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Public health and smoking are old enemies because smoking is among the 10 leading causes of ill health on a global scale and is also possible to prevent, as repeatedly [...]

PURPOSE: To evaluate the appropriateness of the primary health care system to support smoking cessation as well as individual patterns for successful quitting. METHODS: University hospital employees (n=5218) were addressed [...]

J M Mahoney: Therapist Guidelines in Weight Control and Self-regulation of Body Weight.E Lichtenstein & B G Banaher: Behavioral Treatment of Smoking.P E Natan: Behavioral Assessment and Treatment of Chronic Alcoholism.R R Bootzin: Behavioral Treatment of Insomnia S Diamond: Proper Selection of Headache Patients for Biofeedback and Applications of Biofeedback to the Headache Patients

Fjorton frivilliga forsakspersoner deltog i ett tre veckors experiment far utprovning av covert extinction i rakavanjning. Efter en veckas registreringar av cigarettkonsumption och rok-sug, foljde en veckas daglig behandling. Daref-ter foljde ytterligare en vecka med bara registring. Tre manader senare gjordes en efterupp-foljning med registrering i ytterligare en vecka. Samtliga forsokspersoner fick instruktio att sluta roka efter vecka 1, och blev darefter slumpmassigt indelade i tre grupper. En grupp fick traning i (1) covert extinction (forestall-ningsmassig extinction), en annan grupp fick (2) avs lappningstraning och en tredje grupp blev placerad pa (3) vUantelista for behandling efter experimente. Inga skillnader framkom mellan grupperna, varken for roksug eller antal cigar-retter. Bade for roksug och antal cigarretter framkom en reduktion over tid, nagot senare for roksug an for antal cigarretter. Experimentet har inte lyckats visa nagon specifik effekt av covert extinction pa rokning.K-O Fagerstrom, K G Gotestam & L Melin: Smoking cessation through covert extinction. Fourteen voluntary subjects participated in a three week experiment to test the efficacy of covert extinction in smoking cessation. After one week of baseline registrations, one weeks' daily treatment followed. The experiment was terminated with another one week registration. Three months after the experiment, a final week of registration was introduced. All Ss got an instruction to quit smoking after Week 1, and were then randomly assigned to three groups: (1) Covert extinction training, (2) Relaxation training, or a (3) Waiting list control condition. There were no differences between the different groups. In both craving and cigarette consumption there was a decrease after the instruction to quit smoking, earlier in cigarette consumption than in craving. Smoking also increased significantly after Week 2. The conclusion is that the experiment failed to show any specific treatment effect of covert extinction in smoking cessation.

Syftet med denna uppsats har varit att i en kontrollerad studie prova en ny metod for behandling av perifer vasospasm. Utgångspunkten var att den “naturliga” lanken som finns mellan kyla och vaso-konstriktion ar starkare for manniskor med vaso-spasmer an vad som ar normalt. Behandlingen innebar forsok till att forsvaga denna lank genom att exponera kroppen for kyla och samtidigt exponera de for vasospasm kansliga kroppsdelarna for varme i 43-gradigt vatten och på så satt åstadkomma vasodilation. Detta upprepades tio gånger under en fjortondagarsperiod. En placebo-grupp fick exakt samma behandling med den skillnaden att temperaturen i vattnet for dem var 23 grader. Placebo-gruppen anvandes också som cross-over. Matningar av temperaturfall mattes fore och efter respektive behandling och gav vid handen signifikanta skillnader for behandlingsgruppen medan placebogruppens temperaturfall var oforandrat. Under behandlingens gång mattes forvantan på behandling; inga skillnader forelåg mellan grupperna. Efter cross-over och samtliga fått aktiv behandling hade 75 procent långsammare temperaturfall an innan det att aktiv behandling givits. Behandlingen har klinisk relevans, då de registreringar som gjorts visar på betydligt farre karlsammandragningar efter att behandling givits.

En 54 års kvinna som i 4 år lidit av en storning i blodcirkulationen, Raynauds sjukdom, behandlades framgångsrikt efter rokavvanjning med avslappningstraning. Det goda resultatet forklaras med att patienten var mycket motiverad till att trana avslappning samt att avslappningstraning just i detta fall passade speciellt bra då patientens autonoma nervsystem var klart overaktivt.

Ett fall av trotthet vid bilkorning analyserades, och visade att den subjektiva trottheten utvecklades parallellt med en kedja av overta beteenden (stimuli och responser). Behandlingen bestod i att tidigt bryta denna beteendekedja och fora in en kontrollerande respons, som tranades forestallningsmassigt.

Nine patients suffering from peripheral vasospasms of type Raynaud's disease were treated by a conditioning procedure. The treatment consisted of having the patient exposed to cold while the vasospastic extremity was immersed in warm water, thus causing a vasodilation. Five of the 9 patients were improved at a 4 month follow-up. The patients whose precipitating stimulus was cold benefited more from this treatment than patients whose precipitating stimulus was emotional in nature.

Vasomotoric activity, measured by changes in peripheral skin temperature, has been shown to be rather sensitive to classical conditioning. Earlier studies have shown, by establishing a connection between coolness (UCS, hand in cold water) and a buzzing signal/ or a whispered nonsense word (CS), that the CS alone can produce a peripheral vasoconstriction (CR). By changing the UCS to warm water the CS alone can produce vasodilatation. The aim of the present study was to investigate if the bilateral hand reflex could be temporary diminished using a classical conditioning procedure. This was tested by pairing two diametrically opposite UCS (one hand in warm and the other in cold water, simultaneously) to a single CS (a tone) in 10 healthy subjects. A diminished bilateral hand reflex is defined as a temperature increase in the warm exposed and a temperature decrease in the cold exposed hand in presence of the CS alone. The results showed that the bilateral reflex was not diminished by the conditioning procedure. Instead, the conditioning procedure elicited significant vasoconstriction also in the hand exposed to warm water almost at the same magnitude as for the hand exposed to cold water. This indicates that the cold UCS has a dominating impact on the conditioning procedure when both warm and cold UCS are presented simultaneously. The outcome raises interesting questions about future research on classical conditioning and peripheral lateralization.

This paper presents the outcome of a twelve months follow-up of a behavioural treatment of 12 subjects suffering from peripheral vasospasm of the type Raynaud's disease. The subjects were offered a behavioural treatment with a classical conditioning procedure. The method was intended to weaken the unconditioned link between cold and peripheral vasoconstriction. This was accomplished by having patients in a cold room (+3 °C) while their hands were immersed in warm water (+3 °C) causing vasodilation (10 trials). Six of the subjects formed a placebo group, which received the same procedure as the treatment group except for the temperature of the water. This group was later given active treatment. The objective measures of decrease in finger temperature during cold test as well as the subjective recording of number of attacks demonstrated the short-term effectiveness of the active treatment, reported earlier in this journal (Melin and Fagerstrom, 1981). The present paper shows that the positive effects were maintained at 12 months follow-up. However, data indicate that booster sessions are important for maintenance.

Oforklarliga ångestproblem hos en ung kvinna relateras till en traumatisk våldtaktsupplevelse som hon helt glomt att hon varit med om. Det beskrivs hur våldtakten rekonstrueras och aterupplevs och vilka konsekvenser detta fått for kvinnans ångestproblem.

A woman aged 43 with chronic constipation had been using laxatives and enemas regularly for 26 years. She was instructed to use daily a fast-acting suppository as a stimulus for elicitation of the defecation reflex. Evacuation thus occurred as one in a series of various regular morning activities, the other serving as conditioning stimuli. After three weeks of training, the use of the laxative was gradually withdrawn and defecation occurred spontaneously. The outcome remains successful after a follow-up period of 6 months.