Reconceptualizing adult attachment relationships: A network perspective

This article explores attachment relationships from a network theory perspective: Correlations among behaviors, beliefs, and feelings related to attachment are hypothesized to stem from causal relations. The authors used two data sets that assessed relationships with four attachment figures (mother, father, romantic partner, and best friend) using the Relationship Structures Questionnaire. Separate networks (Gaussian Graphical Models) were estimated based on 10 items for each attachment figure. Across networks in Study 1 (N = 310), items related to anxiety, seeking support, and discomfort disclosing feelings clustered with other items from their respective domains; a trust‐related item bridged the clusters. Study 2 replicated these findings in a larger and more diverse sample (N = 3,710). The potential of network analysis for advancing the study of attachment is discussed.     

Intimate boundaries: Therapists’ perception and experience of erotic transference within the therapeutic relationship

Aim: This study explored therapists’ understanding and experiences of erotic transference within therapeutic relationships. Method: A small‐scale qualitative research project was undertaken with six therapists working within different counselling contexts. Data was collected through semi‐structured face‐to‐face interviews, and an Interpretative Phenomenological Analysis used for analysis of individual perception and experience. Findings: All participants had experienced what they understood to be erotic transference and/or sexual and loving feelings within therapy. There was little differentiation between the two phenomena, and both were often referred to interchangeably. There were contradictory views as to whether using the phenomena would be beneficial to client work, but there was a strong motivation to learn more about it. Therapists who encountered sexual attraction within therapy experienced feelings including shame and embarrassment. Supervisory support was seen to be beneficial. Implications/conclusion: The importance for therapists to acknowledge a lack of clarity that exists around the understanding of erotic transference and its relationship to sexual attraction within therapy is noted. Also, a recognition that better access to training regarding erotic transference and sexual responsibility within client relationships might be helpful to therapists in their work.     

Modifying Threat-related Interpretive Bias in Adolescents

Socially anxious feelings sharply increase during adolescence and such feelings have been associated with interpretive biases. Studies in adults have shown that interpretive biases can be modified using Cognitive Bias Modification procedures (CBM-I) and subsequent effects on anxiety have been observed. The current study was designed to examine whether the CBM-I procedure has similar effects in adolescents. Unselected adolescents were randomly allocated to either a positive interpretation training (n = 88) or a placebo-control condition (n = 82). Results revealed that the training was successful in modifying interpretations and effects generalized to a new task. The interpretive bias effects were most pronounced in individuals with a threat-related interpretive bias at pre-test. No effects on state anxiety were observed. The current findings are promising with regard to applying bias modification procedures to adolescents, while further research is warranted regarding emotional effects.     

The spontaneous decay of compulsive urges

An experiment was carried out on eleven obsessional patients who complained of compulsive checking rituals. Exposure to a provoking situation produced marked anxiety/discomfort and strong urges to check. With minor exceptions, execution of the appropriate ritual was followed by marked decreases in anxiety/discomfort and urges. The results were interpreted as being consistent with an anxiety/discomfort reduction hypothesis.

The spontaneous decay of anxiety/discomfort and urges was observed during a 3-hr response-prevention period. The greatest part of the discomfort and compulsive urges dissipated within an hour. Discomfort scores and urges ran a closely parallel course. Few resurgences of discomfort or urges were observed during the 3-hr observation period, and there was little sign of displacement checking activity.     

Obsessional-compulsive checking: Experimental replication and development

The purpose of this experiment was to resolve some inconclusive findings from an earlier study on the effects of compulsive checking rituals. Twelve obsessional-compulsive checkers carried out a provoking act followed by their compulsive checking ritual, in natural situations, under two conditions—E present and E absent. The provoking act produced subjective discomfort, tension, worry and anxiety; these feelings were reduced after completion of the checking ritual. Both the increases and post-ritual decreases in discomfort were more pronounced in the spontaneous occurrence condition (E absent). The results are consistent with the hypothesis that compulsive rituals serve to reduce discomfort.     

Anxiety experiences of male psychotherapists: A hermeneutic phenomenological study

Aims: There is currently a lack of clarity surrounding how men experience anxiety. This is caused by epistemological limitations with the perspectives employed to explore male anxiety, but equally by a lack of empirical research and uncertainty of how to define masculinity. In order to explain male anxiety more effectively this study needed to overcome these limitations by both incorporating the notion that there are multiple masculinities, through which men experience specific anxieties, and allowing men to talk directly about their experiences. This study focused on one kind of masculine identity: that of male psychotherapists. Research design: A hermeneutic phenomenological method was employed. Eight male psychotherapists of various modalities were interviewed who work in a number of therapeutic contexts. Results: Anxiety patterns are complex and comprise of feelings that are very difficult to deal with. Yet, anxiety is also an impetus for learning and improvement. Conclusions: The few existing ideas of male anxiety fail to capture the complexity of how men experience anxiety. Concepts of male anxiety need to be defined with more accuracy.     

“A Failure of Curiosity”

ABSTRACT

This essay discusses the clinician's defense against and resolution of the experience of boredom in the countertransference as an incident of projective identification in the treatment of a woman with dissociative identity disorder. The essay details the inner mind of the therapist as she discovers both her own feelings and judgements of those feelings. As the essay progresses, she begins to grasp the significance of her discomfort in informing the therapeutic process. We watch as this material is made use of to move forward a stalled therapy into new territory.     

Patterns of situational appraisal in experiences of worry and anxiety

Abstract

Three studies investigating differences in people's appraisals of worry and anxiety situations are presented. First, data from a study by Reisenzein & Spielhofer (1994) were reanalyzed. Second, two further studies were conducted to replicate the findings of the reanalysis and to explore whether any additional appraisal dimensions were relevant for a differentiation of worry and anxiety situations. In sum, results showed that appraisals associated with situations in which worry and anxiety were experienced differed on eight appraisal dimensions. Compared to experiences of anxiety, experiences of worry were more often associated with positive self-evaluation, positive social-relationship evaluation, feelings of closeness, and sentiments of importance, and less often associated with feelings of inferiority. Moreover, in worry experiences, focus was often not on the self, but on other persons. Finally, with respect to temporal dimensions, worry situations were less often associated with notions of suddenness and momentariness than anxiety situations. Implications of these findings are discussed with respect to models of emotional appraisal and research on worry and generalized anxiety disorder.     

The Luscher Color Test: An Investigation of Validity and Underlying Assumptions

This experiment investigated several underlying assumptions and one aspect of the validity of the Luscher Color Test, a projective test developed in Europe and relatively unknown in the United States. It was predicted that Ss would report increases in “negative” feelings to the color red, while blue would have the opposite effect, and yellow would produce an increase in “positive” feelings. Twenty-three male and 23 female Ss rated their immediate reactions to the LCT colors on seven mood adjectives, following which they were given the short version LCT and the IPAT Anxiety Scale. The results supported the hypotheses regarding blue and yellow, but not those regarding red nor the validity of the LCT as an anxiety measuring instrument.     

Genetic Testing Considerations in Breast Cancer Patients

Genetic testing is now feasible for a growing number of cancers. Although the implications for unaffected relatives have been widely described, the impact of the tests on affected individuals are often not recognized. We present and discuss four cases that highlight some of the issues—for example, feelings of guilt and anxiety, intrafamilial conflict, and support needs—that may arise in testing affected individuals. We offer some suggestions to aid in the approach to such testing.     

Taming the Brain Weasels: Reducing Self-Criticism Through Externalization and Compassion

ABSTRACT

Self-criticism is a natural process occurring across mental health disorders. When self-criticism is excessive, vulnerability to mental health disorders such as depression and anxiety increases. Compassion-focused approaches can effectively address a variety of concerns; however, highly self-critical individuals might balk at the idea of self-directed compassion due to shame, self-blame, or discomfort with positive emotions, resulting in treatment resistance. The brain weasel is an intervention strategy that uses the Narrative Therapy technique of externalization as an intermediate step toward compassion-oriented work. Through creative externalization and therapeutic humor, self-critical individuals can decenter and explore their self-critical dialogue. This article contains several ways to introduce and use the brain weasel personification in counseling.     

Psychotherapeutic work with refugees: Understanding the therapist's countertransference

Abstract

Most therapists are chosen to work with refugees because they speak the language or come from the same cultural or racial background and/or have had experiences which resonate with those of the client. They are often people who can easily understand the clients' experiences, which creates interesting and potent therapeutic dynamics. They can offer a great deal of support to the person, but often with the high risk of over-identification. This paper is an attempt to examine from the therapist's perspective the complex dynamics involved in working with refugee clients. It is a collection of thoughts and feelings expressed in psychotherapeutic and supervisory work by different types of refugee mental health workers. It is an attempt to understand the therapeutic relationship further by focusing on the therapist's psychological response to the client. The paper will outline briefly some of the common themes reported by refugees, but the primary aim is to focus on the therapist's countertransference feelings. Countertransference in this context is defined as a personal psychological response, as well as consisting of socio-political components.     

Treatment of Excessive Interpersonal Dependency: A Cognitive-Behavioral Model

Clients with excessive dependency often seek treatment for an Axis I anxiety or mood disorder. Simply providing treatment for the Axis I disorder may fail to address the long-standing personality factors that may underlie the acute anxiety and depression. A four-stage model has been proposed for the treatment of excessive interpersonal dependency. This model describes strategic ways therapy content and style should change over the course of treatment. Despite the apparent utility of the four-stage treatment model, it may be difficult to apply in many sites that now emphasize short-term approaches to treatment. In many cases, therapy can be designed to address themes that are relevant to both dependency and the Axis I syndrome. Therapy can be focused around helping clients make improvements in stabilizing emotional reactions, enhancing views of the self, and improving social functioning. Treatment focused on stabilizing emotional reactions can help clients confront and develop tolerance for feelings of depression and anxiety. Treatment focused on enhancing views of the self can help clients improve their self-esteem, self-reinforcement and reduce self-criticism. Treatment focused on improving social functioning can enhance social skills, reduce social anxiety and challenge feelings of loneliness. In addition, treatment can focus on reducing specific aspects of interpersonal dependency and confronting developmental antecedents that may underlie the dependency.     

Anesthesia Awareness: Narrative Review of Psychological Sequelae,Treatment, and Incidence

Awareness during general anesthesia occurs when patients recall events or sensations during their surgeries, although the patients should have been unconscious at the time. Anesthesiologists are cognizant of this phenomenon, but few discussions occur outside the discipline. This narrative review summarizes the patient recollections, psychological sequelae, treatment and follow-up of psychological consequences, as well as incidence and etiology of awareness during general anesthesia. Recalled memories include noises, conversations, images, mental processes, feelings of pain and/or paralysis. Psychological consequences include anxiety, flashbacks, and posttraumatic stress disorder diagnosis. Limited discussion for therapeutic treatment after an anesthesia awareness experience exists. The incidence of anesthesia awareness ranges from 0.1 to 0.2% (e.g., 1–2/1000 patients). Increased recognition of awareness during general anesthesia within the psychological/counseling community, with additional research focusing on optimal therapeutic treatment, will improve the care of these patients.     

Effects of social anxiety and depressive symptoms on the frequency and quality of sexual activity: a daily process approach

Diminished positive experiences and events might be part of the phenomenology of social anxiety; however, much of this research is cross-sectional by design, limiting our understanding of the everyday lives of socially anxious people. Sexuality is a primary source of positive experiences. We theorized that people with elevated social anxiety would have relatively less satisfying sexual experiences compared to those who were not anxious. For 21 days, 150 college students described their daily sexual episodes. Social anxiety was negatively related to the pleasure and feelings of connectedness experienced when sexually intimate. The relationship between social anxiety and the amount of sexual contact differed between men and women—it was negative for women and negligible for men. Being in a close, intimate relationship enhanced the feelings of connectedness during sexual episodes for only individuals low in social anxiety. Depressive symptoms were negatively related to the amount of sexual contact, and the pleasure and feelings of connectedness experienced when sexually intimate. Controlling for depressive symptoms did not meaningfully change the social anxiety effects on daily sexuality. Our findings suggest that fulfilling sexual activity is often compromised by social anxiety.     

CBT for Anxiety and Associated Somatic Complaints in Pediatric Medical Settings: An Open Pilot Study

Objective To examine the initial feasibility and potential efficacy of a cognitive-behavioral intervention for youth with anxiety disorders and non-medical somatic symptoms. Background Based on a strong relationship between somatic complaints and anxiety disorders, screening youngsters seeking medical care due to physical symptoms with no organic basis may enhance the recognition of anxiety disorders and facilitate access to appropriate services. Method Seven boys and girls, ages 8 through 15, with medically unexplained gastrointestinal complaints and anxiety disorders received a 12-session cognitive-behavioral intervention targeting anxiety and physical symptoms. Assessments were conducted at baseline and following treatment. Results All participants were classified as treatment responders. Three of the seven participants no longer met diagnostic criteria for their principal anxiety disorder. Children’s physical discomfort decreased from a moderate to minimal level based on self- and parent-reports. Conclusions Our modified cognitive-behavioral approach has promise for reducing anxiety and somatic symptoms in children seeking medical care.     

Deconstructing trait anxiety: a network perspective

Background and objectives: For decades, the dominant paradigm in trait anxiety research has regarded the construct as signifying the underlying cause of the thoughts, feelings, and behaviors that supposedly reflect its presence. Recently, a network theory of personality has appeared. According to this perspective, trait anxiety is a formative construct emerging from interactions among its constitutive features (e.g., thought, feelings, behaviors); it is not a latent cause of these features.

Design: In this study, we characterized trait anxiety as a network system of interacting elements.

Methods: To do so, we estimated a graphical gaussian model via the computation of a regularized partial correlation network in an unselected sample (N?=?611). We also implemented modularity-based community detection analysis to test whether the features of trait anxiety cohere as a single network system.

Results: We find that trait anxiety can indeed be conceptualized as a single, coherent network system of interacting elements.

Conclusions: This radically new approach to visualizing trait anxiety may offer an especially informative view of the interplay between its constitutive features. As prior research has implicated trait anxiety as a risk factor for the development of anxiety-related psychopathology, our findings also set the scene for novel research directions.     

Cognitive-Behavioral Treatment of Social Phobia

Social phobia can be a chronic disorder, capable of restricting a client's social and occupational functioning. Cognitive-behavioral therapy can help many clients learn to overcome their social inhibitions, and make lasting changes in their interpersonal style. Cognitive-behavioral therapy for social phobia includes four general components for helping clients learn to manage their social anxiety. First, therapy begins with the establishment of a sound therapeutic alliance, a focus on assessment, diagnostic interviewing, and education regarding anxiety symptoms and their treatment. Second, the therapist helps clients to develop competence in social skills, relaxation training, and cognitive restructuring. Third, therapy uses exposure to social situations in order to help clients confront their fears and refine their coping skills. Fourth, relapse prevention strategies are used to help clients learn to tolerate feelings of discomfort and confront challenging social interactions. This treatment framework can be adapted to the specific needs of different clients.     

Emotional support and counselling for people with visual impairment: Quantitative findings from a mixed methods pilot study

Aims: This paper reports on mainly quantitative findings from a mixed methods evaluation of a new model of emotional support and counselling for people with moderate visual impairment. Method: The CORE Outcome Measure was completed with service users at baseline and post‐intervention to assess the impact of the new service on psychological wellbeing and social functioning. Their perceived needs and expectations of the service were also explored. Results: Of the 35 individuals providing data at each assessment time, mean item scores on the CORE fell significantly (p<.001), taking the sample from within a clinical population before therapy, to a mean score below this following therapy. A more positive outlook accompanied this improvement in functioning. Discussion: Findings from the study augment the growing evidence that emotional support and counselling services can play an important role alongside and within related vision services. Implications for practice: The study indicates that therapeutic input for the visually impaired client group may need to target both wellbeing (feelings about oneself and the future) and problems (depression, anxiety, physical health, and trauma). Conclusions: Our findings suggest that a dual model of emotional support and counselling offers considerable benefit for people with visual impairment.