A randomized clinical trial on the effectiveness of a reintegration training program versus booster sessions after short-term inpatient psychotherapy

Although several studies show symptomatic improvements in patients with personality disorders after short-term inpatient psychotherapy, reintegration remains difficult. In this study the effectiveness of a specifically designed reintegration training program is investigated. One hundred twenty-eight patients were randomized to either a reintegration training program aimed at improving general functioning and work resumption, or booster sessions. Outcome measures used were symptom level, work status, absence from and impediments at work. The results showed that compliance in the booster session group was significantly better than in the reintegration training program. The percentage of persons with a paid job increased during the booster sessions from 64 to 87%, but not during the reintegration training (76%). There were no differences in the other outcome measures. We concluded that reintegration training was not more (cost)-effective than booster sessions. Our hypothesis is that continuity of care (same therapists and program) explains the favorable results of the booster sessions.     

The Effect of an Ethical Decision-Making Training on Young Athletes’ Attitudes Toward Doping

This article examines whether a training program in ethical decision making can change young athletes’ doping attitudes. Fifty-two young elite athletes were randomly assigned to either an ethical decision-making training group or a standard-knowledge-based educational program group. Another 17 young elite athletes were recruited for no-treatment control purposes. The ethical decision-making training comprised six 30-min online sessions in which the participants had to work through 18 ethical dilemmas related to doping. The standard-knowledge-based educational program was also conducted in six online sessions of comparable length to that of the ethical training. A short version of the Performance Enhancement Attitude Scale was administered to measure the effects of the trainings on doping attitude. Prior to as well as after the intervention, the mean doping attitude scores of the young athletes were low to very low, indicating vehement rejections of doping. The results of our experiment showed that the ethical training led to an attenuation of these rejections. No intervention effect was found in the standard education group. The observed slight increase in the doping attitude score could be an indication that the ethical decision-making training was successful in breaking up the athletes’ stereotypical style of reasoning about doping.     

A Healthy Lifestyle Program for the Treatment of Obesity in Minority Men

Historically, minority males have had limited success in programs designed to reduce weight. Twenty-five obese minority males participated in a healthy lifestyle program designed to treat essential hypertension, hyperlipidemia, type II diabetes, obesity, and hypothyroidism. Coined the LE ³ AN Lifestyle Program (emphasizing healthy lifestyles, realistic exercise, reasonable expectations and emotions, attitudes, and nutrition), the program offered a treatment model that involved reasonable low-intensity short exercise regimens, instruction, and extensive practice in making healthy food choices, behavior modification, and self-monitoring techniques coupled with guidance on realistic weight loss and exercise expectations. The participants were able to lose 13 Ib during the inpatient plus day treatment phases of the program and continued to maintain a 19-lb weight loss at 12 months. A program overview, case examples, and suggestions to improve outcome efficacy with difficult to manage obese, minority, male patients are provided.     

Emotions as wishes and beliefs

Emotions can be assessed by means of different diagnostic methods, for example, by self-report instruments, ratings of facial expressions, or by projective techniques. This study presents an alternative approach: a computerized investigation of verbally expressed emotions by means of the Affective Dictionary Ulm (ADU; Dahl, H?lzer, & Berry, 1992), which was applied to responses in the Holtzman Inkblot Technique (HIT; Holtzman, 1988; Holtzman, Thorpe, Swartz, & Herron, 1961). A normal group (n = 30), patients with neurotic disorders (n = 30), borderline patients (n = 30), acute schizophrenics (n = 25), and chronic schizophrenics (n = 25) were compared in regard to verbally expressed emotions. According to the results, patients with neurotic disorders did not differ from the normal group in regard to verbally expressed emotions. Borderline patients expressed fear and emotions in general significantly more frequently than all other diagnostic groups. Furthermore, borderline patients differed in regard to specific emotions from patients with neurotic disorders, acute schizophrenics, and chronic schizophrenics. Acute schizophrenics did not differ from the normal group in regard to the expression of emotions, whereas chronic schizophrenics expressed anger, fear, anxiety, and emotions in general significantly less frequently than normals. By a discriminant analysis using verbally expressed emotions as predictors of the diagnosis, hit rates between 87% and 100% could be achieved. Furthermore, hypotheses about correlations between emotions on the one hand and internalized primitive object relations and bizarre-idiosyncratic thinking were tested empirically. Significant correlations could be demonstrated. These results support the validity of assessing emotions through a lexical content analysis of the HIT by use of the ADU.     

The effect of affective bibliotherapy on clients' functioning in group therapy

Abstract The effect of affective group bibliotherapy (GB) was compared to affective group therapy (GT) on patients' functioning in therapy and their session impression. Three small groups totaling twenty-five in-patients in a hospital in Israel participated in the study. Clients concurrently participated in both group types, undergoing three sessions in each condition. In-therapy behaviors were assessed through the Client Behavior System (CBS; Hill & O'Brien, 1999). Results indicated that in the GB condition compared to the GT condition, clients showed less resistance, used simple responses less frequently, and expressed greater affective exploration. The Session Evaluation Questionnaire (SEQ; Stiles et al., 1994) was used to measure clients' impressions of the sessions. Results indicated that patients evaluated the two treatment conditions equally. Overall, the results support earlier findings, suggesting that affective bibliotherapy can be an effective method of treatment.     

What are the combined effects of negative emotions and illness cognitions on self-care in people with type 2 diabetes? A longitudinal structural equation model

Objective: To explore whether negative emotions mediate the effect of diabetes cognitions on diabetes self-care and conversely whether diabetes cognitions mediate the effect of negative emotions on diabetes self-care.

Design: Longitudinal observational study in adults with type 2 diabetes.

Main outcome measures: Self-reported depression and anxiety (Diabetes Wellbeing Questionnaire), cognitions (Illness Perceptions Questionnaire-Revised; Beliefs about Medicines Questionnaire), and diabetes self-care (Summary of Diabetes Self-Care Activities Scale) were completed at baseline and six months. Analyses used structural equation modelling.

Results: Baseline medication concerns were associated with elevated symptoms of depression and anxiety at follow-up, but emotions did not mediate medication concern’s effect on diabetes self-care. Baseline depression and anxiety symptoms were associated with specific diabetes cognitions over time, but these cognition domains did not mediate emotion’s effect on diabetes self-care. Personal control remained independent of emotions and was associated with diabetes self-care over time.

Conclusions: Negative emotions did not act directly or alongside cognitions to influence diabetes self-care. The reciprocal relationship between diabetes cognitions and emotions suggests cognitive restructuring, in addition to other mood management intervention techniques would likely improve the emotional wellbeing of adults with type 2 diabetes. Likewise, personal control beliefs are likely important intervention targets for improving self-care.     

Measuring optimism bias among military personnel

High numbers of young military personnel die due to road traffic collisions (RTCs). Yet, there is a paucity of research related to the contributing factors (i.e., optimism bias and willingness to take risks) associated with RTCs and the examination of road safety education program tailored at reducing young military fatalities. In order to address this gap in the literature, we examined one specific road safety educational intervention tailored for the UK military personnel and investigated their attitudes towards the program, optimism bias and willingness to take risks. Measures evaluating their optimism bias, willingness to take risks and attitudes towards the program were asked after the participants attended the road safety interventions. The results revealed that young military personnel, aged 18–25, had higher optimism bias and willingness to take risks compared to older military personnel, and that this effect diminishes with age. The results provide importance evidence related to military personnel’s attitudes to risk-taking.     

The Psychoanalytic Study of the Child,Volume VI Edited by Ruth S. Eissler,Anna Freud,Heinz Hartmann,Ernst Kris

Abstract

The effect of affective group bibliotherapy (GB) was compared to affective group therapy (GT) on patients’ functioning in therapy and their session impression. Three small groups totaling twenty–five in–patients in a hospital in Israel participated in the study. Clients concurrently participated in both group types, undergoing three sessions in each condition. In–therapy behaviors were assessed through the Client Behavior System (CBS; Hill &; O’Brien, 1999). Results indicated that in the GB condition compared to the GT condition, clients showed less resistance, used simple responses less frequently, and expressed greater affective exploration. The Session Evaluation Questionnaire (SEQ; Stiles et al., 1994) was used to measure clients’ impressions of the sessions. Results indicated that patients evaluated the two treatment conditions equally. Overall, the results support earlier findings, suggesting that affective bibliotherapy can be an effective method of treatment.     

Internalization of the therapeutic process: differences between borderline and neurotic patients

Intersession process in psychotherapy refers to the thoughts, memories, and feelings about each other and about their therapy sessions that participants experience during the intervals between sessions. This study compared the intersession process experienced by patients who had been diagnosed with severe borderline personality disorders (BPD) with others who had not. A total of 76 patients with neurotic disturbances and 20 patients with BPD were treated in a therapeutic day clinic and completed the Intersession Experience Questionnaire (IEQ) before sessions of individual psychotherapy and the Session Questionnaire (Stundenbogen) after those sessions. Comparison of the two groups on these measures of intersession process and postsession outcome showed markedly different patterns in patients' evaluations and internalizations of in-session therapeutic experiences: most prominently, that BPD patients internalize therapy sessions with much more negative and contradictory emotions.     

Motivations underlying attitudes: regulatory focus and majority versus minority support

Drawing on regulatory focus theory, the present work examined the motivations underlying intergroup attitudes expressed under conditions of majority versus minority support. In two studies, participants expressed their attitudes towards equality and non‐discrimination of foreigners and were informed that the equality and non‐discrimination principle was supported by either a majority or a minority. Regulatory focus was assessed as the extent to which participants felt promotion‐related and prevention‐related emotions when acting either inconsistently or consistently with the egalitarian principle. Results provided evidence supporting the hypothesis that attitudes are related to prevention emotions when supported by a majority, but to promotion emotions when supported by a minority. Copyright © 2007 John Wiley & Sons, Ltd.     

Improving the psychosocial wellbeing of international students: the relevance of mindfulness

ABSTRACT

In this study we analysed the potential of a mindfulness programme for improving psychosocial wellbeing among students at a Dutch university. Based on interviews and observations of sessions, the study demonstrated that students joined the programme to manage stress and anxiety, cultivate self-awareness, and regulate difficult emotions. They all reported positive outcomes, but students who participated in the sessions regularly and did the homework assignments reported better outcomes, including enhanced self-awareness, self-care, and positive attitudes towards others. Although students reported improved emotion regulation, many still believed that the programme was less strong in this area. The study affirms the potential of mindfulness programmes for improving the psychosocial wellbeing, and builds a case for the integration of mindfulness interventions in university counselling services.     

A comparative study of the impact of education vs. process groups for families of patients with affective disorders

This clinical project compares the relative impact of two types of multiple family groups on psychiatric inpatients and their families. Forty patients with a diagnosis of affective disorder, and their family members, were randomly assigned to a traditional multiple family group with a process orientation that emphasized support, destigmatization, and self-help about common problems; or to a psychoeducational multiple family group that emphasized the provision of information about the patient's illness and methods of coping with it effectively. Both groups, which met for four hours on a Saturday afternoon, were an integral part of an ongoing inpatient program specializing in the treatment of affective disorders. Pre- and post-measures were obtained regarding family and patient knowledge about affective disorders, level of personal distress, attitudes about the illness, and dyadic adjustment. In addition, both patients and family members were asked to rate their satisfaction with the group experience. A number of differences in knowledge, attitude and dyadic adjustment were found in the participants of both groups immediately following their respective group sessions, but there were only a few statistically significant differences between the two groups. Those who attended the psychoeducational session, however, reported significantly more satisfaction with the experience.     

Pro‐peace or anti‐war: The effect of emotions primed by protest songs on emotions toward in‐group and out‐group in conflict

Members of societies in conflict hold stable positive and negative views, and emotions of the in‐group and out‐group, respectively. Music is a potent tool to express and evoke emotions. It is a social product created within a social and political context, reflecting, and commenting it. Protest songs aim to change views and attitudes toward ongoing conflicts. Their message may be expressed positively (pro‐peace songs) or negatively (anti‐war songs). Previous research has shown that evoking emotions such as guilt toward the in‐group or empathy toward the out‐group may influence attitudes toward reconciliation. The present research, conducted in Israel, presents three studies investigating whether emotions evoked by positive or negative protest songs may influence in‐group members' guilt toward the in‐group (Israeli Jews) and empathy toward the out‐group (Palestinians). Studies 1 and 2 show that negative emotions evoked by negative protests songs predicted both empathy and guilt when the out‐group is considered as a whole (Study 1) or as a particular individual (Study 2). Study 2 in addition showed that empathy predicts an altruistic decision regarding an out‐group member. Emotions evoked by lyrics alone (Study 3) did not contribute to explained variance in either guilt or empathy, nor the altruistic decision. Results suggest that negative emotions expressed by negative protest songs, focused on the in‐group, are more effective in influencing attitudes toward out‐groups. Results are discussed in the context of group emotions in conflict and the role of protest songs in intergroup relations.     

An assessment of the effectiveness of an intergenerational program for youth

The purpose of this research was to assess the effectiveness of an intergenerational program for youth. Findings indicated that, after participating in the program, youth had more favorable attitudes toward the elderly and more knowledge of the aging process than youth in the control group. The program did not appear to have a direct effect on participants' willingness to volunteer, although results indicated that willingness to volunteer may increase indirectly through the improved attitudes of participants toward the elderly.     

Personal models of diabetes and their relations to self-care activities

Investigated the personal models of diabetes held by 46 female outpatients with non-insulin-dependent diabetes mellitus. The subjects' mean age was 64 years (range = 46 to 79 years), and 24 subjects were taking insulin. Their personal models were explored by using a comprehensive interview including questions on beliefs and emotions about cause, symptoms, course, treatment, and consequences of their diabetes. Two weeks after their interview, patients provided information about their levels of self-care activities, including exercise, diet, and glucose testing. The interview provided multiple indicators of the personal-model constructs from which four composites were formed assessing cause, symptoms, treatment, and seriousness (a combination of course and consequences). In hierarchical multiple-regression analyses, these dimensions significantly improved the prediction of diet level and marginally improved the prediction of exercise after accounting for the effects of age and insulin taking. The results are discussed in terms of variations in personal models across different patient groups and diseases and the role of personal models in determining self-care behaviors.     

A bright side of sadness: The depolarizing role of sadness in intergroup conflicts

Intractable conflicts constitute violent and threatening environments that lead to intense emotions and polarized attitudes. Sadness is one emotion frequently elicited by the price of such conflicts. This investigation characterized the effects of sadness on conflict‐related information processing and attitudes in the Israeli–Palestinian conflict. Findings from four experimental studies suggest that both incidental and integral sadness can induce a depolarization of political attitudes. In Study 1 (N = 163), sadness reduced the effect of political ideology on conflict‐related decisions. Sadness reduced the effect of political ideology on in‐group bias in resource allocation in Studies 2 (N = 213) and 4 (N = 274), willingness to negotiate in Studies 1 and 3 (N = 174), and openness to information supporting the out‐group's perspective (Study 4). Overall, in addition to its more negative implications, these results suggest that sadness (compared to both the non‐emotional and anger conditions) may have a bright side, since it may induce depolarization of political attitudes in intractable conflicts.     

Validation of the Spanish version of the Frankfurt Emotion Work Scales

This study presents the validity and reliability analysis of a questionnaire that assesses emotion work in the service sector. Emotion work is a term introduced by Hochschild (1983) and it refers to the expression of organizationally desirable emotions to influence the interactions with clients at work. The results show a 6-factor structure: Requirement to display Positive, Negative and Neutral Emotions, Sensitivity Requirements, Interaction Control and Emotional Dissonance. The analysis of the sub-scale scores reveals that the most frequently expressed emotions are positive, whereas negative emotions are expressed less frequently.     

Behavioural aspects of the management of diabetes mellitus: Education,self-care and metabolic control

A review is presented of factors relevant to the level of the knowledge, self-care and metabolic control of diabetic patients. Methods of assessing each of these are described, and ways of improving them reviewed. Recommendations are made for further work in this field.It is suggested that traditional education programmes have little clinical value beyond improving knowledge about diabetes. Among the recommendations made are approaches to the assessment and change of relevant health beliefs, and the use of behavioural methods of self-regulation, to improve the quality of self-care. The difficulties created by the variety of factors influencing metabolic control are discussed, with particular attention to the relevance of emotional stress.     

The Formation of Attitudes Toward New Immigrant Groups1

People often receive information about new immigrant groups prior to any direct contact with group members. However, it is not clear how this information shapes attitudes toward the groups. To explore this issue, 204 subjects were told about an unknown immigrant group that was presented as high or low in personal relevance. Subjects were then given positive or negative consensus information about the emotions that group members elicit from others, group members' personality traits, and group members' values. As expected, results indicated that the presentation of positive information about emotional reactions, personality traits, and values caused attitudes to be more favorable than did the presentation of negative information. Importantly, however, the combined impact of the emotion and personality trait information depended on whether the group was perceived to be of high or low personal relevance. Specifically, when the information about emotions and personality traits was similarly valanced (i.e., both were positive or both were negative), attitudes toward the group tended to be less favorable in the high personal relevance condition than in the low personal relevance condition. In contrast, when mixed information was presented (i.e., positive emotions and negative personality traits or negative emotions and positive personality traits), attitudes tended to be more favorable in the high personal relevance condition. In addition, attitudes, once formed, predicted further perceptions of the group and behavioral intentions toward group members. The implications of the findings for the reduction of prejudice toward new immigrant groups are discussed.     

Is Expressed Emotion an Index of a Transactional Process? I. Parents' Affective Style

The degree to which expressed emotion (EE) attitudes in key relatives reflect ongoing transactional processes in families is a topic of controversy. The associations between EE attitudes, as measured during an acute hospitalization (using the Camberwell Family Interview) and during the aftercare period (using 5-minute speech samples), and interactional behavior in parents of recent-onset schizophrenics (this article) and in patients themselves (second article), were investigated. In the first study, EE attitudes manifested by parents during the aftercare period were stronger correlates of their interactional behaviors during the aftercare period than were EE attitudes measured during the inpatient period, despite the frequent correspondence between the two EE measures. The pattern of attitudes shown between the inpatient and outpatient periods also predicted transactional styles in parents during the outpatient period, findings not accounted for by clinical attributes of patients. When high-EE attitudes persist during the aftercare period and are reflected in transactional behaviors, the risk for subsequent patient relapse may be enhanced.