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.     

Eye movement desensitization and reprocessing (EMDR) therapy in the treatment of victims of domestic violence: A pilot study

IntroductionThe purpose of this study was to determine the effectiveness of EMDR in reducing PTSD symptoms, anxiety and depression.MethodThirty-six women participated in this study; 12 were treated with EMDR, 12 received eclectic psychotherapy, and 12 were assigned to the control group.ResultWomen in the EMDR condition showed significantly reduced PTSD and anxiety compared with those in the eclectic psychotherapy condition. The two psychotherapy approaches led to significantly reduced scores (PTSD, depression, anxiety) after treatment compared to the control group. These effects were maintained at the 6-month follow-up. Finally, effect sizes for the IES and STAI scores were greater for the subjects in the EMDR condition.ConclusionThis study met our expectations in the sense that our findings confirm the advantages and the potential of EMDR.     

Chronic PTSD Treated With Metacognitive Therapy: An Open Trial

This paper reports on an open trial of metacognitive therapy (MCT) for chronic PTSD. MCT does not require imaginal reliving, prolonged exposure, or challenging of thoughts about trauma. It is based on an information-processing model of factors that impede normal and in-built recovery processes. It is targeted at modifying maladaptive styles of worry/rumination and attention so that emotional processing can proceed spontaneously. Eleven out of 13 patients with a mean duration of PTSD of 19.5 months completed treatment. Therapists followed the treatment manual by Wells and Sembi (2004b). Self-report measures of PTSD symptoms, anxiety and depression, and assessor ratings of PTSD were administered at pre- and posttreatment, and at 3- and 6-month follow-up. Treatment appeared to result in large and significant improvements on all measures of PTSD and general measures of anxiety and depression. Statistically significant treatment gains were maintained at 3- and 6-month follow-up. Jacobson's criteria for recovery showed that 90% of patients were recovered at posttreatment. At 6-month follow-up approximately 89% were recovered or reliably improved. Results suggest that MCT could be highly effective and extend evidence of its applicability to more treatment-resistant chronic PTSD cases. Comparisons against other active interventions are now clearly indicated.     

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.     

Psychological distress in the local hillsborough or ‘host’ community following the Hillsborough football stadium diaster

This paper describes levels of psychological distress and accounts of disaster among the local host community following the Hillsborough Football Stadium disaster. Thirty-two participants were interviewed 4–6 months after the event. Rates of psychological distress symptoms were high in the sample as measured by PTSD (DSM III criteria), Impact of Events Scale (IES) and the General Health Questionnaire (GHQ-28). The study also explores the relationships between levels of exposure, levels of distress and participants' accounts of the disaster. Implications for community outreach projects after disasters are discussed.     

The Göteborg discothèque fire, 1998

Findings from a study of 563 adolescents’ reactions following a discotheque fire that killed 63 young people in Göteborg in October 1998 are presented. The group answered a questionnaire seven months following the disaster. The questionnaire included the Impact of Event Scale (IES) and the Birleson Depression Self‐Rating Scale (DSRS). The level of trauma was found to be very high, while depression scores were less elevated. A little under a third of the students scored above a clinical cut‐off point (> 35) on the IES, indicating high posttraumatic stress levels. Girls evidenced more depression and traumatic stress reactions than boys. Levels of reactions increased with more closeness (knowing victims personally) and if the adolescents were of non‐Swedish origin.     

Cognitive-behavior therapy vs exposure therapy in the treatment of PTSD in refugees

The present study investigated the efficacy of cognitive-behavior therapy (CBT) and exposure therapy (E) in the treatment of post-traumatic stress disorder (PTSD) in refugees. Sixteen outpatients fulfilling the DSM-IV criteria for PTSD were randomized to one of the two treatments. Assessor and self-report measures of PTSD-symptoms, generalized anxiety, depression, quality of life and cognitive schemas were administered before and after treatment, and at a 6-month follow-up. The patients were treated individually for 16-20 weekly sessions. The results showed that both treatments resulted in large improvements on all the measures, which were maintained at the follow-up. There was no difference between E and CBT on any measure. E and CBT led to a 48 and 53% reduction on PTSD-symptoms, respectively, a 49 and 50% reduction on generalized anxiety, and a 54 and 57% reduction on depression. The results were maintained at the 6-month follow-up. The conclusion that can be drawn is that both E and CBT can be effective treatments for PTSD in refugees.     

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.     

Standardized Web-Based Cognitive Behavioural Therapy of Mild to Moderate Depression: A Randomized Controlled Trial with a Long-Term Follow-Up

Depression is common but undertreated. Web-based self-help provides a widely accessible treatment alternative for mild to moderate depression. However, the lack of therapist guidance may limit its efficacy. The authors assess the efficacy of therapist-guided web-based cognitive behavioural treatment (web-CBT) of mild to moderate depression. Fifty-four individuals with chronic, moderate depression participated in a randomized wait-list controlled trial, with an 18-month follow-up (immediate treatment: n = 36, wait-list control: n = 18). Primary outcome measures were the Beck Depression Inventory (BDI-IA) and the Depression scale of the Symptom Checklist-90-Revised (SCL-90-R. DEP). Secondary outcome measures were the Depression Anxiety Stress Scales and the Well-Being Questionnaire. Five participants (9%) dropped out. Intention-to-treat analyses of covariance revealed that participants in the treatment condition improved significantly more than those in the wait-list control condition (.011 < p < .015). With regard to the primary measures, between-group effects (d) were 0.7 for the BDI-IA and 1.1 for the SCL-90-R DEP. Posttest SCL-90- R DEP scores indicated recovery of 49% of the participants in the treatment group compared with 6% in the control group (odds ratio = 14.5; p < .004). On average, the effects were stable up to 18 months (n = 39), although medication was a strong predictor of relapse. The results demonstrate the efficacy of web-CBT for mild to moderate depression and the importance of therapist guidance in psychological interventions.     

Reducing teachers' psychological distress through a mindfulness training program

Teachers constitute one of the professional collectives most affected by psychological problems. The purpose of this quasi-experimental study is to examine the efficacy of a mindfulness training programme to reduce psychological distress in a group of teachers. The sample comprised 68 teachers of Secondary School Education, from various public schools; half of them formed the experimental group, and the another half the control group. The levels of psychological distress were measured, in both groups, by the Symptom Checklist-90-R (SCL-90-R) before and after the application of the programme. Statistical analysis shows the significant reduction of three general measures of psychological distress (Global Severity Index, Positive Symptom Distress Index, and Positive Symptom Total), as well in all its dimensions (somatization, obsessive-compulsive, interpersonal sensibility, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism), in the experimental group compared with the control group. Follow-up measures show that these results were maintained for four months after termination of the intervention in the experimental group.     

Cognitive Processing Therapy Versus Supportive Counseling for Acute Stress Disorder Following Assault: A Randomized Pilot Trial

The study tested the efficacy and tolerability of cognitive processing therapy (CPT) for survivors of assault with acute stress disorder. Participants (N = 30) were randomly allocated to CPT or supportive counseling. Therapy comprised six individual weekly sessions of 90-min duration. Independent diagnostic assessment for PTSD was conducted at posttreatment. Participants completed self-report measures of posttraumatic stress, depression, and negative trauma-related beliefs at pre-, posttreatment, and 6-month follow-up. Results indicated that both interventions were successful in reducing symptoms at posttreatment with no statistical difference between the two; within and between-group effect sizes and the proportion of participants not meeting PTSD criteria was greater in CPT. Treatment gains were maintained for both groups at 6-month follow-up.     

Religious Orientation, Mature Faith, and Psychological Distress: Elements of Positive and Negative Associations

There are substantial data exploring the link between religiousness and health, yet there is little consensus regarding the nature of the relationship between religiousness domains and mental health. The purpose of this study was to identify the types of mental health outcomes associated with religiousness domains. Participants included 251 ( M = 19.02; range = 17–25) young adults who completed self-report measures of religiousness (Intrinsic, Extrinsic, and Quest Orientations, Faith Maturity Scale), and psychological distress subscales (SCL-90-R). We identified significant relationships between each of the religiousness measures and the SCL-90-R subscales and analyzed the relative contributions of each of the religiousness measures in predicting psychological distress with hierarchical multiple regression. The Faith Maturity Scale was a particularly robust predictor of positive and negative psychological adjustment. The specific pathways by which religiousness influences mental health outcomes remain to be elaborated in future research.     

Cognitive therapy for post-traumatic stress disorder: development and evaluation

The paper describes the development of a cognitive therapy (CT) program for post-traumatic stress disorder (PTSD) that is based on a recent cognitive model (Behav. Res. Therapy 38 (2000) 319). In a consecutive case series, 20 PTSD patients treated with CT showed highly significant improvement in symptoms of PTSD, depression and anxiety. A subsequent randomized controlled trial compared CT (N = 14) and a 3-month waitlist condition (WL, N = 14). CT led to large reductions in PTSD symptoms, disability, depression and anxiety, whereas the waitlist group did not improve. In both studies, treatment gains were well maintained at 6-month follow-up. CT was highly acceptable, with an overall dropout rate of only 3%. The intent-to-treat effect sizes for the degree of change in PTSD symptoms from pre to post-treatment were 2.70-2.82 (self-report), and 2.07 (assessor-rated). The controlled effect sizes for CT versus WL post-treatment scores were 2.25 (self-report) and 2.18 (assessor-rated). As predicted by the cognitive model, good treatment outcome was related to greater changes in dysfunctional post-traumatic cognitions. Patient characteristics such as comorbidity, type of trauma, history of previous trauma, or time since the traumatic event did not predict treatment response, however, low educational attainment and low socioeconomic status were related to better outcome.     

Stress and coping: The Loma Prieta Earthquake

This study examined the stress response, coping strategies, and behavioral intentions of 185 subjects following the Loma Prieta Earthquake. Subjects completed a series of open ended questions about previous experience with earthquakes and their preparedness for previous and future earthquakes. The Impact of Event Scale (IES) and the Symptom Checklist, Version 90R (SCL-90R), were used to measure participants’ subjective stress response and symptoms of psychological distress at two days and either one week or three weeks following the earthquake. At one or three weeks, some subjects also completed the Coping Strategies Inventory. This study describes the stress response in this earthquake population and explores the relationship of the passage of time and past experiences with earthquakes to psychological distress following the earthquake. Coping strategies and behavioral intentions were also assessed. Results indicated that, although stress levels were elevated at the time of the initial testing, there were declines in reported stress as early as the one week follow-up session. Additionally, a number of gender differences were found in terms of the stress response to the earthquake.     

Meta-analysis of the efficacy and acceptability of cognitive-behavioural therapy for Arab adult populations experiencing anxiety,depression or post-traumatic stress disorder

A meta-analysis of the literature of cognitive behaviour therapy (CBT) with Arab adult populations experiencing anxiety, depression or post-traumatic stress disorder (PTSD) was conducted. Nine studies (n = 536) met the eligibility criteria. Three of the nine studies (33%) were randomised control trials using waitlist control groups. All studies (100%) reported a statistically significant reduction in psychological symptoms at post-treatment with large effect sizes for anxiety (effect size, 95% confidence interval) (1.44 [1.29, 1.59]), depression (1.26 [1.16, 1.35]) and PTSD (2.08 [1.94, 2.23]). Six out of the nine studies (67%) collated follow-up data and reported that reductions of psychological symptoms were maintained at follow-up. An average dropout rate of 26% indicated good overall acceptability. Five out of nine (55%) of the trials reported diagnostic remission rates and of those trials the mean remission rate was 31%). Five of the nine eligible studies (55%) delivered remotely via Internet or telephone were found to have similar effect sizes as face-to-face CBT. The current meta-analysis indicates the potential of CBT, delivered either face-to-face or via internet, as efficacious and acceptable interventions for the treatment of anxiety, depression and PTSD for Arab adult populations.     

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.     

Randomized controlled trial of yogic meditation techniques for patients with obsessive-compulsive disorder

The objective of this study was to compare efficacy of two meditation protocols for treating patients with obsessive-compulsive disorder (OCD). Patients were randomized to two groups-matched for sex, age, and medication status-and blinded to the comparison protocol. They were told the trial would last for 12 months, unless one protocol proved to be more efficacious. If so, groups would merge, and the group that received the less efficacious treatment would also be afforded 12 months of the more effective one. The study was conducted at Children's Hospital, San Diego, Calif. Patients were selected according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised (DSM-III-R) criteria and recruited by advertisements and referral. At baseline, Group 1 included 11 adults and 1 adolescent, and Group 2 included 10 adults. Group 1 employed a kundalini yoga meditation protocol and Group 2 employed the Relaxation Response plus Mindfulness Meditation technique. Baseline and 3-month interval testing was conducted using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Symptoms Checklist-90-Revised Obsessive Compulsive (SCL-90-R OC) and Global Severity Index (SCL-90-R GSI) scales, Profile of Moods scale (POMS), Perceived Stress Scale (PSS), and Purpose in Life (PIL) test. Seven adults in each group completed 3 months of therapy. At 3 months, Group 1 demonstrated greater improvements (Student's independent groups t-test) on the Y-BOCS, SCL-90-R OC and GSI scales, and POMS, and greater but nonsignificant improvements on the PSS and PIL test. An intent-to-treat analysis (Y-BOCS) for the baseline and 3-month tests showed that only Group 1 improved. Within-group statistics (Student's paired t-tests) showed that Group 1 significantly improved on all six scales, but Group 2 had no improvements. Groups were merged for an additional year using Group 1 techniques. At 15 months, the final group (N=11) improved 71%, 62%, 66%, 74%, 39%, and 23%, respectively, on the Y-BOCS, SCL-90-R OC, SCL-90-R GSI, POMS, PSS, and PIL; P<0.003 (analysis of variance). This study demonstrates that kundalini yoga techniques are effective in the treatment of OCD.     

Psychopathological Symptom Dimensions in Patients with Gastrointestinal Disorders

The current study aims to investigate the factorial validity of a widely used psychopathological rating scale, the Symptom Check List-90-R (SCL-90-R), in a group of patients suffering from gastrointestinal disorders, and to determine the specific psychopathological profiles that characterize the individual patient subgroups. Patients suffering from either irritable bowel syndrome, ulcerative colitis, non-erosive reflux disease or erosive reflux disease completed the SCL-90-R at a tertiary care gastroenterology department. Seven factors were identified, with one major distress factor and six minor factors. Comparison of the gastrointestinal disorder subgroups indicated that irritable bowel syndrome patients exhibited significantly more psychological distress compared to the other groups, and that gastrointestinal patients as a group, compared to healthy controls, were characterized by high levels of irritable depression and somatization. In planning further studies we encourage the use of factors identified in our study. The treatment of substantial irritable depression can be an important factor in improving quality of life in patients suffering from gastrointestinal disorders.     

Neuropattern: a new translational tool to detect and treat stress pathology. II. The Teltow study

The present study was designed to test the clinical utility of Neuropattern (NP), a newly developed translational diagnostic tool. NP consists of biological and psychological measures that facilitate the identification of functional changes (called "neuropatterns") in patients with stress-related health problems. In this prospective, randomized control trial, we expected NP to improve therapeutic efficacy, as compared with the usual treatment. NP was applied to 101 in-patients suffering from various mental disorders (mainly depression, anxiety disorders, and adjustment disorders), and scoring high on the Symptom Checklist-90-R (SCL-90-R) somatization scale. The patients (73% females, mean?±?standard deviation age 46?±?9.03 years) were randomly assigned to two groups: in the experimental group (n?=?51), physicians received results from NP diagnostics, while in the control group (n?=?50), this information was not available until discharge from the hospital. Improvements of symptoms in consequence of treatment were monitored by two self-rating scales, the SCL-90-R and Short Form-12 health survey, and a physician's clinical global rating (Beeintr?chtigungs-Schwere Score). There was a significantly greater improvement in the experimental group in the self-rating assessments on symptom severity (p?=?0.03) and quality of life (p?=?0.05), but not in the observer rating of emotional, physical, and social-communicative functioning (p?=?0.13). Treatment efficacy in patients can be improved by providing the attendant physician and the patient with diagnostic information and treatment recommendations by NP. The role of concrete mediators of treatment efficacy awaits further research.     

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.