The effects of active worrying on working memory capacity

According to the attentional control theory, worry, a crucial component of anxiety, impairs task performance through its direct effect on working memory capacity (WMC) by using up the limited resources available for performance thus reducing attentional control. We tested this hypothesis in the current study by examining the causal influence of active worrying on WMC in a sample of undergraduate university students (n?=?64) assigned either to a worry condition or to a non-worry control condition. Participants performed a change detection task before and after the worry/control manipulation. Mediation analyses showed that the level of self-reported worry mediated the effects of condition on change in WMC as demonstrated by the significant indirect effect of worry and the resulting non-significant direct effect of condition on change in WMC. Similar results were obtained when using state anxiety measures as mediating factors. Results of the current study are amongst the first to demonstrate that worry impairs WMC and as such have important implications for understanding the impact of worry.     

The worried mind: autonomic and prefrontal activation during worrying

To study the psychophysiological correlates of worrying, the authors recorded heart rate, respiratory sinus arrhythmia (RSA), skin conductance level, and alpha electroencephalographic asymmetry in healthy males during baseline, relaxation, worry induction, and anticipation of an impromptu speech task. Compared with baseline, relaxation, and anticipation, worrying was associated with greater heart rate and lower RSA. Worrying was further characterized by higher skin conductance levels compared with baseline but lower levels than during anticipation. Finally, worrying was associated with relatively greater left frontal activity compared with anticipation. Trait public speaking anxiety was positively correlated with left frontal activity during worrying. These results support the notion that worrying is a unique emotional state that is different from fearful anticipation.     

The motivational effects of thinking and worrying about the effects of smoking cigarettes

We tested a strategy to encourage cigarette smokers to think more frequently about the negative consequences of smoking, reasoning that increased thought might lead to greater worry and motivation to quit. College students who smoked daily were randomly assigned to one of three conditions in which they wore watches for one week that sounded an alarm randomly four times each day. When alerted, the students read one of eight cards that either had a written statement about studying (control condition), a statement about the negative effects of smoking behaviour (text condition), or a negative smoking statement accompanied by a picture (e.g., a blackened lung; image condition). Measures collected at week's end revealed that the smoking cards had no effects on perceived risk, but they increased worry and reports of intrusive thoughts, and had a small but reliable effect on plans to quit. Correlational data also supported the relationship between worry and motivation to quit, and we discuss the possible benefits of “normal” worrying and strategies for capitalising on the worry–motivation relationship to encourage smokers to abandon cigarettes.     

The Oedipus complex as observed in work with couples and their children

In work with couples where there is a child referred to a Child and Adolescent Mental Health Service, there are opportunities to observe and to work with unresolved Oedipal issues brought by the parents to the task of creating a family. These conflicts can be seen enacted by the child or children, either internally or externally. Examples are given from five cases: the first two from brief family work where the children are under five and the difficulties are to some extent resolved. The next two demonstrate more intractable problems of psychopathology where the parental Oedipal conflicts are handed down to the next generation, and the paper concludes with an example of couple work in relation to individual therapy with a child, where despite the pressure of considerable pathology in the parents' backgrounds there is a will to integration and progress is made.     

Prevalence of anxiety among patients undergoing colorectal surgery

To assess prevalence of anxiety 36 consecutive patients undergoing colorectal surgery with general anesthesia were interviewed on the day of surgery and completed the State-Trait Anxiety Inventory. Postsurgical ratings of pain and anxiety were obtained within 24 hours after surgery. Analysis indicated that 29 scored moderate or higher on the State Anxiety scale prior to surgery. The correlations for scores on presurgical Trait Anxiety with postsurgical pain and Trait Anxiety scores were significant (p<.01) but not that for pre- and postsurgical State Anxiety     

The relation between worrying and concerns: the importance of perceived probability and cost

The relation between worrying and individuals' concerns was examined in a sample of 197 college students. Participants described the five undesirable outcomes that they thought about most often, indicated how likely they thought the outcomes were, and how upset they would be by them. Worry severity was measured using the Penn State Worry Questionnaire. The relation between worry severity and the life domains about which individuals were concerned was quite weak. In contrast, as predicted, greater worry was associated with higher probability and cost estimates. In addition, cost estimates moderated the relation between worry severity and probability estimates. The potential importance of perceived threat for understanding worrying is discussed.     

Winnicott's children: The holding environment and therapeutic communication in brief and non-intensive work

This paper discusses brief and non-intensive work using a Winnicottian framework for understanding the processes involved. The importance of play, communication and interpretation are considered within the careful establishment of a unique holding environment for each patient. Parallels are drawn with ordinary development and care of the infant and young child. Two clinical examples are given to illustrate these concepts. The first describes the treatment of parents and children following the accidental death of the youngest child, and the second describes time-limited work with a sexually abused and abusing teenage boy. The value of providing a range of psychoanalytic treatments to meet the range of needs of patients is discussed. The importance of conceptualizing such treatments in ways that do not imply that they are ‘diluted’ psychoanalysis is also stressed, particularly with a view to the increasing pressure on therapists to offer help to as many children as possible within limited treatment time.     

Sexual quality of life in patients undergoing coronary artery bypass graft surgery

Objectives: Despite improvements in many domains of functioning, sexual quality of life often remains impaired following coronary artery bypass graft (CABG) surgery. This study examined associations among sexual quality of life, fear of sexual activity and receiving information from providers about sexual activity in CABG patients.

Methods: Participants completed a survey assessing sexual activity, mental health and physical health at baseline (3–5-day post-surgery; n?=?60) and 2-month post-surgery (n?=?42).

Results: Sexual quality of life showed moderate difficulties at baseline and did not improve by follow-up (p values ≥0.09). At follow-up, greater patient fear was associated with lower sexual quality of life in some domains; receiving information was related to lower fear (p values ≤0.03) and greater sexual satisfaction and interest (p values ≤0.04). Suggestive of mediation, there was a significant indirect effect of information on patient fear and of patient fear on sexual interest (p?=?0.05).

Conclusions: Though data were cross-sectional, findings suggest that fears of sexual activity may play a role in lowering CABG patients’ motivation for sexual activity and that receiving information from a medical provider may assist in hastening sexual rehabilitation. Prospective and intervention studies are needed to support findings.     

The capacity to tell a joke: Reflections from work with Asperger children

The capacity to tell a joke is a highly complex interpersonal event that depends upon the maturation of certain developmental achievements which are absent or stunted in children with Asperger's Syndrome. These include the ability to know another's mind, a sense of interpersonal timing and, most notably, a capacity for abstract thinking. The author discusses Freud's ( 1905 ) notion of joke‐work, which is akin to dream‐work, both of which are pathways to forming mental representations. Freud considered joke‐work as a mental activity that operated on the verbal level and the author examines the preverbal dimensions that are rooted in the earliest mother/infant interactions. An extended case discussion of the psychoanalytic treatment of an Asperger boy is offered to illustrate these points and to demonstrate the activity of joke‐work as a means of building mental representations.     

Family transmission of work affectivity and experiences to children

Theory and research suggest that children develop orientations toward work appreciably influenced by their family members’ own expressed work experiences and emotions. Cross-sectional data from 100 children (53 girls, 47 boys; mean age = 11.1 years) and structural equation modeling were used to assess measures of work affectivity and experiences and to test hypotheses suggesting that family work experiences and emotions influence the orientations children develop toward work and how they in turn influence children’s work and school motivation. Results indicated that the family setting influences children’s perceptions of and future orientation toward the world of work through adults’ expression of positive work experiences, negative work affect, and negative work experiences. Furthermore, children’s work and school motivations appear to be principally influenced by indicators of favorable work affect and experiences. Implications and suggestions for future research are offered that cast the family as an important core setting for children’s vocational development.     

The effects of hospitalization and surgery on children: A critical review

This article critically evaluates past research on children's psychological responses to the experience of hospitalization and surgery. Many methodological problems are revealed but in spite of these, several conclusions can be drawn. First, at least 20% of children admitted into a hospital experience some degree of behavioral and/or emotional distrubance, but this usually subsides within the first 6 months after discharge. Second, prolonged or repeated hospitalization increases the chances of later problems. Third, younger children, especially those between the ages of 6 months and 4 years, tend to show more adverse reactions to hospitalization than older children. Fourth, increased risk of problem behaviors is associated with coming from a psychosocially disadvantaged family. Recommendations are made for future research.     

Investigating the effect of intolerance of uncertainty on catastrophic worrying and mood

Intolerance of uncertainty (IU) is a construct known to influence catastrophic worry and is often observed in Generalized Anxiety Disorder (GAD). Research into the psychological manifestations of GAD suggests IU is associated with worry, but has not confirmed a causal link. The current study investigated the relationship between catastrophic worry and IU in a non-clinical undergraduate and postgraduate population (n = 46), with a mean age of 26.8 (SD = 5.52 years), where 71.74% were women. Participants received either a high or low IU manipulation, mood was measured throughout the study on 100 point visual analogue scales (VAS), and worry was measured using the catastrophising interview (CI). The high IU group generated significantly more catastrophising steps than the low IU group. Increased levels of sadness and anxiety were observed in the high as compared to the low IU group post IU manipulation, and this difference was maintained throughout the CI interview. A mediation analysis revealed that sadness and anxiety did not significantly mediate the relationship between IU and number of CI steps. These findings have implications for GAD treatment, as they suggest that manipulating IU affects measures of worry and its associated emotional and behavioural symptoms.     

Similar-other support for men undergoing coronary artery bypass surgery.

This field experiment examined effects of a support intervention on the physical and mental health of coronary artery bypass graft (CABG) surgery patients. Control participants (N = 90) received usual hospital care; experimental participants (N = 100) also received visits from a "similar other" while in the hospital. Similar others were Veterans Administration veterans who had CABG surgery previously and were trained in simple supportive techniques. Outcomes were assessed prior to surgery and at 1, 6, and 12 months afterwards. Unexpectedly, the intervention generally had no effects on participants' well-being. Further analysis showed that participants who talked often with fellow cardiac patients in the hospital ("de facto similar others") experienced improvements in their physical and emotional well-being over time.     

Inflated responsibility and the use of stop rules for catastrophic worrying

The present paper reports the results of two experiments designed to test some predictions from a mood-as-input explanation of catastrophic worrying (). In particular, these experiments attempted to identify whether worriers possess characteristics that would contribute to the use of relatively strict 'as many as can' closure rules for catastrophising. Experiment 1 demonstrated that high worriers begin a catastrophising task with higher self-reported levels of responsibility towards fully considering all issues involved, than low worriers. Experiment 2 suggested that inflated responsibility has a causal effect on perseveration at the catastrophising task (rather than being a simple non-causal by-product of excessive worrying), and that inflated responsibility exacerbates catastrophising only in conjunction with negative mood. This suggests a relatively complex relationship between responsibility and mood, where there are mood conditions in which high responsibility does not generate greater persistence than low responsibility. These findings are consistent with predictions from a mood-as-input account of catastrophic worrying, and provide evidence for a putative mechanism that mediates the influence of variables such as inflated responsibility on perseveration.     

Responsibility to continue thinking and worrying: evidence of incremental validity

This two-part study examined the role of the responsibility to continue thinking, beliefs that one needs prolonged thinking about stressful problems, in the prediction of excessive worry. This construct is considered to reflect high levels of motivation to continue inflexible thinking and the use of rigid stop rules. In Study 1, 122 students completed questionnaires. A regression analysis revealed that responsibility accounted for a unique variance beyond negative meta-cognitive beliefs about worry. One hundred and fifty students participated in Study 2, where worry was regressed on emotional instability (Neuroticism), responsibility, and other worry-related cognitive variables (intolerance of uncertainty, positive/negative meta-cognitive beliefs, poor problem-solving orientation, and cognitive avoidance). Again, responsibility was a significant predictor, after controlling for emotional instability (Neuroticism) and other worry-related cognitions. These results indicate the incremental validity of the responsibility to continue thinking.     

Some Oedipal problems in work with adopted children and their parents

This paper has two main theses. Firstly that Oedipal material is a particular feature of clinical work with adopted children; secondly, that the concept of developmental deficit, and not only that of psychic defence, is essential to an understanding of this aspect of the work with adopted children and their families. Three levels are distinguished at which Oedipal difficulties are manifest: the first two within the individual child and the third within the triangle formed by the child, his adoptive parents and the child psychotherapist. Some consideration is given to the limitations of a conventional treatment framework for containing the powerful Oedipal dynamic forces at play when an adopted child is a patient in individual psychotherapy. Dieser Artikel hat zwei Hauptthesen. Erstens, dass ödipales Material ein besonderes Merkmal der klinischen Arbeit mit adoptierten Kindern ist; zweitens dass das Konzept eines Entwicklungsdefizit, und nicht nur das eines psychischen Abwehrmechanismus, für das Verstehen dieses Aspekts der Arbeit mit adoptierten Kindern und ihren Familien unerlässlich ist. Es werden drei Stufen differenziert, in denen sich ödipale Schwierigkeiten manifestieren: die ersten zwei innerhalb des Kindes und die dritte innerhalb des Dreiecks, das vom Kind, seinen Adoptiveltern und dem Kindertherapeuten gebildet wird. Es werden überlegungen bezüglich der Grenzen des konventionellen Behandlungsrahmens angestellt, inwieweit er die mächtigen ödipalen dynamischen Kräfte, die im Spiel sind, 'containen' kann, wenn ein adoptiertes Kind Patient in individueller Psychotherapie ist. Dans son texte, l'auteur développe deux thèses principales: d'abord, que le matériel ?dipien est d'une importance particulière dans le traitement d'enfants adoptés; et, ensuite, que le concept de trouble déficitaire du développement, en plus de celui de défense psychique, est essentiel pour comprendre cet aspect de la prise en charge d'enfants adoptés et de leur famille. L'auteur distingue trois niveaux auxquels se manifestent la problématique ?dipienne?:?les deux premiers concernent l'enfant lui-même en tant qu'individu, le troisième renvoie au triangle composé de l'enfant, de ses parents adoptifs et du psychothérapeute. Certaines limitations imposées par le cadre thérapeutique traditionnel sont ensuite explorées, notamment par rapport à la possibilité de contenir la puissante dynamique ?dipienne évoquée dès qu'un enfant adopté est pris en psychothérapie individuelle. Questo articolo sostiene due tesi principali. La prima e' che il materiale edipico e' una caratteristica particolare del lavoro clinico con bambini adottati; la seconda e' che il concetto di deficit evolutivo, e non solo quello di difesa psichica, e' essenziale per capire questo aspetto del lavoro con bambini adottati e le loro famiglie. Vengono distinti tre livelli in cui si manifestano le difficolta' edipiche: i primi due all'interno del singolo bambino, il terzo all'interno del triangolo formato dal bambino, dai suoi genitori adottivi e dallo psicoterapeuta infantile. Vengono fatte alcune considerazioni sulle limitazioni che il contesto terapeutico convenzionale ha nel contenere le potenti forze dinamiche edipiche in gioco quando un bambino adottato diventa paziente in terapia individuale.     

Illness representations and psychological distress in patients undergoing coronary artery bypass graft surgery

Preoperative psychological distress has been shown to predict both postoperative distress and subsequent cardiac morbidity in patients undergoing coronary artery bypass graft (CABG) surgery. This study assessed the associations between illness perceptions and psychological well-being among 56 patients awaiting CABG surgery using the Profile of Mood States (POMS) and the Illness Perception Questionnaire-Revised (IPQ-R). Patient perceptions of their illness as chronic were associated with reduced beliefs in both personal control over illness and efficacy of treatment, and increased perceived consequences of illness in terms of life functioning. In addition, psychological distress regarding illness was significantly correlated with psychological distress in general. Reduced illness coherence was also associated with increased psychological distress. Preoperative psycho-education aimed at helping patients better understand their illness, treatment, and its effects may reduce psychological distress, and perhaps improve future well-being as a result.