Food and violence: Childhood violence and emotional abuse as complicating factors in the inpatient treatment of eating disorders

SUMMARY

This paper considers the treatment, on an inpatient eating disorders ward, of patients who have suffered violence and emotional abuse during childhood. The complex web of relationships surrounding these patients is discussed, and it is suggested that there are multiple transferences — to the institution, to various members of staff, and to other patients — and that splitting of these transferences is inevitable. Staff experience powerful countertransference feelings, related to the patient's violent history. A central task for the staff team as a whole is to understand and contain the patient's disturbance — taking on, tolerating, and processing the projections. This demands the close working-together of the members of the multidisciplinary team, so that staff can together openly examine the patient's interaction with them and their own emotional responses to the patient and to other members of staff. If these responses are not understood by the ward staff, they can lead to conflict and inappropriate decisions. On the other hand, if the staff team together can build up a picture of the patient's relationships on the ward, and their meaning for the patient, this picture, like a particular projection of the world in an atlas, provides a ‘map’ of the patient's inner world. This ‘map’ can be used by the staff team in navigating their interactions with the patient. It can also assist the psychotherapist in her work to help the patient recognise and, eventually, own the split-off parts of herself.     

Posttraumatic stress and worry as mediators and moderators between political stressors and emotional and behavioral disorders in Palestinian children

This study was designed to assess whether the symptoms of posttraumatic stress mediate or moderate the relationship between political stressors and emotional and behavioral disorders in Palestinian children. It was hypothesized that (a) posttraumatic stress and worry mediate the effect of political stressors on behavioral and emotional disorders and (b) the relationship between political stressors and behavioral and emotional disorders should be attenuated for children with low levels of worry and posttraumatic stress and strengthened for children with high levels of worry and posttraumatic stress. The total sample was 1267 school age children of both sexes with a mean age of 11.97 years. Interviews were conducted with children at school. As hypothesized, the results indicated that posttraumatic stress and worry mediated and moderated the relationship between political stressors and emotional and behavioral disorders in children. Cognitive-behavioral therapy may be used to reduce the incidence of posttraumatic stress and decrease self-reported worry, somatic symptoms, general anxiety, and depression among children exposed to political trauma. Cognitive-behavioral treatment that exclusively targets excessive worry can lead to clinical change in the other interacting subsystems at the cognitive, physiological, affective and behavioral levels.     

Attentional bias and emotional reactivity as predictors and moderators of behavioral treatment for social phobia

Cognitive behavioral therapy (CBT) is a well-established treatment for anxiety disorders, and evidence is accruing for the effectiveness of acceptance and commitment therapy (ACT). Little is known about factors that relate to treatment outcome overall (predictors), or who will thrive in each treatment (moderators). The goal of the current project was to test attentional bias and negative emotional reactivity as moderators and predictors of treatment outcome in a randomized controlled trial comparing CBT and ACT for social phobia. Forty-six patients received 12 sessions of CBT or ACT and were assessed for self-reported and clinician-rated symptoms at baseline, post treatment, 6, and 12 months. Attentional bias significantly moderated the relationship between treatment group and outcome with patients slow to disengage from threatening stimuli showing greater clinician-rated symptom reduction in CBT than in ACT. Negative emotional reactivity, but not positive emotional reactivity, was a significant overall predictor with patients high in negative emotional reactivity showing the greatest self-reported symptom reduction.     

Brief psychological treatments for emotional disorders in Primary and Specialized Care: A randomized controlled trial

Background/Objective Brief transdiagnostic psychotherapies are a possible treatment for emotional disorders. We aimed to determine their efficacy on mild/moderate emotional disorders compared with treatment as usual (TAU) based on pharmacological interventions. Method: This study was a single-blinded randomized controlled trial with parallel design of three groups. Patients (N = 102) were assigned to brief individual psychotherapy (n = 34), brief group psychotherapy (n = 34) or TAU (n = 34). Participants were assessed before and after the interventions with the following measures: PHQ-15, PHQ-9, PHQ-PD, GAD-7, STAI, BDI-II, BSI-18, and SCID. We conducted per protocol and intention-to-treat analyses. Results: Brief psychotherapies were more effective than TAU for the reduction of emotional disorders symptoms and diagnoses with moderate/high effect sizes. TAU was only effective in reducing depressive symptoms. Conclusions: Brief transdiagnostic psychotherapies might be the treatment of choice for mild/moderate emotional disorders and they seem suitable to be implemented within health care systems.     

Job-role quality and women's psychological well-being: Locus of control and social support as moderators

Despite the recognition that the stress-buffering effect of social support may in part be due to its relation to locus of control, no study on women's roles to date has considered both locus of control and social support in the prediction of psychological functioning. The present study was intended to test the three-way interaction between job-role quality, locus of control and support in relation to two measures of women's psychological well-being (happiness and symptoms of distress). This study was based on cross-sectional data. In the English sample of 109 employed women, the results provided evidence of the threee-way interaction between job challenge, locus of control and work support in predicting happiness. Neither locus of control nor work support independently moderated the effects of job challenge. However, locus of control and work support combined interactively to moderate the impact of job challenge on happiness. As predicted, support interacted with job challenge only for internals; no such interaction effect was observed for externals. For distress, no significant interaction was found.     

The disappointing gift: dispositional and situational moderators of emotional expressions

Inferences about emotions in children are limited by studies that rely on only one research method. Convergence across methods provides a stronger basis for inference by identifying method variance. This multimethod study of 116 children (mean age = 8.21 years) examined emotional displays during social exchange. Each child received a desirable gift and later an undesirable gift after performing tasks, with or without mother present. Children’s reactions were observed and coded. Children displayed more positive affect with mother present than with mother absent. Independent ratings of children by adults revealed that children lower in the personality dimension of Agreeableness displayed more negative emotion than their peers following the receipt of an undesirable gift. A curvilinear interaction between Agreeableness and mother condition predicted negative affect displays. Emotional assessment is discussed in terms of links to social exchange and the development of expressive behavior.     

Parents as moderators of psychological and physiological correlates of inner-city children's exposure to violence

This paper discusses the psychological and physiological correlates of inner-city violence on children, and the potential mediating and moderating roles of parents. Data are based on interviews regarding exposure to community violence (ECV), parenting practices, child distress, posttraumatic symptomology, and competence. Cardiovascular activation was also measured. Community violence exposure related to distress, posttraumatic symptomology, and incompetence. Harsh parenting related to aggression, distress, incompetence, and higher heart rates. Parenting moderated but did not mediate the effects of violence on measures of competence. High violence plus harsh parenting predicted lower levels of systolic (SBP) and diastolic blood pressure (DBP). Results are discussed within an ecological framework of parent–child relations and as they relate to the conclusion that children undergoing dual levels of stress may experience a dissociative response.     

Parental drinking problems and children's adjustment: vagal regulation and emotional reactivity as pathways and moderators of risk.

Children's emotional regulation (as indexed by vagal suppression) and children's emotional reactivity during an argument were examined as moderators and mediators of parental problem drinking and children's adjustment in a sample of 6- to 12-year-olds. Cardiac vagal tone was assessed during both a baseline condition and exposure to an audiotaped argument. Vagal suppression was calculated by subtracting vagal tone during the baseline from that recorded during the argument, with a higher number representing increased suppression of vagal tone during the argument. Emotional reactivity was based on both observations of overt behaviors of children and their reported feelings during the argument. A higher level of vagal suppression was a protective factor against children's externalizing, internalizing, and social problems associated with exposure to parental problem drinking. Emotional reactivity was a vulnerability factor, and children's increased anger and fear, and to a lesser degree sadness, each moderated and exacerbated the effects of parental problem drinking on child outcomes.     

A constructionist account of emotional disorders

Lindquist et al. present a strong case for a constructionist account of emotion. First, we elaborate on the ramifications that a constructionist account of emotions might have for psychiatric disorders with emotional disturbances as core elements. Second, we reflect on similarities between Lindquist et al.'s model and recent attempts at formulating psychiatric disorders as networks of causally related symptoms.     

Self‐esteem and emotional health in adolescents – gender and age as potential moderators

Moksnes, U. K. & Espnes, G. A. (2012). Self‐esteem and emotional health in adolescents – gender and age as a potential moderators. Scandinavian Journal of Psychology 53, 483–489. The present paper investigates possible gender and age differences on emotional states (depression and anxiety) and self‐esteem as well as the association between self‐esteem and emotional states. The cross‐sectional sectional sample consists of 1,209 adolescents 13–18 years from public elementary and secondary schools in mid‐Norway. The results showed that girls reported higher scores on state anxiety and state depression, whereas boys consistently scored higher on self‐esteem in all age groups. Self‐esteem was strongly and inversely associated with both state depression and state anxiety. An interaction effect of gender by self‐esteem was found on state depression, where the association was stronger for girls than for boys. The associations found give support for the positive role of self‐esteem in relation to adolescents’ emotional health and well‐being.     

Family factors associated with attention deficit hyperactivity disorder and emotional disorders in children

Few well-controlled studies have identified psychosocial profiles of families of boys with ADHD and boys with emotional disorders compared with normal controls. However, the clinical and theoretical literature pinpoints four domains in which distinctive profiles would be expected to occur. In this study, twenty-two mothers and thirteen fathers of twenty-two boys with ADHD; twenty mothers and fifteen fathers of twenty boys with a mood or anxiety disorder; and twenty-six mothers and sixteen fathers of twenty-seven normal controls were compared on: (1) stress, support and quality of life; (2) current family functioning; (3) parenting style and satisfaction in the family of origin and current family; and (4) current and past parental functioning. The two clinical groups showed higher levels of stress and lower levels of both social support and quality of life than did normal controls. Both clinical groups showed deficits in current family functioning, but contrary to expectations the ADHD and emotional disorder group did not show distinctly different profiles. Parents of ADHD children reported higher levels of authoritarian parenting styles, and parents from both clinical groups reported less parenting satisfaction than did normal controls in both their current families and their families of origin. Parents of children with ADHD and emotional disorders reported greater parenting satisfaction in their families of origin than in their current families. This discrepancy was greatest for parents of ADHD children. Parents of children with ADHD and emotional disorders reported greater psychological health problems and more childhood ADHD symptomatology than did normal controls. Parents of children with ADHD and emotional disorders have significant psychosocial difficulties in family and personal functioning. Family intervention is highly appropriate for families with children who are referred for help with both types of difficulties.     

The users of an online psychological advice service: a sociodemographic analysis

Although online psychological services and research based on them are increasing rapidly, it is not that easy to find investigations that focus on the kind of people that demand them. To know their profile could help to improve the online psychological services that are offered to them. For this purpose, we analysed the sociodemographic characteristics of 1052 participants, all of them having posed a psychological question to our online advice service. The relations between sociodemographics and variables related to the psychological consultation are analysed herein. Features such as age distribution, a high proportion of long-term problems, the large quantity of questions from Latin America, or the under representation of the lowest socioeconomic and educational levels could lead to clinical, social and legal implications that we comment on in this work.     

Gender and family factors as predictors of late adolescent emotional expressiveness and adjustment: A longitudinal study

This study examined the longterm effects of the socialization of emotion in a sample of European American families. Late adolescents, whose families had been more emotionally expressive and accepting of emotions when they were in fifth grade, were more likely to report showing emotions not traditionally associated with their gender roles—specifically, males reported a greater propensity for crying, and females reported a greater tendency to express anger. In addition, in late adolescence, greater frequency of showing fear and showing warmth or affection were associated with higher levels of social and psychological adjustment—whereas crying was associated with better adjustment for males and poorer adjustment for females. Overall, adolescent females tended to report a higher level of emotional expressiveness and a higher level of family support of emotions than did adolescent males.     

Conflict over emotional expression: psychological and physical correlates

This study addresses the construct of conflict or ambivalence over emotional expression. Ambivalence is seen as an important mediator in the link between emotional styles and psychological and physical well-being. Using the "personal striving" framework, a questionnaire measure of ambivalent emotional strivings (AEQ) was designed. In Study 1, 292 Ss completed this measure along with questionnaire measures of expressiveness, social desirability, and intense ambivalence. Women scored significantly higher than men on both the AEQ and expressiveness. In Study 2, scores on the AEQ were found to be negatively correlated with self-reported and peer-rated expressiveness. In Study 3, 48 Ss participated in a 21-day study of mood and health. Expressiveness was positively correlated with some measures of well-being and with daily negative affect. Ambivalence was positively correlated with several indices of psychological distress. Although the AEQ correlated with questionnaire measures of physical symptomatology, neither the AEQ nor the expressiveness measures correlated with daily symptom reports. Results support the contention that conflict over emotional expressiveness is a variable worthy of study in its own right, having implications for research on personality and health.     

Individual differences in emotional complexity: their psychological implications

Two studies explored the nature and psychological implications of individual differences in emotional complexity, defined as having emotional experiences that are broad in range and well differentiated. Emotional complexity was predicted to be associated with private self-consciousness, openness to experience, empathic tendencies, cognitive complexity, ability to differentiate among named emotions, range of emotions experienced daily, and interpersonal adaptability. The Range and Differentiation of Emotional Experience Scale (RDEES) was developed to test these hypotheses. In Study 1 (N=1,129) students completed questionnaire packets containing the RDEES and various outcome measures. Study 2 (N=95) included the RDEES and non-self-report measures such as peer reports, complexity of representations of the emotion domain, and level of ego development measured by a sentence completion test. Results supported all of the hypotheses, providing extensive evidence for the RDEES's construct validity. Findings were discussed in terms of the role of emotional complexity in ego maturity and interpersonal adaptability.     

Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial

This study further evaluates the efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP). A diagnostically heterogeneous clinical sample of 37 patients with a principal anxiety disorder diagnosis was enrolled in a randomized controlled trial (RCT) involving up to 18 sessions of treatment and a 6-month follow-up period. Patients were randomly assigned to receive either immediate treatment with the UP (n=26) or delayed treatment, following a 16-week wait-list control period (WLC; n=11). The UP resulted in significant improvement on measures of clinical severity, general symptoms of depression and anxiety, levels of negative and positive affect, and a measure of symptom interference in daily functioning across diagnoses. In comparison, participants in the WLC condition exhibited little to no change following the 16-week wait-list period. The effects of UP treatment were maintained over the 6-month follow-up period. Results from this RCT provide additional evidence for the efficacy of the UP in the treatment of anxiety and comorbid depressive disorders, and provide additional support for a transdiagnostic approach to the treatment of emotional disorders.     

A new perspective on psychological resources: Unanticipated consequences of impulsivity and emotional intelligence

In this study, we sought to understand why people engage in these two forms of voluntary and discretionary behaviours. Expanding upon key resource theories to include individual abilities, we examined the idea of incongruence between resources and behaviours (i.e., resources that have been traditionally framed with a positive tone lead to negative behaviours and resources that have been traditionally framed with a negative tone lead to positive behaviours). Data from 234 employees revealed that impulsivity positively influenced organizational citizenship behaviours, and that emotional intelligence (EI) significantly contributed to deviant workplace behaviours. Post hoc analysis revealed that the ability to perceive emotions was the most influential branch of EI in predicting deviant behaviours. We thus found a non‐compatible view of the individual resources–behaviour relationship, such that ‘positive’ personal resources lead to negative behaviours and ‘negative’ personal resources lead to positive behaviours. Implications for research and practice are discussed.