Therefore, given an adequate motivation the person should be encouraged to try self-help measures. It is generally better if the patient is able to solve his problems himself. The ideas behind this sequential model can be summarized as follows. Of course, the model delineated below represents an abridgement, that in clinical practice needs to be specified according to disorders and other factors. These considerations lead to the proposal of more or less rational “ sequential models “for clinical practice ( Margraf, 1996) such as the one detailed in Table 7. As a general rule, measures with the best cost-benefit ratio should be tried first.
In addition, it has to be clarified whether and when the patient should be transferred to another specialist and what role primary care physicians and self-help measures could play. These decisions need to take into account other variables such as the motivation and personality of the patient, the possible existence of comorbidity, or the availability of treatments or therapists.
We need to ask ourselves how to choose the most promising method for each individual case or for the rank order of the different approaches that could possibly be applied to the case. Yet this does not mean that every therapist can do what they want regardless of the research findings. As long as this is the case, we need a broad spectrum of treatment options that address different facets of the problematic structures. Even the best treatments yield a certain amount of failures. There are still no “100% methods “for most mental disorders. However, one cannot derive from the research findings that behavioral methods are the only ones that should be applied. In principle, the superior empirical basis for behavioral treatments should imply that these methods should play a central role in psychotherapeutic patient care. Behavioral treatments can therefore have very different contents depending on the nature of the problem to be treated. For most disorders, specific treatment programs tailored to their individual characteristics have been developed and tested.
In addition to the large number of studies on the efficacy of the individual treatment methods, the vast body of knowledge collected by clinical psychology and its neighboring disciplines on the etiology, diagnosis, and epidemiology of mental disorders contributes to this success. The behavioral approach therefore very clearly deserves the certificate of being the best validated psychotherapeutic orientation.
Provided a reversible aggregation of components is taking place in plasma membranes, it is conceivable that the high-affinity state of pancreozymin receptors is associated with a calcium ionophore-like effector system and maximal secretion, whereas the low affinity state of the receptors, resulting from a high degree of hormone occupancy, may be necessary for full activation of adenylate cyclase or for other effector systems such as glucose transport and Na +-dependent amino acid transport. According to another model, the negative cooperativity of pancreozymin binding might arise from a variable affinity for effector(s) of mobile receptors when occupied by pancreozymin. This ligand-induced conformational transition provokes negative cooperativity. The vacant subunits change their conformation in response to the binding of a pancreozymin agonist to a neighboring subunit. André Vandermeers, in Nutrition, Digestion, Metabolism, 1981 6.4/ Changing conformation of pancreozymin receptorsĪccording to the sequential model of Koshland, the probable structure of pancreozymin receptors is that of an oligomeric protein existing in one conformation only when unliganded.