囤积症的行为心理特征及相关因素

囤积症是指过度获取和不能丢弃那些没有用处或失去价值的物品。这种行为通常会给患者本人及其家庭成员带来感情、躯体、财务、社会甚至法律方面的负面影响。对于囤积症的行为特征、心理特征及相关因素,学界已有大量的研究。近期,囤积症已被纳入DSM-5,这将有助于确定有持续性丢弃困难的个体,并对其予以帮助与干预。     

An Evaluation of an Ambiguous Loss Based Psychoeducational Support Group for Family Members of Persons Who Hoard: A Pilot Study

The current study is a pilot evaluation of a six-week psychoeducational-support group based in an ambiguous loss framework for family members of people who hoard. Findings suggest that participants who completed the six-week intervention group (N?=?8) indicated positive results at the two-month follow up interview, reporting an increased understanding of family members’ hoarding behaviors and their own experiences related to the hoarding behavior and its impact on the family system. Participants also reported that having personal and professional support from others who understand hoarding behavior was helpful to them in lowering psychological distress and improving interactions with their family members.     

Family narrative interaction and children's sense of self

Family narratives about the shared past may be a particularly significant site for preadolescents' emerging sense of self both as an individual and as a member of a unified family. We examined the relations between family narrative interaction style when reminiscing and preadolescents' sense of self. Results indicated three narrative interaction styles that describe the extent to which families discuss or fail to discuss their past in integrated and validating ways. Specifically, conversations with a coordinated perspective incorporated information from all members and were related to higher self-esteem, especially in girls. Conversations with an individual perspective, in which family members took turns telling their thoughts and feelings about the event without integration among the perspectives, were associated with a more external locus of control, especially in boys. Conversations with an imposed perspective, in which one family member was in charge of the conversation or in which unpleasant exchanges between members occurred, were not associated with either self-esteem or locus of control. Implications of these narrative interaction styles for children's developing sense of self are discussed.     

A sociocultural stress, appraisal, and coping model of subjective burden and family attitudes toward patients with schizophrenia

A sociocultural stress, appraisal, and coping model was developed to understand relatives' burden of care and negative affective attitudes toward patients with schizophrenia. Ninety-two African American and 79 White patients and a significant other (80% mothers) completed 2 10-min family problem-solving discussions. In addition, the Kreisman Rejection Scale and a global self-report rating of family burden were administered to relatives, and a self-report rating of substance use was administered to patients. Results indicated that subjective burden of care and patients' odd and unusual thinking during the family discussion each independently predicted relatives' attitudes toward patients, suggesting that negative attitudes are based in part on both patients' symptoms and perceived burden of care. African American relatives' perceived burden was also predicted by patients' substance abuse. Finally, White family members were significantly more likely than African Americans to feel burdened by and have rejecting attitudes toward their schizophrenic relative suggesting that cultural factors play an important role in determining both perceived burden and relatives' attitudes toward patients.     

The buried in treasures workshop: Waitlist control trial of facilitated support groups for hoarding

Hoarding is a serious form of psychopathology that has been associated with significant health and safety concerns, as well as the source of social and economic burden (Tolin, Frost, Steketee, & Fitch, 2008; Tolin, Frost, Steketee, Gray, & Fitch, 2008). Recent developments in the treatment of hoarding have met with some success for both individual and group treatments. Nevertheless, the cost and limited accessibility of these treatments leave many hoarding sufferers without options for help. One alternative is support groups that require relatively few resources. Frost, Pekareva-Kochergina, and Maxner (2011) reported significant declines in hoarding symptoms following a non-professionally run 13-week support group (The Buried in Treasures [BIT] Workshop). The BIT Workshop is a highly structured and short term support group. The present study extended these findings by reporting on the results of a waitlist control trial of the BIT Workshop. Significant declines in all hoarding symptom measures were observed compared to a waitlist control. The treatment response rate for the BIT Workshop was similar to that obtained by previous individual and group treatment studies, despite its shorter length and lack of a trained therapist. The BIT Workshop may be an effective adjunct to cognitive behavior therapy for hoarding disorder, or an alternative when cognitive behavior therapy is inaccessible.     

Group cognitive-behavioral therapy for hoarding disorder: an open trial

Although cognitive-behavioral therapy (CBT) appears to be a promising treatment approach for hoarding disorder, treatment to date has been quite labor intensive. The goal of this study, therefore, was to assess the potential effectiveness of group CBT for hoarding, without home visits by the clinician. Forty-five individuals with hoarding disorder enrolled in either a 16 or 20 session program of group CBT; 30 (67%) completed treatment. Using mixed-effects models to account for missing data, we report data from 35 (78%) participants who provided enough data for analysis. Participants demonstrated significant improvements in hoarding symptoms, as well as symptoms of depression and anxiety, and quality of life. Improvements in hoarding symptoms were comparable to two published clinical trials on individual CBT for hoarding disorder. Results of this study suggest that group CBT for hoarding, without home discarding sessions by the clinician, may be an effective treatment option with the potential advantage of increasing treatment access by reducing clinician burden and cost of treatment.     

A multidimensional, multilevel examination of mother and father involvement among culturally diverse Head Start families

In this study we examined the relationships between family demographics and level of satisfaction with school contact as possible determinants of multiple dimensions of family involvement in early childhood education. Participants included 171 urban, Head Start parents (108 mothers and 63 fathers). Results revealed that for mothers, having less than a high school education was negatively associated with levels of home-school conferencing. For fathers, primary language spoken in the home was associated with both levels of home-school conferencing and school-based involvement, with Polish- and Spanish-speaking fathers participating less compared with their English-speaking counterparts. In addition, fathers of boys reported higher levels of home-school conferencing. Involvement at school was significantly associated with level of satisfaction with school contact for both mothers and fathers. Multilevel analyses revealed parent gender and satisfaction as the most salient predictors of involvement at the level of the family. Implications for future research, as well as family involvement practice and policy, are discussed.     

Caregiver burden and family functioning in different neurological diseases

Aim of this study is to examine caregiver burden and family functioning in different neurological conditions. Forty-two primary caregivers of patients with Amyotrophic Lateral Sclerosis (ALS), Alzheimer’s Disease and other dementia (AD), Parkinson’s Disease (PD), Acquired Brain Injuries (ABI) and Multiple Sclerosis (MS) were administered scales for the evaluation of caregiver burden (CBI) and family functioning (FACES IV). Caregiver burden was overall high, with caregivers of patients with ALS and ABI having exceeded the CBI cut-off score for possible burn-out. The average scores of caregivers of patients with AD or other dementia and PD were close to the cut-off score, whereas those of caregivers of patients with MS were significantly lower than the others. Family cohesion, family satisfaction and the quality of family communication were associated with reduced levels of caregiver burden, whereas disengagement was associated with a higher burden. The data from the present study confirm that caregiver burden is a relevant issue in the context of neurological diseases, especially for those causing higher degrees of impairment. Significant correlations with family functioning emerged as well, highlighting the importance of studying and treating caregiver burden within the context of family relations.     

Childhood Healthcare Experience,Healthcare Attitudes,and Optimism as Predictors of Adolescents’ Healthcare Behavior

Late adolescence and early adulthood is a time when people establish many of their life-style behaviors. Thus, in order to promote optimal health, it is important to identify factors predictive of young adults’ healthcare behavior. This study evaluated the relationship between measures of childhood healthcare experience, healthcare attitudes, and optimism with young adults’ healthcare behavior in a sample of college students (n = 100). Results suggested that prior healthcare experience, attitudes about healthcare, and optimism are associated with current healthcare behavior. In addition, the relation between childhood healthcare experience and current healthcare behavior was moderated by optimism, such that those who reported both more negative childhood healthcare experiences and low levels of optimism reported the least adaptive healthcare behaviors and those who reported the most positive childhood healthcare experience and the highest levels of optimism reported the most adaptive healthcare behavior.     

Delivery of internet treatment for compulsive hoarding (D.I.T.C.H.)

This study tested the effectiveness of an existing private online CBT-based group intervention designed to help people with hoarding. Web-group participants were hypothesized to show more improvement in hoarding symptoms over time compared to those placed on a naturalistic waitlist. This web-based self-help group (N = 106 members, N = 155 waitlisted) includes a formal application process and requires that participants post action steps and progress at least once monthly. Members have access to educational resources on hoarding, cognitive strategies, and a chat-group. Potential research participants were invited to complete an anonymous web-based survey about their hoarding behaviors and clinical improvement on five occasions (3 months apart). The sample was mainly middle-aged, female and White. Regression analyses show that Recent members reported greater improvement and less clutter at 6 months (than Waitlist). Long-term members reported milder hoarding symptoms than Recent ones, suggesting benefits from group participation over time. All members showed reductions in clutter and hoarding symptoms over 15 months. Less posting activity was associated with greater hoarding severity. Online CBT-based self-help for hoarding appears to be a promising intervention strategy that may extend access to treatment. Evaluating the benefits of internet self-help groups is critical given growing popularity of and demand for web-based interventions.     

Qualitative Research in Marriage and Family Therapy: Who is in the Interview?

Qualitative interviews are a rich means of gathering information from families. The qualitative interviewer has a choice of interviewing individual family members, multiple family members at the same time, or a combination. The configuration of interviewees is a choice guided by the epistemology of the researcher, research aims, and questions. This article reviews the literature on interviewing different configurations of family members. A content analysis was conducted on articles in the marriage and family therapy literature from 1990 to 2005. Over half of the articles were conducted with individual family members separate from their families. This finding is discussed in the context of the decision regarding whom to interview.     

Childhood experience of illness as a risk factor for medically unexplained symptoms

Clinical experience suggests that a high proportion of patients with medically unexplained symptoms or somatoform disorders give histories of adverse childhood experiences. Previous work has reported that both personal and family experience of illness may be associated with later unexplained symptoms in the individual. Most of this research is subject to recall bias. This review explores data from the UK Medical Research Council National Survey of Health and Development, a population-based birth cohort study. The main finding of this work is that childhood experience of illness in parents is an independent risk factor for later unexplained symptoms. Personal experience of illness has a more complicated relationship. There is no evidence that severe physical disease in childhood is associated with later unexplained symptoms, but common childhood unexplained symptoms are predictors of symptoms in adulthood.     

Hope and Burden among Latino Families of Adults with Schizophrenia

This study examined hope and family burden among Latino families of individuals with schizophrenia. The sample consisted of 54 family members, one family member per outpatient adult recruited from public mental health programs in a diverse urban community. Hierarchical linear regression analyses were used to test the hypothesis that the family member's increased hope for the patient's future would be associated with decreased family burden beyond effects explained by the patient's length of illness and severity of symptoms. Results supported the study hypothesis. Family hope for the patient's future was associated with four of five types of family burden. Findings point to the prominent role of hope as a source of resilience for Latino families dealing with severe mental illness of a loved one.     

Neighborhood Disorder and Children’s Antisocial Behavior: The Protective Effect of Family Support Among Mexican American and African American Families

Using data from a sample of 673 Mexican Origin families, the current investigation examined the degree to which family supportiveness acted as a protective buffer between neighborhood disorder and antisocial behavior during late childhood (i.e. intent to use controlled substances, externalizing, and association with deviant peers). Children's perceptions of neighborhood disorder fully mediated associations between census and observer measures of neighborhood disorder and their antisocial behavior. Family support buffered children from the higher rates of antisocial behavior generally associated with living in disorderly neighborhoods. An additional goal of the current study was to replicate these findings in a second sample of 897 African American families, and that replication was successful. These findings suggest that family support may play a protective role for children living in dangerous or disadvantaged neighborhoods. They also suggest that neighborhood interventions should consider several points of entry including structural changes, resident perceptions of their neighborhood and family support.     

Nonreligious coping and religious coping as predictors of expressed emotion in relatives of patients with schizophrenia

Expressed emotion (EE) is a measure of the amount of criticism and emotional over involvement expressed by a key relative towards a relative with a disorder or illness. Research has established that living in a high EE environment, which is characterised by increased levels of critical and emotionally exaggerated communication, leads to a poorer prognosis for patients with a mental illness when compared to low EE environments. Despite evidence that EE is a strong predictor of the course of the illness, there continue to be questions concerning why some family members express excessive levels of high EE attitudes about their mentally ill relatives while others do not. Based on indirect evidence from previous research, the current study tested whether religious and nonreligious coping serve as predictors of EE. A sample of 72 family members of patients with schizophrenia completed an EE interview, along with questionnaires assessing situational nonreligious coping and religious coping. In line with the hypotheses, results indicated that nonreligious coping predicted EE. Specifically, less use of adaptive emotion-focused coping predicted high EE. Also consistent with predictions, maladaptive religious coping predicted high EE above and beyond nonreligious coping.     

A multilevel mediation model of stress and coping for women with HIV and their families

Families are influential systems and may be an important context in which to consider the stress and coping process. To date, many studies have focused on modeling the stress and coping process for the individual, isolated from the family. The purpose of this secondary analysis was to investigate a cross-sectional stress and coping model for HIV-positive African-American mothers recruited from HIV service facilities in South Florida (n=214) and their family members (n=294). Avoidance coping was hypothesized to mediate the relationship between stress and psychological distress. In addition, the family average of individual stress was hypothesized to moderate the relationship between avoidance coping and psychological distress. For all constructs, individuals reported on themselves and multilevel modeling techniques were used to account for similarities between members of the same family. The estimated mediation effect was significant. Aggregated family stress significantly moderated the relationship between avoidance coping and psychological distress. This study suggests that individuals exhibit different relationships between avoidance coping and psychological outcomes and that average stress reported by members of a family moderates the relationship between avoidance coping and psychological distress.     

Infant illness severity and family adjustment in the aftermath of NICU hospitalization

Up to 15% of parents have an infant who will spend time in a neonatal intensive care unit (NICU). After discharge, parents may care for a medically fragile infant and worry about their development. The current study examined how infant illness severity is associated with family adjustment. Participants included parents with infants who had been discharged from the NICU 6 months to 3 years prior to study participation (N = 199). Via a Qualtrics online survey, parents reported their infants’ medical history, parenting stress, family burden, couple functioning, and access to resources. Multivariable regression analyses revealed that more severe infant medical issues during hospitalization (e.g., longer length of stay and more medical devices) were associated with greater family burden, but not stress or couple functioning. Infant health issues following hospitalization (i.e., medical diagnosis and more medical specialists) were associated with greater stress, poorer couple functioning, and greater family burden. Less time for parents was associated with increased stress and poorer couple functioning. Surprisingly, parents of infants who were rehospitalized reported less stress and better couple functioning, but greater family burden. Family-focused interventions that incorporate psychoeducation about provider−patient communication, partner support, and self-care may be effective to prevent negative psychosocial sequelae among families.     

Links Between Life Course Trajectories of Family Dysfunction and Anxiety During Middle Childhood

Using data from three waves of a large Canadian data set, we examine the relationship between two middle childhood trajectory variables, family dysfunction and anxiety. We draw upon family systems theory and developmental psychopathology, while attempting to expand their boundaries by capitalizing on the strengths within both approaches. Our data treatment strategy, guided by the life course analytical framework, included separate multivariate logits to examine this relationship, with and without the extent to, which selected explanatory risk variables predicted belonging to the highest family dysfunction trajectory. We also explored possible interactions between anxiety and explanatory risk variables. Supporting our hypothesis, a prolonged duration of high doses of family dysfunction was associated with the most extreme developmental trajectories of anxious behavior during middle childhood for both boys and girls. This relationship prevailed above and beyond the influence of other correlates of family dysfunction such as marital transition, socioeconomic status, family size, and depressive symptoms experienced by the informant (mostly mothers). Specific details regarding the sample, characteristics of measures, and unspecified estimates and their standard errors per data source are available from the first author in the form of tables and figures.     

Stability of Family Interaction from Ages 6 to 18

Research has demonstrated the stability of juvenile offending during childhood and adolescence but generally has not focused on the continuity of family interactions associated with juvenile offending. The present report focused on the stability of several family interaction events and attributes (i.e., physical punishment, communication, supervision, positive parenting, and parent–child relationship) for a large sample of male adolescents and their primary caretakers, drawn from a multiyear longitudinal study that represented middle childhood through late adolescence (ages 6–18). We also assessed the impact of ethnicity, family composition, teenage motherhood, and youth delinquency on these interactions. Test–retest correlations and growth-curve analyses were used to assess relative and absolute stability of the interactions, respectively. As predicted, relative stability of family interaction was high. There was an absolute change in scores of physical punishment (decreased) compared to poor supervision and low positive parenting (both increased), whereas poor communication and bad relationship with the caretaker did not measurably change with age. Single-parent families and families with teenage mothers experienced significantly worse interactions over time than did families consisting of two biological parents present in the household. These findings are discussed in relation to the development of juvenile offending.     

Family Therapy and Childhood-Onset Schizophrenia: Pursuing Clinical and Bio/Psycho/Social Competence

Childhood-onset schizophrenia is perceived as more complicated because of its complexity, pervasive duration, and impact on individual and family functioning. Viewing the symptoms of childhood schizophrenia as creating a bio/psycho/social competence within which the therapist and family must interact may help contribute to treatment success. Competent family therapists working within this culture should be knowledgeable about the characteristics of childhood-onset schizophrenia, aware of their own biases towards psychosis, and skillful in its treatment. Guidelines are provided to help therapists identify their attitudes about schizophrenia and understand appropriate skills for treating the disorder.