Increased use of safety-seeking behaviors in chronic back pain patients with high health anxiety

Many patients with chronic pain also exhibit elevated levels of health anxiety. This study examined the effect of health anxiety on the use of safety-seeking behaviors (SSBs) in pain-provoking situations. Participants were 20 chronic back pain patients with high health anxiety (Group H), 20 with low health anxiety (Group L) and 20 pain-free controls (Group C). Two physical tasks were video recorded, and compared both for overt pain behavior (identified by blind observers following a standardized procedure) and for the occurrence of SSB (identified by showing the participants video playback and asking them to specify motivation for all actions/behaviors displayed during the tasks). While there were no differences in the display of overt pain behaviors, Group H deployed a greater number of SSBs than Groups L and C. This finding held true for both tasks and remained significant when concurrent pain and mood ratings were statistically controlled for. SSB was correlated with catastrophizing thoughts but not pain intensity; pain intensity was correlated with overt pain behavior but not catastrophizing. Taken together, these findings suggest that SSB is distinct from overt pain behavior and may be a defining characteristic of chronic pain patients reporting high levels of health anxiety.     

Learning from experience in case conference: A Bionian approach to teaching and consulting

In case conferences as well as didactic seminars, the power of the group can bring psychoanalytic education to life. However, primitive anxieties activated by group dynamics may also interfere with teaching and learning. The authors offer the example of a stalemated private practice case conference that had unconsciously organized against learning as the members began to read Bion's work. The case conference leader, an analyst, presented her case conference, which was mired in basic assumption dependency dynamics, to our peer consultation group. Drawing upon Bion's early contributions on groups, as well as his later ideas about thinking and mental growth, the peer group facilitated the case conference's return to work-group functioning and learning from experience. Activated in the peer group, commensal container↔contained processes gradually spread throughout the entire relational system of peer group, case-conference leader, case-conference members, and patients. This example underscores the importance of promoting within our institutes a culture in which faculty view themselves as part of an evolving intersubjective matrix that works to foster the containing capacities of candidates, patients, and faculty alike.     

Ambivalent sexism,attitudes towards menstruation and menstrual cycle‐related symptoms

The objective of the present study was to investigate the relationship between ambivalent sexism and beliefs and attitudes towards menstruation, and, in turn, to study the influence of these variables on menstrual cycle‐related symptoms. One hundred and six Mexican women completed the Ambivalent Sexism Inventory, the Beliefs about and Attitudes toward Menstruation Questionnaire and the Menstrual Distress Questionnaire. The higher scores on benevolent sexism were associated with the most positive attitudes towards menstruation and also with the belief that a menstruating woman should or should not do some activities and that menstruation keeps women from their daily activities. The higher scores on hostile sexism were associated with rejection of menstruation as well as with feelings of embarrassment about it. Beliefs about and attitudes towards menstruation predicted menstrual cycle‐related symptoms related to negative affect, impaired concentration and behavioural changes, but did not predict somatic symptoms. These results will be useful to health professionals and advocates who want to change the negative expectations and stereotypes of premenstrual and menstrual women and reduce the sexism and negative attitudes towards women that are evident in Mexican culture.     

A Validation Study of the Brief Irrational Thoughts Inventory

This study examines the reliability and validity of the “Brief Irrational Thoughts Inventory” (BITI) in a sample of 256 justice-involved youths. The BITI is a questionnaire used to determine the nature and severity of irrational thoughts related to aggressive (externalizing), sub-assertive (internalizing), and distrust-related behavior in adolescents with conduct problems. The results of this study demonstrated adequate internal consistency reliability and supported validity of the BITI in terms of construct, convergent, concurrent and divergent validity. Construct validity was assessed using a confirmatory factor analysis. The BITI proved to be measurement invariant for sex and ethnic origin, i.e., the results indicated that items were interpreted in a similar way by boys and girls as well as native and non-native Dutch respondents. The BITI also proved to be insensitive to intelligence, education, and age (divergent validity). However, weak to moderate correlations were found between the degree of social desirability and irrational thoughts related to aggressive (externalizing) and distrust-related behavior (BITI). Finally, concurrent validity was satisfactory, with the exception of thoughts related to sub-assertive (internalizing) behavior.     

Trauma,personality disorders and chronic depression – the role of the conversational model of psychodynamic psychotherapy in treatment resistant depression

Objective: To report preliminary data describing the interim treatment outcome of 44 patients referred with treatment-resistant depression (TRD), comorbid personality disorders and histories of early childhood trauma using the Conversational Model (CM) of psychodynamic psychotherapy. Method: Patients (N = 44), 13 males and 31 females with long histories of depression ranging from 2 to 30 years, resistant to multiple trials of treatment, were referred by mental health practitioners, including psychiatrists. They were treated with twice weekly CM psychotherapy by multidisciplinary trainees and supervised by experienced trained clinicians. Questionnaires were administered at assessment and at 12 months to assess symptoms, functioning, self-esteem, history of trauma, personality functioning and suicidality. In this preliminary study, there was no separate control group, and patients served as their own controls. Results: Patients with TRD were found to have comorbid severe personality disorders and histories of early childhood trauma. Significant improvement in symptoms, self-esteem, functioning and suicidality was noted after 12 months. Conclusion: Patients responded with symptomatic and functional improvement to twice weekly CM therapy.