The Role of Optimism/Pessimism in HRQOL in Chronic Hepatitis C Patients

One hundred and twenty three outpatients with compensated chronic hepatitis C (CHC) completed the SF-36, BSI, and questions regarding the expected impact of CHC on their health. Respondents were categorized as optimists (N = 17, 13.8%), realists (N = 98, 79.6%), and pessimists (N = 8, 6.5%). Pessimism was associated with lower scores on nearly all SF-36 subscales (p < .001 –.03) and higher scores on 6 BSI subscales indicative of greater emotional distress (p < .05). Pessimism was not associated with demographics, liver disease severity, substance abuse, or comorbid medical conditions. However, pessimism was associated with the presence of a psychiatric comorbidity and self-reported health status (p < .05). We conclude that optimism/pessimism may be an important determinant of QOL and emotional status in CHC patients and that additional studies of cognitive predispositions and coping skills in CHC patients are warranted.     

Rates and Correlates of DSM-IV Diagnoses in Women Newly Diagnosed with Breast Cancer

Although the presence of psychological distress has been documented in women with breast cancer, previous studies have not established rates of DSM-IV diagnoses in this population, nor have prior investigations compared the utility of diagnostic interviewing vs. symptom checklists to assess distress. DSM-IV diagnoses of anxiety disorders and major depression, symptoms of anxiety and depression, and quality of life were examined in 207 women with newly diagnosed breast cancer. Eighteen percent of breast cancer patients met criteria for a current DSM-IV anxiety or depressive disorder and 54% met criteria for a disorder at some point in their lifetime. These rates are comparable to those found in recent community epidemiological studies (e.g., R. C. Kessler, K. A. McGonagle, S. Zhao, C. B. Nelson, M. Hughes, S. Esheman, et al., 1994). Sensitivity, specificity, and positive predictive value for anxiety and depression symptoms as predictors of DSM disorders were relatively poor. However, after accounting for demographic, treatment, and cancer variables, self-reported anxiety symptoms were significantly related to the presence of an anxiety disorder and self-reported depressive symptoms were significantly related to a diagnosis of a depressive disorder. Symptoms of anxiety and depression contributed significantly and uniquely to physical, medical, and sexual quality of life; DSM-IV diagnoses were not significantly related to quality of life after controlling for symptoms of depression and anxiety. The importance of measuring both symptoms of distress and psychiatric diagnoses in cancer patients and the clinical practice implications of the results are discussed.     

慢性肾脏病患者心理状态研究进展

慢性肾脏病是一种很难治愈的一种疾病,绝大多数的患者需要中西医结合治疗。患有慢性肾脏病的患者最终需要肾脏替代疗法来缓解症状,如透析治疗或选择肾脏移植。巨大花费同疾病本身使患者身心均受到很大的压力,CKD患者抑郁、焦虑情况普遍存在,影响患者生存质量、营养状态和治疗配合性及疾病的预后,因此解决其心理问题至关重要。     

Efficacy of brief guided self-help cognitive behavioral treatment for perfectionism in reducing perinatal depression and anxiety: a randomized controlled trial

Perfectionism has been proposed as a transdiagnostic process that maintains depression and anxiety through shared cognitive and behavioral processes. The purpose of this study was to investigate the efficacy of a brief, guided cognitive behavioral treatment (CBT) for perfectionism delivered via a self-help booklet in reducing perfectionism and symptoms of depression and anxiety during the antenatal period. Pregnant women in their third trimester were randomly allocated to self-help (n = 30) or waitlist control (n = 30). There were significant reductions in perfectionism and symptoms for participants who received CBT for perfectionism from pre- to post-treatment, which were maintained at 3-month follow-up, while the waitlist control group demonstrated no significant changes. Path analysis demonstrated a significant indirect effect of treatment condition on post-treatment depression and anxiety scores via perfectionism, controlling for pre-treatment scores, suggesting changes in perfectionism were associated with decreases in symptoms. The findings suggest that it would be useful for future research with larger samples to further investigate the efficacy of CBT for perfectionism for perinatal depression and anxiety.     

The contribution of anxiety and depression to fatigue among a sample of Australian university students: suggestions for university counsellors

Responses to the Zung Self-Rating Anxiety Scale (SAS: Zung, W. (1971). A rating instrument for anxiety disorders. Psychosomatics, 12, 371–379), the Self-Rating Depression Scale (SDS: Zung, W. (1973). From art to science: The diagnosis and treatment of depression. Archives of General Psychiatry, 29, 328–337) and the Fatigue Severity Scale (FSS) developed by Krupp and colleagues (Krupp, L.B., LaRocca, N.G., Muir-Nash, J., & Steinberg, A.D. (1989). The fatigue severity scale: Application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of Neurology, 46, 1121–1123) were collected from 200 Australian university students to explore the links between these three disorders. Reliability data were satisfactory for all three scales and there were no significant gender or age-related differences between total scale scores. Factor analyses revealed a 5-factor solution for the SAS, a 6-factor solution for the SDS and a single factor for the FSS. There were 8 major and meaningful correlations found and these were entered into a regression of the SAS and SDS factor scores upon the single factor of the FSS. Fatigue factor scores were most powerfully predicted by psychomotor agitation, pain and resultant fatigue and cognitive and emotional arousal factor scores from the SAS and SDS. These data argue for an arousal/anxiety-fatigue-depression progression in disease that may be developmental or accumulative, with extreme levels of psychomotor arousal, resultant muscle fatigue and pain, plus concurrent elevated emotional state and cognitive arousal contributing to an eventual depletion of physical resources, leaving the individual in extreme fatigue. Implications for diagnosis and treatment by counsellors are discussed.     

慢性腰背痛患者和抑郁症患者的情绪、睡眠及疼痛症状

本研究对慢性腰背痛患者、抑郁症患者和对照人群的疼痛、抑郁水平、焦虑水平和睡眠质量进行测评,发现慢性腰背痛患者的抑郁、焦虑程度增高,失眠较常见;抑郁症患者的焦虑和失眠现象严重,疼痛是其常见症状。结果提示临床上对慢性疼痛患者和抑郁症患者的疼痛、情绪和睡眠问题予以评定和治疗具有重要意义。     

Processes of change in a school-based mindfulness programme: cognitive reactivity and self-coldness as mediators

The underlying mechanisms of the effectiveness of mindfulness-based interventions for emotional well-being remain poorly understood. Here, we examined the potential mediating effects of cognitive reactivity and self-compassion on symptoms of depression, anxiety and stress using data from an earlier randomised controlled school trial. A moderated time-lagged mediation model based on multilevel modelling was used to analyse the data. The findings showed that post-treatment changes in cognitive reactivity and self-coldness, an aspect of self-compassion, mediated subsequent changes in symptoms of depression, anxiety and stress. These results suggest that cognitive reactivity and self-coldness may be considered as transdiagnostic mechanisms of change of a mindfulness-based intervention programme for youth.     

IQ independence of measures of dysfunctional cognition

An important step in validating measures of dysfunctional cognition is to ensure that they are not confounded with general intelligence. We evaluated the Cognitions Checklist (Depression and Anxiety subscales), the Dysfunctional Attitudes Scale, and the Hopelessness Scale in a sample of 162 outpatients with depressive or anxiety disorders. These measures were not confounded with fluid or crystallized intelligence. Furthermore, correlations between the dysfunctional cognition scales and symptom severity measures were not attenuated when intelligence was statistically controlled.     

案例概念化在临床上的应用

随着心理治疗方法的发展, 案例概念化作为治疗工作的重要组成部分, 日益成为临床关注的热点。案例概念化主要指在一定治疗理论的基础上, 就来访者的问题成因和维持因素提出假设, 为构建治疗方案提供指导蓝图。西方的临床研究表明案例概念化能有效地促进咨询师和来访者对于问题的认识和理解, 提高治疗效果。以认知行为治疗理论为基础, 具体地介绍案例概念化技术在焦虑症和抑郁症的临床应用。     

Dissemination of Therapist-Assisted Internet Cognitive Behaviour Therapy: Development and Open Pilot Study of a Workshop

There is considerable research suggesting that therapist-assisted Internet cognitive behaviour therapy (ICBT) is efficacious in the treatment of depression and anxiety. Given this research, there is a growing interest in training students in therapist-assisted ICBT in order to assist with the dissemination of this emerging modality into routine clinical practice. In this study, we developed, delivered, and evaluated a therapist-assisted ICBT workshop for clinical psychology graduate students (n = 20). The workshop provided both research evidence and practical information related to the delivery of therapist-assisted ICBT. The workshop also incorporated an experiential component with students working on and discussing responses to client e-mails. Before and after the workshop, we measured knowledge of therapist-assisted ICBT research and professional practice issues, as well as attitudes towards and confidence in delivering therapist-assisted ICBT. Statistically significant changes were observed in all areas. Eighty-five per cent of students are now offering therapist-assisted ICBT under supervision. We conclude by discussing future research directions related to disseminating therapist-assisted ICBT.     

An Investigation of the Rate and Predictors of Initiating and Attending Group Cognitive Behavioral Therapy for Insomnia After Referral

Although group Cognitive Behavioral Therapy for Insomnia (CBT-I) is an efficacious and well-studied treatment, relatively less is known about its clinical effectiveness in community outpatient settings. Prior research has suggested that dropout from CBT-I may be high in treatment settings vs. clinical trials. The current study therefore investigated the rates and predictors of initiating and attending CBT-I group within an outpatient psychiatry clinic. Participants were 75 consecutive outpatients presenting for treatment at a specialty sleep and anxiety clinic who completed an evaluation and were referred to CBT-I group. Participants completed self-report measures at initial evaluation, and their attendance throughout treatment was tracked. The majority of patients attended ≥1 session, with a mean of 3/5 sessions completed for initiators. Those with poorer global sleep quality and longer sleep onset latency were less likely to attend group and attended fewer sessions. Those with more severe anxiety and depression were less likely to initiate attendance and attended fewer sessions. The majority of patients referred to CBT-I initiated group and attended at least half of the sessions. Further, demographics do not seem to impact these rates. Unfortunately, those with the most severe symptoms, and thus in most need for treatment, are least likely to initiate and attend. This may be due to comorbid anxiety or depression symptoms. Future research should replicate these findings, as well as explore how to encourage those most in need of treatment to initiate and attend CBT-I.     

Negative cognitive style and looming cognitive style synergistically predict stress generation

There is a growing body of evidence that suggests that cognitive vulnerabilities to depression or anxiety may lead individuals to generate negative interpersonal life events. However, there has been no study to date that examines the effects of co-occurring vulnerabilities to depression and anxiety. In a sample of 304 participants, we examined the potential interaction of co-occurring negative cognitive style, a vulnerability to depression and looming cognitive style, vulnerability to anxiety. Results indicate that co-occurring cognitive vulnerabilities synergistically predict higher levels of negative interpersonal life events six weeks later, even when controlling for initial levels of stressful life events and symptoms of depression and anxiety. Thus, co-occurring vulnerabilities may have stronger stress generating effects than would be expected from the additive effects of each vulnerability considered separately. This finding highlights the importance of examining cognitive vulnerabilities as interactive effects rather than as individual vulnerabilities.     

MMPI-2 Content Scale Validity Within a Sample of Chronic Pain Patients

The concurrent, criterion-related and discriminant validity of four of the MMPI-2 content scales were examined within a population of 309 patients being evaluated for the treatment of chronic pain. Utilizing both self-report and therapist-derived criteria, the MMPI-2 content scales designed to assess symptoms of anxiety (ANX), depression (DEP), low self-esteem (LSE), and anger (ANG) demonstrated the ability to provide valid information beyond that provided by the traditional MMPI-2 clinical and validity indices. Further, a multi-trait/multi-method analytic approach revealed; (1) strong discriminant validity for the ANG content scale and (2) substantial variance overlap among all the self-report measures of subjective distress, compromising our efforts to evaluate the discriminant validity of the ANX, DEP, and LSE content scales.     

慢性非细菌性前列腺炎患者焦虑、抑郁情绪分析与治疗

慢性非细菌性前列腺炎是男科常见病,因常规的药物和物理治疗效果不佳,我们的调查显示,多数患者存在明显的焦虑、抑郁情绪,成为其求诊和持续接受治疗的障碍。本研究发现对这些患者,在常规治疗基础上给予心理干预可有效改善治疗效果和提高治疗依从性。     

Tired,moody and pregnant? Exercise may be the answer

Negative psychological states such as depression, fatigue and anxiety are experienced by many women during pregnancy. This study examined whether engaging in an exercise programme during pregnancy is associated with improvements in psychological well-being among previously inactive women (n?=?56, M age?=?30.34, SD?=?4.57; M weeks pregnant?=?22.58, SD?=?5.32). Participants completed the Profile of Mood States–Short Form and State Trait Anxiety Scale-Trait version at baseline and after four weeks of exercise. Exercise was assessed using accelerometers and these data were used to determine bouts of 30-min of moderate-to-vigorous exercise. Factorial repeated measures ANOVAs demonstrated that participants who met Canadian guidelines for exercise during pregnancy at week four (n?=?17) experienced significant decreases in depression (p?=?.004, η²?=?.13), anger (p?=?.03, η²?=?.08), tension (p?=?.03, η²?=?.08), fatigue (p?=?.01, η²?=?.10), trait anxiety (p?=?.01, η²?=?.12) and increases in vigour (p?=?.001, η²?=?.19) compared to those who were not meeting guidelines (n?=?39). From a psychological health perspective, these findings highlight the importance of continuing to promote exercise during pregnancy.     

Depression and Anxiety: Integrating the Tripartite and Cognitive Content-Specificity Assessment Models

The cognitive content-specificity hypothesis proposes that depression and anxiety can be discriminated on the basis of unique cognitive profiles. Alternatively, the Tripartite model suggests that, although depression and anxiety share a general distress factor, anhedonia is a characteristic of depression with anxious arousal a characteristic of anxiety. Past research devoted to integrating these two models has been limited in a number of ways. To remedy these limitations, this study attempted to assess the complete Tripartite model and used a multidimensional cognitive assessment tool to handle the heterogeneity of anxious cognitive content. Results on data collected from 411 clients seeking services at a university counseling center suggested that a one-to-one mapping between Tripartite dimensions and cognitive content was possible. Further, variables from each model simultaneously explained unique variance in depression and anxiety ratings.     

Durability of Cognitive Behavioral Therapy Effects for Youth and Adolescents With Anxiety,Depression, or Traumatic Stress:A Meta-Analysis on Long-Term Follow-Ups

Cognitive behavioral therapies (CBT) for youth with anxiety, traumatic stress, and depression have demonstrated strong effects in individual studies and meta-analyses. Relatively more attention has been given to posttreatment effects, though, and assessment of follow-up effects has been limited at the meta-analytic level. The current meta-analysis aimed to (a) examine the effects of youth CBT at posttreatment, 1-month, 3-month, 6-month, 1-year, and long-term (2 + years) follow-up as well as (b) identify research-related variables (e.g., measure respondent type) that relate to effects. Using a random effects model across 110 child and adolescent CBT groups, within-group effect sizes were large at posttreatment (g = 1.24) and from 1-month through long-term follow-up (g = 1.23–1.82), and effect sizes did not significantly differ by treatment target (i.e., anxiety, traumatic stress, depression). However, availability of outcome data for effect sizes diminished across later follow-up assessments. Moreover, effect sizes were significantly associated with outcome respondent type across assessment timing, with outcome measures from caregiver and youth respondents associated with smaller effect sizes (B = -0.97, p < 0.001) relative to outcome measures that were evaluator-reported. Results provide initial support for the durability of treatment effects for youth CBTs and highlight the importance of some confounding variables. Implications for improving treatment research standards and prioritizing assessment of long-term follow-up assessment are discussed.     

恐惧学习的发展认知神经机制研究回顾与展望

恐惧可以帮助个体快速地评估危险情景,并调动生理和行为反应来应对危险刺激。恐惧发展始于婴儿时期,神经回路表现为杏仁核未参与恐惧反应,但杏仁核功能连接可以预测早期恐惧反应;发展到童年期的恐惧学习特点为安全学习不足和过度泛化,其根源是负责辨别刺激的海马还处于发育中;进入青春期恐惧加工主要特征是由于前额叶发育较晚导致的消退能力弱。恐惧虽有益于人类生存,但恐惧异常会引发焦虑障碍,本文从恐惧的习得、消退和泛化三个阶段,对比了焦虑与健康青少年的恐惧学习差异。最后,文章从增加婴儿时期研究、创新青少年恐惧研究范式和开发安全有效的干预手段三个方面对未来研究提出展望,以期进一步推动恐惧研究的发展。     

Specificity of relations between adolescents’ cognitive emotion regulation strategies and symptoms of depression and anxiety

ABSTRACT

The aim of this study was to examine the extent to which cognitive emotion regulation strategies were “common or transdiagnostic correlates” of symptoms of depression and anxiety and/or “specific correlates” distinguishing one problem category from the other. The sample comprised 582 13- to 16-year-old secondary school students. Symptoms of depression and anxiety were measured by the SCL-90, and cognitive emotion regulation strategies were measured by the CERQ, in a cross-sectional design. Multivariate regression analyses were performed. Before controlling for comorbidity, the same cognitive emotion regulation strategies that were related to symptoms of depression were also related to symptoms of anxiety. However, after controlling for comorbid anxiety symptoms, rumination, self-blame (only girls), positive reappraisal, and positive refocusing (the latter two inversely) were uniquely (and significantly) associated with depression symptoms; and after controlling for comorbid depression symptoms, catastrophising and other-blame were uniquely related to anxiety symptoms. The results supported the cognitive content-specificity model, in which anxiety is supposed to be uniquely characterised by thoughts concerning the overestimation of threats and harm, and depression is supposed to be uniquely characterised by negative evaluations of self, and of past and future events.     

A Transdiagnostic Examination of Intolerance of Uncertainty Across Anxiety and Depressive Disorders

Intolerance of uncertainty (IU) has been identified as a potential maintaining factor for generalised anxiety disorder; however, there is a growing evidence to suggest that IU may contribute to other anxiety and depressive disorders. Moreover, certain components of IU (namely prospective and inhibitory IU) have been shown to be differentially associated with symptoms of emotional disorders. The aim of this study was to determine the extent to which individuals with various anxiety and depressive disorders endorsed IU, firstly as a trait variable (with prospective and inhibitory components) and secondly in reference to regularly occurring, diagnostically relevant situations (situation-specific IU). The degree to which diagnosis predicted IU was examined in a highly comorbid clinical sample (N = 218). Regardless of specific diagnoses, the degree of comorbidity emerged as a significant predictor of prospective IU and situation-specific IU. Conversely, specific diagnoses of social phobia, generalised anxiety disorder, depression, and obsessive compulsive disorder were uniquely related to inhibitory IU. These findings suggest that IU is a transdiagnostic construct and have implications for current diagnosis-specific and transdiagnostic theory and clinical practice.