Sexual dysfunction prior to high-dose chemotherapy and bone marrow transplantation.

A number of studies have suggested that high-dose chemotherapy and bone marrow transplantation may be associated with a variety of abnormalities of psychological function including sexual dysfunction. However, few studies have prospectively evaluated the association between sexual dysfunction and BMT. In particular, there are very little baseline data about sexual function immediately before transplant. The sexual function of 30 patients was assessed immediately prior to high-dose chemotherapy and bone marrow transplantation using the Derogatis Interview for Sexual Functioning (DISF) for males and females. More than 80% of patients had hematological malignancies; more than half were allograft recipients. Forty-seven percent of patients were found to have global sexual dysfunction and 60% had abnormalities of at least one parameter of sexual function. Forty-seven percent were dissatisfied with their sex life. Sexual dysfunction was associated with ejaculatory problems (P < 0.02) and erectile problems (P = 0.06) but not with amenorrhea. There was an association between cancer-related psychological problems and sexual dysfunction. A control group of inpatients with cancer had a similar incidence of sexual dysfunction (53% vs 47%, P = NS) suggesting that the tumor and its therapy were the major reasons for the sexual problems and not the prospect of transplant per se. This study emphasizes the need for baseline (pre-BMT) studies of quality of life and psychological function in BMT patients. We conclude that sexual dysfunction is a common finding prior to BMT; whether intervention can reduce this problem requires further study.

A prospective study of the effects of high-dose chemotherapy and bone marrow transplantation on sexual function in the first year after transplant.

Patients undergoing high-dose chemotherapy and bone marrow transplantation (BMT) may experience a variety of abnormalities of psychological and physical function including sexual dysfunction. However, no study has prospectively evaluated whether there is an association between sexual dysfunction and BMT. In a previous study in which we analyzed the sexual function of 30 patients immediately before transplant, we found that nearly half of all patients had sexual dysfunction using the Derogatis Interview for Sexual Functioning for males and females. The findings of the pilot study led us to hypothesize that the incidence of sexual dysfunction would not be significantly altered by BMT; we performed a prospective study designed to test this hypothesis. In this study a further 20 patients about to undergo BMT were surveyed, making a total of 50. Thirty-one of 38 survivors were reanalyzed 3-6 months after transplant. The major finding of the study is that the incidence of sexual dysfunction is unchanged 3 months after transplant (48 vs 36%, P = NS). The mean total score on the DISF was decreased by 7.5 points but this was also not significant. A preliminary analysis of 16 patients surveyed at 12 months post-BMT suggests little change in sexual function between 3 and 12 months post-BMT. We conclude that in the first 12 months after high-dose chemotherapy and BMT the pretreatment difficulties remain.

Introduction to special section: mental retardation and mental illness.

Historically, the perceived relation between mental illness and mental retardation has undergone substantial changes. During the past 2 centuries, clinical observations and systematic research addressing these 2 constructs have developed along separate lines. Consequently, the pathogenesis and treatment of psychopathology, emotional disorders, and behavior problems experienced by individuals with mental retardation have not been the purview of mainstream clinical psychology. This article initiates a special section on mental retardation and mental illness to provide up-to-date summaries of various key clinical and research issues regarding this population (i.e., individuals with "dual diagnoses").

Outpatient psychotherapy for adults with mental retardation and concomitant psychopathology: research and clinical imperatives.

As the number of adults with mental retardation and concomitant psychological difficulties living in the community increases, so does the need for effective outpatient psychotherapy services. Despite this need, the relevant literature base is sorely lacking. This article is a brief review of this literature with regard to psychodynamic, behavioral, and group psychotherapy approaches. On the basis of this review, a research agenda is offered concerning future directions. Last, because of the lack of a rich database regarding effective treatment approaches for such individuals, this article includes a description of a model of clinical decision making that is geared to aid the practicing clinician in designing clinical interventions for adults with mental retardation.

Social problem-solving therapy for unipolar depression: an initial dismantling investigation.

Tests the efficacy of social problem-solving therapy for unipolar depression and examines the relative contribution of training in the problem-orientation component of the overall model. This process involves various beliefs, assumptions, appraisals, and expectations concerning life's problems and one's problem-solving ability. It is conceptually distinct from the remaining four problem-solving components that are specific goal-directed tasks. A dismantling research design, involving 39 depressed Ss, provides findings that indicate problem-solving to be an effective cognitive-behavioral treatment approach for depression, thereby extending previous research. Moreover, the results underscore the importance of including problem-orientation training.

Effect of length of treatment on weight loss.

In this study we tested whether the efficacy of behavior therapy for obesity might be improved by lengthening the duration of treatment. Forty-eight obese clients were randomly assigned to either a standard treatment of 20 weekly sessions or to an extended treatment of 40 weekly sessions. The content of each program was identical, but the treatment procedures were introduced in a more gradual manner in the extended condition. At Week 20, the conditions showed equivalent weight losses. At 40- and 72-week evaluations, however, the extended treatment produced significantly greater mean weight losses than did the standard treatment.

Individual versus group therapy for obesity: effects of matching participants to their treatment preferences.

This study examined the effects of matching participants to treatments on the basis of their preferences for either individual or group therapy for obesity. Seventy-five obese adults who expressed a clear preference for either individual or group therapy were randomly assigned to either their preferred or their nonpreferred treatment modality within a 2 (individual vs. group therapy) x 2 (preferred vs. nonpreferred modality) factorial design. At posttreatment, group therapy produced significantly greater reductions in weight and body mass than individual therapy, and no significant effects were observed for treatment preference or the interaction for treatment preference by type of therapy. All treatment conditions showed equivalent improvements in psychological functioning. These findings suggest that group therapy produces greater weight loss than individual therapy, even among those clients who express a preference for individual treatment.

Relapse prevention training and problem-solving therapy in the long-term management of obesity.

This study compared 2 extended therapy programs for weight management with standard behavioral treatment (BT) without additional therapy contacts. Participants were 80 obese women who completed 20 weekly group sessions of BT and achieved a mean initial weight loss of 8.74 kg. Participants were randomly assigned to a no-further-contact condition (BT only) or to one of two extended interventions consisting of relapse prevention training (RPT) or problem-solving therapy (PST). No significant overall weight-change differences were observed between RPT and BT or between RPT and PST. However, participants who completed the PST intervention had significantly greater long-term weight reductions than BT participants, and a significantly larger percentage of PST participants achieved clinically significant losses of 10% or more in body weight than did BT participants (35% vs. 6%).

Comparative effectiveness of social problem-solving therapy and reminiscence therapy as treatments for depression in older adults.

Compared the effects of 2 psychotherapies based on divergent conceptualizations of depression in later life. Seventy-five older adults diagnosed with major depressive disorder were assigned randomly to problem-solving therapy (PST), reminiscence therapy (RT), or a waiting-list control (WLC) condition. Participants in PST and RT were provided with 12 weekly sessions of group treatment. Dependent measures, taken at baseline, posttreatment, and 3-month follow-up, included self-report and observer-based assessments of depressive symptomatology. At posttreatment, both the PST and the RT conditions produced significant reductions in depressive symptoms, compared with the WLC group, and PST participants experienced significantly less depression than RT subjects. Moreover, a significantly greater proportion of participants in PST versus RT demonstrated sufficient positive change to warrant classification of their depression as improved or in remission at the posttreatment and follow-up evaluations.

Sense of humor as a moderator of the relation between stressful events and psychological distress: a prospective analysis.

Previous research has indicated that one's sense of humor serves as a moderator of the deleterious effects of negative stressful life events. However, because this research has been only cross-sectional in nature, such conclusions remain tentative. The purpose of this study was to provide for a more rigorous test of the humor as a stress-buffer hypothesis by using a prospective design that also attempted to control for the variance attributable to prior level of distress. Additionally, two measures of humor were included to increase the construct validity of the findings. Results from a series of regression analyses indicated that humor served as a moderator of stress for depressive, but not anxiety, symptomatology, regardless of the measure of humor that was used in the analyses. Implications of these findings for future research are noted.

The prepared family caregiver: a problem-solving approach to family caregiver education.

Early hospital discharges, greater reliance on outpatient care, and the growing prevalence of chronic diseases has increased the demands on family members who care for patients at home. Family caregivers need information and training to insure that patients' needs are met and that home care is coordinated with that of health professionals. We propose a prescriptive problem-solving model for how care should be managed at home and for the kinds of information and training family caregivers should receive. The Prepared Family Caregiver model, which is summarized in the acronym COPE (Creativity, Optimism, Planning, and Expert information), teaches family caregivers how to develop and carry out orderly plans which address both medical and psychosocial problems and are coordinated with care plans of health professionals. The model is based on extensive research on problem-solving training and therapy. It empowers family members and patients for coping with illness and can help to moderate caregiver stress.

Assertiveness and problem-solving training for mildly mentally retarded persons with dual diagnoses.

This study investigated the differential effectiveness of assertiveness and problem-solving training on dually diagnosed patients' adaptive social behavior, distress and psychiatric symptoms, anger control, and problem-solving coping skills using a counterbalanced design. Assessments were conducted at pretreatment, midphase, posttreatment, and a 3-month follow-up examination. A combined assertiveness and problem-solving training package was effective for treatment of individuals with mild mental retardation with dual psychiatric diagnoses. Specifically, improvements occurred regarding both self-report measures of distress and caregiver ratings of adaptive functioning; however, no essential differences were found between these two treatment protocols. The importance of using self-regulatory models of therapy with this population is highlighted, and recommendations were made for future research.

Effects of stress from current problems: comparison to major life events.

The present investigation evaluated the stressful effects of self-defined problematic situations on consequent depressive and anxiety symptomatology. It was hypothesized that the frequency of problems would be a meaningful predictor of distress apart from the stress associated with major life changes. A prospective design was used to evaluate this predictive relationship. Further, prior levels of distress served as relevant covariates to control for premorbid status. Results from 129 college students were found to be supportive of the major hypothesis.

Cognitive appraisal of problem solving effectiveness: relation to depression and depressive symptoms.

This paper describes two studies that assessed the strength of the relationship between the appraisal of one's problem solving effectiveness and depressive symptomatology. Assessment of problem solving appraisal included the Problem Solving Inventory (PSI). In the first study, 268 college undergraduates completed the PSI and the Beck Depression Inventory. Regression analyses indicated that all three problem solving dimensions were significant predictors of depressive symptoms. The second study compared subjects who were diagnosed as experiencing unipolar major depressive disorder with demographically similar normal controls. Results from multivariate analyses indicated that the depressed group appraised their overall problem solving attempts as less effective, rated their problem solving attempts to be less systematic, and reported lowered ability to maintain personal control in problem situations.