The Role of Intrusive Imagery in Hoarding Disorder

Despite the incidence of trauma in the histories of people with Hoarding Disorder (HD), reexperiencing symptoms, namely intrusive images, have not been investigated in the condition. To address this, 27 individuals who met DSM-5 criteria for HD and 28 community controls (CCs) were interviewed about (a) their everyday experiences of intrusive imagery, and (b) the unexpected images they experience when discarding high- and low-value possessions. Compared to CCs, everyday images described by the HD group were more frequent, had a greater negative valence, and were associated with greater interference in everyday life and attempts to avoid the imagery. With regard to discard-related imagery, a MANOVA followed up with mixed ANOVAs showed that HD participants reported more negative experiences of intrusive imagery in comparison with CCs during recent episodes of discarding objects of low subjective value. However, HD and CC participants both experienced positive imagery when discarding high-value objects. CC participants reported greater avoidance of imagery in the high-value object condition, but imagery-avoidance did not change between conditions for HD participants. The findings are discussed, particularly in relation to the potential of imagery-based interventions for HD.     

Near-Death Experiences in a Multi-religious Hospital Population in Sri Lanka

Near-death experiences (NDEs) are a wide range of experiences that occur in association with impending death. There are no published studies on NDEs in general hospital populations, and studies have been mainly conducted on critically ill patients. We assessed the prevalence of NDEs and its associations in a multi-religious population in a general hospital in Sri Lanka. A randomised sample of patients admitted to the Colombo North Teaching Hospital was assessed using the Greyson NDE scale and clinical assessment. Out of total 826 participants, NDEs were described by 3%. Compared to the NDE-negative participants, the NDE-positive group had a significantly higher mean for age and a ratio of men. Women reported deeper NDEs. Patients of theistic religions (Christianity, Islam and Hinduism) reported significantly more NDEs compared to patients from the non-theistic religious group (Buddhism). NDE-positive patient group had significantly higher reporting of a feeling ‘that they are about to die’, the presence of loss of consciousness and a higher percentage of internal medical patients. This is the first time that NDEs are assessed in a general hospital population and NDEs being reported from Sri Lanka. We also note for the first time that persons with theistic religious beliefs reported more NDEs than those with non-theistic religious beliefs. Medical professionals need to be aware of these phenomena to be able to give an empathic hearing to patients who have NDE.     

Psychometric Properties of the Depressive Experiences Questionnaire in a College Population

The Depressive Experiences Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976) was developed to permit the study of the continuities between normal and pathological forms of depression. Since its publication over 10 years ago, the DEQ has been increasingly used in a wide range of investigations of depression in clinical and nonclinical samples and as a measure of two major personality dimensions in a number of studies of differential responsiveness to various life stressors. This study provides an analysis of the DEQ responses in a large sample of undergraduate subjects in an attempt to articulate more clearly the psychometric properties of the DEQ. The DEQ consists of 66 items describing experiences frequently reported by depressed individuals. In the original development of the DEQ, factor analyses using male and female undergraduate samples yielded three orthogonal factors, Dependency, Self-Criticism, and Efficacy (Blatt et al., 1976). Most subsequent studies have used the factor scoring coefficients from the female sample to score men and women's DEQs. The factor loadings in the new male and female samples were very similar to one another and to the original female factor loadings. Thus, the continued use of the scoring parameters from the original female sample is recommended. Factor scores for Dependency and Self-Criticism continue to be uncorrelated in both men and women. Normative data are presented from the new samples, with men scoring higher on Self-Criticism and women scoring higher on Dependency.     

Music as a Trigger for Peak Experiences Among a College Staff Population

Guilford's 1950 presidential address to the American Psychological Association helped spark the growth of creativity research in the 2nd half of the 20th century. This growth has been fueled by an influx of creativity researchers, a group of individuals about whom we know little. In this study, the first 32 volumes of the Journal of Creative Behavior were subjected to an author analysis to identify 1st-time authors per year, create a contribution distribution of its authors, identify a possible trend in 1-time authors, and identify highly productive authors. The results of this study suggest that the field of creativity is similar to other scientific fields in respect to its author contribution distribution. There is a positive trend in 1-time contributors, and prolific contributors to this journal are no longer active, at least as can be estimated from an analysis of authors' contributions to the first 32 volumes of the Journal of Creative Behavior.     

Differences in Imagery Content and Imagery Ability Between High and Low Confident Track and Field Athletes

The purpose of this research was to examine how high and low trait sport confident track and field athletes differed in their imagery content and imagery ability. NCAA Division I track and field athletes ( M age = 20.5 +/- 1.61 years; M = 7.15 +/- 3.3 years experience; N = 111, 44 males and 67 females) completed the following measures: Trait Sport Confidence Inventory (TSCI), Sport Imagery Questionnaire (SIQ), and Movement Imagery Questionnaire - Revised (MIQ-R). Profile analyses revealed that high trait sport confident athletes utilized each category of imagery (Motivational General - Mastery, Motivational General - Arousal, Motivational Specific, Cognitive General, and Cognitive Specific) significantly more than low trait sport confident athletes. No significant differences emerged between the groups on the two imagery ability scales. The results suggest that the high confident athletes used more imagery, but they did not have higher imagery skills than low confident athletes.     

Social-evaluative versus self-evaluative appearance concerns in Body Dysmorphic Disorder

Body Dysmorphic Disorder (BDD) is characterised by significant preoccupation and distress relating to an imagined or slight defect in appearance. Individuals with BDD frequently report marked concerns relating to perceived negative evaluation of their appearance by others, but research specifically investigating such concerns remains limited. This study investigated the extent and nature of appearance-related social-evaluative and self-evaluative concerns in individuals with BDD and healthy controls. BDD participants, in comparison to controls, reported high levels of importance and anxiety associated with perceptions of others' views of their appearance, in addition to their own view. No differences were observed in the level of importance and anxiety associated with their self-view in comparison to others' views. These findings support existing evidence indicating that appearance-related social-evaluative concerns are a central feature of BDD. Cognitive-behavioural treatment implications are discussed.     

Attitudes and Experiences of High School Students Living in Turkey

A group of 105 tenth-grade high school students living in Turkey were studied to discover their attitudes toward their host nation and experiences while living away from the United States. It was hypothesized that neither the length of time a student resides in a country nor his sex would have an effect on either the number of experiences related to his host country or his attitude while living in a foreign country. The results indicated that the longer the students live overseas, the more experiences related to the culture of the host country they have. Their attitudes were the same regardless of their sex or length of residence.     

Intrusive images and memories in major depression

Individuals with current major depression were interviewed to investigate the prevalence of distressing intrusive mental imagery among depressed patients and study the phenomenology of these intrusions. Of the 39 currently depressed patients, 17 experienced some form of repetitive intrusive imagery (i.e., either an intrusive memory or image), with intrusive memories being more common than images. The intrusive imagery was experienced as highly uncontrollable and interfered significantly with patients' everyday lives. The intrusions were experienced with a sense of 'nowness', as well as physical and emotional re-experiencing. Despite high levels of re-experiencing, levels of dissociation were very low. The intrusive imagery was in some patients part of a wider network of key defining autobiographical memories, consistent with the idea that it is likely to play a significant role in maintaining the patient's depressive mood. Interventions targeting these intrusions could potentially result in a positive shift in depressed mood.     

Intrusive memories and depression in cancer patients

Matched samples of depressed and nondepressed cancer patients were interviewed about past life events, particularly experiences of death and illness. They identified and described any spontaneous intrusive visual memories they had experienced in the past week corresponding to these events. About one quarter reported such memories and, as predicted, the majority of intrusive memories concerned illness, injury and death. The mean levels of intrusion and avoidance were equivalent to patients with post-traumatic stress disorder. Consistent with prediction, depressed patients reported significantly more intrusive memories than controls, and described the memories as typically beginning with or being exacerbated by the onset of depression. Greater numbers of intrusive memories were associated with more maladaptive coping, and greater avoidance with deficits in autobiographical memory functioning.     

Clinical Application of a Behavioral Model for the Treatment of Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) is characterized by an obsessive concern over a perceived flaw in bodily appearance. If a minor flaw does exist, the patient displays unwarranted distress. This preoccupation typically leads to compulsive behaviors, such as mirror checking or mirror avoiding, camouflaging, and seeking reassurance from others regarding one’s appearance or the perceived “flaw.” Although some theorists have outlined important maintaining mechanisms of the disorder, a full model of the etiology and maintenance of this disorder has only recently been articulated in the literature (Neziroglu, Roberts, & Yaryura-Tobias, (2004). A behavioral model for body dysmorphic disorder. Psychiatric Annals, 34, 915–920.). The aim of the present article is to review this model and demonstrate its application to the successful treatment of BDD via a case presentation.     

Empirically Defining Treatment Response and Remission in Body Dysmorphic Disorder Using a Short Self-Report Instrument

Determining response or remission status in body dysmorphic disorder (BDD) usually requires a lengthy interview with a trained clinician. This study sought to establish empirically derived cutoffs to define treatment response and remission in BDD using a brief self-report instrument, the Appearance Anxiety Inventory (AAI). Results from three clinical trials of BDD were pooled to create a sample of 123 individuals who had received cognitive-behavioral therapy for BDD, delivered via the Internet. The AAI was compared to gold-standard criteria for response and remission in BDD, based on the clinician-administered Yale–Brown Obsessive Compulsive Scale, modified for BDD (BDD-YBOCS), and evaluated using signal detection analysis. The results showed that a ≥ 40% reduction on the AAI best corresponded to treatment response, with a sensitivity of 0.71 and a specificity of 0.84. A score ≤ 13 at posttreatment was the optimal cutoff in determining full or partial remission from BDD, with a sensitivity of 0.75 and a specificity of 0.88. These findings provide benchmarks for using the AAI in BDD treatment evaluation when resource-intensive measures administered by clinicians are not feasible.     

Distress and Psychosocial Needs of a Heterogeneous High Risk Familial Cancer Population

In order to assess the levels of distress and psychosocial support needs of a high risk population, we undertook a study to look at both the objective and subjective levels of distress and the wants and needs of individuals from a high familial cancer risk population. Three hundred and eighteen individuals (160 affected, 158 unaffected) completed several distress and psychosocial needs questionnaires (including the Brief Symptom Inventory-18). Sixty key informants were also surveyed about their perspective on the support needs of this population. In the largely female (90%), largely HBOC syndrome group (approximately 90%), 20% had significant levels of generalized distress, with no significant differences between affected and unaffected individuals. Generalized distress was also not significantly different as a function of mutation status. Individuals who received inconclusive test results, however, were more likely to indicate somatic symptoms of distress. Those individuals who did not have social support were more likely to be those who had never had cancer and who either had a mutation, received inconclusive test results, or were not tested. Key informants were most likely to indicate that patients need more support. These results provide evidence for the importance of establishing regular psychosocial distress screening, including a focus on somatic symptoms, in such high risk populations.     

Sudden Gains in Internet-Based Cognitive Behavior Therapy for Body Dysmorphic Disorder

Sudden gains have been associated with better short- and long-term treatment outcomes in a number of psychiatric disorders. However, no studies to date have evaluated sudden gains in body dysmorphic disorder (BDD). We used data from a previous randomized controlled trial evaluating the efficacy of an Internet-based cognitive-behavior treatment (CBT) for BDD. The sample consisted of 47 adults diagnosed with BDD. We compared the treatment outcomes of sudden gainers vs. gradual gainers (i.e., treatment responders with no sudden gains) and non-sudden gainers (i.e., gradual gainers plus nonresponders) at posttreatment and 3, 12, and 24 months after the end of the treatment. Twelve (25.5%) participants experienced a sudden gain. Compared to non-sudden gainers and to gradual gainers, sudden gainers showed significantly larger improvements on the Yale-Brown Obsessive-Compulsive Scale modified for BDD at posttreatment (g = 1.23 and g = .91, respectively), and at 3-month (g = 1.23 and g = 1.00, respectively), 12-month (g = 1.12 and g = .91, respectively), and 24-month follow-up (g = 1.11 and g = .97, respectively). This translated into higher rates of treatment responders and remitters in the sudden gainers across all time points. The occurrence of sudden gains in Internet-based CBT for BDD is associated with favorable short- and long-term treatment outcomes. This suggests that a sudden improvement during the treatment could be a marker of good prognosis, while non-sudden—including gradual—gainers are more likely to need continued support or booster sessions. Early identification of patients who are not progressing as expected and subsequent tailoring of the delivered intervention has the potential to improve treatment outcomes in this group.     

Symbolism and Imagery in a Group of Chronic Schizophrenics

Block training in group psychotherapy makes it possible to train professionals living far apart and to import conductors to an area or country lacking sufficient expertise. This article reports experience with such a training program in Norway. Training is given in blocks of 5 weekends a year, each weekend containing small group therapy, supervision, theory courses, lectures, and large group experiences. The participants were questioned about their personal and professional gains from the training. These findings and the effect of the program in relation to stated goals are discussed.