The role of psychological processes in estimates of stuttering severity

Purpose

To examine the associations of trait anxiety (STAI), social anxiety (SIAS), depression (BDI-II), and personality features (ADP-IV) with three measures of stuttering severity: %SS, Stuttering Severity, Instrument, and the Overall Assessment of the Speaker's Experience of Stuttering.

Method

Fifty adults with a history of stuttering served as participants. Participant scores on trait, anxiety, social anxiety, depression, and personality features were entered into a regression analysis, with the criterion variables (DVs) being: %SS, SSI-3, OASES total score. In order to explore the OASES, further, each of the four OASES subscales were also examined. A separate regression was conducted for, each dependent variable.

Results

The OASES total score model was significant (p < .0001) and revealed that social anxiety and, trait anxiety were the only significant predictors, with medium effect sizes noted for both variables. In contrast, percent syllables stuttered and the SSI were not significantly associated with psychological, variables, suggesting that anxiety may not always be related to overt indicators of stuttering. Depression and personality dysfunction were not significantly associated with any measure of, stuttering severity.

Conclusion

Anxiety in the form of social and trait anxiety are significantly associated with stuttering, severity as indicated by the OASES. Traditional procedures for assigning severity ratings to individuals, who stutter based on percent syllables stuttered and the Stuttering Severity Instrument are not, significantly related to psychological processes central to the stuttering experience. Depression and, personality characteristics do not meaningfully account for stuttering.Educational objectives: The reader will be able to: (a) differentiate forms of anxiety that are likely to be associated with stuttering (b) understand the importance of determining features of stuttering that go beyond the obvious, surface characteristics of stuttering frequency, and (c) discuss the important clinical and theoretical implications for understanding the degree of psychological dysfunction that is likely to be characteristic of those who stutter.     

Group Cognitive Behavioral Treatment for PTSD: Treatment of Motor Vehicle Accident Survivors

Individual cognitive behavioral therapies (CBT) are now considered the first-line treatment for posttraumatic stress disorder (PTSD; Foa, Keane, & Friedman, 2000). As mental health reimbursement becomes more restricted, it is imperative that we adapt individual-format therapies for use in a small group format. Group therapies have a number of advantages, including provision of a natural support group, the ability to reach more patients, and greater cost efficiency. In this article, we describe the development of a group CBT for PTSD in the aftermath of a serious motor vehicle accident (MVA). Issues unique to the group treatment format are discussed, along with special considerations such as strategies to reduce the potential for triggering reexperiencing symptoms during group sessions. A case example is presented, along with discussion of group process issues. Although still in the early stages, this group CBT may offer promise as an effective treatment of MVA-related PTSD.     

Smoking,personality, and imagery preference in Relation to spontaneous bilateral electrodermal activity

Effects of smoking on spontaneous bilateral skin conductance were studied as a consequence of interactions with set and setting. Bilateral skin conductance was recorded in six men and six women who smoked and an equal number of nonsmokers on two different days. On the first day, spontaneous electrodermal activity was recorded before and after a 10-minute rest period during which half the smokers smoked a cigarette. On the second day, one week later, spontaneous activity was again recorded before and after a 10-minute rest period during which the remaining smokers smoked a cigarette. Nonsmokers did not smoke at any time. Following smoking there was a significant negative correlation between a preference for visual over nonvisual imagery and spontaneous skin conductance responsivity in the left as compared to the right hand. Correlations were significantly different in smokers and nonsmokers. Smokers showed significantly greater preferences for either visual or nonvisual imagery than nonsmokers. Nonresponding nonsmokers were higher on the psychoticism (P) scale of the Eysenck Personality Questionnaire (EPQ) than responding nonsmokers. Smokers scored higher on P than nonsmokers. Interactions between personality, cognitive style, and the experimental situation, set, and setting were discussed in relation to the arousing effects of nicotine.     

Peak Performance of Business Leaders: An Experience Parallel to Self-Actualization Theory

To investigate peak performance, 40 business leaders described personal experiences through interviews and the Privette Experience Questionnaire. In order to discriminate processes of peak performance from personality attributes of business leaders, their questionnaire data were compared with parallel data from a sample of 41 university men. Multivariate analyses of variance of factors and items and follow-up analyses indicated that scores differed but not on defining attributes. The peak performance dyad—full focus and clear sense of self—and aspects of peak experience—significance and fulfillment—were endorsed by both samples. Business leaders endorsed sociability and personal discipline and denied playfulness more than the university men, who endorsed fluidity. The relation of peak performance to self-actualization theory is discussed.     

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.     

The effects of attentional focus and partner arousal on sexual responding in functional and dysfunctional men

The effects of attentional-focus instructions (self vs partner focus) and level of partner arousal (high, low and ambiguous) on sexual responding, both objectively and subjectively measured, were examined with sexually-functional (N = 8) and sexually-dysfunctional (N = 8) men. These instructional sets were delivered just before the subjects viewed an erotic film depicting a heterosexual couple in which they identified with the male. When both groups were focusing on themselves rather than their partner, higher tumescence was observed when their partner was displaying low arousal. When the partner's level of arousal was ambiguous, highest tumescence was achieved during partner attentional focus. When the partner was displaying high sexual arousal, functional subjects reached highest levels of tumescence during partner focus, while dysfunctional subjects reached highest levels of tumescence during self focus. In fact, high partner arousal seemed to inhibit dysfunctional subjects' tumescence under partner focus. Examination of self-report of arousal data as measured by a subjective lever revealed interesting group differences. Results are discussed in light of possible maintaining factors in sexual dysfunction and their treatment implications.     

Understanding the relationship between posttraumatic stress disorder and trauma cognitions: The impact of thought control strategies

Several models of PTSD suggest that dysfunctional beliefs play an important role in the maintenance of PTSD. This study examined whether thought control strategies intermediated in the relationship between PTSD and dysfunctional cognitions. It was hypothesized that PTSD would be positively associated with dysfunctional cognitions and that negative thought control strategies (worry and self-punishment) would partially account for this relationship. These maladaptive strategies were predicted to be associated with increased levels of PTSD and more trauma-related beliefs. Additionally, it was predicted that positive thought control strategies (social control and reappraisal) would be associated with decreased levels of PTSD and fewer trauma-related beliefs. Finally, because the literature supports distraction as both an adaptive and a maladaptive thought control strategy, no a priori hypothesis was made. Results support worry and self-punishment as maladaptive intervening variables in the association between PTSD and dysfunctional cognitions, resulting in greater levels of PTSD and trauma cognitions. Social control and distraction emerged as adaptive strategies, resulting in lower levels of PTSD and trauma cognitions, while reappraisal showed no relationship with PTSD severity. Although the results are cross-sectional, continued focus on the effects of thought control strategies as meditational maintenance variables over time appears warranted.     

Treatment of PTSD in Older Adults: Do Cognitive-Behavioral Interventions Remain Viable?

The literature examining trauma among older adults is growing, but little is known about the efficacy of empirically supported interventions for PTSD within this population. Clinical writing on this topic often implies that cognitive-behavioral treatments may be ineffective or inappropriate for older adults with PTSD given physical and/or cognitive vulnerabilities. Review of the limited research in this area, however, provides little support for the claim that cognitive-behavioral interventions are ineffective in treating PTSD among the elderly. In an effort to explicate specific issues related to treatment process and outcome among older survivors of trauma, a case series is presented outlining the treatment of three older adults within the context of a structured, cognitive-behavioral group intervention. Observations from this case series suggests that cognitive-behavioral interventions continue to be useful in treating PTSD with this population. Specific treatment issues unique to older adults are explored and recommendations for future research are discussed.     

Developmental and family milieu correlates of resilience in urban children who have experienced major life stress

Reports findings from interviews with parents of demographically-comparable groups of highly-stressed urban children with stress-resilient (SR) and stress-affected (SA) outcomes at ages 10-12. SR and SA children were compared on family milieu and child development variables assessed within a developmental framework. Compared to SAs, parents of SRs scored higher on variables reflecting parent perceptions of a nurturant caregiver-child relationship and self-views as effective caregivers, in the context of positive discipline practices, a child's positive early temperament, and support for primary caregivers. A discriminant function analysis identified seven variables that optimally differentiated the groups and correctly classified 86% of the Ss as SR or SA.