Mindfulness‐based cognitive therapy is effective as relapse prevention for patients with recurrent depression in Scandinavian primary health care

This study examined the effectiveness of mindfulness‐based cognitive therapy (MBCT) in primary care for patients with recurrent depression (major depressive disorder: MDD). According to the World Health Organization (WHO), MDD is now the leading cause of disease burden in middle‐ and high‐income countries. Patients (N = 45) with three or more previous depressive episodes were recruited to participate in MBCT as a preventative intervention. Using a benchmarking approach, outcome data was compared with data from a recent efficacy study. The methodology is a rigorous approach to assessing effectiveness when evidence‐based UK protocols are transferred into the existing Scandinavian service delivery. Additionally, a person‐centred methodological approach was used to assess clinical significance on the Reliable Change Index (RCI). The analysis revealed comparable or larger effects from pre‐test to post‐test in reduced psychiatric symptoms, increased quality of life and level of mindfulness, and the effects were maintained over 14 months. Analysis of the relapse rate in the current study (16%) compared to the TAU in the efficacy study (68%) yielded an h value of 0.78, a moderate effect size. Only 13% dropped out of the treatment. According to the RCI findings, 65% to 67% of participants in the clinical group improved, no individual worsened, and women showed a significantly greater improvement of depression and anxiety than men. Therapeutic alliance and motivation had no impact on the outcome. The overall result suggests that MBCT can be implemented successfully in Scandinavian primary health care as a preventive intervention for patients with recurrent depression.     

Thriving,burnout, and coping strategies of early and later career counseling center psychologists in the United States

We interviewed seven early career psychologists (ECPs) and seven later career psychologists (LCPs) employed at university counseling centers in the United States about their experiences with thriving, burnout, and coping. We analyzed the data using Consensual Qualitative Research. Typical factors that contributed to thriving included recognition for achievement and the climate of counseling center and campus, although the latter was more important for ECPs than LCPs. Typical factors that contributed to burnout included challenges with tasks and responsibilities and challenges related to professional relationships. Finally, interpersonal support (general), self-care, cognitive strategies, and behavioral strategies (typical) were coping strategies used by both ECPs and LCPs, but only ECPs identified using personal therapy. Implications for counseling centers and for research are presented.     

Therapist perspectives on using silence in therapy: A qualitative study

Twelve experienced therapists were interviewed about their perceptions of why they used silence in therapy. Qualitative analyses revealed that these therapists typically perceived themselves as using silence to convey empathy, facilitate reflection, challenge the client to take responsibility, facilitate expression of feelings, or take time for themselves to think of what to say. Therapists generally indicated that a sound therapeutic alliance was a prerequisite for using silence, and they typically educated their clients about how they used silence in therapy. Therapists typically believed they did not use silence with clients who were psychotic, highly anxious, or angry. They typically thought they now used silence more flexibly, comfortably, and confidently than when they began doing therapy. Therapists typically believed they learned how to use silence from their own experience as a client and from supervision.     

Human variable ratio performance

The generality of the mathematical principles of reinforcement (MPR) was tested with humans. In Experiment 1A, participants’ mouse clicks were reinforced according to a series of variable-ratio (VR) values. In one condition, a situated task was used (searching for treasure on a map presented via a PC monitor); in the other, abstract version of the task, participants clicked on a white screen. Under the “map” condition, response rates increased with increasing ratio value before decreasing with further ratio increases; under the “no-map” condition, response rates decreased linearly from a peak at the smallest ratio. In Experiment 1B, the pattern of responding was confirmed under the “map” conditions using a different set of ratio values. In Experiment 2, reinforcer magnitude was manipulated using the “map” context. Response rates did not differ significantly when large rather than small cash reinforcers were delivered according to a VR 30 but were significantly higher when large rather than small cash reinforcers were delivered according to a VR 120. Together these experiments offer qualified support for extending MPR to the behavior of human participants.     

Traumatization Through Human Agency: “Embodied Witnessing” is Essential in the Treatment of Survivors*

The American Journal of Psychoanalysis - The importance of human relations in understanding and treating trauma is evident not only from the severity of traumatization inflicted by human agency and...     

Development of the Meaning in Life Measure

To correct problems identified in existing measures of meaning in life (MIL) (lack of inclusion of items related to felt sense, mattering, and reflectivity), a new 8-item Meaning in Life Measure (MILM) was developed. Two subscales emerged: Experience (MILM-E, with items related to felt sense, mattering, goals, coherence) and Reflectivity (MILM-R, with items related to valuing thinking about meaning). High internal consistency and test–retest reliability were found for both subscales. Concurrent validity was demonstrated by a strong positive correlation between MILM-E and the Meaning in Life Questionnaire-Presence (MLQ-P), and a moderate correlation between MILM-R and the Meaning in Life Questionnaire-Search (MLQ-S). For both subscales, small to moderate positive correlations were found with subjective well-being, extraversion, conscientiousness, openness, agreeableness, self-deception, and impression management; moderate negative correlations were found with depression and emotional instability. Participants who were older, female, of higher income, and married with children scored slightly higher than their counterparts on MILM-E; women scored slightly higher than men on MILM-R. We concluded that the MILM has good psychometric properties and that MIL seems to be composed of two factors.     

Ferenczi’s Revolutionary Therapeutic Approach*

Many of the revolutionary principles introduced by Ferenczi in his clinical practice have now been widely accepted especially in the field of trauma and trauma therapy. Examples of these innovative views include his emphasis on empathy as opposed to technical neutrality and his stress on the real conditions of child caring and family environmental deficits and on the consequences of interpersonal violence and abuse that lead to “identification with the aggressor” by the victim thereby resulting in the internalization of both aggressiveness and guilt (the split guilt of the abuser). The resulting “fragmentation” of the personality, which is now considered dissociation (instead of Freud’s “repression”), is at the root of several severe disorders, characterized by distortion of reality, loss of touch with one’s body and loss of trust in the other. Therefore “abreaction is not enough”. A new, positive relational experience must be re-inscribed at the level of implicit memory.     

Zika virus and pregnant women: A psychological approach

Zika virus presents risk of physical harm to pregnant women, but the fear of infection is also affecting women around the world. There is a gap in the research on Zika virus in the areas involving the impact on the psychosocial well-being of pregnant women. Therefore, this study is aimed at the investigation of the psychosocial adjustment of pregnant women to the risks of Zika virus infection during pregnancy. We investigated 14 pregnant women who were classified in three different groups: six in the first trimester, five in the second trimester and three in the third trimester, aged from 28 to 40 years (33.43 ± 3.76 years). Content analysis was used to interpret data. Our results show that the psychosocial adjustment of participants was significantly negative and included five aspects: (1) negative feelings, (2) changes in family planning, (3) adopting new customs (avoiding places of risk, use of specific clothes and use of repellent), (4) changed attitudes regarding body image and (5) feeling of external demand regarding prevention. The fear of Zika virus infection and all its associated risks have a negative biopsychosocial impact on the pregnant women in this study.     

The structure of feared social situations among individuals with a lifetime diagnosis of social anxiety disorder in two independent nationally representative mental health surveys

The present study employed both exploratory and confirmatory factor analytic approaches with nationally representative samples of individuals with a lifetime diagnosis of social anxiety disorder (n=1123; n=3091, respectively) using split-halves of the National Comorbidity Replication Survey (n=9282) and cross-validated with the Canadian Community Health Survey on Mental Health and Wellbeing (n=36,984). Strong support was found for a three-factor solution. This model was obtained from exploratory factor analysis and was further evaluated using two confirmatory factor analytic investigations in the two national samples. The three social situational domains reflected (1) Social Interaction Fears, (2) Observation Fears, and (3) Public Speaking Fears. Individuals with generalized social anxiety disorder (i.e., those who endorsed 7 or more of 13 feared social situations assessed in the survey) were significantly more likely to report Social Interaction Fears and Observation Fears compared to individuals with non-generalized social anxiety disorder (i.e., those who endorsed only 6 or fewer of 13 feared social situations). Individuals with generalized social anxiety were particularly characterized by combinations of Public Speaking Fears plus Social Interaction Fears and Observation Fears. The clinical and classification implications of our study for DSM-V are discussed.     

Factors affecting agreement between severely mentally ill alcohol abusers' and collaterals' reports of alcohol and other substance abuse.

This study examined subject-collateral reports of alcohol use among a sample of 167 dually diagnosed individuals seeking outpatient treatment at a community mental health clinic. All subjects met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria for a schizophrenia-spectrum or bipolar disorder and for alcohol abuse or dependence. Subjects were recruited within 2 weeks of treatment entry and completed measures of cognitive functioning, alcohol dependence severity, psychiatric symptoms, and quantity and frequency of substance use over the previous 60 days using the Timeline Follow-Back interview (L. C. Sobell & M. B. Sobell, 1996). They also provided a urine sample, which was screened for recent drug use. Collateral interviews were conducted by phone and included an assessment of the subject's alcohol and drug use over the same 60-day period. Collaterals also reported their confidence in the accuracy of their reports. Overall, the results indicated generally poor subject-collateral agreement. However, subject-collateral agreement appeared better for those individuals (n = 97) with negative urine drug screens. The most consistent predictor of subject-collateral discrepancy scores was subjects' recent drug use. Recommendations for enhancing the validity of self-reports of substance use in a severely mentally ill population are discussed.