A randomized clinical trial of a brief, problem-focused couple therapy for depression

The aim of this study was to evaluate a brief couple therapy for depression targeted for mildly discordant or nondiscordant couples struggling with the negative impact of depression. Subjects included women with major depression or dysthymia who had husbands without clinical depression. Thirty-five couples were randomly assigned to the 5-week intervention (n = 18) or a waitlist control group (n = 17), and followed up 1 and 3 months later. Results showed a significant effect of treatment in reducing women's depressive symptoms, with 67% of women improved and 40% to 47% recovered at follow-up, compared to only 17% improved and 8% recovered among women in the control group. Treatment was also effective in secondarily improving women's marital satisfaction, reducing husbands' levels of psychological distress and depression-specific burden, and improving both partners' understanding and acceptance of depression. The treatment was implemented in five 2-hour sessions, representing an efficient, cost-effective approach. Findings support the growing utility of brief, problem-focused couple interventions that simultaneously target depression, relational functioning, and psychological distress experienced by the loved ones of depressed persons.     

Differential outcomes of skill training,group counseling,and individual cognitive therapy for persons with acquired visual impairment

As part of the Living Skills Training Program, group counseling and individual cognitive therapy were implemented to decrease psychological distress for adults with acquired visual impairment. This quasi‐experimental design study compared the outcomes of a 6‐month skill training program combined with a group counseling program (n = 37), with (n = 9) or without (n = 10) individual cognitive therapy, and with a control group (n = 42). The outcome measures were the Profile of Mood States and the Nottingham Adjustment Scale Japanese Version. The results showed that participants with low psychological distress decreased anxiety and increased acceptance of disability, even when they did not participate in group counseling. However, among the participants with high distress, they did not show any improvement without group counseling or individual therapy. The participants with high distress who engaged in group counseling showed an improving trend in attitudes toward others. Moreover, the participants who chose to engage in individual therapy in addition to group counseling showed decreased tension‐anxiety, depression, and fatigue, and significantly improved acceptance of disability. These results suggest that group counseling, combined with individual cognitive therapy, can be an effective part of rehabilitation treatment for clients who have high psychological distress.     

An outcome evaluation study of a psycho‐educational course in a primary care setting

Rationale: To date relatively little research has examined the effectiveness of psycho‐educational courses provided in a primary care setting to adults with mild‐to‐moderate mental health concerns. Aims: To determine whether group psycho‐education could be a viable alternative to individual counselling by (1) assessing the clinical effectiveness of an 8‐week psycho‐educational course, and (2) examining the group outcomes in comparison with individual treatment outcomes from a previous study in the same counselling service. Method: A total of 57 participants attending a psycho‐educational course provided data over a 36‐month period, using the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE‐OM) pre‐ and post‐intervention. A comparison was then made with the data of 58 previous participants of individual counselling evaluation, using the same CORE‐OM system. Results: Participants reported significantly lower levels of psychological distress after attending the course and these results are comparable to outcomes measured in the same service for individual counselling, indicating that group interventions could be considered a legitimate alternative to individual counselling, thus increasing cost effectiveness and reducing waiting times. Limitations of the study and implications for practice and further investigation are considered.     

Homemaking-role quality and the psychological well-being and distress of employed women

This paper examines the quality of employed women's experience in the homemaking-role and its relationship to their psychological well-being and distress. The subjects (N=403) were drawn from a random stratified sample of women, ages 25 to 55, who were employed as social workers or licensed practical nurses. Positive homemaking-role experience was associated with increased psychological well-being and lowered psychological distress. These associations were affected by the quality of the subjects' experiences in the paid work-role. Thus the favorable association of positive homemaking-role quality with psychological well-being and distress was enhanced by positive paid work-role quality, suggesting that the relationship of homemaking-role quality to the psychological outcomes is influenced by the effects of paid work-role quality on psychological well-being and distress.Data for this paper were collected as part of a larger project funded by the National Institute on Occupational Safety and Health (1 RO1-OHO-1968). The initial analyses and writing of this paper took place at the Center for Research on Women, Wellesley College, and was supported by NIMH postdoctoral training grant no. MH-17058-053. We would like to express special thanks to the late Grace K. Baruch for her enthusiastic support and encouragement of this paper.     

Mindfulness and Emotional Distress: the Mediating Role of Psychological well-Being

The present cross-sectional study aimed to clarify the relationships among specific facets of dispositional mindfulness, psychological well-being, and emotional distress. To understand the relationships among these variables is crucial in order to expand the knowledge of the processes underlying mindfulness effects and to develop effective interventions. The participants (119 Italian males and females; mean age = 29 years) completed self-report questionnaires assessing mindfulness (i.e., observing, describing, acting with awareness, non-judging of inner experience, non-reactivity to inner experience), emotional distress, and psychological well-being. Path analysis revealed that each facet of mindfulness played a unique role in influencing emotional suffering. In line with our prediction, no significant correlation emerged between the observing facet and either psychological well-being or emotional distress. Both the capacity to describe inner events and to act with awareness had an indirect effect on emotional distress, which was fully mediated by the perception of psychological well-being. On the other hand, the capacity for non-reacting to emotions and thoughts directly influenced emotional distress. Interestingly, non-judging inner events showed both a direct and indirect effect on the outcome variable. These findings confirmed the significant role of psychological well-being in mediating the relationship between some facets of mindfulness and emotional distress. Moreover, different mindfulness abilities play specific roles in reducing emotional distress, so mindfulness should be considered as a multidimensional construct.     

Beliefs About Emotion: Links to Emotion Regulation,Well-Being,and Psychological Distress

People differ in their implicit beliefs about emotions. Some believe emotions are fixed (entity theorists), whereas others believe that everyone can learn to change their emotions (incremental theorists). We extend the prior literature by demonstrating (a) entity beliefs are associated with lower well-being and increased psychological distress, (b) people's beliefs about their own emotions explain greater unique variance than their beliefs about emotions in general, and (3) implicit beliefs are linked with well-being/distress via cognitive reappraisal. These results suggest people's implicit beliefs—particularly about their own emotions—may predispose them toward emotion regulation strategies that have important consequences for psychological health.     

Social Comparison and the Subjective Well-Being of Cancer Patients

Although cancer patients may suffer from more physical and psychological distress than healthy persons, they seem not to differ in subjective well-being. In this article the influence of social comparison on the relation between physical distress and subjective well-being was examined among cancer patients. LISREL analyses provided support for the following model: First, the psychological distress that resulted from physical distress induced a need for comparison. This need, in turn, affected the frequency of downward comparison. Whereas psychological distress negatively affected perceptions of how well one was doing in comparison with others, selectively comparing downward had the reverse impact, contributing to a feeling of relative well-being. Unexpectedly, these relative evaluations also seemed to be affected directly by the amount of physical distress patients experienced. Finally, although both the amount of physical and psychological distress had strong direct effects on subjective well-being, the perception of how well one was doing compared to most others explained an additional significant amount of variance. Interestingly, this model was also supported in a healthy control group, suggesting that we are dealing here with a general behavioral model that suggests that social comparison processes may contribute to well-being when well-being is threatened by stress.     

Psychological Distress Reported by Patients Undergoing Limb Reconstruction Surgery: Implications for Psychological Interventions

Limb reconstruction is an orthopaedic surgical technique designed to restore or improve functioning and appearance. The aims of the present study were to investigate levels of psychological distress in adults undergoing limb reconstruction as a result of traumatic injury, to examine which variables could account for any variations in distress during and after treatment, and to ascertain the potential relevance of psychological interventions. A cross-sectional sample of patients completed measures of psychological distress, posttraumatic symptomatology, coping, social support, pain, and disability. Self-reported levels of psychological distress and posttraumatic symptoms were high but did not tend to vary across stage of treatment, suggesting that distress is not solely attributable to limb reconstruction treatment per se but to other factors. Both medical variables (pain and mobility) and psychological variables (symptoms of trauma and coping strategies) accounted for a significant percentage of the variance in HAD scores. These results suggest that both medical and psychological interventions have potential for reducing distress and increasing well-being in an orthopaedic population who are experiencing high levels of emotional distress.     

The effect of the two-chair dialogue intervention on self-compassion - adding an emotional evocative component to a basic Rogerian condition

Objective

How people relate to themselves when facing distress or failure influences general psychological well-being and vulnerability to psychological disorders. The aim of the present study was to explore the effect of an emotionally evocative intervention on self-compassion.

Methods

The data were retrieved from a larger study of Emotion-Focused Therapy (EFT) utilising a multiple baseline design comparing two treatment phases. The baseline phase consisted of 5, 7 or 9 therapy sessions where the therapist solely adhered to Rogerian relational conditions, as prescribed in EFT. A two-chair dialogue intervention was then added for five sessions. The sample consisted of 18 self-critical clients with clinically significant symptoms of depression and/or anxiety. The “Self-Compassion Scale” (SCS) was administered pre, mid and post therapy.

Results

The baseline phase did not lead to significant changes in self-compassion. However, the addition of the two-chair dialogue was associated with a significant increase in self-compassion. This increase was due to reductions in the negative subscales, especially the isolation subscale.

Conclusion

The emotionally evocative two-chair dialogue was associated with a significant change in self-to-self relating, compared to relational conditions alone. The two-chair dialogue, thus, seems to be a promising intervention for promoting healthier self-to-self relating.     

Evidence-based psychological treatments for distress in family caregivers of older adults

This review identifies evidence-based psychological treatments (EBTs) for reducing distress, and improving well-being, of family members caring for an older relative with significant cognitive and/or physical impairment. Three categories of psychologically derived treatments met EBT criteria: psychoeducational programs (N = 14 studies), psychotherapy (N = 3 studies), and multicomponent interventions (N = 2 studies). Specifically, support within the psychoeducational category was found for skill-training programs focused on behavior management, depression management, and anger management and for the progressively lowered threshold model. Within the psychotherapy category, cognitive-behavioral therapy enjoys strong empirical support. Within the multicomponent category, programs using a combination of at least 2 distinct theoretical approaches (e.g., individual counseling and support group attendance) were also found to be effective. Suggestions for future research include the development of more well-integrated multicomponent approaches, greater inclusion of ethnically diverse family caregivers in research protocols, and greater incorporation of new technologies for treatment delivery.     

Long-term effects of lifestyle changes on well-being and cardiac variables among coronary heart disease patients

OBJECTIVE: To focus on psychological well-being in the Lifestyle Heart Trial (LHT), an intensive lifestyle intervention including diet, exercise, stress management, and group support that previously demonstrated maintenance of comprehensive lifestyle changes and reversal of coronary artery stenosis at 1 and 5 years. DESIGN AND MAIN OUTCOME MEASURES: The LHT was a randomized controlled trial using an invitational design. The authors compared psychological distress, anger, hostility, and perceived social support by group (intervention group, n = 28; control group, n = 20) and time (baseline, 1 year, 5 years) and examined the relationships of lifestyle changes to cardiac variables. RESULTS: Reductions in psychological distress and hostility in the experimental group (compared with controls) were observed after 1 year (p < .05). By 5 years, improvements in hostility tended to be maintained relative to the control group, but reductions in psychological distress were reported only by experimental patients with very high 5-year program adherence. Improvements in diet were related to weight reduction and decreases in percent diameter stenosis, and improvements in stress management were related to decreases in percent diameter stenosis at both follow-ups (all p < .05). CONCLUSION: These findings illustrate the importance of targeting multiple health behaviors in secondary prevention of coronary heart disease.     

Self-forgiveness and well-being: Does divine forgiveness matter?

ABSTRACT

A reliable association exists between self-forgiveness and well-being. But self-forgiveness and its correlates will not be fully understood without considering forgiveness by God or divine forgiveness, especially in light of the fact that the majority of the population identifies as religious. This study therefore examined the role of divine forgiveness in understanding the association between self-forgiveness and well-being using data collected from 435 young adults. Because well-being is not the absence of distress, this study examined whether self-forgiveness and divine forgiveness relate to psychological well-being and distress in the same way. Self-forgiveness and divine forgiveness were independently related to psychological well-being and distress even with religiosity statistically controlled. Divine forgiveness also moderated the relationship between self-forgiveness and psychological distress in that perceived forgiveness by God was associated with fewer depressive symptoms at lower but not higher levels of self-forgiveness. The implications for future research are outlined.     

Hostility and the clinical course of outpatients with congestive heart failure

Objective: The role of depression and quality of life on clinical outcomes of congestive heart failure (CHF) is well recognised. However, there are fewer studies investigating the prognostic role of subclinical psychological distress and well-being impairments. The aims of this study were to evaluate clinical/subclinical psychological distress and well-being in CHF outpatients, and the influence of these psychological factors on adverse cardiac events (re-hospitalisation, cardiac death), at 4-year follow-up.

Design: Sixty-eight CHF outpatients underwent psychological assessment at baseline and, after 4 years, information about cardiac events was collected in 60 patients by means of clinical records.

Main outcome measures: Psychological assessment included structured clinical interview for DSM (major/minor depression), Interview for diagnostic criteria for psychosomatic research (demoralisation), symptom questionnaire, psychological well-being scales.

Results: At follow-up, 39.7% of the baseline sample reported cardiovascular events (14 CHF-related re-hospitalisations and 13 cardiac deaths) and 5.9% other causes for death. Among the variables examined as potential risk factors for adverse cardiovascular outcomes, only hostility was significant, even after controlling for disease severity (hazard ratio = 2.38, 95%confidence interval: 1.04–5.45, p = .040).

Conclusion: In outpatients with CHF, psychological assessment should include both clinical and subclinical distress such as hostility, in order to better address psychological risk factors for cardiac outcomes.     

Factors of regular sponsorship of African children: A cross-ethnic study

This study examined psychological well-being influences of personal factors on regular sponsorship of, or donation to, African children living in Africa. Study participants (N = 597) were 338 Koreans (50.3% female, n = 170) and 259 Chinese (56.8% female, n = 147). They responded to measures of psychological well-being, individual social responsibility, social impression management, and subjective norms. Following multiple group analyses applying structural equation modelling, subjective well-being influenced psychological well-being among the Korean donors; whereas social responsibility influenced psychological well-being among the Chinese donors. In both the Korean and Chinese groups, psychological well-being was associated with an increased regular sponsorship of African children. Latent ethno-cultural personal orientations appear to explain psychological well-being with donation activity.     

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.     

Group critical incident stress debriefing with emergency services personnel: a randomized controlled trial

Although single-session individual debriefing is contraindicated, the efficacy of group psychological debriefing remains unresolved. We conducted the first randomized controlled trial of critical incident stress debriefing (CISD) with emergency workers (67 volunteer fire-fighters) following shared exposure to an occupational potentially traumatic event (PTE). The goals of group CISD are to prevent post-traumatic stress and promote return to normal functioning following a PTE. To assess both goals we measured four outcomes, before and after the intervention: post-traumatic stress, psychological distress, quality of life, and alcohol use. Fire brigades were randomly assigned to one of three treatment conditions: (1) CISD, (2) Screening (i.e., no-treatment), or (3) stress management Education. Controlling for pre-intervention scores, CISD was associated with significantly less alcohol use post-intervention relative to Screening, and significantly greater post-intervention quality of life relative to Education. There were no significant effects on post-traumatic stress or psychological distress. Overall, CISD may benefit broader functioning following exposure to work-related PTEs. Future research should focus on individual, group, and organizational factors and processes that can promote recovery from operational stressors. Ultimately, an occupational health (rather than victim-based) approach will provide the best framework for understanding and combating potential threats to the health and well-being of workers at high risk for PTE exposure.     

Infertility and Adjustment in Women: The Effects of Attachment Style and Social Support

The moderating effects of two psychological resources—attachment style and perceived social support—on adjustment were studied in 109 infertile women, examining the effects of duration of infertility and of primary (the woman has no child of her own) versus secondary (the woman already has a child of her own) infertility. Subjects were administered questionnaires measuring marital adjustment, psychological distress, and well-being. A model viewing attachment style and social support as moderators between stress psychological well-being was explored. The results showed that among the objective characteristics, only duration of infertility had any impact on the psychological measures. Furthermore, the psychological resources were highly associated with the adjustment scores in general. A hierarchical regression analysis showed that attachment style and social support both were related to marital quality and to psychological well-being and that these two resources function as stress moderators. It was concluded that attachment style and social support are important resources for individuals in times of stress, as exemplified in the infertility situation.     

The Effectiveness of Emotionally Focused Couples Therapy With Veterans With PTSD: A Pilot Study

The current study is a pilot project conducted at Baltimore VA Medical Center investigating the use of emotionally focused couples therapy (EFT) for couples in which one partner is a veteran who has been diagnosed with posttraumatic stress disorder (PTSD). Fifteen couples enrolled in the study and seven of these couples completed treatment (26 to 36 weekly sessions of EFT). Both partners were assessed on measures of relationship satisfaction, psychological distress, depression, and quality of life, and veterans were assessed on measures of PTSD symptoms at baseline and 2 weeks after the intervention. Paired t-tests were used to compare scores before and after EFT. In terms of results, the veterans' partners reported significant improvements in relationship and life satisfaction and in decreased depression and a decrease in psychological distress. Veterans demonstrated a significant decrease in self-reported symptoms of PTSD. These results provide preliminary evidence for the usefulness of EFT to help foster improved relationship satisfaction, and psychological well-being for veterans with PTSD and their partners who completed treatment.     

Randomised trial of expressive writing for distressed metastatic breast cancer patients

Women with metastatic breast cancer and significant psychological distress (N?=?87) were assigned randomly to engage in four home-based sessions of expressive writing or neutral writing. Women in the expressive writing group wrote about their deepest thoughts and feelings regarding their cancer, whereas women in the neutral writing group wrote about their daily activities in a factual manner. No statistically significant group differences in existential and psychological well-being, fatigue and sleep quality were found at 8-weeks post-writing. However, the expressive writing group reported significantly greater use of mental health services during the study than the neutral writing group (55% vs. 26%, respectively; p?<?0.05). Findings suggest that expressive writing may improve the uptake of mental health services among distressed cancer patients, but is not broadly effective as a psychotherapeutic intervention.     

Why is the receipt of social support associated with increased psychological distress? an examination of three hypotheses

Abstract

Although there is a great deal of research linking social support with favourable psychological well-being outcomes a number of contradictory findings have been published showing support to be associated with increased psychological distress. These contrary findings arise when social support is measured as the receipt of supportive behavior rather than perceptions of support availability and quality. This paper examines three hypotheses that have been advanced to explain why the receipt of support is associated with distress. The first of these hypotheses (the support mobilisation hypothesis) argues that the relationship is a spurious one, and that it is a product of distressing circumstances which increase both support receipt and psychological distress. The other two hypotheses (the inequity hypothesis and the esteem threat hypothesis) both argue that receiving support actually causes distress. We tested these hypotheses in two samples. One sample was a group of individuals who reported having some form of disability (N = 106). the other sample was a 'healthy' comparison group (N = 134). Our analyses showed that in both groups the receipt of support was significantly and positively related to reports of anxiety, but not to reports of depression. Among the 'healthy' sample, controlling for subjects' sex largely explained the positive association between support receipt and anxiety. This was not the case among the 'disabled sample, where the inequity hypothesis received the strongest support. The implications of these findings for interventions based around the provision of social support are examined.