Stress-related disorders. Recent developments in hospital treatment

The stress treatment program at Ochsner, New Orleans, provides participants with knowledge of necessary skills and opportunities for rehearsal and practice within the setting. In addition, the modalities chosen reinforce what Lazarus and Opton described as "perceived control," which was found to be as instrumental as actual control in anxiety reduction. Upon return to day-to-day living, participants have the opportunity to use skills acquired and to receive reinforcement for doing so. The staff and patients found that traditional supportive and/or insight-oriented psychotherapy was as important as the vast array of behavioral training measures for inclusion in the patient's daily schedule. Individual therapy was provided to each patient up to 45 minutes daily, and one-hour group psychotherapy sessions were conducted three times a week. The belief that individual attention, social support, and insight into previous learning were critical ingredients to the appeal of individual psychotherapy was borne out in patient follow-up questionnaire data. Patients who were followed at the time of discharge and at six months in the Clark and Stiles study consistently ranked "individual session with their doctor" high within the ranking of some 14 treatment modalities or experiences. Collectively, the average of such rankings demonstrated "individual session" of equal benefit with the "stress management session," a purely behavioral/stress inoculation training experience. Such data therefore supported our initial belief that a marriage of the best of what traditional psychotherapy can offer with the best of behavioral medicine provides the optimal opportunity for growth and symptom improvement.