Chest pain without coronary artery disease: An exploratory comparison with panic disorder

Recent reports have indicated similarities between patients with persistent chest pain of nonorganic origin and patients with panic disorder. In order to explore this association further, we administered a structured interview and three self-report measures (State-Trait Inventory, Beck Depression Inventory, and SCL90-R) to three subject groups: (1) a sample with persistent chest pain (CP; n=14) who had been screened and found to have normal coronary arteries, (2) a sample of patients with panic disorder (PD; n=14), and (3) a sample of matched normals (n=14). CP patients were considered to be free of coronary artery disease (CAD) following normal cardiac catheterization and/or normal thallium stress tests and were not diagnosed initially with panic disorder. PD patients were diagnosed with a standardized psychiatric interview and were free of organic causes of panic. Using an exploratory data analytic approach, the results indicated that both CP and PD samples reported increased levels of state and trait anxiety (p <.0001), depression (p <.01), and somatization (p <.0001) compared with normals. CP patients differed from PD patients in their less frequent use of anxiolytic medication (p <.01) and lower levels of reported panic anxiety and phobic avoidance (p <.0001). These data suggest that persistent chest pain in the absence of CAD shares some features with panic disorder, yet differs from panic in key ways as well. The results are discussed in light of the role of anxiety in contributing to symptom labeling.This research was supported by Grant 86G-491 from the American Heart Association, Texas Affiliate, to J.G.B. H.T. is the recipient of USPHS Research Career Development Award K04-HL-0122246.     

Frequency analysis of electromyographically measured covert speech behavior

Eleven subjects were asked to silently read slides of the letters “P” and “T,” and to view meaningless control slides similarly as they were presented visually. One-eighth-second electromyographic excerpts were sampled from the baseline and response periods. The data were then transformed into the frequency domain for inferential analyses. The mean power spectral frequencies for the response period were significantly lower than those for the base-line in the overall analysis. There were, however, no significant changes from baseline as a function of kind of stimulus (T, P, or Control) or muscle activated (lips or tongue). It was concluded that there was a generalized responding, not unique to the processing of the specific stimuli studied. Frequency analysis of EMG measures of covert behavior holds some promise of yielding unique information not available through traditional analysis procedures, but more sensitive methods than those used here would be required to demonstrate this.     

ACQUISITION,GENERALIZATION, AND MAINTENANCE OF QUESTION-ANSWERING SKILLS IN AUTISTIC CHILDREN

We conducted an investigation to evaluate the effects of a training strategy for teaching autistic students generalized responses to three forms of wh— questions (what, how, and why). Students were taught, using modeling and reinforcement procedures, to answer questions with magazine pictures as the referents. Each question form was divided into two or more subcomponents reflective of common social usage and was taught within the context of a modified multiple probe design across subcomponents. Following acquisition of each subcomponent, generalization to natural context and storybook questions was assessed; additional probes were conducted to assess responding over time and whether acquisition of responses to questions promoted question-asking skills. Results showed that the picture training procedure was effective in teaching a generalized response to questions for which the relevant cue was visible, whereas specific generalization programming was required for situations in which the relevant cue was not visible. All acquired responses were durable over time.     

Counting On Blood Donors: Increasing the Impact of Reminder Calls

Two experiments were conducted to see if blood drive attendance could be increased by altering the content of reminder calls. In Experiment 1 college students received either a standard reminder (the place, time, and necessity of eating beforehand) or a commitment-enhancing reminder in which they agreed to be "counted on". Those in the latter condition were significantly more likely (p <.007) to attend a blood drive. Experiment 2 demonstrated that an alternate wording for the commitment-enhancing message was possible; that a verbal response was necessary to ensure the commitment; and that a message enhancing altruism was not as effective. The studies suggest that asking for an additional commitment during a reminder call can appreciably increase blood drive participation rates.     

Reviews

H enderson , J oseph L. Cultural Attitudes in Psychological Perspective
C arotenuto , A ldo . The Vertical Labyrinth: Individuation in Jungian Psychology
K ugelmann , R obert . The Windows of Soul: Psychological Physiology of the Human Eye and Primary Glaucoma
D ryden , W indy (ed.). Individual Therapy in Britain
W elch , J ohn . Spiritual Pilgrims: Carl Jung and Teresa of Avila
T omlin , E. W. F. Psyche, Culture and the New Science: The Role of PN     

Reviews

F ordham , M ichael . Explorations into the Self
R edpearn , J oseph . My Self, My Many Selves
H obson , R obert F. Forms of Feeling: the Heart of Psychotherapy
C asement , P atricia . On Learning from the Patient
S hepherd , M ichael . Sherlock Holmes and the Case of Dr Freud
A bend , S. M., P order , M. S., W illick , M. S. Borderline Patients: Psychoanalytic Perspectives
V an H erik , J udith . Freud on Femininity and Faith     

Generalised anxiety: A controlled treatment study

The effects of anxiety management training were evaluated by allocating 66 generally anxious clients to either a wait list condition, non-directive counselling, or a combination of relaxation and brief cognitive therapy. Anxiety management was significantly more effective than the wait list condition on a number of relevant measures at post-treatment, but there were relatively few differencs between anxiety management and non-directive counselling, either at post-treatment or at 6 months follow-up. Those differences which were found could plausibly be explained in terms of the demand characteristics of training in relaxation or cognitive therapy. It was concluded that anxiety management is clearly better than a non-treatment control condition, but that its superiority to plausible alternatives which lack the specific components thought to be responsible for improvement has yet to be demonstrated.     

Effective functioning in dual-career families: an investigation

This study is concerned with the commonalities inherent in diverse psychotherapeutic strategies, despite seemingly discontinuous theoretical stances. Two approaches were evaluated with respect to effective family functioning, viz. Analytical Psychology and Systems Theory. Analytical Psychology posits the growth of conscious awareness in the individual as the source of therapeutic change. Problem centred systems therapy of the family emphasizes the importance of teaching clinically presenting families to negotiate collectively family rules and expectations and thus to allocate and monitor roles via clear and direct verbal communication. Both positions thus stress the reflective mode as a pivotal factor in effective problem solving. Analytical psychology maintains that conscious awareness expands to the extent that the individual integrates the contrasexual aspect of the personality, that is, the affective, expressive mode or 'feminine principle' in the male, or the instrumental, assertive 'masculine principle' in the female. Such individuals are said to be 'androgenous'. It was therefore hypothesized that such individuals would more readily be able to negotiate family rules and expectations in a manner consistent with a major therapeutic thrust of family therapy. These clinically derived hypotheses were subjected to an empirical test by assessing twenty, non-clinical, dual-career families where both parents pursued careers and were therefore presumably both required to share instrumental and affective roles on the basis of mutual agreement. Results indicated that negotiation contributed significantly to successful role fulfilment and effective family functioning, thus substantiating the focus of family therapy strategies upon clear and direct communication and role allocation.     

Clinician experiences of homework in couples and family therapy: A survey of perceived impact on the working alliance

The process of engaging clients in homework assignments has been studied extensively in research settings, but rarely have the challenges in the implementation of the science been considered in couples and family therapy. A survey was conducted of 226 clinicians regarding (1) their experience of homework adherence (quantity and quality) with couple and family clients, and (2) their experience of the impact of homework non-completion (IHN) on the working alliance. Clinicians working with families reported less overall homework quantity and quality. However, across both couples and family clients, more negative IHN was reported among clinicians experiencing less homework quantity, both in terms of IHN bond (couple ρ = 0.71, p < 0.001; family ρ = 0.78, p < 0.001) and IHN agreement (couples ρ = 0.25, p < 0.001; ρ = 0.19, p = 0.006), and among clinicians with fewer years of clinical experience (r = 0.19, n = 136, p < 0.05). The present findings suggest that, in the context of couples and family therapy, there is a risk of perceived negative IHN on the working alliance. There would be merit to future investigations examining the processes of facilitating homework engagement within the context of a strong working alliance.