participant’s goals (e.g. managing feelings of anxiety), but also due to the nature of the cognitive impairments experienced by the participant. High levels of learning support were required, even with those familiar with technology. While appreciating the potential of technology to support psychosocial interventions and to provide a basis for ongoing remote management and support of dementia, many primary goals were unsuited to a technology-based solution and the importance of human interaction remained evident. We demonstrate that technology should not aim to replace this interaction; rather it should be added to therapeutic work in a meaningful way.