Peritraumatic dissociation and posttraumatic stress after pregnancy loss: a prospective study

This study examined (1). predictors for peritraumatic dissociation, (2). its relations with acute and chronic symptoms of posttraumatic stress disorder (PTSD), and (3). pathways regarding these relations in response to pregnancy loss. In early pregnancy, about 1370 women volunteers completed questionnaires for neuroticism, control over emotions, dissociative tendencies, absorption, and prior life events. Of these, 126 subsequently experienced pregnancy loss and most of them completed measures 1 month (N = 118) and 4 months (N = 104) later. At 1 month, peritraumatic dissociation, memory of pregnancy loss (degree of fragmentation, sensory impressions, and emotional intensity), thought suppression, and PTSD symptoms were assessed, and at 4 months, PTSD symptoms were re-assessed. Peritraumatic dissociation was predicted by prior low control over emotions, dissociative tendencies, and lower education. It was not predicted by neuroticism, absorption, and prior life events. Peritraumatic dissociation was related to acute PTSD symptoms and LISREL analyses indicated that self-reported memory fragmentation and thought suppression of pregnancy loss mediated this relation. It also predicted chronic PTSD symptoms, and this relation was mediated by acute PTSD symptoms.     

The effects of underestimated pain and their relationship to habituation

The intensity of a painful stimulus was experimentally manipulated in order to induce underpredictions of pain. The experiment aimed at (1) replicating previous findings on the effects of underpredicted pain and (2) investigating the relationship between underpredicted pain and habituation. Most previous findings were replicated: underpredictions of pain were followed by raised expectations of pain and increased fear of pain. In addition, the underprediction had long-term effects on fear of pain, uncertainty about predictions, and expected aversiveness of the painful stimulus. In contrast to previous findings and to Rachman's match/mismatch model, it was found that underpredicted pain can have dishabituating effects. It is theorized that inaccurately predicted pain can cause dishabituation, depending on the extent of the underprediction and on the subjective certainty of the prediction. Theoretical and clinical implications are discussed.     

Pre-service teachers’ implicit and explicit attitudes toward obesity influence their judgments of students

Obese children experience disadvantages in school and discrimination from their teachers. Teachers’ implicit and explicit attitudes have been identified as contributing to these disadvantages. Drawing on dual process models, we investigated the nature of pre-service teachers’ implicit and explicit attitudes, their motivation to respond without prejudice, and how attitudes influence their judgments of an obese student. Results showed that implicit anti-obesity bias might stem from an implicit positivity toward thinness rather than from an implicit negativity toward obesity. Explicit attitudes were mixed: positive attitudes toward achievement, a dislike of obese persons, and neutral attitudes concerning blame and health responsibility emerged. Implicit and explicit attitudes affected judgments of language proficiency and intelligence: pre-service teachers with more positive attitudes judged the obese student more favorably. The results of multiple regression analyses suggest that attitudes might exert a greater influence when pre-service teachers must draw inferences to derive the judgment.     

Pathways to spider phobia.

Using a revised version of the Phobic Origin Questionnaire (POQ; Ost, L. G. & Hugdahl, K. Behaviour Research and Therapy, 19, 439-477; 1981), the present study examined whether conditioning experiences, modeling experiences, and/or informational learning experiences were more often reported by spider phobics (n = 41) than by non-fearful controls (n = 30). The two groups did not differ with regard to the overall frequency of conditioning or modeling events. Remarkably, the frequency of informational learning was higher among non-fearful Ss than among phobics. Although the limitations inherent to the retrospective nature of the present study should be borne in mind, the data suggest that, at least in spider phobics, conditioning events, modeling experiences, and/or informational learning do not necessarily give rise to phobic fears.     

Imagery ability and exposure in vivo in spider phobia

The present study deals with the effect of imagery ability on treatment outcome in spider phobias. Thirty-eight spider phobics completed the Questionnaire on Mental Imagery (QMI) and the Spider Questionnaire (SPQ). Subjects also went through a behavioral approach task (BAT) during which heart rate and avoidance behavior were measured. Each subject was then given one-session treatment as described by Ost. Immediately after treatment, SPQ and BAT data were again obtained. On the basis of their QMI scores, subjects were assigned to a 'good', 'moderate', or 'poor' imagers group. Neither pre-treatment nor post-treatment measures were found to vary as a function of imagery ability. Thus it appears that, at least for specific phobias such as spider fear, imagery ability is not a relevant variable for predicting the effects of in vivo exposure.     

Attention, not anxiety, influences pain

Four hypotheses about the influences of anxiety and attention on pain impact were tested in a critical experiment: (1) anxiety increases pain; (2) anxiety decreases pain; (3) attention to pain increases pain; (4) only the combination of anxiety and attention to pain increases pain (interaction hypothesis). In a 2 x 2 design, anxiety (low vs high) and attention (attention vs distraction from the pain) were experimentally manipulated. Subjects received 20 electrically produced painful stimuli. Subjective pain experiences, skin conductance responses and heart rate responses gave no support for a pain impact increasing effect of anxiety. The anxiety-attention interaction hypothesis did not receive any support either. There was some support, only from the heart rate responses, that anxiety reduces pain impact. The critical factor appeared to be attention. Attention to the pain stimulus was related to a stronger pain impact (indicated by all measures) and to less subjective habituation, compared to distraction.     

Eyeblink startle responses in spider phobies before and after treatment: A pilot study

Before and after treatment, acoustic probes eliciting eyeblink startles were presented to 41 female spider phobies during a behavioral approach test (BAT). During this test, subjects pulled a glass jar containing a live spider as nearby as they normally would tolerate. In order to obtain baseline startles, the subjects also carried out a BAT with a basket containing attractive food items. Startle responses were found to be relatively larger during the spider BAT than during the food BAT. This difference in relative magnitude decreased as a result of one-session treatment. The startle response appeared to be relatively independent of other outcome measures (i.e., Spider Questionnaire, BAT, and heart rate). Taken together, the results sustain findings previously reported by Lang and co-workers.     

Three preparatory studies for promoting implementation of outpatient schema therapy for borderline personality disorder in general mental health care

ObjectiveThree studies were conducted to prepare for the implementation of Schema Therapy (ST) for Borderline Personality Disorder (BPD) in general mental healthcare settings. Two were surveys to detect promoting and hindering factors, one was a preliminary test of a training program in ST.MethodsIn 2004, a diagnostic analysis of factors promoting and hindering implementation of a new treatment for BPD was conducted among both managers (n = 23) and therapists (n = 49) of 29 Dutch mental healthcare institutes through a written survey (Study 1). Next, a training program, including a set of DVDs displaying the major therapeutic techniques, was developed and tested among eight therapists. The training program was evaluated by the participants. After the training, three independent raters evaluated therapists' adherence and competence, viewing videos of the therapists completing structured role-plays (Study 2). In 2008, a second written survey was conducted in 22 mental health institutes to study factors for future nationwide implementation of ST (Study 3).ResultsBoth surveys indicated that the situation in most institutes was favorable for implementing a new effective treatment, as participants were not satisfied with the existing treatments, had suitable professional backgrounds, worked in settings with (B)PD-oriented care programs, and expressed a need for change. The surveys yielded clear results for promoting or hindering successful implementation of ST. Promoting factors included scientific evidence for the effectiveness of the treatment, structural changes in the patient's personality, rapidly noticeable effects for the patient, low drop-out rates and a favorable cost-effectiveness. Possible barriers included implementation mandated unilaterally by management, choosing ST based on financial or organizational needs, extending implementation over a lengthy period of time and providing telephone support by therapists beyond office hours. The eight-day training program received very positive ratings. After the training, therapists were rated as sufficiently adherent and competent applying ST to treat BPD patients, with peer supervision and supervision recommended as a supplement to the training.ConclusionThis study showed that the situation in 2005 was advantageous to start implementation of ST. Evaluation of the training and the achieved competence scores of trainees concluded that the training program was a good basis for training therapists in ST. Outcome of the survey in 2008 demonstrated that there was a clear interest for implementation of ST for BPD patients in the future.     

Responsibility and obsessive-compulsive disorder: an experimental test

To test the causal status of responsibility in obsessive-compulsive disorder (OCD), an experiment was executed in which responsibility was experimentally manipulated. OCD patients, non-OCD anxiety controls, and non-patients executed a classification task in either a high or a low responsibility (LoRes) condition. Subjective ratings related to danger and responsibility indicated that the manipulation was successful. Subjective OCD-like experiences and checking behaviors were higher in OCD patients in the high responsibility (HiRes) condition than in all other groups. Although the checking subscale of the Padua Inventory correlated with subjective ratings in the OCD patients in the HiRes condition, it was not associated with checking behaviors. The results confirm the hypothesis that responsibility plays a causal role in OCD.     

How to push someone's buttons: A comparison of four anger-induction methods

This study compared the effects of four ways of inducing anger: film, stress interview, punishment, and harassment. Sixty-four healthy participants were randomly assigned to one of these conditions. Effects were examined by means of self-report and physiological measures (blood pressure, heart rate, skin conductance level, and skin conductance response). All four methods produced comparable levels of self-reported anger, while harassment and interview produced the largest cardiovascular effects, and electrodermal activity increased more in reaction to harassment, interview, and punishment conditions compared to film. Thus, physiological reactivity was especially increased by anger-induction methods that included personal contact (harassment and interview). Regarding specificity of self-reported emotions, fear and frustration were the only emotions out of nine non-target emotions that increased in comparable degree to anger following film, interview, and punishment, while harassment produced more self-reported anger than fear. Possible explanations and further recommendations are discussed.