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Experiments are reported that add to the growing literature on the voluntary provision of public goods. Information conditions are manipulated to address whether early findings of above-equilibrium contributions to a public good are a result of complete information regarding the symmetry of the game. No significant information effect was found. Further, by examining designs with an interior Nash equilibrium, this research suggests that the nonzero contributions observed in the previous dominant strategy environments, where the prediction was a zero level of provision of the public good, were not simply transitional errors as the system converged to a boundary equilibrium.
Aviation passenger screening has been used worldwide to mitigate the translocation risk of SARS-CoV-2. We present a model that evaluates factors in screening strategies used in air travel and assess their relative sensitivity and importance in identifying infectious passengers. We use adapted Monte Carlo simulations to produce hypothetical disease timelines for the Omicron variant of SARS-CoV-2 for travelling passengers. Screening strategy factors assessed include having one or two RT-PCR and/or antigen tests prior to departure and/or post-arrival, and quarantine length and compliance upon arrival. One or more post-arrival tests and high quarantine compliance were the most important factors in reducing pathogen translocation. Screening that combines quarantine and post-arrival testing can shorten the length of quarantine for travelers, and variability and mean testing sensitivity in post-arrival RT-PCR and antigen tests decrease and increase with the greater time between the first and second post-arrival test, respectively. This study provides insight into the role various screening strategy factors have in preventing the translocation of infectious diseases and a flexible framework adaptable to other existing or emerging diseases. Such findings may help in public health policy and decision-making in present and future evidence-based practices for passenger screening and pandemic preparedness.
Though there are effective psychological and drug treatments for obsessive–compulsive disorder (OCD), many patients remain inadequately treated or untreated. Making effective self-treatment guidance available may increase the number of patients being helped. In this review, database and manual literature searches were performed of case studies, open and randomised controlled trials (RCTs) of bibliotherapy, self-help groups, telecare and computer-aided self-help for OCD. We found no RCTs of bibliotherapy or self-help groups for OCD. Three open studies showed the efficacy of brief exposure and ritual prevention (ERP) instructions delivered by a live therapist by phone. A vicarious ERP computer program was effective in a small open study. Fully interactive computer-aided self-help by ERP for OCD was efficacious in two open studies and a large multicentre RCT, and in a small RCT compliance and outcome with that program was enhanced by brief scheduled support from a clinician. Although more research is needed, self-help approaches have the potential to help many more patients who would otherwise remain inadequately treated or untreated. Their dissemination could save resources used by health care providers. We propose a stepped care model for the treatment of OCD.
Treatment of neurosis is selectively surveyed, including physical methods. At least four differing aims of psychotherapeutic techniques can be distinguished—to produce a rewarding experience; to nurture self-knowledge; to allow confession or catharsis; and to effect a lasting change in behaviour. The report concentrates on the last two aims. Effects of psychological treatments are considered first by syndromes and then by procedures. Prognostic issues are defined and research strategies outlined. Further work is suggested, including the relief of acute neurotic distress before referral for specialist help, the combination of psychotropic drugs and psychological treatments, the application of specific psychotherapeutic techniques for defined ends, and elucidation of the active therapeutic ingredients in these methods.
Research in neurosis is reviewed from the standpoint of genetics, phylogenesis, physiology, epidemiology, and prognosis. Family and sociocultural variables are discussed, and experimental paradigms noted. Directions for further research are suggested in these areas, including perceptual and physiological reflex mechanisms triggered in neurosis and in normal people, cross-cultural longitudinal epidemiological studies of specific neurotic syndromes which are linked to family and social variables, factors governing illness behaviour, and field observations of family and marital pathology.
Aunque hay tratamientos psicológicos y farmacológicos eficaces para el trastorno obsesivo-compulsivo (TOC), muchos pacientes reciben tratamiento inadecuado o no lo reciben en absoluto. Proporcionar una guía de auto-tratamiento eficaz puede incrementar el número de pacientes que reciben ayuda. En esta revisión, se realizaron búsquedas en bases de datos y manuales en las publicaciones de estudios de casos, ensayos al descubierto y ensayos controlados distribuidos al azar (ECDA) de biblioterapia, grupos de autoayuda, teleatención y autoayuda asistida por ordenador para el TOC. No encontramos ECDA de biblioterapia o grupos de autoayuda para el TOC. Tres estudios al descubierto mostraron la eficacia de instrucciones de exposición breve y prevención de rituales (EPR) dadas por un terapeuta en directo por teléfono. Un programa de ordenador de EPR vicaria fue eficaz en un pequeño estudio al descubierto. La autoayuda completamente interactiva asistida por ordenador por EPR para el TOC fue eficaz en dos estudios al descubierto y un gran ECDA multicéntrico, y en un ECDA pequeño el cumplimiento y la evolución con ese programa se reforzó por un apoyo breve programado de un clínico. Aunque se necesita más investigación, los enfoques de autoayuda tienen el potencial de ayudar a muchos más pacientes que, en otro caso, podrían recibir tratamiento inadecuado o no recibirlo en absoluto. Su difusión podría ahorrar recursos utilizados por profesionales sanitarios. Proponemos un modelo escalonado de atención para el tratamiento del TOC.
In an open study, ten people with phobia or panic disorder who could not travel repeatedly to a therapist accessed a computer-aided exposure self-help system (Fear Fighter) at home on the internet with brief therapist support by telephone. They improved significantly, and their outcome and satisfaction resembled those in patients with similar disorders who used Fear Fighter in clinics with brief face-to-face therapist support.
Most anxiety/depression is not effectively treated.
Aims
Open evaluation of a free clinic giving immediate computer-aided cognitive – behavioural therapy (CBT) self-help plus brief advice from a therapist.
Method
Test of outcome of self-referrals who used one of four computer-aided CBT systems for depression, phobia/panic, general anxiety or obsessive-compulsive disorder.
Results
The equivalent of one full-time clinician managed 355 referrals over a year. Of the 266 who had a screening interview 79% were suitable. Completers and non-completers of computer-aided CBT had similar pre-treatment features, with very chronic, moderately severe problems. Completers of the computer-aided self-help had a mean total of an hour's live therapist support over 12 weeks. They improved significantly and clinically meaningfully with three of the four systems and felt ‘fairly satisfied’. Improvement resembled that in controlled and other trials of computer-aided CBT.
Conclusions
Computer-aided self-help is a‘clinician extender’ that greatly cuts per-patient therapist time without impairing improvement. It could reduce the per-patient cost of CBT.
Patients' perspectives concerning impaired functioning provide important information.
Aims
To evaluate the reliability and validity of the Work and Social Adjustment Scale (WSAS).
Method
Data from two studies were analysed. Reliability analyses included internal scale consistency, test – retest and parallel forms. Convergent and criterion validities were examined with respect to disorder severity.
Results
Cronbach's α measure of internal scale consistency ranged from 0.70 to 0.94. Test – retest correlation was 0.73. Interactive voice response administrations of the WSAS gave correlations of 0.81 and 0.86 with clinician interviews. Correlations of WSAS with severity of depression and obsessive–compulsive disorder symptoms were 0.76 and 0.61, respectively. The scores were sensitive to patient differences in disorder severity and treatment-related change.
Conclusions
The WSAS is a simple, reliable and valid measure of impaired functioning. It is a sensitive and useful outcome measure offering the potential for readily interpretable comparisons across studies and disorders.
Psychiatric therapy needs assessment regarding its maturation as a therapeutic science.
Aims
Judgement of whether such a science is emerging.
Method
Four criteria are used: efficacy; identification of responsible treatment components; knowledge of their mechanisms of action; and elucidation of why they act only in some sufferers.
Results
Brief behavioural, interpersonal, cognitive, problem-solving and other psychotherapies have a mature ability to improve anxiety and depressive disorders reliably and enduringly, often only with instruction from a manual or a computer. Therapy's cost-effectiveness and acceptability deserve more attention. We know little about which treatment components produce improvement, how they do so and why they do not help all sufferers.
Conclusions
Therapy is coming of age regarding efficacy for anxiety and depression, but is only a toddler regarding the scientific principles to explain its effects.
Long-term follow-up has rarely been reported after self-exposure therapy for phobias.
Aims
Completion of such a follow-up.
Method
Two-year follow-up was achieved in 68 (85%) of 80 patients with phobias who had completed a previous 14-week randomised controlled trial comparing therapist-accompanied self-exposure, self-exposure or self-relaxation. Measures were self-reported ratings of symptoms, satisfaction and use of other treatment.
Results
Improvement at week 14 was maintained 2 years later. Clinician-accompanied exposure and self-exposure did not differ on any measure. Compliance with self-exposure homework during weeks 0–8 predicted more improvement 2 years later. Patients who failed to improve with relaxation by week 14 improved after subsequent crossover to exposure. A need for more treatment for their phobias was still felt by 33 patients (49%).
Conclusions
Patients with phobias maintained their improvement to 2-year follow-up after the end of self-exposure therapy.
This study (part of a larger one whose main outcomes were reported by Marks, Lovell, Noshirvani, Thrasher, & Livanou, 1998) investigated the impact of exposure therapy and cognitive restructuring alone and combined on the individual symptoms of PTSD and on associated features. Exposure therapy was expected to act mainly on fear and avoidance, and cognitive restructuring mainly on detachment, restricted range of affect, and associated features of PTSD. Seventy-seven PTSD outpatients were randomly allocated to one of four treatments: 1) exposure alone; 2) cognitive restructuring alone; 3) combined exposure and cognitive restructuring; or 4) relaxation (placebo control). The active treatments were superior to relaxation in improving clusters of PTSD symptoms and associated features and some but not all individual symptoms and associated features of PTSD. Exposure and cognitiverestructuring improved almost all individual symptoms similarly.
Distressing mental imagery is hard to study experimentally in obsessive–compulsive disorder (OCD).
Aims
To develop a way to assess mental imagery in OCD during functional magnetic resonance imaging (fMRI).
Method
A small randomised study, controlled for type and order of mental imagery and for treatment condition (exposure therapy guided by a computer or by a therapist, or relaxation guided by audio-tape). Before and after treatment, during fMRI scanning, patients imagined previously-rehearsed scenarios that evoked an urge to ritualise or non-OCD anxiety or a neutral state, and rated their discomfort during imagery.
Results
The method evoked greater discomfort during OCD imagery and anxiety (non-OCD) imagery than during neutral imagery. Discomfort was reduced by cancelling imagery. Discomfort during OCD imagery (but not during anxiety non-OCD imagery) fell after exposure therapy but not after relaxation.
Conclusions
Results showed differences between OCD and non-OCD images and their change after successful treatment, and confirmed clinical suggestions that cancelling images reduced OCD discomfort. The method's success paves the way for further studies of mental imagery in OCD: for instance, during fMRI.
The Daily Living Programme (DLP) offered intensive home-based care with problem-centred case management for seriously mentally ill people facing crisis admission to the Maudsley Hospital, London. The cost-effectiveness of the DLP was examined over four years.
Method
A randomised controlled study examined cost-effectiveness of DLP versus standard in/out-patient hospital care over 20 months, followed by a randomised controlled withdrawal of half the DLP patients into standard care. Three patient groups were compared over 45 months: DLP throughout the period, DLP for 20 months followed by standard care, and standard care throughout. Bivariate and multivariate analyses were conducted (the latter to standardise for possible inter-sample differences stemming from sample attrition and to explore sources of within-sample variation).
Results
The DLP was more cost-effective than control care over months 1–20, and also over the full 45-month period, but the difference between groups may have disappeared by the end of month 45.
Conclusions
The reduction of the cost-effectiveness advantage for home-based care was perhaps partly due to the attenuation of DLP care, although sample attrition left some comparisons under-powered.
Two studies tested whether subjects with obsessive-compulsive disorder could successfully use BT STEPS, a computer-aided system, to perform self-assessment for self-treatment of obsessive-compulsive disorder by exposure and ritual prevention.
Method
Subjects were given a self-guiding manual and could use a touch-tone telephone to access computer-controlled Interactive Voice Response interviews at their convenience from home. Using the BT STEPS system, patients rated themselves and worked out a plan for individually tailored self-exposure therapy.
Results
Outcomes were similar in the two studies. Of the 63 subjects who used BT STEPS, 84% completed the self-assessment module. Most calls were made outside usual office hours. As expected, subjects did not improve merely by completing self-assessment. However, completion of self-assessment predicted later improvement with self-exposure therapy.
Conclusions
Most subjects successfully completed self-assessment using BT STEPS from their homes.