Cognitive Behavior Therapy for Women With Generalized Anxiety Disorder in the Perinatal Period: Impact on Problematic Behaviors

Generalized anxiety disorder (GAD) is the most frequently diagnosed anxiety disorder among women in the perinatal period (pregnancy to one year postpartum). Recent studies have examined the relationship between problematic behaviors and GAD symptoms. Studies in nonperinatal samples indicate that adults with GAD engage in avoidance and safety behaviors and these behaviors are associated with greater symptom severity. Little research has examined the use of problematic behaviors among pregnant or postpartum women. However, preliminary research suggests that these behaviors may have a negative impact on both anxious women and their children. Our aim was to examine the extent to which women with GAD in pregnancy or the postpartum engage in problematic behaviors and whether cognitive behavioral therapy is effective in reducing these behaviors. Fifty-eight women with GAD in pregnancy or postpartum were recruited from a larger clinical trial (Clinicaltrials.gov ID NCT02850523) evaluating the effectiveness of group-based cognitive behavioral therapy (CBGT) for perinatal anxiety disorders. The results indicated that women with perinatal GAD reported high levels of avoidance and safety behaviors and greater engagement in these behaviors was associated with higher levels of worry and related symptoms. CBGT was effective in reducing GAD symptoms and problematic behaviors and a bidirectional relationship was found between changes in worry and problematic behaviors during treatment. Limitations and future directions are discussed.     

Dealing with feeling: a meta-analysis of the effectiveness of strategies derived from the process model of emotion regulation

The present meta-analysis investigated the effectiveness of strategies derived from the process model of emotion regulation in modifying emotional outcomes as indexed by experiential, behavioral, and physiological measures. A systematic search of the literature identified 306 experimental comparisons of different emotion regulation (ER) strategies. ER instructions were coded according to a new taxonomy, and meta-analysis was used to evaluate the effectiveness of each strategy across studies. The findings revealed differences in effectiveness between ER processes: Attentional deployment had no effect on emotional outcomes (d(+) = 0.00), response modulation had a small effect (d(+) = 0.16), and cognitive change had a small-to-medium effect (d(+) = 0.36). There were also important within-process differences. We identified 7 types of attentional deployment, 4 types of cognitive change, and 4 types of response modulation, and these distinctions had a substantial influence on effectiveness. Whereas distraction was an effective way to regulate emotions (d(+) = 0.27), concentration was not (d(+) = -0.26). Similarly, suppressing the expression of emotion proved effective (d(+) = 0.32), but suppressing the experience of emotion or suppressing thoughts of the emotion-eliciting event did not (d(+) = -0.04 and -0.12, respectively). Finally, reappraising the emotional response proved less effective (d(+) = 0.23) than reappraising the emotional stimulus (d(+) = 0.36) or using perspective taking (d(+) = 0.45). The review also identified several moderators of strategy effectiveness including factors related to the (a) to-be-regulated emotion, (b) frequency of use and intended purpose of the ER strategy, (c) study design, and (d) study characteristics.     

Behavioral training and predisposed coping strategies interact to influence resilience in male Long-Evans rats: implications for depression

Effective coping strategies and adaptive behavioral training build resilience against stress-induced pathology. Both predisposed and acquired coping strategies were investigated in rats to determine their impact on stress responsiveness and emotional resilience. Male Long-Evans rats were assigned to one of the three coping groups: passive, active, or variable copers. Rats were then randomly assigned to either an effort-based reward (EBR) contingent training group or a non-contingent training group. Following EBR training, rats were tested in appetitive and stressful challenge tasks. Physiological responses included changes in fecal corticosterone and dehydroepiandrosterone (DHEA) metabolites as well as neuropeptide Y (NPY)-immunoreactivity in the hippocampus and amygdala. Regardless of a rat's predisposed coping strategy, EBR rats persisted longer than non-contingent rats in the appetitive problem-solving task. Furthermore, training and coping styles interacted to yield the seemingly most adaptive DHEA/corticosterone ratios in the EBR-trained variable copers. Regardless of training group, variable copers exhibited increased NPY-immunoreactivity in the CA1 region.     

The Role of Maturity in the Cognitions that Govern Love Relationships and Sexual Satisfaction

This article discusses the Stage Climbing model, a cognitive behavioral therapy based system designed to identify the beliefs and attitudes typical of different developmental life stages that may explain or identify obstacles to resolving present day relationship issues. We suggest that self-defeating beliefs and behaviors characteristic of dysfunctional couples give evidence of one or both partners operating from a stage of development or level of maturity in that aspect of the relationship that is different from what would be optimal given their presenting issues and therapeutic goals.     

Defining health and unhealthiness: Perceptions held by Native American Indians with persistent mental illness1

Discrepancies in definitions of health exist. These discrepancies, if not acknowledged, create major communication gaps between health-care professionals and their clients, which interferes with the provision of culturally responsive care. The purpose of this study was to understand how Native American Indians experiencing persistent mental illness (PMI) define/describe being healthy and being unhealthy. Grounded theory design was used in conducting data gathering (semistructured interviews) and analysis (constant comparative) because the study focuses on generating social/psychological phenomena or process. Forty-four audiotaped interviews were conducted and transcribed. Symbolic interactionism is this study's framework. During data analysis, health emerged as being in balance/equilibrium, having a sense of harmony, and not being out of control of spiritual, cognitive, emotional, and physical domains. Furthermore, as this study reflects, the modified Circle of Wellness model emerges as a better fit for Native American Indians with PMI than the traditional Medicine Wheel because it more effectively presents the social nature/needs and the centrality of spiritualism of this population. Clearly, deficits in healthy social environments and relationships affect the ability of a Native American Indian with PMI to maintain health. To provide culturally competent care, professionals and native healers need to work the integration of spirituality into treatment processes, and advocate the creation and maintenance of healthy environments for improved social opportunities.     

“Chaotic soup of politics:” a Native American Indian mental health perspective

Through a grounded theory process, tribal politics emerged as a core theme from interviews with mental health providers (MHPs) and Native American Indian people experiencing persistent mental illness (PMI). Interviews were conducted over a four-year period with 13 Indian MHPs and administrators, and 18 persons experiencing PMI. Symbolic Interactionism was the informing framework. Findings indicate that reservation life promotes a high immersion in Eurocentric politics, which negatively affects the person with PMI in their maintenance of a healthy spirit balance. To be effective, MHPs need immersion in; the oneness of culture, spirituality, and politics of the community; knowledge of the tribal history; and communication with elders/spiritual leaders. This personal growth could facilitate provision of culturally responsive care needed for a client's navigation of intergovernmental regulations. MHPs should work for adequate funding policies of human service centers while supporting the establishment of indigenous governing practices through tribal sovereignty.     

Toward an Ecological Theory of Concepts

Psychology has had difficulty accounting for the creative, context-sensitive manner in which concepts are used. We believe this stems from the view of concepts as identifiers rather than bridges between mind and world that participate in the generation of meaning. This article summarizes the history and current status of concepts research and provides a nontechnical summary of work toward an ecological approach to concepts. We outline the rationale for applying generalizations of formalisms originally developed for use in quantum mechanics to the modeling of concepts, showing how it is because of the role of context that deep structural similarities exist between the two. A concept is defined not just in terms of exemplary states and their features or properties but also by the relational structures of these properties and their susceptibility to change under different contexts. The approach implies a view of mind in which the union of perception and environment drives conceptualization, forging a web of conceptual relations or “ecology of mind.”