(2001). The neurosurgeon and continuing medical education: the UK perspective. British Journal of Neurosurgery: Vol. 15, No. 5, pp. 443-443.

Hypnosis has been used as a behavioral approach to help children tolerate aversive medical procedures more effectively, but empirical longitudinal research evaluating the outcome of such interventions has been limited. In the present study, 36 children with acute lymphoblastic leukemia between the ages of 6 and 12 years of age undergoing repeated bone marrow aspirations (BMAs) were randomized to hypnosis or play comparison groups. Subjects were selected on their behavioral performance on baseline procedures and received interventions prior to their next three BMA procedures. Major results indicated an improvement in self-reported distress over baseline with both interventions, with no differences between them. Girls exhibited more distress behavior than boys on three of four dependent measures used. Suggestions of an interaction effect between sex and treatment group were noted. The role of rapport between patient and therapist in therapeutic outcome was also evaluated. Results are discussed in terms of potential individual differences in responding to stress and intervention that warrant further research.

Vomiting is often a major source of distress for adolescent oncology patients. This study evaluates the effectiveness of hypnosis in reducing the vomiting associated with chemotherapy and disease in 12 adolescents with cancer. Eight patients receiving chemotherapy demonstrated significant reductions in the frequency (p less than 0.01) and intensity (p less than 0.05) of emesis. Six of the eight patients also demonstrated a shortened duration of emesis. The ninth patient, whose vomiting was secondary to her brain tumor, showed a gradual but steady reduction in vomiting with eventual total elimination following hypnosis intervention. Three patients rejected hypnosis. Trait anxiety scores for the group were significantly lower at retest 6 months following hypnosis intervention (p less than 0.05). Significant changes in scores of health locus of control, impact of illness, or self-esteem were not found. These data support the efficacy of hypnosis for reducing vomiting when used in the context of a comprehensive clinical approach to the cancer patient.

RESUMENDos artículos criticados sobre el tratamiento conductual de la anorexia nerviosa publicados por la Dra. Bruch (1976), en los que afirma que el peso ganado por ese procedimiento se pierde rápidamente y que esta ganancia de peso no se acompaña de otros cambios positivos, se compara con la revisión de varios artículos en los que se utilizó la terapia de conducta en este trastorno. Las críticas de Bruch no son apoyadas por los datos. Se observa la existencia de pruebas empíricas que apoyan la idea de que la terapia de conducta es el tratamiento de elección en la anorexia. A pesar de los grandes conocimientos de la autora en el área de los trastornos de comida y sus numerosas publicaciones, su crítica es muy pobre, especialmente en los que se refiere a datos controlados. En este estudio se intenta probar los supuestos planteados por la Dra. Bruch comparando sus críticas con los tratamientos conductuales de anorexia que se han publicado.

Eighteen adolescents with cancer were trained in hypnosis to ameliorate the discomfort and anxiety associated with bone marrow aspirations, lumbar punctures, and chemotherapeutic injections. Two patients rejected hypnosis. The remaining 16 adolescents achieved significant reductions in multiple measures of distress after hypnosis training. Preintervention data showed no pattern of spontaneous remission or habituation, and, in fact, an increasing anticipatory anxiety was observed before hypnotic treatment. Group reductions in pain and anxiety were significant at levels ranging from p less than 0.02 to p less than 0.002 (two-tailed t-tests). Significant reductions were also found in Trait Anxiety. A non-significant trend toward greater self-esteem was present. The predicted changes in the Locus of Control and General Illness Impact were not found. Comparisons between hypnosis rejectors and successful users unusually showed higher levels of pretreatment anxiety in the former. The pragmatic nature of hypnosis as part of comprehensive medical care in oncology is noted.

Journal Article WISC-R Verba/Performance Discrepancy in Children with Cancer: A Statistical Quirk? Get access Jonathan Kellerman, Jonathan Kellerman 2 Department of PediatricsUniversity of Southern California School of Medicine, Division of Hematology-Oncology, Childrens Hospital of Los Angeles, and Laboratory of Developmental Psychology, National Institute of Mental Health 2All correspondence should be addressed to Jonathan Kellerman, Division of Hematology-Oncology, Children's Hospital of Los Angeles, 4650 Sunset Boulevard, Los Angeles, California 90027. Search for other works by this author on: Oxford Academic PubMed Google Scholar Howard A. Moss, Howard A. Moss Department of PediatricsUniversity of Southern California School of Medicine, Division of Hematology-Oncology, Childrens Hospital of Los Angeles, and Laboratory of Developmental Psychology, National Institute of Mental Health Search for other works by this author on: Oxford Academic PubMed Google Scholar Stuart E. Siegel Stuart E. Siegel Department of PediatricsUniversity of Southern California School of Medicine, Division of Hematology-Oncology, Childrens Hospital of Los Angeles, and Laboratory of Developmental Psychology, National Institute of Mental Health Search for other works by this author on: Oxford Academic PubMed Google Scholar Journal of Pediatric Psychology, Volume 7, Issue 3, September 1982, Pages 263–266, https://doi.org/10.1093/jpepsy/7.3.263 Published: 01 September 1982

Endogenous opiates have been implicated in pain and stress experiences. In order to directly assess the relationship between endorphin activity and acute behavioral distress, beta-endorphin immunoreactivity (beta-EPI) was measured by radioimmunoassay in cerebrospinal fluid of 75 children with acute leukemia undergoing routine lumbar puncture. These data were related to four measures of behavioral distress collected during the procedure. For children 4 years of age and above, beta-EPI correlated inversely with age (r = -.31,p less than or equal to .05). All behavioral measures also inversely correlated with age (r = -.26 to -.67,p less than or equal to .05 to .001). Females had a significantly lower mean beta-EPI than males (p less than or equal to .01), and exhibited greater behavioral distress. beta-EPI and behavioral measures interacted with the use of specific antileukemia agents. L-Asparaginase was associated with lower beta-EPI (p less than or equal to .05), while prednisone was associated with lower behavioral distress on three of the four measures (p less than or equal to .05 to .01). After controlling for age, sex, and chemotherapy, beta-EPI and nurse ratings of anxiety were positively correlated (partial correlation coefficient = .31, p less than or equal to .05). Correlations between beta-EPI and other behavioral measures demonstrated positive trends. Results of this study are interpreted as support for the reactive nature of beta-EPI in cerebrospinal fluid to acute distress, and may help explain documented sex differences in distress behavior. Potential clinical implications and directions for further research are discussed.

A combined cognitive behavioral approach was used to successfully treat matricidal obsessions in an otherwise psychologically well-adjusted 12-year-old boy. The primary problem was conceptualized as anxiety over loss of control. Therapeutic techniques included re-defining of symptoms, thought-stopping, hypnotic enhancement of imagery in order to facilitate cognitive restructuring, covert reinforcement, home practice, and paradoxical instructions to produce the symptom. A decline in obsessions began after 3 sessions and total remission was observed after 6 sessions (10 weeks). 2-year follow-up revealed no recurrence of symptoms. The value of hypnosis as an adjunct to behavior therapy with children is discussed.

Night fears and sleeplessness in three children of varying ages arose from an initial anxious reaction to a realistic stimulus combined with its subsequent reinforcement because of its avoidance properties and of parental attention. Treatment using incompatible response training based on the principle of reciprocal inhibition and self-paced exposure along with operant reinforcement of appropriate sleep behavior was associated with the elimination of problem behavior within three or four sessions for all three children. Extended follow-up revealed maintenance of therapeutic gains accompanied by improvement in other areas of psychological functioning.

Adolescent perceptions of the impact of illness were measured through the administration of an original questionnaire to 345 healthy adolescents and 168 adolescents with diabetes mellitus, cystic fibrosis, cancer, and cardiac, renal, or rheumatologic diseases. Total impact of illness (e.g., leukemia or colds) did not differ between ill and healthy respondents, and the nature of adolescent concerns were similar for both groups. Restriction of freedom was seen as the major disruption brought about by illness, with other areas of impact including relations with peers, siblings, and parents. Adolescents with cancer were most likely to view treatment as highly disruptive and, along with rheumatologic patients, expressed greatest disruption of body image secondary to disease and treatment. Perceived school disruption was most common in cardiac and oncologic patients, with the former also expressing a high degree of concern about sexuality. Females in all groups reported more impact of illness on physical appearance than did males; this difference was greatest in adolescents with cancer, rheumatologic diseases, and cystic fibrosis. The essentially healthy psychologic status of chronically ill adolescents is noted, as is the generally hopeful and positive quality of patient responses.

Three hundred and forty-nine healthy adolescents were compared with 168 adolescents with various chronic or serious diseases on standardized measures of trait anxiety, self-esteem, and health locus of control (perception of self-control over health and illness). No differences in anxiety or self-esteem were found between healthy and ill groups or between various ill groups. Patients with oncologic, renal, cardiac, and rheumatologic disorders perceived significantly less control over their health than did healthy adolescents and patients with cystic fibrosis or diabetes mellitus. Stability of prognosis was related to low anxiety, as was length of time since diagnosis. Other physician-rated variables including course of disease, visible signs of illness, severity, and number of hospitalizations did not relate to psychologic variables. The data are interpreted as casting doubt upon the supposition that chronic or serious disease inevitably leads to psychopathology in adolescents. The overall pattern presented was one of psychologic normalcy, and attitudes regarding control over health are seen as reflecting realistic perceptions on the part of patients. The importance of looking at the effects of serious disease upon day-to-day functioning, as opposed to emphasizing inferred psychologic deviance, is stressed.

A behavioral observation study of 14 children with cancer treated in a laminar airflow protected environment (PE) unit was done over a period of 2 years. A total of 3629 observations were completed, and results related to perception, sleep, intellectual functioning, physical discomfort, mood, management problems, activity patterns, social-communicative behavior, and sedation are reported. In general, despite evidence from the literature that sensory deprivation and social isolation can cause severe disturbance of the sensory apparatus, no debilitating or long-term psychological effects related to prolonged PE treatment were noted. The differences between PE and deprivation-isolation contexts are discussed, and the need for psychosocial support of these patients is emphasized.

A 3-year-old girl diagnosed with acute lymphocytic leukemia presented with a 1-month history of recurrent nightmares. Symptoms of the disturbance conformed to a clinical picture of slow wave arousal night terrors, or pavor nocturnus. Behavioral treatment aimed at reducing anxiety related to maternal separation and medical procedures, and at reinforcing appropriate sleep patterns was effective in reducing and eventually eliminating the symptoms. Follow-up revealed no return of nightmares or existence of new problems. A brief review of descriptive, etiological and treatment aspects of night terrors is presented and the hypothesis is put forth that such episodes represent a psychological reaction to trauma. The importance of being aware of age variables in the expression of children's anxiety is noted as is the value of careful tabulation of outcome data.

Though the theoretical and clinical ramifications of attribution of primary responsibility to mothers for child rearing have been discussed extensively, there is little empirical data in this area. In the present study a sample of parents rated several child-rearing behaviors in terms of ideal maternal and paternal responsibility. Mothers were attributed primary responsibility for the largest proportion of behaviors, fathers for the smallest, and an intermediate number of items were rated as parentally shared. In addition, item analysis indicated a relationship between the directionality of responsibility attribution and traditional sex-role stereotypes. Implications for patterns of intrafamilial blame and clinical intervention are discussed.

The authors questioned the directors of 13 protected-environment installations on the psychological effects of protected environment treatment. Psychological problems reported included anxiety, depression, sleep disturbance, withdrawal, regression, and hallucinations. Children seemed to adapt better than adults to protected environments. Respondents recommended the use of preentry orientation, structured recreation programs, steps to prevent time disorientation, and psychological support for both patients and staff to minimize the psychological effects of treatment in protected environments.