Posts Tagged ‘panic’

A Primer of Supportive Psychotherapy

A Primer of Supportive Psychotherapy

Pinsker H

Hillsdale (NJ): The Analytic Press; 1997. 278 pp. with index

ISBN 0-88163-274-0 (cloth)

Convincing evidence has accumulated that the supportive or nonspecific component, common to most forms of psychotherapy, is responsible for most of the change that results from psychotherapeutic interventions. This component appears to be both supportive — in that it is derived from the quality of the therapeutic relationship — and technical — in that it stems from the contract established with the patient and the use of nonspecific interventions. Specific interventions drawn from different schools of thought account for surprisingly little of the variance in outcome for most disorders, with the possible exceptions of panic and obsessive-compulsive disorders. The implications of these findings are clear. All mental health clinicians, regardless of their field, should be well versed in nonspecific interventions, and clinical training should emphasize integrated or so-called transtheoretical perspectives. Unfortunately, both practice and training tend to lag behind research. Many clinicians continue to rely on specific psychotherapeutic models, and training rarely gives nonspecific interventions the weight that they deserve, although there is some evidence that this is changing.

In this context, Dr. Pinsker’s very practical little volume is a useful addition to the growing number of texts on supportive therapy. Although one might disagree with some of the ideas and with the theoretical model that lies behind the volume, one must agree with the tone. This is the work of a sensitive and humane clinician who respects his patients. The approach emphasizes a conversational style and a responsive approach, rather than listening silently or interrogating the patient. The volume offers a model worth emulating. Anyone who adheres to the spirit of this work will not go far wrong, nor will his or her patients come to harm.

The value of this work lies in the large number of examples of the kinds of statements patients typically make and the clinician’s possible responses. The topics discussed include most of the key issues in therapy: increasing self-esteem, reducing and preventing anxiety, promoting adaptive skills, building a treatment alliance, and so on. These topics are explored through specific examples that include illustrations of helpful and less helpful responses that therapists may make. It is these examples that make this book especially helpful as an introductory text. Here is an experienced clinician talking in a common-sense way about the nuts and bolts of therapy. This makes for a style that is at times a little dull but replete with clinical wisdom. The simple practical examples will be helpful to a neophyte clinician who is learning how to conduct assessment and therapy interviews. They may also be worth a brief perusal by those who are much more experienced, who may be surprised to recognize bad habits unwittingly accumulated over the years.

The volume is not without limitations. Two issues are worthy of comment. First, some of the examples are a little sparse, and the discussion of alternative responses by the clinician is a little limited. Hence, the implications of the different possible therapist responses may not always be clear to the beginning therapist. More problematic is the theoretical perspective that runs through the volume. This is classically psychodynamic; hence, much is made of the distinction between supportive and expressive therapy. With increasing emphasis on integrated approaches, this distinction is less important. It may also be a little dated. The problem emerges on the first page when supportive therapy is differentiated from expressive therapy in terms of technical considerations. These are defined as using a conversational style, viewing the patient-therapist relationship as a real relationship that is not analysed, and supporting defences that are not maladaptive. Perhaps the important issue is not the distinction between supportive and exploratory therapy — which is important only to those who espouse the psychoanalytic tradition — but rather the degree of intrusiveness and the extent to which generic mechanisms are used to effect change. Dr. Pinsker describes these clearly, although in different terms. Consequently, it is easy to put theoretical issues to one side and concentrate on the practical component of the book. In this regard, the volume meets its goal of being a is a useful primer.

Handbook of Behavioral State Control

Handbook of Behavioral State Control: Cellular and Molecular Mechanisms

Lydic R, Baghdoyan HA, editors

Boca Raton (FL): CRC Press LLC; 1999. 700 pp. with index

ISBN 0-8493-3151-X (hard cover)

Although one may argue that any change in neuronal activity may ultimately lead to behavioural alterations, a closer relation between single cell function and behavioural consequences is needed. This relation is complex, and there are numerous and inter-related regulatory levels between cellular/molecular processes and behavioural outcome. It is therefore not surprising that there is a remarkable lack of exhaustive textbooks that explain cellular mechanisms underlying behavioural activity more globally. This book, edited by Lydic and Boghdoyan, both from Pennsylvania State University, partially fills this gap. It is a carefully planned handbook divided into 38 chapters organized in 8 sections, and written by 95 authors. The book’s major goal is to provide updated material on the cellular and molecular mechanisms generating diverse behavioural states. The authors do not explain cellular mechanisms of particular behaviours but rather provide information about the neural processes that regulate behavioural states, such as sleep, wakefulness, consciousness, arousal, etc. Different behavioural states, in turn, determine a subset of possible behavioural outcomes. The dominating theme of the book is sleep, wakefulness, arousal, and vigilance; this theme is compatible with the research interest and experience of the editors in the neurobiology of sleep mechanisms.

The handbook represents a working reference for numerous topics relating to physiological, psychological and pathophysiological states, including information on epidemiology, diagnosis, and treatment of common state disorders. The chapters in the first section discuss mammalian circadian rhythms, structure and function of the suprachiasmatic nuclei, melatonin rhythm-generation systems, and genetic circadian clock mechanisms. The subsequent chapters of the second section describe daily alterations in the arousal state, REM sleep dreaming, NREM sleep mentation, and neurological disorders of sleep. Section 3 deals with the anatomical substrate, neurochemical coding, and functional organization of components of the ascending reticular activating system, which includes ascending cholinergic, monoaminergic, and glutamatergic pathways. Particular attention is paid to the mesopontine cholinergic system and its role in REM sleep, wakefulness and cortical activation, and the noradrenergic and serotonergic pathways and their role in sleep, wakefulness, regulation of motor output and sensory information processing. The same systems are further discussed in more detail in the next section. Successive chapters deal with intrinsic membrane properties, synaptic activity, membrane current characteristics and excitability of cholinergic, noradrenergic, and serotonergic neurons. Particular attention is focused on the state-dependent cellular oscillations in the corticothalamic system and on the rhythmic oscillations in the hippocampal formation.

Mechanisms of behavioural state control may be altered by centrally active drugs. Several chapters in the section entitled “Molecules modulating mental state” discuss this issue. Neuronal and neurochemical mediation of addictive behaviour, and alterations in behavioural state caused by benzodiazepines, barbiturates, ethanol, caffeine, nicotine, marijuana, and serotonin antagonists are discussed.

The following 2 sections of the handbook review the current knowledge regarding state-dependent processing in somatosensory pathways and the role of the rostral ventromedial medulla in regulating ascending sensory transmission. Several chapters of the last 2 sections of the handbook deal with pathophysiological states. There is a particular emphasis on pain sensation, anesthesia, pharmacological and surgical treatment of pain, and immunological alterations in the arousal state. The topics cover cytokines in sleep regulation, immune effects on neurotransmission, and finally, body temperature, fever and microbial modulations of arousal.

Although the textbook covers vast areas of behavioural neuroscience, there are several important areas that are not represented. Results of the vast research concerning emotional states, such as anxiety or fear, and relevant regulatory functions of the limbic structures are not included. Also, psychopathological states of panic, depression, or euphoria are not described, except in parts of one chapter about addictive behaviour and neural mechanisms of reward. This topical selection was probably necessary to keep the textbook at the manageable size.

The textbook is well illustrated and contains overall 3500 references, more than 90 references per chapter. The book may serve as an excellent resource for advanced undergraduate and graduate students, postdoctoral fellows and biomedical researchers working with animal models of neurological and neuropsychiatric disorders. It will also be highly useful for medical residents, lecturers in neuroscience courses, and other professionals interested in problems of behavioural neuroscience and general neural principles governing animal and human behaviour.