Psychological aspects of multiple sclerosis and its treatment: toward a biopsychosocial perspective

Multiple sclerosis (MS) is a chronic, progressive neurological disease that produces demyelination of the CNS nerve fibers. With onset most often in young adulthood, the disease produces a variety of neurological symptoms and follows an unpredictable course characterized by exacerbations and remissions. This article reviews the literature on psychological aspects of MS including early psychoanalytic studies and more current psychosocial research. Literature on the relationship between stress and symptoms, and the extent of cognitive impairment experienced is reviewed. A view of psychosocial adjustment to MS based upon an adaptive coping model, and a psychological treatment approach suited to the special needs of individuals with MS are discussed. Finally, a biopsychosocial research model is recommended due to the complex, interactive nature of MS and unique research difficulties it presents.     

Neurological and neuropsychological signs in obsessive compulsive disorder: interaction with behavioural treatment

The main aim of this study was to test the hypothesis that neurological soft signs and neuropsychological abnormalities associated with obsessive-compulsive disorder (OCD) predict poor response to behavioural treatment. The design permitted investigation of secondary hypotheses, regarding correlations among these neurological markers and levels of symptomatology, and their stability in relation to changes in levels of symptomatology. Thirty-five participants satisfying DSM-IV diagnostic criteria for OCD were assessed pre- and postbehavioural treatment using a scaled measure of symptom severity, and a battery of tests sensitive to neuropsychological deficits associated with OCD. Eighteen of the participants were also assessed on an inventory of neurological soft signs. Neither neuropsychological test deficits nor neurological soft signs pretreatment predicted response to behavioural treatment. Lower performance on neuropsychological tasks and symptom severity were both significantly correlated with levels of soft signs. Some neurological markers were less severe posttreatment, but these changes were not related to treatment response.     

Dual career marriages: Problems,satisfactions, and therapeutic considerations

A prognosis for the dual career marriage with and without children is developed and evaluated. A brief history is given, current shifts in sex-role stereotypes within and out of marriage are delineated, advantages and satisfactions as well as disadvantages and problems of the dual career marriage are discussed. Some particular issues facing clergy couples are cited and therapeutic considerations are briefly touched upon. Pertinent research and literature in the field of Marriage, Family, and Child Counseling and Pastoral Counseling is reviewed throughout.     

The history of couple therapy: a millennial review

In this article, we review the major conceptual and clinical influences and trends in the history of couple therapy to date, and also chronicle the history of research on couple therapy. The evolving patterns in theory and practice are reviewed as having progressed through four distinctive phases: Phase I–Atheoretical Marriage Counseling Formation (1930–1963); Phase II–Psychoanalytic Experimentation (1931–1966); Phase III–Family Therapy Incorporation (1963–1985); and Phase IV–Refinement, Extension, Diversification, and Integration (1986–present). The history of research in the field is described as having passed through three phases: Phase I–A Technique in Search of Some Data (1930–1974), Phase II–Irrational(?) Exuberance (1975–1992), and Phase III–Caution and Extension (1993–present). The article concludes with the identification of Four Great Historical Ironies in the History of Couple Therapy.     

Why “Gender” disappeared from the gender gap: (re-)introducing gender identity theory to educational gender gap research

Educational gender gap research tries to explain the differential achievement of boys and girls at secondary school, which manifests in many western countries. Several explanatory frameworks are used for this purpose, such as masculinities theory. In this review article, the history of educational gender gap research in Anglo-Saxon literature and problems with the contemporary approach are discussed. It is argued that gender identity theory could prove valuable both in furthering educational gender gap research and mitigating several problems with masculinities theory. To this end, an overview of the history and recent developments in gender identity theory is given. The scarce research combining educational gender gap research with gender identity theory is reviewed. Possible contributions, assets and research questions from gender identity theory to educational gender gap research are discussed.     

Shame,attachment, and addictions: Implications for family therapists

Research based on attachment theory is reviewed for its relevance to the development of later addictions. The problem of internalized shame as an attachment related issue is discussed. Some original research into internalized shame using the Internalized Shame Scale is summarized. The relevance of this research and theory for family of origin based treatment of addictions is explored.     

The impact of Tarasoff on clinical practice

The clinical impact of Tarasoff (1976) has meant an increased emphasis on violence as a topic in treatment and a concern for therapists. This paper discusses the limits of confidentiality and the management of dangerous patients both before and after the landmark decision of Tarasoff. The existing research surveys on therapists' responses to Tarasoff are reviewed. Some of the clinical implications of recent court cases such as Jablonski are described. Recommendations for the management of threatening patients are made.     

Fundamentally misunderstanding visual perception. Adults' belief in visual emissions

The authors reviewed research about a profound misconception that is present among college students, namely, the belief that the process of vision includes emanations from the eyes, an idea that is consistent with the extramission theory of perception, which was originally professed by early Greek philosophers and which persisted in scholarly circles for centuries. The authors document the strength and breadth of this phenomenon and the object failure of traditional educational techniques to overcome this belief, and they reveal that students are leaving psychology courses with a flawed understanding of one of the most studied processes in the history of psychology--visual perception. Some suggestions are offered for overcoming this misconception in traditional college classroom settings.     

Irritable bowel syndrome: A behavioral model

Current models for explaining irritable bowel syndrome (IBS), the most common gastrointestinal disorder, are critically reviewed and found wanting. Although inadequate to explain the complex clinical features of IBS. these models now determine treatment and research strategy. A behavioral model is offered as an alternative in the hope that it will lead to effective treatment and a progressive research program. The central features of this model are: (a) that verbal, motoric and physiological behavior characteristitic of IBS are capable of independence or desynchrony; (b) that these aspects of behavior are quantitative variations of normal; and (c) that there is a genetic predisposition to neuroticism which, in turn, predisposes to IBS. Some of the model's implications are discussed.     

Quality of Life and Neurological Illness: A Review of the Literature

This article highlights some of the conceptual and methodological problems associated with quality of life (QoL) measurement in individuals with neurological illness. It is suggested that these problems have contributed to the underdeveloped status of QoL research in neurological settings. Many of the existing QoL measures that have been used, or show potential for use with individuals with neurological illness, are reviewed in terms of their theoretical basis, content, and practicality. A large proportion of these measures fail to meet adequate psychometric standards and/or have rarely been psychometrically tested. The confusion that surrounds adequate psychometric standards is discussed, and the dynamic nature of QoL is highlighted as a factor that requires further attention. Research addressing the discrepancies between proxy and patient ratings of patient QoL is also warranted. More focused research in these areas may contribute to a clearer understanding of how to assess QoL in individuals with neurological illness.     

A positive emotional bias in confabulatory false beliefs about place

Some neurological patients with medial frontal lesions exhibit striking confabulations. Most accounts of the cause of confabulations are cognitive, though the literature has produced anecdotal suggestions that confabulations may not be emotionally neutral, having a ('wish-fulfilment') bias that shapes the patient's perception of reality in a more affectively positive direction. The present study reviewed every case (N = 16) of false beliefs about place reported in the neuroscientific literature from 1980 to 2000, with blind raters evaluating the 'pleasantness' of the patient's actual and confabulated locations. In each case the confabulated location was evaluated as more pleasant. This striking finding supports the claim that there may be a systematic affective bias in the false beliefs held by neurological patients with confabulation.     

Implosive therapy in the counselling of a pupil who set fires

Some clinical data on children who set fires are reviewed, and the apparent lack of research on how to deal with them is noted. A technique based on implosive therapy (IT) using the concept of 'realistic anxiety' is described as a possible way of meeting certain treatment difficulties. An illustrative case-study of a pupil referred to an educational psychologist is outlined. It is suggested that a number of other difficult-to-treat disorders might be approached in the same way.     

Forgetting the lessons of history

While a great deal of behavior analytic research has focussed on studying current contingencies, the amount of work done in the area of conditioning history is spotty, at best. Weiner (1964, 1969) conducted history research with human subjects, but little has followed in either the human or the nonhuman literature. Some direction can also be found in the literature studying the effects of conditioning on drug effects (e.g., Barrett, 1977; Urbain, Poling, Millam, & Thompson, 1978). However, "behavioral history" or "conditioning history" has not been a fully-developed area within behavior analysis. It is suggested that empirical work on history effects might have implications for (a) better understanding human-nonhuman behavioral differences and similarities, (b) clinical applications, especially where clients are resistant to behavioral change, and (c) theoretical assumptions in behavior analysis in relation to both basic and applied concerns.     

Electrical Injury and Lightning Injury: A Review of Their Mechanisms and Neuropsychological,Psychiatric, and Neurological Sequelae

Exposure to electrical current via industrial or residential accidents or lightning strikes is a serious and growing concern in today's medical community. The sequelae that result are referred to as electrical injury (EI) or lightning injury (LI). The relevant principles in electricity are reviewed with particular attention given to their damaging capabilities on the body. Specific neuropsychological, psychiatric, and neurological signs and symptoms as well as objective measures of psychological and neuropsychological functioning and brain imaging in victims of EI and LI, are reviewed from past research. Important issues relevant to researchers in the field are discussed. Finally, the role that neuropsychology might play in this area is outlined.     

Sexual and nonsexual marital aggression: Legal considerations, epidemiology, and an integrated typology of perpetrators

In this paper, the legal history of marital rape and the current status of “marital rape allowances” to sexual assault statutes are reviewed. The prevalence of marital rape and its comorbidity with nonsexual violence, as well as the physical and psychological sequelae found to be specifically associated with sexual aggression in marriage is reviewed. Our current limited theoretical understanding of the relationship between sexual and nonsexual violence in marriage is extended by integrating marital rape and marital violence batterer typology research. Specifically, we offer a four-type batterer typology integration (i.e., family-only, dysphoric/borderline, generally violent/antisocial, and sexually obsessive batterers) that fully describe husbands that are only nonsexually violent, both physically and sexually violent, or only sexually violent. Theoretical and practical implications of this integration are identified. Future research directions are outlined, and the need for greater clinical attention to the phenomena of sexual violence in marriage is highlighted.     

Sexual and nonsexual marital aggression: Legal considerations, epidemiology, and an integrated typology of perpetrators

In this paper, the legal history of marital rape and the current status of “marital rape allowances” to sexual assault statutes are reviewed. The prevalence of marital rape and its comorbidity with nonsexual violence, as well as the physical and psychological sequelae found to be specifically associated with sexual aggression in marriage is reviewed. Our current limited theoretical understanding of the relationship between sexual and nonsexual violence in marriage is extended by integrating marital rape and marital violence batterer typology research. Specifically, we offer a four-type batterer typology integration (i.e., family-only, dysphoric/borderline, generally violent/antisocial, and sexually obsessive batterers) that fully describe husbands that are only nonsexually violent, both physically and sexually violent, or only sexually violent. Theoretical and practical implications of this integration are identified. Future research directions are outlined, and the need for greater clinical attention to the phenomena of sexual violence in marriage is highlighted.     

Developing evidence-based guidance – implications for systemic interventions

This article provides a brief review of the history and current approaches to the development of clinical guidelines, particularly as applied to systemic and more generally psychological therapies. Some commonly identified problems associated with guideline development in mental health are reviewed and their implications for guideline development considered. The challenges this work presents for systemic therapies are considered, along with likely future development in clinical guidelines.     

Are sons and daughters treated more differently by fathers than by mothers?

According to reciprocal role theory, the father's socialization behavior promotes sex-typing in children. While sex-typing is encouraged by both parents, the father makes a greater differentiation between sons and daughters. In this article, the research on differential socialization behavior is reviewed. Some studies have used multiple measures of parent-child interaction and often only a few of these have revealed differences related to the sex of the parent. However, as indicated both in a qualitative review of the literature and in a meta-analysis, results that are significant provide a modest degree of support for father-specific socialization behaviors. In 20 of 39 independent published studies, the father's ratings or treatment of boys and girls differed significantly. By contrast, the differences for mothers, if present at all, were comparatively few in any of the studies. The pattern of father-specific effects was most evident in the area of discipline and physical involvement and was weak in the areas of affection and everyday speech with infants and toddlers. Research on children's perceptions of parental socialization behavior is consistent with the existence of differential socialization practices used by the father in particular. Reciprocal role theory is discussed in terms of influences on parent-child interaction with regard to traditional and nontraditional family arrangements. Further research using within-family designs is required to examine fathers' differential treatment in the context of changing family and work roles.