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.     

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.     

Meditation has stronger relationships with mindfulness,kundalini, and mystical experiences than yoga or prayer

Contemplative practices can have profound effects on mindfulness and on physical and sensory and mystical experiences. Individuals who self-reported meditation, yoga, contemplative prayer, or a combination of practices and their patterns of practice were compared for mindfulness, kundalini effects, and mystical experiences. The results suggest that the amount of practice but not the pattern and social conditions of practice influences mindfulness and possibly mystical experiences. Meditation, yoga, contemplative prayer, or a combination of practices all were found to be associated with enhancements of mindfulness, kundalini effects, and mystical experiences, but meditation had particularly strong associations and may be the basis of the associations of yoga and prayer with these outcomes. The results further suggest that the primary association of contemplative practices is with the real time awareness and appreciation of sensory and perceptual experiences which may be the intermediary between disparate practices and mindfulness, kundalini effects, and mystical experiences.     

The Bergen 4-day treatment for OCD: four years follow-up of concentrated ERP in a clinical mental health setting

There are few long-term follow-up studies on psychological treatment of anxiety disorders carried out in clinical mental health settings, so called effectiveness studies. The present paper presents a four year follow-up of patients with obsessive-compulsive disorder treated by the Bergen 4-day treatment (B4DT), a concentrated form of exposure and response prevention (ERP). A total of 77 obsessive–compulsive disorder (OCD) patients received treatment during four consecutive days and were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) pre, post, and at follow-ups after 3 and 6 months, and 4 years post-treatment. The Y-BOCS mean score changed from 25.9 at pre- to 10.0 post-treatment and 9.9 at long-term follow-up. The proportion fulfilling the strict international consensus criteria for remission was 73% at post-treatment and 69% at follow-up. When taking declining rate, attrition rate, remission, relapse, and further improvement during the follow-up period into account, 72% were recovered on a long-term basis. A comparison with previously published effectiveness studies of ERP indicated that the 4-day treatment yielded significantly higher proportions of remission at post-treatment and recovery at follow-up, as well as within-group effect size on the Y-BOCS. The implications of these results are discussed.     

The Attention Training Technique as an Attempt to Decrease Intrusive Thoughts in Obsessive–Compulsive Disorder (OCD): From Cognitive Theory to Practice and Back

The attention training technique (ATT) is a cognitive treatment method that is aimed at ameliorating intrusive thoughts in anxiety disorders. To the best of our knowledge, no randomized controlled study has yet been conducted on individuals with obsessive–compulsive disorder (OCD). For the present study, we recruited 80 participants with OCD over the internet and allocated them to an experimental (ATT implemented as bibliotherapy) or a wait-list condition. Assessments were made at baseline and four weeks later. Groups performed similar at both time points on the self-report version of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Obsessive Compulsive Inventory-revised (OCI-R). The present study speaks against the effectiveness of ATT as a stand-alone bibliotherapeutical approach for OCD. From our data and increasing evidence that OCD patients do not suffer from severe attention or executive deficits we consider an approach targeting attentional biases for certain OCD-related events more useful than a generic (i.e., OCD-unspecific) cognitive remediation approach.     

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.     

Psychometric validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory: Part I

This article reports on the validation of the Obsessive Beliefs Questionnaire (OBQ) and Interpretations of Intrusions Inventory (III) developed by the Obsessive Compulsive Cognitions Working Group (OCCWG) to assess the primary beliefs and appraisals considered critical to the pathogenesis of obsessions. A battery of questionnaires that assessed symptoms of anxiety, depression, obsessive-compulsive symptoms and worry was administered to 248 outpatients with a DSM-IV diagnosis of Obsessive-Compulsive Disorder (OCD), 105 non-obsessional anxious patients, 87 non-clinical adults from the community, and 291 undergraduate students. Tests of internal consistency and test-retest reliability indicated that the OBQ and III assessed stable aspects of OC-related thinking. Between-group differences and correlations with existing measures of OC symptoms indicated that the OBQ and III assess core cognitive features of obsessionality. However, the various subscales of the OBQ and III are highly correlated, and both measures evidenced low discriminant validity. The findings are discussed in terms of the relevance and specificity of cognitive constructs like responsibility, control and importance of thoughts, overestimated threat, tolerance of uncertainty and perfectionism for OCD.     

Pilot Study of Psychopathology Among Roman Catholic Secular Clergy

This pilot study gathered information regarding overall levels of psychopathology in a nationally selected, random sample of U.S. Roman Catholic secular (i.e., diocesan) priests using the Symptom Checklist-90-Revised (SCL-90-R; Derogatis, 2004). The study yielded a response rate of 45%. One-half of the participants reported marked psychological problems, with interpersonal sensitivity, anxiety, and depression most strongly correlated with the instrument’s overall index of psychopathology. Four dimensional scales were elevated (i.e., obsessive-compulsive, interpersonal sensitivity, depression, psychoticism), as were two indices (i.e., GSI, PST). Implications and directions for future research are discussed.     

Change in metacognitions predicts outcome in obsessive–compulsive disorder patients undergoing treatment with exposure and response prevention

Wells' (Wells, A. (1997). Cognitive therapy of anxiety disorders: a practice manual and conceptual guide. Chichester, UK: Wiley) metacognitive model of obsessive–compulsive disorder (OCD) predicts that metacognitions must change in order for psychological treatment to be effective. The aim of this study was to explore: (1) if metacognitions change in patients undergoing exposure treatment for OCD; (2) to determine the extent to which cognitive and metacognitive change predicts symptom improvement and recovery. The sample consisted of 83 outpatients with a diagnosis of OCD who completed exposure and response prevention treatment. The Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), the Metacognitions Questionnaire (MCQ-30) and the Obsessive Beliefs Questionnaire (OBQ-44) were administered before treatment, after treatment, and at 12-month follow-up. Treatment resulted in significant changes in symptoms, metacognition score, responsibility and perfectionism. Regression analysis using post-treatment Y-BOCS as the dependent variable indicated that when the overlap between predictors was controlled for, only changes in metacognition were significant. Changes in metacognitions explained 22% of the variance in symptoms at post-treatment when controlling for pre-treatment symptoms and changes in mood. A further regression revealed that two MCQ-30 subscales made individual contributions. The patients had significantly higher scores compared to community controls on the MCQ-30. Patients who achieved clinical significant change had lower scores on the MCQ-30 compared to patients who did not change. The results did not change significantly from post-treatment to follow-up assessment. These findings provide further support for the importance of metacognitions in treating OCD.     

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.     

The association between retrospective outcome evaluations and pre-post-treatment changes in psychodynamic group-psychotherapy

In the present study of 203 patients in psychodynamic group psychotherapy, we explore associations between patient and therapist global retrospective outcome evaluations (ROE), and pre-post-treatment changes on the Symptom Check List 90 Revised (SCL-90-R) and non-symptomatic focus of therapy. There were no significant associations between ROE, diagnoses and demographic variables, and pre-treatment SCL-90-R associations were negligible (less than 4% of overlapping variance). SCL-90-R subscale improvement expressed as residual gain score explained the overall largest percent of variance in both patients and therapists (44% and 25%, respectively) when compared with raw difference scores (32% and 18%), and percent reduction from baseline (34% and 23%). Moreover, ROE/end-state adjustment associations were substantial (42% and 24%). Therapists' evaluation of change showed the strongest association with improvement in non-symptomatic focus of therapy, while patients' evaluation had the strongest association with improvement in SCL-Depression. It is concluded that retrospective evaluations reflect changes related to treatment. However, unexplained variance may be independent of symptomatic state, and associated with personality factors or domains not captured by standard questionnaires.     

Treatment of Obsessive Compulsive Disorder in Young Children: An Intervention Model and Case Series

This article presents an intervention model for young children with obsessive-compulsive disorder (OCD). The intervention, designed to reduce compulsive behavior and improve parenting practices, was tested using a multiple baseline design with 7 children (M = 6 years old; 57% female) in which participants were randomly assigned to 1, 2, or 3 weeks of baseline (i.e., no treatment). All children were diagnosed with OCD using a semi-structured diagnostic interview. Baseline and weekly ratings of obsessive-compulsive (OC) symptoms and family accommodation were obtained. In addition, at pre- and post-treatment and 1-month follow-up, independent evaluators and/or parents completed measures assessing the severity and impact of OC symptoms and child and family functioning. Findings revealed that participants had a 33–66% reduction in OC symptoms (as measured by the Children's Yale-Brown Obsessive Compulsive Scale; CYBOCS) at posttreatment and 6 of the 7 children were rated as treatment responders on the Clinical Global Impression-Improvement (CGI-I) Scale. At the 1-month follow-up, participants had a 17–82% reduction in OC symptoms. Treatment was also effective in reducing parental accommodation of child OC behaviors. Overall treatment satisfaction was high and parents found most core treatment ingredients (e.g., psychoeducation, exposure and ritual prevention, contingency management) very helpful. Implications for further developing and testing psychosocial treatments for young children are discussed.     

Adding motivational interviewing to exposure and ritual prevention for obsessive-compulsive disorder: an open pilot trial

Exposure and ritual prevention (EX/RP) is an efficacious treatment for obsessive-compulsive disorder (OCD), but high dropout rates and variable treatment adherence limit its effectiveness. Motivational interviewing (MI) has shown promise as an adjunct to symptom-focused treatments for improving treatment adherence and outcomes. The authors developed a manual integrating MI with EX/RP, consisting of three information-gathering/motivational enhancement sessions and 15 EX/RP sessions with an optional MI module to be used as needed. Six patients with moderate to severe OCD symptoms (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score> or =16) underwent treatment. Five showed a decrease in their baseline Y-BOCS scores and an increase in their quality of life, with three achieving an excellent response (i.e. Y-BOCS< or =12 at Session 18). The authors briefly describe the motivational strategies used in the six cases and suggest that integrating MI with standard EX/RP is a promising method to increase and sustain patient engagement with EX/RP. Challenges in combining these treatments and maintaining the integrity of each as well as limitations of the study are discussed.     

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.     

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.     

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.     

Measuring Change in OCD: Sensitivity of the Obsessive-Compulsive Inventory-Revised

This study examined the sensitivity to change and specificity of response of the Obsessive-Compulsive Inventory-Revised (OCI-R), an 18-item self-report measure of obsessive-compulsive disorder (OCD) severity. Seventy-seven OCD patients received cognitive-behavioral therapy incorporating exposure and response prevention (ERP). Change from pre- to posttest on the OCI-R was compared to changes as assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and other measures of OCD and related symptoms. Results suggest the OCI-R is sensitive to treatment effects and that pre- to posttest change on this instrument reflects improvement in OCD and related symptoms of depression, anxiety, and global functioning. The OCI-R was not sensitive to improvement in patients’ insight into the senselessness of their OCD symptoms. The OCI-R appears suitable for use in clinical settings and naturalistic outcome studies where time and resources do not permit administration of lengthy symptom interviews.     

Beziehungsgewalt

The objective of our questionnaire study was to investigate posttraumatic stress disorders of abused women and to analyze differences between affected women suffering from high versus low symptom strain with respect to the duration and intensity of the abuse and to victimization incidences in their childhood. We collected data on characteristics of the abuse relationship, kind and frequency of experienced violence, symptoms of posttraumatic stress disorder (PTSD, PCL-C according to DSM-IV), and comorbid complaints (SCL-90-R). Participants were 71 women with a mean age of 43 years. On average, they had lived in an abusive relationship for 11 years. Two thirds had experience with psychotherapy. All provided information on abuse that may be considered traumatic. 62% suffered from injuries necessitating medical treatment at least once, and half sustained lasting physical damage. With respect to all SCL-90-R scales, the research participants were under significantly higher strain than the normed female sample. PTSD was diagnosed in 58%. Compared to women without PTSD, women with PTSD reported very serious assault, comorbid symptoms as well as physical and sexual victimization in their childhood significantly more often.     

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).     

The empirical relationships between standardized measures of religiosity and personality/mental health

The aim of this study was to investigate the relationships between standardized, factor-based measures of religiosity and personality/mental health. In a sample of 471 self-identified Christian subjects, 303 females and 168 males, 79 non-psychotic psychiatric in-patients and 392 non-patients, personal extrinsicness was partially positively correlated with the BCI Obsessive score. In multiple regression analyses some of the factor-based religious orientation indices related differently to the BCI Oral, Obsessive and Hysterical Scales and the SCL-90 Global Symptom Index as dependent variables. The religious orientations explained 8.8% of the variance of the BCI Oral Score, 4.2% of the BCI Obsessive score, 3.3% of the BCI Hysterical score, and 12.3% of the SCL-90 Global Symptom Index score. Of the doctrinal belief and morality indices only Moral conservatism was significantly related to the BCI Hysterical score, and then negatively.