Lack of a close confidant: prevalence and correlates in a medically underserved primary care sample

The present study examined prevalence of lack of a close confidant in a medically underserved primary care sample, and evaluated demographic, medical, and psychological correlates of patients' deficits in close, personal contact. Adult patients (n = 413) reported on confidant status and symptoms of depression and anxiety. Sociodemographic and medical information were obtained through chart review. One-quarter of patients endorsed lack of a close confidant. Past month anxiety and depression symptoms, but not medical status, were associated with unmet socioemotional needs. Implications for primary healthcare interventions are discussed.     

The role of computer‐aided psychotherapy within an NHS CBT specialist service

To date, the feasibility of computer‐aided psychotherapy as an intervention has only been recognised in primary care practice. The present study sought to evaluate the impact of ‘Beating the Blues’ (BtB), an established computerised cognitive behaviour therapy (CCBT) self‐help programme for the management of anxiety and depression, within an NHS CBT specialist healthcare centre. Of the 555 service users who used BtB as part of routine care, with follow‐up assessment at six to eight weeks, 71% completed all eight sessions. Statistically significant differences on the Beck Depression Inventory‐II (BDI‐II) and Beck Anxiety Inventory (BAI) were found in completer and intention‐to‐treat analyses; 50% of completers achieved reliable change on the BDI‐II and approximately 25% of completers achieved reliable and clinically significant change on both measures. Outcomes were benchmarked against outcomes in studies of routine face‐to‐face CBT. These findings provide evidence that BtB may be of value to service users in secondary mental healthcare centres, alleviating current burdens on public health and therapeutic resources. Future research directions should include examining which factors influence individuals’ decisions to try computer‐aided psychotherapy, which individuals are best suited to using these interventions, and why some users drop out prior to programme completion.     

RATIONAL EMOTIVE BEHAVIOR THERAPY AFTER ELLIS: PREDICTIONS FOR THE FUTURE

The 9 members of the Institute for Rational-Emotive Therapy’s International Training Standards and Review Committee (of which Albert Ellis is currently one) predict the status of Rational Emotive Behavior Therapy (REBT) after the death of Albert Ellis, its progenitor. Most respondents addressed whether REBT will exist in its own right or be subsumed under the broad umbrella of Cognitive Behavior Therapy. Reprinted from Journal of Mental Health Counseling, 17, 413–427, 1995. AMHCA. Reprinted with permission. No further reproduction authorized without written permission from the American Mental Health Counselors Association. Stephen G. Weinrach was a professor of counseling and human relations at Villanova University, Villanova, Pennsylvania. He died in 2004. The authors expressed their appreciation to Martin Gerstein and Allen Ivey for their generous contributions to a draft version of this article. Colleen Deeter provided valuable editorial assistance in the preparation and coordination of this project.     

BODY OBJECTIFICATION AND DEPRESSION IN ADOLESCENTS: THE ROLE OF GENDER, SHAME, AND RUMINATION

Objectification theory posits that the tendency to view oneself as an object to be looked at and evaluated by others negatively affects girls', but not boys', subjective well-being. Although it has been established that women self-objectify more than men, research in this area has been limited to the study of adult college women. The aim in the current longitudinal study was to investigate the role of body shame and rumination in the link between self-objectification and depression among a community sample of girls and boys at ages 11 and 13. Results indicated that adolescent girls reported higher levels of self-objectification, body shame, rumination, and depression than boys. The findings support a model in which body shame and rumination mediate a direct relation between self-objectification and depression among girls; developmentally, the gender difference in self-objectification appears before the gender differences in rumination and depression.     

The effects of context on the correspondence between observational ratings and questionnaire reports of hostile behavior: a multitrait, multimethod approach.

Scholars who study close relationships often measure the same concept with both observational ratings and questionnaire items. In studies where this has been done, the correlations between the two measures have often been low, and one reason may be a "context by measurement" confound. Observational ratings are usually based on behaviors during a specific task, whereas most questionnaire responses are based on a broader context such as "during the past month." In 2001, a total of 292 young couples were videotaped during a discussion task and asked to report on their own behavior and that of their partner during the discussion task and during the past month. The data were configured as a multitrait, multimethod matrix, and the magnitudes of the correlations were estimated with confirmatory factor analysis. The resulting correlations between observer ratings and questionnaire reports of hostile behavior during the videotaped discussion were roughly twice the magnitude of the correlations between observer rating and questionnaire reports during the past month. This suggests that the correspondence between behavioral categories and the content of questionnaire items is greater than previous studies have indicated.     

Medicare's search for effective obesity treatments: diets are not the answer

The prevalence of obesity and its associated health problems have increased sharply in the past 2 decades. New revisions to Medicare policy will allow funding for obesity treatments of proven efficacy. The authors review studies of the long-term outcomes of calorie-restricting diets to assess whether dieting is an effective treatment for obesity. These studies show that one third to two thirds of dieters regain more weight than they lost on their diets, and these studies likely underestimate the extent to which dieting is counterproductive because of several methodological problems, all of which bias the studies toward showing successful weight loss maintenance. In addition, the studies do not provide consistent evidence that dieting results in significant health improvements, regardless of weight change. In sum, there is little support for the notion that diets lead to lasting weight loss or health benefits.     

Rumination-focused cognitive behaviour therapy for residual depression: a case series

The treatment of chronic and recurrent depression is a priority for the development of new interventions. The maintenance of residual symptoms following acute treatment for depression is a risk factor for both chronic depression and further relapse/recurrence. This open case series provides the first data on a cognitive-behavioural treatment for residual depression that explicitly targets depressive rumination. Rumination has been identified as a key factor in the onset and maintenance of depression, which is found to remain elevated following remission from depression. Fourteen consecutively recruited participants meeting criteria for medication--refractory residual depression [Paykel, E.S., Scott, J., Teasdale, J.D., Johnson, A.L., Garland, A., Moore, R. et al., 1999. Prevention of relapse in residual depression by cognitive therapy--a controlled trial. Archives of General Psychiatry 56, 829-835] were treated individually for up to 12 weekly 60-min sessions. Treatment specifically focused on switching patients from less helpful to more helpful styles of thinking through the use of functional analysis, experiential/imagery exercises and behavioural experiments. Treatment produced significant improvements in depressive symptoms, rumination and co-morbid disorders: 71% responded (50% reduction on Hamilton Depression Rating Scale) and 50% achieved full remission. Treating depressive rumination appears to yield generalised improvement in depression and co-morbidity. This study provides preliminary evidence that rumination-focused CBT may be an efficacious treatment for medication--refractory residual depression.     

Use it or lose it: examining preschoolers' difficulty in maintaining and executing a goal

Individuals with low working memory capacity (e.g. preschoolers) are more prone to goal neglect, or a failure to execute a goal even though it is understood. We examined the role of goal neglect in performance on the Dimensional Change Card Sort by including 'redundant' cards that could be sorted without attending to the rules, as well as the traditional 'conflict' cards that encouraged awareness of the rules. In Experiment 1, 4- and 5-year-old children were administered two card sorts that differed on the proportion of redundant cards presented (20% vs. 80%). Children neglected the goal more often when faced with a preponderance of redundant cards, suggesting that consistent attention to the rules leads to goal maintenance. In Experiment 2, results were replicated even when the post-switch rules were repeated on every trial. Implications for the development of working memory are discussed.