A Comparison of the 1988 and 1994 Diagnostic Criteria for Chronic Fatigue Syndrome

Chronic Fatigue Syndrome (CFS) is an illness that involves severe, prolonged fatigue as well as neurological, immunological, and endocrinological system pathology. Because the pathogenesis of CFS has yet to be determined, case definitions have relied on clinical observation in classifying signs and symptoms for diagnosis. In an attempt to address various criticisms and inconsistencies in diagnostic criteria, there have been several revisions of the CFS case definition. The current investigation examined the differences between 1988 and 1994 definitions as well as participants who had a psychiatric explanation for their fatigue. Dependent measures included psychiatric comorbidity, symptom frequency, and functional impairment. The 1988 criteria, compared to the 1994 criteria, appeared to select a group of participants with more symptomatology and functional impairment, but these groups did not significantly differ in psychiatric comorbidity. Implications of these findings are discussed.     

Chronic Fatigue Syndrome: The Need for Subtypes

Chronic fatigue syndrome (CFS) is an important condition confronting patients, clinicians, and researchers. This article provides information concerning the need for appropriate diagnosis of CFS subtypes. We first review findings suggesting that CFS is best conceptualized as a separate diagnostic entity rather than as part of a unitary model of functional somatic distress. Next, research involving the case definitions of CFS is reviewed. Findings suggest that whether a broad or more conservative case definition is employed, and whether clinic or community samples are recruited, these decisions will have a major influence in the types of patients selected. Review of further findings suggests that subtyping individuals with CFS on sociodemographic, functional disability, viral, immune, neuroendocrine, neurology, autonomic, and genetic biomarkers can provide clarification for researchers and clinicians who encounter CFS characteristically confusing heterogeneous symptom profiles. Treatment studies that incorporate subtypes might be particularly helpful in better understanding the pathophysiology of CFS. This review suggests that there is a need for greater diagnostic clarity, and this might be accomplished by subgroups that integrate multiple variables including those in cognitive, emotional, and biological domains.     

Collective stress and coping in the context of organizational culture

We examined from a cultural perspective how well-being was collectively defined, what were the sources of collective stress, and what kind of collective coping mechanisms were used to alleviate such stress in three divisions of a multinational company. In the first phase of the study we collected data on organizational culture by using individual thematic interviews (N = 63). Applying the grounded theory methodology and an inductive analysis, specific cultures describing the divisions were identified. In terms of co-operation we found the following fundamental cultural recipes: joint focused efforts on money-making, despite the awareness of the common goals employees interested only in fulfilling their own role (jig-saw puzzle), and the awareness of the common goals lacking (scattered islands). In the second phase we conducted group interviews (N = 32) using the critical incident technique to assess collective definitions of well-being, sources of collective stress and respective collective coping mechanisms. These data were complemented with observations at the work site, participant observations at meetings, and analysis of documents. The definitions of well-being varied across cultures as regards their emphasis either on work or on other life domains as sources of well-being. Furthermore, the more hectic the organizational context, the more permissive the collective conception of well-being was. Collective stress emerged as a response to two types of signals: (1) adaptation to the environment of the division or work unit was imperfect (fluctuation, risk of unemployment, continuously changing customer needs, poor client satisfaction, multinational game, group bonus, culture shock due to a merger, work overload, and pressure toward more extensive autonomy), or (2) friction inside the community (undervaluation of a group of employees, and the “penal colony” reputation). Of the corresponding coping mechanisms, a large proportion were found to be collective, learned uniform responses to remove the stressor, to change the interpretation of the situation or to alleviate negative feelings. In conclusion, our results suggest that stress experiences and coping strategies have collective qualities. Culture not only seems to moderate the appraisal of stress, but also contains collective coping responses to stressors, which seem to have their origin either in the organizational environment or inside the community itself.     

Perception of correlation reexamined

Almost all studies of adult notions of correlation between dichotomous variables show that people do not incorporate two conditional probabilities as they should according to normative definitions. However, these studies disagree considerably about what correlational notions people do have. This paper identifies three factors that contribute to the variability in research results. The first two factors were mentioned in the literature, and the evidence concerning them is summarized: (1) the way data are presented and (2) the instructions subjects receive. A third factor is suggested and studied; the type of variables between which correlation is judged may affect subjects’ notion of correlation, Specifically, asymmetric, present/absent variables (e.g., symptom: present, absent) may strengthen the incorrect notion of correlation as the tendency of two events to coexist (e.g., presence of symptom and presence of disease) disregarding the complementary events. In three experiments, subjects were asked to choose among five interpretations of the sentence “A strong [or no] relationship exists between [two variables],” The above prediction was confirmed.     

Enduring cognitive dysfunction in unipolar major depression: A test–retest study using the Stroop paradigm

Hammar, Å., Sørensen, L., Årdal, G., Oedegaard, K.J., Kroken, R., Roness, A. & Lund, A. (2009). Enduring cognitive dysfunction in unipolar major depression: A test–retest study using the Stroop‐paradigm. Scandinavian Journal of Psychology. The aim of the study was to investigate automatic and effortful information processing with the Stroop paradigm in a long term perspective in patients with major depressive disorder (MDD). Patients were tested at two test occasions: at inclusion with a Hamilton Depression Rating Scale (HDRS) score >18, and after 6 months, when most patients had experienced symptom reduction. The Stroop paradigm is considered to measure aspects of attention and executive functioning and consists of three conditions/cards: naming the color of the patches (Color), reading of the color‐words (Word) and naming the ink color of color‐words (Color‐Word). The Color‐Word condition is proved to be the most cognitive demanding task and requires the proband to actively suppress interference and is therefore considered to require more effortful information processing, whereas naming the color of the patches and reading the color‐words are expected to be more automatic and less cognitive demanding. A homogenous group of 19 patients with unipolar recurrent MDD according to DSM‐IV and a HDRS score of >18 were included in the study. A control group was individually matched for age, gender and level of education. Depressed patients performed equal to the control group on the Color and Word cards at both test occasions. However, the patients were impaired compared with the control group on the Color‐Word card task at both test occasions. Thus, the depressed patients showed no improvement of effortful attention/executive performance as a function of symptom reduction. The results indicate that the depressed patients showed impaired cognitive performance on cognitive demanding tasks when symptomatic and that this impairment prevailed after 6 months, despite significant improvement in their depressive symptoms.     

Repeated-measures contrasts for "multiple-pattern" hypotheses

Contrast analysis of repeated-measures data generally focuses on hypotheses when only 1 pattern of results is of theoretical interest. This article articulates a framework for contrast analysis in repeated-measures contexts in which researchers have hypotheses relevant to 1 potential pattern or multiple potential patterns of results. For example, a researcher might ask whether participants exhibit a pattern of (a) immediate symptom reduction or (b) delayed symptom reduction. Alternatively, the researcher might ask whether 2 or more groups exhibit 2 or more patterns to differing degrees. Building on the familiar logic and computational procedures for 1-pattern hypotheses, the authors present a contrast analysis framework that integrates analysis of 1-pattern and multiple-pattern hypotheses and accommodates 1 group or multiple groups of participants.     

Investigation of placement outcomes 3 years after a job skills training program for chronically unemployed adults

This analysis of chronically unemployed job seekers after they completed a comprehensive job skills training program reveals dynamic interpersonal and intrapersonal characteristics that have an impact on job‐finding success. Of primary interest in this study was the relationship between R. B. Cattell's (1988) second‐order personality factors and participants' employment status 3 years after they graduated from the job skills program. Furthermore, U.S. Department of Labor worker trait classifications, such as aptitude, academic achievement, work history, and Holland's hexagonal definitions of career interest were also analyzed (United States Employment Service, 1972). Relatively robust correlations between job holding status and 2 of the second‐order personality factors on Cattell's Sixteen Personality Factor Questionnaire were illuminated: Independence and Objectivity.     

Personality as modifier of the life event-distress relationship: A longitudinal structural equation model

A structural equation model is presented of the way in which personalityfactors may modify responsiveness to life events and examines this model using data collected in the Groningen Study on a sample of 296 Dutch adults. Three definitions of vulnerability were studied: neuroticism, self-esteem and locus of control. Unlike the Brown/Harris model our model does not assume ‘all or none’ variables but considers exposure to provoking factors, vulnerability and symptom levels as continuous variables. The analysis suggested the following major conclusions. Firstly, previous symptom level was strongly related to current symptom level. The strenght of the relationship was independent from vulnerability. Secondly, the three personality factors did not modify the response to exposure to adversity. Thirdly, locus of control and self-esteem somewhat modified the impact of desirable events. Among high vulnerability Ss (external, low self-esteem) desirable events appeared to reduce symptom level. The implications of these findings for the role of personality in influencing symptom level of Brown/Harris vulnerability model are discussed.     

Is There a Stronger Association Between Children and Happiness Among the Religious? Religion as a Moderator in the Relationship Between Happiness and Child Number

The literature on child number and happiness has progressed beyond simple associations and has begun to explore the roles of various attitudinal and environmental factors that moderate the relationship. Here the role of religiosity as a moderator in the relationship between happiness and child number is tested. This effect has not been examined before, which is surprising given the role that religion has been shown to play in child number more generally. I draw on both the psychology and demography literature to make a theoretical case that, as religiosity in the United States tends to be associated with pronatalist norms and culture, and as happiness is positively associated with fulfilling sociocultural imperatives, then, all things being equal, the more religious will have a higher happiness effect (or lower unhappiness effect) from their children than the less religious. Using General Social Survey data, my empirical analysis empirically confirmed this hypothesis, showing a positive and significant interaction term between self-identifying as very religious and child number. This interaction is partially mediated by another interaction term between higher ideal family size (measuring pronatalist tendencies) and number of children.     

A classmate in distress: schoolchildren as bystanders and their reasons for how they act

Research has shown that bystanders more often fail to or are slower to help a victim in emergency when there are other bystanders than when there are not. The study presented in this paper is a qualitative case study with a focus on students’ own reasons why they do not help a classmate in emergency when there are other children witnessing the emergency situation in the real-life classroom case studied. Grounded theory methods were used to analyse the data. The individual conversations with the students indicated a variety of definitions of the specific distress situation when they recalled and talked about the classroom incident. During the process of the analysis seven concepts of definitions associated with passive or non-intervention bystander behaviour were constructed and grounded in the empirical material: trivialisation, dissociation, embarrassment association, busy working priority, compliance with a competitive norm, audience modelling, and responsibility transfer. Relations between these concepts of definitions were also analysed. However, this study is a first step and a first report from an ongoing study about school children as helper and bystander.     

A controlled evaluation of group cognitive therapy in the treatment of irritable bowel syndrome

We randomized, at two sites, 210 patients with Rome II diagnosed irritable bowel syndrome (IBS), of at least moderate severity, to one of three conditions: group-based cognitive therapy (CT; n=120), psychoeducational support groups (n=46) as an active control, or intensive symptom and daily stress monitoring (n=44). One hundred eighty-eight participants completed the initial treatment. Those in symptom monitoring were then crossed over to CT. For an intent to treat analysis on a composite GI symptom measure derived from daily symptom diaries, both CT and the psychoeducational support groups were significantly more improved than those in the intensive symptom monitoring condition, but the CT and psychoeducational support group did not differ. Among treatment completers on the same composite measure of GI symptoms, again, both CT and psychoeducational support groups were statistically superior to symptom monitoring but did not differ on the symptom composite, or on any other measure. On individual IBS symptoms, both CT and psychoeducational support were statistically superior to symptom monitoring on reductions in abdominal pain and tenderness and for flatulence. Patient global ratings at the end of treatment showed the two active conditions statistically superior to symptom monitoring on change in Bowel Regularity, with CT superior to symptom monitoring on reduction in overall pain and in improvement in sense of well-being. Three-month follow-up data on 175 patients revealed maintenance of significant improvement or continued significant improvement on all IBS symptoms, including the McGill Pain Questionnaire. Group CT and psychoeducational support groups continued not to differ on any measure. We thus conclude that group CT is not superior to an attention placebo control condition.     

Nervous strain,anxiety and symptoms amongst 32-year-old men at work in Britain

Amongst a group of 1052 men followed up since birth and living throughout Britain, it was found that reports of nervous strain at work related to features of the job (those in more highly demanding jobs reporting more strain), to earlier indications of prior susceptibility to anxiety and to a more frequent report of stomach pain, headache and sleep problems. The report of these symptoms, however, related to the indicators of susceptibility to anxiety rather than to the apparently stressful factors of the job, and it is concluded that exposure to the job demands examined in this study did not affect the frequency of symptom reporting.     

Few Gender Differences Exist Between Women and Men with Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) is generally considered to be a women's health issue, but the illness occurs also in men. The research objective of this study was to determine if illness patterns and functional status differed between the sexes. Because our own data showed that women with CFS have significantly more comorbid fibromyalgia or multiple chemical sensitivity than men, we eliminated patients with these comorbid conditions from our evaluation. Women with CFS were quite similar to men with CFS in terms of demographics, psychiatric status, functional status, and assessments of disability. Women reported more infectious/flu-like symptoms (represented by a factor derived from factor analysis) than men, but these differences were insignificant after controlling for other variables. Cluster analysis revealed that women were more likely than men to fall in the cluster characterized by symptom severity. Differences found were those of degree rather than of type; strikingly different illness patterns—suggestive of different pathophysiological processes between the sexes—were not found.     

The effects of clinical motor variables and medication dosage on working memory in Parkinson’s disease

In this study, we investigate the interrelationship between clinical variables and working memory (WM) in Parkinson’s disease (PD). Specifically, the aim of the study was to investigate the relationship between disease duration, dopaminergic medication dosage, and motor disability (UPDRS score) with WM in individuals with PD. Accordingly, we recruited three groups of subjects: unmedicated PD patients, medicated PD patients, and healthy controls. All subjects were tested on three WM tasks: short-delay WM, long-delay WM, and the n-back task. Further, PD encompasses a spectrum that can be classified either into akinesia/rigidity or resting tremor as the predominant motor presentation of the disease. In addition to studying medication effects, we tested WM performance in tremor-dominant and akinesia-dominant patients. We further correlated WM performance with disease duration and medication dosage. We found no difference between medicated and unmedicated patients in the short-delay WM task, but medicated patients outperformed unmedicated patients in the long-delay WM and n-back tasks. Interestingly, we also found that akinesia-dominant patients were more impaired than tremor-dominant patients at various WM measures, which is in agreement with prior studies of the relationship between akinesia symptom and basal ganglia dysfunction. Moreover, the results show that disease duration inversely correlates with more demanding WM tasks (long-delay WM and n-back tasks), but medication dosage positively correlates with demanding WM performance. In sum, our results show that WM impairment in PD patients depend on cognitive domain (simple vs. demanding WM task), subtype of PD patients (tremor- vs. akinesia-dominant), as well as disease duration and medication dosage. Our results have implications for the interrelationship between motor and cognitive processes in PD, and for understanding the role of cognitive training in treating motor symptoms in PD.     

The Relationship Between Dropout and Outcome in Naturalistic Cognitive Behavior Therapy

Dropout from psychotherapy is frequent and limits the benefits patients can receive from treatment. The study of factors associated with dropout has the potential to yield strategies to reduce it. This study analyzed data from a large sample of adults (N = 1,092) receiving naturalistic cognitive behavioral therapy (CBT) to test the hypotheses that dropouts, as compared to completers, had (1) higher symptom severity at treatment termination, (2) a slower rate of symptom change during treatment, and (3) a higher odds that the therapist rated treatment as ending for reasons related to poor outcome. Results showed that although dropouts ended treatment with higher symptom severity than completers, dropouts and completers did not differ in their rate of symptom change during treatment, suggesting that dropouts had higher symptom severity at termination because they received fewer sessions of treatment, not because their symptoms changed at a slower rate. Dropout was also associated with a higher odds of having a therapist-rated termination reason indicating a poor outcome, suggesting that dropout is more likely if patients are dissatisfied with some aspect of the therapy outcome or process. These findings suggest that strategies for monitoring and enhancing patient satisfaction with the process and outcome of treatment may help patients stay in treatment longer and end treatment with fewer symptoms than if they had dropped out.     

Two Trajectories of Depressive Symptom Reduction Throughout Behavioral Activation Teletherapy Among Underserved,Ethnically Diverse,Primary Care Patients: A VitalSign6 Report

While prior research has investigated trajectories of depressive symptom change throughout psychotherapy, such work has not been conducted exclusively among underserved patients receiving brief Behavioral Activation (BA) teletherapy, intervention modifications that should reduce barriers to therapy initiation and engagement. The current project used cluster analysis to determine discrete groups of symptom change among patients receiving an 8-session BA teletherapy intervention, and analyzed whether demographic and clinical characteristics were associated with group membership. Data from 105 patients referred from charity primary care clinics and receiving at least two therapy sessions were analyzed. Patients were predominantly female and Latina. The 9-item Patient Health Questionnaire (PHQ-9) was the outcome. Two categories were determined: a larger group (N = 61) demonstrating initially less severe symptoms and experiencing a gradual recovery, and a smaller group beginning with more severe symptoms, and experiencing a steeper recovery. In both groups, a majority of participants experienced at least a 5-point drop in depressive symptoms, while in the latter group, a majority of patients achieved depressive symptom remission (PHQ-9 < 5). Monolingual Spanish speakers were more likely to be in the former group, but no other demographic or clinical characteristics were associated with group membership. In both groups, a majority of the symptom reduction occurred by sessions 4–6. Therefore, two categories of depressive symptom change, slow responders and rapid responders, occur among patients receiving a brief BA teletherapy intervention. No demographic differences aside from primary language, nor any clinical characteristics, distinguish group membership, suggesting similar patterns of symptom reduction among a primarily underserved sample.     

Screening for obsessive and compulsive symptoms: validation of the Clark-Beck Obsessive-Compulsive Inventory

The 25-item Clark-Beck Obsessive-Compulsive Inventory (CBOCI) was developed to assess the frequency and severity of obsessive and compulsive symptoms. The measure uses a graded-response format to assess core symptom features of obsessive-compulsive disorder (OCD) based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria and current cognitive-behavioral formulations. Revisions were made to the CBOCI on the basis of psychometric and item analyses of an initial pilot study of clinical and nonclinical participants. The construct validity of the revised CBOCI was supported in a subsequent validation study involving OCD, nonobsessional clinical, and nonclinical samples. A principal-factor analysis of the 25 items found 2 highly correlated factors of Obsessions and Compulsions. OCD patients scored significantly higher on the measure than nonobsessional anxious, depressed, and nonclinical samples. The questionnaire had strong convergent validity with other OCD symptom measures but more modest discriminant validity.     

A Third Moment Adjusted Test Statistic for Small Sample Factor Analysis

Goodness-of-fit testing in factor analysis is based on the assumption that the test statistic is asymptotically chi-square, but this property may not hold in small samples even when the factors and errors are normally distributed in the population. Robust methods such as Browne's (1984) asymptotically distribution-free method and Satorra Bentler's (1988, 1994) mean scaling statistic were developed under the presumption of nonnormality in the factors and errors. This article finds new application to the case where factors and errors are normally distributed in the population but the skewness of the obtained test statistic is still high due to sampling error in the observed indicators. An extension of Satorra Bentler's statistic is proposed that not only scales the mean but also adjusts the degrees of freedom based on the skewness of the obtained test statistic in order to improve its robustness under small samples. A simple simulation study shows that this third moment adjusted statistic asymptotically performs on par with previously proposed methods and at a very small sample size offers superior Type I error rates under a properly specified model. Data from Mardia, Kent, and Bibby's (1980) study of students tested for their ability in 5 content areas that were either open or closed book were used to illustrate the real-world performance of this statistic.     

A Review of School Counseling Outcome Research: Implications for Practice

In this review, the authors summarize school counseling outcome research published between 1988 and 1995. Gysbers and Henderson's (1994) comprehensive developmental guidance model served as the organizing model through which the status of empirical literature regarding school counseling is examined. Results indicated that research focused more on remediation activities as compared to preventive interventions. This review found tentative support for career planning, group counseling, social skill training activities, and peer counseling. Practical implications and future research direction are drawn from these conclusions.