A controlled comparative investigation of psychological treatments for chronic sleep-onset insomnia

A sample of physician-referred chronic insomniacs was randomly allocated to either progressive relaxation, stimulus control, paradoxical intention, placebo or no treatment conditions. Treatment process and outcome were investigated in terms of mean and standard deviation (night to night variability) measures of sleep pattern and sleep quality. Only active treatments were associated with significant improvement, but the nature of treatment gains varied. In particular, stimulus control improved sleep pattern, whereas relaxation affected perception of sleep quality. All improvements were maintained at 17 month follow-up. Results are discussed with reference to previous research and guidelines are given for clinical practice.     

Negativism and countertransference

The purpose of this work is to explore the phenomenon of negativism and the analyst's response to it during the course of analytic work with a patient in whom negativism is a central behavioral pattern. Melville's short story, "Bartleby the Scrivener," describing in telling detail the response of a sympathetic lawyer to profound and pervasive negativism in his legal scribe, is discussed as a literary analogy to the analyst-analysand dyad. Aspects of the concept of negativism within psychoanalysis are discussed. The potential usefulness of understanding certain unexpected countertransference responses to pervasive negativism is explored, as this is a relatively neglected area of psychoanalytic technique. A case is presented describing the analysis of a patient whose character, like Bartleby's, is a mixture of profound negativism along with schizoid, obsessional, and masochistic elements.     

Reducing smoking among pregnant adolescents

Pregnant adolescents who smoke present a double obstetrical risk. Not only is the adolescent mother at risk from the biological, social, educational, and economic factors associated with childbearing at a young age, she and her developing infant also risk the complications associated with maternal smoking. This paper describes a psychosocial intervention designed to reduce smoking in a group of pregnant adolescents. Five modules are presented. Each is designed to: (1) heighten awareness of the issue, (2) provide motivational messages, (3) enhance the adolescent's social skills, and (4) teach specific smoking-cessation skills.     

Microgenesis as traced by the transient paired-forms paradigm

Two successive, spatially overlapping human faces were exposed for recognition with SOAs ranging from 20 to 160 msec. The subjects effectively perceived one face, which at short SOAs mostly resembled the first stimulus and with increasing SOAs gradually shifted towards the appearance of the second, dimmer stimulus. These results replicated those from the study by Calis, et al, and extended them to the experimental conditions of controlled simultaneity of each of the two temporally separate, extremely brief stimuli and to the conditions of personally unfamiliar stimulus-subjects. In the second experiment we employed a direct measurement of the microgenetic focus in real time by using a procedure by which the subjects' judgments about the relative temporal order of the critical visual stimulus and an auditory click were recorded. Via this procedure it was shown that one of the effects of the first visual stimulus is to speed up the microgenetic process for the second stimulus which then appears subjectively earlier as compared to the single-stimulus control.     

A sermon from hell: Toward a theology of loneliness

Loneliness as part of the human condition is first explored from an experiential-philosophical perspective. A biblical survey suggests loneliness is normative to the faith experience and may portray a more realistic religiosity. Desert imagery in Scripture indicates a strong association among solitude, spiritual development, and potential dangers of spiritual deception. God's not yet-ness-itself a cause of existential loneliness—is paradoxically the way in which communion with God functions in the here and now. The creative use of solitude may enhance social, psychological, and spiritual well-being, and provide a way to theologize about personal isolation and disorientation.He is also editor of theHarding Journal of Religion and Psychiatry.     

Sex differences in the psychological well-being of Chinese adolescents

This study assessed sex differences affecting the psychological well-being of Chinese adolescents. Various instruments were used to measure psychiatric symptoms and positive mental health. The results showed that female adolescents displayed significantly more psychiatric as well as somatic symptoms and scored lower on scales reflecting positive mental health. The findings are generally consistent with those found in the Western literature, but suggest that, in the Chinese culture, sex differences in mental health begin to appear in adolescents.     

Self-discrepancies in clinical depression and social phobia: cognitive structures that underlie emotional disorders?

Previous research indicates that self-discrepancies are cognitive structures that can induce emotional discomfort. The present study compared clinically depressed and social phobic subjects (plus controls) to determine whether different self-discrepancies were associated with the two disorders. In Part 1, it was shown that the depressives possessed the greatest discrepancy between their actual and ideal/own self-states, whereas the social phobics possessed the greatest discrepancy between their actual and ought/other self-states. In a later, ostensibly unrelated study, subjects responded verbally to questions about other people while their mood changes, skin conductance responses, and verbalizations were recorded. The questions included attributes from the subject's ideal and ought self-states that were mismatches with attributes from his or her actual self, as well as mismatch attributes from other subjects. Priming with self-referential mismatches induced momentary syndromes of dejection or agitation (depending on the type of mismatch). The depressives and social phobics showed the greatest increases in dejection and agitation, respectively, according to their dominant self-discrepancy. The results suggest that specific cognitive structures may underlie clinical depression and anxiety.     

The "psychosomatic family" model: an empirical and theoretical analysis

Evolution of the Family Systems Paradigm has been constrained by the dichotomy between theory building and empirical research. This article integrates these two domains by presenting a theoretical analysis of the "psychosomatic family" model as it informs and is informed by an empirical research project. Forty families of children with Crohn's disease (CD), ulcerative colitis (UC), and functional recurrent abdominal pain syndrome (RAP) were rated during standard, videotaped family interaction tasks, lunch, and interview. Laboratory scores of disease activity were associated with triangulation, marital dysfunction, and total "psychosomatic family" scores. Disease activity was not significantly correlated with enmeshment, overprotection, rigidity, conflict avoidance, or poor conflict resolution. Thus, the marital/triangulation and enmeshment/overprotection/conflict clusters may be subcomplexes of the "psychosomatic family" complex. CD, UC, and RAP groups differed in the relations among particular family patterns and disease activity. A heuristic family-psycho-somatic model is presented to facilitate future research.     

Diagnosis of major depression by self-report

The Symptom Checklist-90 (SCL-90), Millon Clinical Multiaxial Inventory (MCMI), and Minnesota Multiphasic Personality Inventory (MMPI) test profiles of inpatients and outpatients with DSM-III major depression (n = 48) were contrasted with the test profiles of a control group of patients with diverse psychiatric disorders (n = 68). In addition, the diagnostic efficiency of the relevant depression subscales for the diagnosis of major depression were examined. The results indicated that the three self-report tests may be used to diagnose DSM-III major depression, and that the depressed patients had characteristic test profiles.     

Sex differences on the revised Beck Depression Inventory for outpatients with affective disorders

The revised Beck Depression Inventory (BDI) was administered to 174 male and 276 female psychiatric outpatients diagnosed with affective disorders. The mean BDI scores, mean number of symptoms claimed, and corrected item-total correlations were comparable for both sexes, and the coefficient alpha for each sex was .88. Principal components analyses found four dimensions of depression underlying both sexes' BDI item-intercorrelation matrices. Although men and women had comparable dimensions with respect to weight loss, self-blame, and somatic-performance symptoms, men had affective and performance symptoms loading on the same factor, whereas women had affective and cognitive symptoms loading on the same dimension.