Emotion Regulation Therapy for Generalized Anxiety Disorder

Despite the success of cognitive behavioral therapies (CBT) for emotional disorders, a sizable subgroup of patients with complex clinical presentations, such as patients with generalized anxiety disorder, fails to evidence adequate treatment response. Emotion Regulation Therapy (ERT) integrates facets of traditional and contemporary CBTs, mindfulness, and emotion-focused interventions within a framework that reflects basic and translational findings in affect science. Specifically, ERT is a mechanism-targeted intervention focusing on patterns of motivational dysfunction while cultivating emotion regulation skills. Open and randomized controlled psychotherapy trials have demonstrated considerable preliminary evidence for the utility of this approach as well as for the underlying proposed mechanisms. This article provides an illustration of ERT through the case of “William.” In particular, this article includes a case-conceptualization of William from an ERT perspective while describing the flow and progression of the ERT treatment approach.     

Primary Femininity and Female Genital Anxiety

The American Journal of Psychoanalysis -     

Gender Role Traits Among Individuals with Social Anxiety Disorder

The present study investigated differences between individuals with and without social anxiety disorder (SAD) in instrumentality and expressiveness, personality traits traditionally linked to the male and female gender roles, respectively. Based on evolutionary and self-discrepancy theories, it was hypothesized that individuals with SAD would score lower on instrumentality and report a discrepancy between their perceived and ideal level of instrumentality compared to control participants. Sixty-four patients with SAD and 31 non-anxious control participants completed a battery of questionnaires, including ratings of their perceived and ideal gender role attributes and current psychosocial distress. Results supported the hypotheses, and provided initial evidence that a discrepancy between perceived and ideal instrumentality may be linked to social anxiety severity, depression and lower quality of life. No differences were detected between groups in expressiveness. The present findings suggest that individuals with SAD perceive themselves to be deficient in instrumentality. They also suggest that increasing instrumentality among individuals with SAD may be beneficial for treatment.     

Psycho-Social Functioning in an Individual with Gender Identity Disorder

An adult transsexual male with presenting complaints of substance dependence was taken up for the study at the All India Institute of Medical Sciences. Past history covering substance use and transsexualism was followed by psychological assessment comprising of Verbal Adult Intelligence Scale, Draw-A-Person Test, Sentence Completion Test, The Adjustment Inventory and Rorschach Psychodiagnostics. The patient presented with interpersonal difficulties and distress owing to substance use. He reported being personally comfortable with his transsexual status and sought help for sex reassignment surgery. The study directs attention towards the fact that individuals with GID are at a risk for healthy adjustment with respect to their socio- cultural set up and in coping with situations. Hence, detailed assessment of distress related to GID, the social milieu leading to acceptance/isolation of the person and co-morbid conditions (if any) is productive.     

Sex-Typed Responses in the Rorschach Protocols of Children With Gender Identity Disorder

A coding system was developed to measure sex-typed responses in the Rorschach protocols of children with gender identity disorder (n = 79). Their responses were compared to that of sibling (n = 25), psychiatric (n = 26), and normal (n = 28) controls. Results show that children with gender identity disorder gave significantly more cross-sex responses than same-sex responses, whereas the psychiatric and normal controls gave significantly more same-sex responses than cross-sex responses. The siblings did not differ in the number of same-sex and cross-sex responses. Results are discussed with regard to various assessment issues in the study of children with gender identity disorder.     

Attention Deficit Disorder,Anxiety Disorder,and Learning Disabilities

Abstract

This article details an individualized psychoeducational model designed to treat a child with interrelated psychological and developmental issues whose psychic functioning was deteriorating within the traditional educational system. The team had leeway to function outside of the educational system to create an individualized, remedial, psychoeducational program. At the time we began the program, her diagnostic picture included: Anxiety Disorder, Attention Deficit/Hyperactivity Disorder, and Learning Disabilities. The treatment team consisted of an education specialist, two additional part-time teachers, a clinical social worker, an occupational therapist, a consulting senior child psychoanalyst, and the child's mother. The results at the close of the first school year are examined. Perspectives informing the psychoanalytic aspects of this case include Winnicottian and Fairbairnian Object Relations Theory and therapeutic milieu model.     

Assessing Emotion Regulation in Social Anxiety Disorder: The Emotion Regulation Interview

Social anxiety disorder (SAD) is thought to involve emotional hyper-reactivity and emotion dysregulation. However, the precise nature of the emotion dysregulation in SAD has not been well characterized. In the present study, the Emotion Regulation Interview (ERI) was developed to quantify the frequency and self-efficacy of five emotion regulation strategies specified by Gross’s (Review of General Psychology 2: 271–299, 1998) process model of emotion regulation. Forty-eight individuals with SAD and 33 healthy controls (HCs) were interviewed about responses during (a) a laboratory speech task and (b) two recent social anxiety-evoking situations. Individuals with SAD reported greater use of avoidance and expressive suppression than HCs, as well as lesser self-efficacy in implementing cognitive reappraisal and expressive suppression. These regulation deficits were not accounted for by differences in emotional reactivity. These findings highlight specific emotion regulation deficits in SAD, and support the idea that the Emotion Regulation Interview may be usefully applied to other clinical disorders.     

The Effects of Ego Identity,Gender Role,and Attachment on Depression and Anxiety in Young Adults

Main and interaction effects of Ego Identity Status/Type (Bennion & Adams, 1986), Gender-Role Orientation (Bem, 1981a), and Adult Attachment Style (Feeney, Noller, & Hanrahan, 1994) on Depression (Beck, Steer, & Brown, 1996) and Anxiety (Beck, Epstein, Brown, & Steer, 1988) were examined. Participants included adults 18 years and older from a midwestern U.S. university. Multivariate analysis revealed significant interactions between ego identity status and gender-role orientation only for participants with an insecure attachment style. A significant main effect for attachment style revealed that secure individuals were less anxious and depressed than insecure individuals. The influence of gender (rather than gender role) is explored. The influence of ethnicity on levels of depression and anxiety for various ego identity statuses and clinical implications are discussed.     

Dysfunctional Cognitions in Children with Social Phobia, Separation Anxiety Disorder, and Generalized Anxiety Disorder

According to cognitive theories of anxiety, anxious adults interpret ambiguous situations in a negative way: They overestimate danger and underestimate their abilities to cope with danger. The present study investigated whether children with social phobia, separation anxiety disorder, and generalized anxiety disorder have such a bias, compared to a clinical and a normal control group. Children were exposed to stories in which ambiguous situations were described, and asked to give their interpretations, using open and closed responses. Results showed that anxious children reported more negative cognitions than control children. However, anxious children did not overestimate danger on the free responses, but they did judge the situations as more dangerous on the closed responses. Anxious children had lower estimations of their own competency to cope with danger than the control groups on both open and closed responses. The results indicate that children with anxiety disorders have dysfunctional cognitions about ambiguous situations.     

Dissociative Identity Disorder,Ambivalence, and Responsibility

If someone with dissociative identity disorder (DID) commits a wrongful act, is she responsible? If one adopts the Multiple Persons Thesis, it may seem that one alter cannot be responsible for the actions of another alter. Conversely, if one regards the subject as a single person, it may seem that she is responsible for any actions she performs. I will argue that this subject is a single person, but one who suffers from delusions of disownership and therefore does not fulfill ordinary requirements for responsible agency. This is because she suffers from extreme ambivalence: her deep‐seated needs and desires conflict, and she forms alter‐personalities as a way to cope with inner discord without abandoning any of these contradictory impulses. However, although the ability to exercise autonomous agency is eroded in such cases, the capacity for autonomous agency is preserved. The subject with DID is weakly responsible for her wrongful acts.     

The Development of Gender Identity,Gender Roles,and Gender Relations in Gifted Students

This article describes the interaction of giftedness with gender identity, gender role, and gender relations. The authors explored ways in which many gifted educational practices are gendered, a model for the development of talent in the context of gender and gender relations, and ways of reducing gender inequities in the realization of potential for both male and female students. Issues that are unique to gifted individuals are aligned with suggestions for counseling interventions.     

Gender, Immigrant Generation, and Ethnocultural Identity

The relation of gender and immigrant generation to ethnocultural identity was examined in an ethnically diverse sample of young adults from immigrant families. We hypothesized that gender differences in ethnocultural identity would occur among the second-generation (those born in the receiving society) daughters and sons of parents who were immigrants. Participants completed several measures that assessed identity and self-construal, including ethnocultural identity. As predicted, among participants who were the second-generation children of immigrants, gender differences occurred on ethnic identity achievement (defined as seeking to learn about and understand one's ethnicity) and reported behavioral commitment (e.g., maintaining cultural practices). Women endorsed these 2 components of ethnic identity more strongly than men did. Second-generation women and men whose parents were immigrants did not, however, differ in a third component of ethnocultural identity, namely, pride and attachment to one's ethnocultural group. The implications of this pattern of findings are discussed.     

Gender,g, Gender Identity Concepts,and Self-Constructs as Predictors of the Self-Estimated IQ

In all 102 participants completed 2 intelligence tests, a self-estimated domain-masculine (DMIQ) intelligence rating (which is a composite of self-rated mathematical–logical and spatial intelligence), a measure of self-esteem, and of self-control. The aim was to confirm and extend previous findings about the role of general intelligence and gender identity in self-assessed intelligence. It aimed to examine further correlates of the Hubris-Humility Effect that shows men believe they are more intelligent than women. The DMIQ scores were correlated significantly with gender, psychometrically assessed IQ, and masculinity but not self-esteem or self-control. Stepwise regressions indicated that gender and gender role were the strongest predictors of DMIQ accounting for a third of the variance.     

Perceptions of Partner Violence: How Aggressor Gender,Masculinity/Femininity,and Victim Gender Influence Criminal Justice Decisions

This study examines the extent to which perceptions of partner violence are influenced by aggressor gender and masculinity/femininity, and victim gender. Participants evaluated a case scenario depicting domestic assault. Results found charges were significantly higher and sentences significantly longer when the victim was female. Masculine aggressors were more likely to be perceived as having threatened bodily injury and as having initiated the assault compared to feminine aggressors. Masculine aggressors in heterosexual relationships were more likely to be identified as having initiated an assault compared to feminine aggressors in heterosexual relationships or individuals in same-sex relationships.     

Sex Differences in Referral Rates of Children with Gender Identity Disorder: Some Hypotheses

From 1978 through 1995, a sex ratio of 6.6:1 of boys to girls (N = 275) was observed for children referred to a specialty clinic for gender identity disorder. This article attempts to evaluate several hypotheses regarding the marked sex disparity in referral rates. The sexes did not differ on four demographic variables (age at referral, IQ, and parent's social class and marital status) and on five indices of general behavior problems on the Child Behavior Checklist; in addition, there was only equivocal evidence that boys with gender identity disorder had significantly poorer peer relations than girls with gender identity disorder. Although the percentage of boys and girls who met the complete DSM-III-R criteria for gender identity disorder was comparable, other measures of sex-typed behavior showed that the girls had more extreme cross-gender behavior than the boys. Coupled with external evidence that cross-gender behavior is less tolerated in boys than in girls by both peers and adults, it is concluded that social factors partly account for the sex difference in referral rates. Girls appear to require a higher threshold than boys for cross-gender behavior before they are referred for clinical assessment.