Clinical Behavioral Medicine

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Springer Science & Business Media, Mar 31, 1988 - Medical - 313 pages
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This book is an effort to integrate some clinical observations, theoretical concepts, and promising clinical procedures that relate psychological variables to physiological variables. My primary emphasis is on what psychological and behavioral concepts and procedures are most likely to enable us to influence physiological functions. The book covers ques tions that have fascinated me and with which I have struggled in daily clinical practice. What types of people are most at risk for physical disor ders or dysfunctions? Why do some people present psychosocial con flicts somatically and others behaviorally? What is the placebo effect and how does it work? How do you arrange the conditions to alter maladap tive belief systems that contribute to psychopathology and patho physiology? Do beliefs have biological consequences? When I was in private clinical practice, and even today in my medi cal school clinical practice situation, I set aside one day each week to puzzle over the theoretical questions that my clinical experience gener ates. Often isolating these underlying theoretical questions provides guidance into the most relevant empirical literature. I have found that this weekly ritual, which I started in private practice many years ago, appears to increase my clinical efficacy or at least makes clinical work more exciting. I find the unexamined clinical practice hard to endure. Kurt Lewin once said, "There is nothing so practical as a good theory.
  

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Contents

WHAT KINDS OF PEOPLE ARE AT HIGH RISK TO DEVELOP CHRONIC STRESSRELATED SYMPTOMS?
1
Hypnotic Ability
4
HighHypnotic Ability
5
LowHypnotic Ability
10
Habitual Catastrophizing Panicking Cognitions
14
Sympathetic ReactivityNegative Affectivity Neuroticism
16
Major Life Changes andIor Daily Hassles
19
Daily Hassles
20
References
154
THE DIAGNOSIS AND PSYCHOPHYSIOLOGICAL MANAGEMENT OF CHRONIC PAIN AND ANXIETY
155
Acute and Chronic Pain
156
Illness Behavior Syndrome and Chronic Pain
159
A Theory of the Acquisition of Chronic Pain and Anxiety
160
Hypnotic Ability
161
Negative Affectivity
163
Rationales for the Use of Psychological and Behavioral Procedures with Pain
164

Coping Skills
21
Discussion
22
Some Predictions from the Model
24
References
26
CLINICAL BEHAVIORAL MEDICINE AND ITS CUTTING EDGES Biofeedback Behavior Therapy and Hypnosis
33
The Origins of Behavioral Medicine
37
Psychophysiological Stress Management Skills for Pain Anxiety and Sleep Disorders
41
Common Features of Biofeedback Behavior Therapy and Hypnosis
44
Potentiating the Placebo Effect
45
Quantitative Dependent Variables
46
Wider Application
47
References
48
HYPNOSIS Scientific Status and Clinical Relevance
55
Current Theories of Hypnosis
57
Parameters of Hypnosis
58
Characteristics of High Hypnotizables
61
Psychopathology Pathophysiology Healing and Hypnotic Ability
64
Increasing Hypnotic Ability
71
Summary of Clinical Implications
73
References
74
CROCKS QUACKS AND SHRINKS
79
Crocks and Quacks
85
Why Skills Taught by Psychotherapists May Be Promising Alternatives to Pills for Some Patients
90
References
93
WHAT IS THE PLACEBO EFFECT AND HOW DOES IT WORK?
97
Theories of the Placebo
100
Origins of the ConditionedResponse Model
102
Unconditioned Stimuli
105
Conditioned Stimuli
106
The Placebo as a Conditioned Response
107
Components of the Conditioned Placebo Response
110
The CognitiveVerbal Component
111
The Physicochemical Component
112
Historical Aspects
114
Acquisition Phase
115
Consolidation Phase
117
Placebo Responding
118
Placebo Responding and Hypnotizability
119
Parameters of Placebo Learning
122
Phenomena of Conditioning
124
Predictions from the Model
125
Testing the Model
128
Conclusion
129
INITIAL PATIENT INTERVIEW
135
Priorities and Procedures
137
References
142
PSYCHOPHYSIOLOGICAL ROLE INDUCTION OR THE TROJAN HORSE PROCEDURE
143
Psychophysiological Demonstrations
144
Educational Model
147
CoInvestigator
149
Out of the ClosetThe Psychotherapy Candidate
150
Data on the Effects of the Psychophysiological Role Induction
153
Hypnosis for Pain
166
Biofeedback for Pain
167
Behavior Modification for Pain
171
Clinical Guidelines for a Psychophysiological Approach to a Chronic Pain Patient
174
Role Induction for Chronic Pain Patients
175
Case Study of a Chronic Pain Patient
177
Summary and Conclusion
179
References
180
HIGHRISK PROFILE Assessment Patient Feedback and Therapy Planning Assessment Questions and Assumptions
185
Discussion of Assessment Questions
188
HighHypnotic Ability
196
LowHypnotic Ability
200
High Catastrophizing Panicking Cognitions
202
Neuroticism Negative Affectivity and Excessive Sympathetic Reactivity
205
Major Life Changes
208
Hassles
211
Support Systems
212
Coping Skills
215
Therapy Planning
217
Case Study of a LowHypnoticAbility Patient
218
Case Study of a HighHypnoticAbility Patient
223
References
229
SELFHYPNOSIS AND THE COMMON COMPONENTS OF OTHER STRESSREDUCTION TECHNIQUES A Theory
233
Psychological Stress
235
Common Procedural Components
237
Common Therapeutic Mechanisms
240
Allocentric Mode of Perception
241
Cognitive Control of Physiology
242
Sensory Restriction and Enhanced Hypnotizability
243
Muscle Relaxation and Enhanced Hypnotizability
245
Summary
247
References
248
APPENDIXES
255
PROBLEMS WITH HYPNOSIS AND CRUCIAL CLINICAL CONCEPTS
257
BRIEF PROCEDURES TO ASSESS HYPNOTIC ABILITY AND ATTITUDE
259
UNOBTRUSIVE PROCEDURES
265
EEC Alpha Density and Hypnotic Ability
266
Experience Inventories
269
WICKRAM EXPERIENCE INVENTORY
271
Wickrams Modification of the Spiegel Hypnotic Induction Procedures
275
INFORMAL CLINICAL TESTING FOR HYPNOTIC ABILITY WITH TEST SUGGESTIONS
277
SUBJECTIVE RESPONSE INQUIRY
281
WICKRAMASEKERAS DIAGNOSTIC INTERVIEW FOR HEADACHE
283
HYPNOTIC PROCEDURE TO REDUCE HEADACHE PAIN
285
IN VITRO DESENSITIZATION SD PROCEDURE
287
BACKGROUND QUESTIONNAIRE
289
BEHAVIORAL MEDICINE CLINIC AND STRESS DISORDERS RESEARCH LABORATORY Statement of Procedures
291
BEHAVIORAL MEDICINE CLINIC AND STRESS DISORDERS RESEARCH LABORATORY Assessment for Admission
293
PSYCHOPHYSIOLOGICAL PROFILE
295
SELECTED BIBLIOGRAPHY
297
INDEX
301
Copyright

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About the author (1988)

Dr. Ian Wickramasekera is past-president of the Association for Applied Psychophysiology and Biofeedback, and was co-founder of AAPB s Primary Care Section. Dr. Wickramasekera developed the High Risk Model, an empirical approach to the diagnosis and treatment of psychophysiological disorders. He is the author of Clinical Behavioral Medicine (1988, NY: Plenum), as well as over eighty articles and book chapters on a wide range of topics, from hypnosis, to psychophysiological psychotherapy, to somatization disorder.

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