Randomized controlled trial of yogic meditation techniques for patients with obsessive-compulsive disorder

The objective of this study was to compare efficacy of two meditation protocols for treating patients with obsessive-compulsive disorder (OCD). Patients were randomized to two groups-matched for sex, age, and medication status-and blinded to the comparison protocol. They were told the trial would last for 12 months, unless one protocol proved to be more efficacious. If so, groups would merge, and the group that received the less efficacious treatment would also be afforded 12 months of the more effective one. The study was conducted at Children's Hospital, San Diego, Calif. Patients were selected according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised (DSM-III-R) criteria and recruited by advertisements and referral. At baseline, Group 1 included 11 adults and 1 adolescent, and Group 2 included 10 adults. Group 1 employed a kundalini yoga meditation protocol and Group 2 employed the Relaxation Response plus Mindfulness Meditation technique. Baseline and 3-month interval testing was conducted using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Symptoms Checklist-90-Revised Obsessive Compulsive (SCL-90-R OC) and Global Severity Index (SCL-90-R GSI) scales, Profile of Moods scale (POMS), Perceived Stress Scale (PSS), and Purpose in Life (PIL) test. Seven adults in each group completed 3 months of therapy. At 3 months, Group 1 demonstrated greater improvements (Student's independent groups t-test) on the Y-BOCS, SCL-90-R OC and GSI scales, and POMS, and greater but nonsignificant improvements on the PSS and PIL test. An intent-to-treat analysis (Y-BOCS) for the baseline and 3-month tests showed that only Group 1 improved. Within-group statistics (Student's paired t-tests) showed that Group 1 significantly improved on all six scales, but Group 2 had no improvements. Groups were merged for an additional year using Group 1 techniques. At 15 months, the final group (N=11) improved 71%, 62%, 66%, 74%, 39%, and 23%, respectively, on the Y-BOCS, SCL-90-R OC, SCL-90-R GSI, POMS, PSS, and PIL; P<0.003 (analysis of variance). This study demonstrates that kundalini yoga techniques are effective in the treatment of OCD.     

Deconstructing therapy outcome measurement with Rasch analysis of a measure of general clinical distress: the Symptom Checklist-90-Revised

Rasch analysis was used to illustrate the usefulness of item-level analyses for evaluating a common therapy outcome measure of general clinical distress, the Symptom Checklist-90-Revised (SCL-90-R; Derogatis, 1994). Using complementary therapy research samples, the instrument's 5-point rating scale was found to exceed clients' ability to make reliable discriminations and could be improved by collapsing it into a 3-point version (combining scale points 1 with 2 and 3 with 4). This revision, in addition to removing 3 misfitting items, increased person separation from 4.90 to 5.07 and item separation from 7.76 to 8.52 (resulting in alphas of .96 and .99, respectively). Some SCL-90-R subscales had low internal consistency reliabilities; SCL-90-R items can be used to define one factor of general clinical distress that is generally stable across both samples, with two small residual factors.     

The Güttingen study of psychoanalytic therapy: First results

Results of a naturalistic study of the effectiveness of psychoanalytic therapy are reported. Outcome data are presented for a sample of N = 36 patients who were treated with psychoanalytic therapy. For a sample of n = 23 of these patients, data for 1-year follow-up are available at present. According to the results, psychoanalytic therapy yielded signifi cant improvements in symptoms (Symptom Checklist 90-R, SCL-90-R and rating of psychoanalysts), in interpersonal problems (Inventory of Interpersonal Problems, IIP), in quality of life (Questionnaire of Quality of Life, FLZ), in well-being (Questionnaire of Changes in Experience and Behaviour, VEV) and in target problems defi ned by the patients (Goal Attainment Scaling, GAS). Large effect sizes between 1.28 and 2.48 were found in symptoms (GSI of the SCL-90-R), interpersonal problems (IIP-total), quality of life (FLZ-total), well-being (VEV) and target problems (GAS). At 1-year follow-up, all improvements proved to be stable or even increased. The self-reported improvements in symptoms were corroborated by the ratings of the psychoanalysts. At the end of therapy, 77% of the patients showed clinically signifi cant improvements. In the 1-year follow-up group, this was true for 80%. Further results are presented and discussed.     

The SCL-90-R as a screening instrument for severe personality disturbance among outpatients with mood and anxiety disorders

Our objective was to examine whether the SCL-90-R, a widely used self-report measure of distress and psychopathology, could screen for personality disorders in general and for severe personality disturbance (SPD) in particular, at the time when patients seek treatment for a state (mood or anxiety) disorder. The SCL-90-R was administered to 112 consecutive outpatients with various mood and anxiety disorders. The personality severity index (PSI) score, defined as the mean value of the scores on the SCL-90-R subscales of interpersonal sensitivity, hostility, and paranoid ideation, was compared with the current symptom index (CSI) score, defined as the mean value of the scores on the remaining six SCL-90-R subscales. A positive screen was considered if PSI > CSI. SPD was defined as the presence of any DSM-III-R Cluster A and/or Cluster B personality disorder. The accuracy of the screen was verified by means of the Structured Clinical Interview for DSM-III-R Personality Disorders. The sensitivity of the PSI > CSI criterion to screen for SPD was 89.4%, while its sensitivity to screen for any DSM-III-R personality disorder was 72.9%. The SCL-90-R subscales that contributed the most to the screening discriminability of this SCL-90-R-derived screening measure were hostility, paranoid ideation, somatization, and obsessive-compulsive behavior. The SCL-90-R may be used to screen for SPD in routine work with outpatients with mood and anxiety disorders, but the results of the screening need to be verified because of the possibility of false negatives and false positives, although that possibility is apparently low. These findings may have important prognostic and treatment implications.     

Comparison of Eleven Short Versions of the Symptom Checklist 90-Revised (SCL-90-R) for Use in the Assessment of General Psychopathology

Eleven short versions of the Symptom Checklist (SCL-90-R) assessing general psychopathology, containing 5 to 53 items, were compared on the basis of data from a sample of one hundred mothers of 0-to-6-year-old children referred for treatment at a Child Psychiatric Family Day Hospital in Münster, Germany. The SCL short versions were compared with regard to internal consistency, sensitivity and specificity, ability to distinguish between subjects by a new test index (PDTS), and association with indicators of validity (SCL-90-R Global Severity Index, BDI scores). All short versions showed almost equally high internal consistency, sensitivity and specificity, and high correlations with validity indices. The PDTS test index describes a ‘good’ ability of the original SCL-90-R to differentiate between subjects, a ‘moderate’ performance for the BSI, the HSCL-25 and the SCL-27, and a ‘poor’ performance of the very short forms—according to the standards of interpreting PDTS scores. The SCL-10S is recommended for screening purposes because this scale represented the best compromise between economy and accuracy. However, for other research and clinical purposes, the use of one of the longer short versions (BSI, HSCL-25, or SCL-27) is recommended because of their superior discriminative ability.     

Neuropattern: a new translational tool to detect and treat stress pathology. II. The Teltow study

The present study was designed to test the clinical utility of Neuropattern (NP), a newly developed translational diagnostic tool. NP consists of biological and psychological measures that facilitate the identification of functional changes (called "neuropatterns") in patients with stress-related health problems. In this prospective, randomized control trial, we expected NP to improve therapeutic efficacy, as compared with the usual treatment. NP was applied to 101 in-patients suffering from various mental disorders (mainly depression, anxiety disorders, and adjustment disorders), and scoring high on the Symptom Checklist-90-R (SCL-90-R) somatization scale. The patients (73% females, mean?±?standard deviation age 46?±?9.03 years) were randomly assigned to two groups: in the experimental group (n?=?51), physicians received results from NP diagnostics, while in the control group (n?=?50), this information was not available until discharge from the hospital. Improvements of symptoms in consequence of treatment were monitored by two self-rating scales, the SCL-90-R and Short Form-12 health survey, and a physician's clinical global rating (Beeintr?chtigungs-Schwere Score). There was a significantly greater improvement in the experimental group in the self-rating assessments on symptom severity (p?=?0.03) and quality of life (p?=?0.05), but not in the observer rating of emotional, physical, and social-communicative functioning (p?=?0.13). Treatment efficacy in patients can be improved by providing the attendant physician and the patient with diagnostic information and treatment recommendations by NP. The role of concrete mediators of treatment efficacy awaits further research.     

Psychological Distress and Symptoms of Posttraumatic Stress Disorder in Jewish Adolescents Following a Brief Exposure to Concentration Camps

We investigated the psychological impact of an organized visit to Polish concentration camps on Jewish-American adolescents. Eighty-seven adolescents who participated in a B'nai B'rith memorial visit to concentration camps in Poland completed measures of general psychological adjustment and posttraumatic stress disorder (PTSD) at four time-points: pretest, posttest, 6-month follow-up and 12-month follow-up. Measures included the SCL-90-R, the Mississippi Scale for PTSD, and the Impact of Events Scale (IES) for PTSD. On the SCL-90-R, changes in somatization, interpersonal sensitivity, obsessive-compulsive tendencies, depression, anxiety, and phobic anxiety were observed over time, with peak symptom scores at posttest and 6-month follow-up. Scores on the Mississippi Scale for PTSD and the IES Intrusion subscale also increased at 6-months. Predictors of PTSD symptoms on the Mississippi Scale included previous psychiatric treatment and SCL-90-R symptoms of paranoia, depression, and psychosis. Elevated psychotic symptoms on the SCL-90-R predicted PTSD symptoms on the IES. Jewish adolescents with preexisting symptoms of generalized distress or psychoticism appeared at increased risk for PTSD symptoms following exposure to Holocaust stimuli. This study contributes a prospective, multi-measure assessment of trauma reactions in adolescents.     

Culture and validity of the Symptom Checklist-90-Revised and Profile of Mood States in a New Zealand student sample

New Zealand students' performance was examined on assessments of psychopathology and mood as compared to normative data from the United States. New Zealand university students (N = 137) completed the Symptom Checklist-90-Revised (SCL-90-R) and Profile of Mood States (POMS). Mean performances differed significantly from normative data for each SCL-90-R scale. No significant differences were found for the POMS scales. Within the sample, European (n = 82), Maori (n = 24), and Asian (n = 24) participants differed significantly on SCL-90-R obsessive-compulsive, phobic anxiety, and anxiety scales and POMS scales of tension and confusion. Implications for assessment of New Zealand samples are discussed.     

Wirksamkeit bioenergetischer Psychotherapien bei Patienten mit bekannter ICD-10-Diagnose

In this study the efficacy of Bioenergetic Analysis and Therapy (BAT) was evaluated retrospectively by means of two questionnaires. Former patients from private practice with a known ICD-10 F group diagnosis participated in the study. The SCL-90-R was modified to allow assessment of the symptoms at the beginning as well as at the end of therapy. The second questionnaire was self-constructed and contained questions about the quality of the therapeutic work, body work in general, the relationship with the therapist, and the way the therapist worked. Both questionnaires were to be answered anonymously. Eight psychotherapists (medical doctors and psychologists) served as contacts to 103 former patients; 48 patients (46.6%) returned the questionnaires. Ten patients belonged to the F3 group, 26 to the F4, and 12 to the F6 groups. All data could therefore be interpreted for each of the F groups as well as for the sum of all patients. Bioenergetic analysis and therapy reduced the symptoms according to the SCL-90-R considerably in all three F groups. Analysis of the individual symptom scales on the SCL-90-R showed high to very high symptom reduction. These were not related to the F group diagnoses. Insight gained as a result of body work produced an even greater symptom reduction independent of the ICD-10 F group diagnosis. Patients receiving BAT rated their therapy favourably and judged the relationship with the therapist as very good. The efficacy of and the satisfaction with the therapy was rated high. The formulation of a therapeutic goal at the beginning of the therapy was possibly a prerequisite for a positive outcome of the therapy. The present study confirms and complements previous efficacy studies of BAT.     

Incremental validity of the Minnesota Multiphasic Personality Inventory-2 and symptom checklist-90-revised with mental health inpatients

This study evaluated the incremental validity of scores from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Symptom Checklist-90-Revised (SCL-90-R) in a sample of mental health inpatients originally published by Archer, Griffin, and Aiduk (1995). The incremental validity of scores from the SCL-90-R primary symptom dimensions and MMPI-2 Clinical, Content, and Restructured Clinical scales was assessed in a sample of 544 mental health inpatients using conceptually related items from the Brief Psychiatric Rating Scale (BPRS) as criteria. A series of hierarchical multiple regressions indicated that scores from the SCL-90-R primary symptom dimensions exhibited limited incremental validity (Mdn DeltaR(2) = .01, range = 0-.01), whereas scores from MMPI-2 scales contributed additional information in the prediction of ratings on all but one BPRS item (Mdn DeltaR( 2) = .08, range = .04-.12).     

Agoraphobia with and without current panic attacks

MMPI and SCL-90-R profiles of agoraphobics with and without current panic attacks are presented. Agoraphobics with current panic attacks were more elevated on Psychopathic Deviate (4), Psychasthenia (7), and Social Introversion (0) scales of the MMPI. On the SCL-90-R agoraphobics with current panic attacks had higher scores on Interpersonal Sensitivity, Anxiety, Phobic Anxiety, and Total/90.     

Utility of the SCL-90-R with depressed and conduct-disordered adolescent inpatients.

We assessed the diagnostic utility of the Symptom Checklist-90-Revised (SCL-90-R) in a sample of adolescent inpatients. In Part 1 (n = 79), convergent and discriminant validity were demonstrated for SCL-90-R scales measuring depression and paranoid ideation. Canonical correlation showed that SCL-90-R scales tapped two dimensions of adolescent psychopathology, a primary dimension of dysphoria and a secondary dimension of anger and mistrust. In Part 2 (n = 50), adolescents diagnosed as having major depression showed significant elevations on scales measuring depression, anxiety, and obsessive-compulsive features. Although several scales had high diagnostic specificity for major depression and conduct disorder, sensitivity was low.     

Factor structure of the SCL-90-R: is there one?

A review of the literature on the factor structure of the Symptom Check List-90-R (SCL-90-R) and its precursors makes evident the many problems inherent in this clinical assessment tool as a measure of independent dimensions of symptom distress, particularly in psychiatric patients. The many versions of the Symptom Check List are evaluated on several criteria (e.g., factor stability, factor loadings, proportion of variance, etc.). It is concluded that interpreting nine dimensions for clinical purposes is highly questionable. It is perhaps still a better measure of general distress as was intended in its original version approximately three decades ago.     

Double Depression in Men: Does It Exist?

Differences between male veterans diagnosed with major depression alone and male veterans diagnosed with both major depression and dysthymia (double depression) were investigated. Assessment instruments included the Structured Clinical Interview for DSM-III-R, the Beck Depression Inventory (BDI), and the Symptom Checklist-90-R (SCL-90-R). Consistent with prior literature, it was hypothesized that male veterans diagnosed with both major depression and dysthymia display more severe depressive symptomatology and other forms of psychopathology than male veterans diagnosed with major depression alone. Results did not corroborate these hypotheses. Patients with double depression (n = 17) yielded BDI and SCL-90-R scores which did not differ significantly from those of patients with major depression alone (n = 14). Our results call into question the existence of double depression among men, a disorder whose existence has been demonstrated primarily among women.     

Measuring depressive symptomatology of patients referred to a behavioral medicine clinic: Concordance of self-report measures

We measured depressive symptomatology of 134 outpatient veterans treated within a Behavioral Medicine Clinic utilizing three reliable instruments with depression subscales: Minnesota Multiphasic Personality Inventory (MMPI), Derogatis Stress Profile (DSP), and Symptom Checklist 90—Revised (SCL-90-R). Results indicate that although the instruments correlate significantly, they differ in sensitivity to depression and are clinically discordant. The MMPI classified a substantially higher number of patients as depressed than either the DSP or SCL-90-R. The present study argues that the discrepancy in clinical concordance and sensitivity of the three depression scales has considerable implications for psychologists concerned with the assessment and treatment of depression.     

Outpatient group psychotherapy following day treatment for patients with personality disorders

This prospective, naturalistic study evaluated the practice and effectiveness of an outpatient group therapy program following day treatment for patients with personality disorders (PDs). One hundred and eighty-seven patients (86% patients with PDs and 14% with no PDs), were treated in outpatient psychodynamic group therapy. Outcome was assessed by Global Assessment of Functioning, Symptom Check List 90-R, and Inventory of Interpersonal Problems-Circumplex, short version, at admission and discharge from day treatment, and at the end of outpatient group therapy. Average length of outpatient therapy was 24 months. Forty-three percent terminated in an irregular manner. Outcome of the continuation therapy was satisfactory for patients without PDs. For PD patients, the improvement from the day treatment was maintained during outpatient therapy, but further improvements were modest for symptoms and interpersonal distress, somewhat better for global functioning. Implications for further treatment development are discussed.     

Creativity and Psychopathology: Sex Matters

The association between creativity and psychopathology has, for decades, been a focus of heated debate fuelled by contradictory findings. Nevertheless, the findings suggest complex associations between creativity and psychopathology. Other studies have investigated the association between creativity and sex, with inconsistent results. The aim of this study was to investigate the influence of sex on the association between creativity and psychopathology. In total, 106 participants (37 men and 69 women) were administered the Symptom Check List (SCL90-R) and the CREA test of creativity. There were no significant associations in the total sample between the variable creativity and the psychopathology scales. Strikingly, when the sample was divided by gender, a moderate-to-high significant positive association between creativity and psychopathology was found among men. Previously, the associations between creativity and gender and between creativity and psychopathology were studied in relative isolation from each other, rather than together as the main focus of research. Our results suggest that the complex associations between psychopathology and creativity differ between men and women.     

Different Associations of Health Related Quality of Life with Pain,Psychological Distress and Coping Strategies in Patients with Irritable Bowel Syndrome and Inflammatory Bowel Disorder

The primary aim of this study was to measure psychological distress, pain severity, health related quality of life (QOL) and pain coping strategies in patients with irritable bowel syndrome (IBS) and ulcerative colitis (UC). A second aim was to determine the influence of somatic and psychological variables on health related QOL. Eighty-eight IBS and 66 UC patients completed the Irritable Bowel Syndrome Quality of Life Questionnaire (IBSQOL), Pain Severity Scale of West Haven Yale Multidimensional Pain Inventory (WHYMPY), Symptom Checklist-90-R (SCL-90-R) and Coping Strategies Questionnaire (CSQ). T-tests and GLM Analysis of Covariance were used for statistical analysis. IBS patients had significantly higher levels of psychological distress, pain severity and maladaptive pain coping strategies (catastrophization), and lower QOL than UC patients. Variance of QOL in IBS was explained for the most part by catastrophization (15%), then by psychological distress (8%), and for the less part by pain severity (5%). In UC, pain severity explained 21%, psychological distress 8%, and catastrophization 3% of the variance of QOL. These results suggest there are differences between IBS and UC patients in the role of physical and psychological factors in QOL and emphasize the importance of cognitive processes in IBS.     

Utility of the SCL-90-R With Depressed and Conduct-Disordered Adolescent Inpatients

We assessed the ciiagnosric utility of the Symptom Checklist-90-Revised (SCL-9O-R) in a sample of adolescent inpatients. In Part 1 (n = 73), convergent and discriminant validity were demonstrated for SCL-90-R scales measuring depression and paranoid ideation, Canonical correlation showed that SCL-90-R scales tapped two dimensions of adolescent psychopathology, a primary dimension of dysphoria and a secondary dimension of anger and mistrust. In Part 2 (n = 50), adolescents diagnosed as having major depression showed significant elevations on scales measuring depression, anxiety, an obsessive-compulsive features. Although several scales had high diagnostic specificity for major depression and conduct dsorder, sensitivity was low.     

Muster früher Traumatisierung und die Effekte stationärer Psychotherapie

Early traumatic experiences of neglect, physical and sexual abuse in adult patients undergoing inpatient psychotherapeutic treatment were retrospectively assessed. Associations between these three forms of trauma and with patient gender were analyzed. The effects of early traumatization in general, gender and patterns of specific experiences on the symptom level, level of everyday functioning and treatment outcome were also investigated. A total of 191 patients in a psychosomatic psychotherapy ward of a university hospital were assessed using standardized questionnaires on sociodemographic and clinical variables on admission and at discharge. The type and extent of early traumatization before the age of 18 years were estimated after the initial interview from standardized reports of the therapists. The results indicate that the probability of being exposed to one of the traumatic experiences under study are not independent of each other. Furthermore, female patients were victims of sexual abuse and neglect more often than males. Compared to non-traumatized patients, trauma victims exhibited more psychological symptoms in the symptom checklist 90 revised (SCL-90-R) and a lower level of functioning according to the global assessment of functioning (GAF) but achieved a comparable relative benefit from treatment. Sexual abuse (SCL-90-R and GAF) and neglect (SCL-90-R only) affected the levels of impairment on admission and at discharge in a similar way; however, only weak evidence for differential effects of trauma patterns on therapy outcomes was found. Methodological limitations of the present approach and implications for the design of inpatient psychotherapeutic interventions in adult patients with early traumatic experiences are discussed.