When Are Clients Ready to Terminate?

Termination of psychotherapy has received less attention in the research literature than other aspects of the treatment process. This paper presents a structured framework emphasizing observable markers to indicate when termination with a client is appropriate during cognitive behavioral treatment. The 7 criteria that indicate when a client is ready for termination are: (a) decrease in symptoms as assessed by sound measures; (b) decrease in symptoms that is stable and maintained for 8 weeks; (c) decrease in functional impairment; (d) evidence that the decrease in symptoms is not a spontaneous remission, such as lower symptoms associated with the use of new skills; (e) usage of the new skills, particularly at times or on themes of former vulnerability; (f) sense of pride regarding the new skills, in contrast to initial doubt regarding whether the techniques would work; and (g) carryover of decrease in symptoms to other areas. A case report and discussion regarding the clinical application of the framework is presented.     

Cross-cultural examination of the tripartite model with children: data from the Barretstown studies.

The Positive and Negative Affect Scale for Children (PANAS-C) and the Physiological Hyperarousal Scale for Children (PH-C) were administered to a group of 240 children from European countries to determine their utility in examining the tripartite model of anxiety and depression in a cross-cultural sample. Most of the children (n = 196) had been diagnosed with a medical illness; the remainder were siblings of these youngsters (n = 44). Only slight variations were noted in items between this sample and samples from the United States. Despite these minor differences, 3 distinct scales measuring the positive affect, negative affect, and physiological hyperarousal constructs of the tripartite model were identified. These findings illustrate that the PH-PANAS-C provides a useful measure of the tripartite model in a cross-cultural sample of youth. The findings also demonstrate that the tripartite model is generalizable to a cross-cultural milieu.     

Specificity of Information Processing Styles to Depressive Symptoms in Youth Psychiatric Inpatients

Although information processing has been widely studied with depressed adults, little emphasis has been placed on the specificity of resultant findings to depression, as opposed to other psychological disorders. Analogously, even less effort has been directed toward examining the information processing styles of depressed children and adolescents. The present study investigated the specificity of information processing styles to depression and anxiety among 58 youth psychiatric inpatients. To assess information processing, we used a self-referent encoding task, in which participants were presented with positive and negative adjectives; participants were asked whether these adjectives described them or not, and were then tested on recall of the adjectives. After controlling for age and gender, lower rates of positive adjective endorsement and lower rates of positive adjective recall were found to be associated with depression, but not anxiety. Additionally, negative adjective endorsement was associated with anxiety symptoms. These results suggest specific cognitive features of depressive symptoms.     

Negative-Feedback Seeking Leads to Depressive Symptom Increases Under Conditions of Stress

An earlier empirical investigation found the interaction of negative-feedback seeking and roommate rejection to be predictive of increases in depressive symptoms. This study replicated and elaborated this finding. Participants who sought negative feedback and performed below their personal standard of success were more likely to experience a subsequent increase in depressive symptoms compared with all other students. Furthermore, the interaction of negative-feedback seeking and midterm failure was specific to predicting increases indepressive symptoms, and did not predict anxious symptoms, thus supporting the specificity of the model to depression. These findings suggest that negative-feedback seeking, combined with a negative life event, may place an individual at increased risk for depressive symptoms. Potential methods and consequences of disrupting the pattern of negative-feedback seeking are discussed.     

The Relative Specificity of Excessive Reassurance-Seeking to Depressive Symptoms and Diagnoses Among Clinical Samples of Adults and Youth

In addition to playing a role in the deterioration of depressed people's interpersonal environment, excessive reassurance-seeking may be implicated as a vulnerability factor for depression. If so, excessive reassurance-seeking should display relative specificity to depression versus other forms of psychopathology. Two studies of psychiatric inpatients (Study 1 on adults and Study 2 on children) tested this possibility. In Study 1 a Depressed group obtained higher reassurance-seeking scores than an Other Disorders group did. Similar findings were obtained in Study 2, such that depressed youth reported higher reassurance-seeking than nondepressed youth. Hence, these two studies of psychiatric inpatients provided reasonable support for the specificity of excessive reassurance-seeking to depression as compared to other forms of psychopathology.     

Childhood diagnoses and later risk for multiple suicide attempts

The relationship between childhood diagnosis, personality psychopathology and suicidal behavior in young adulthood was explored in a sample of 327 suicide ideators, single attempters, and multiple attempters. Of the total sample, 174 received at least one childhood diagnosis; the 153 without a diagnosis provided a comparison group. Results suggest that a childhood history of an anxiety disorder or major depression predispose a person to both later multiple suicide attempts and personality psychopathology. Gender was found to play a significant role, with females being predisposed to multiple attempts in young adulthood but only as a function of childhood anxiety, not major depression. Additionally, childhood anxiety disorders were found to predispose to multiple attempts as a function of personality psychopathology, with distinctly different paths for males and females. Implications are discussed in terms of etiology, prevention, and treatment.     

Reducing hopelessness: the interation of enhancing and depressogenic attributional styles for positive and negative life events among youth psychiatric inpatients

A recovery model of depression (Needles & Abramson, 1990 Journal of Abnormal Psychology, 99, 156-165) proposes that depressed individuals who exhibit an enhancing attributional style for positive events (i.e. make stable, global attributions) will be more likely to regain hopefulness and, thereby, recover from depression when positive events occur. While only a few studies have directly tested this model among clinical and nonclinical adult samples, none have tested a clinical sample of children and adolescents. Furthermore, prior studies testing this model have failed to examine the interactive role of an 'enhancing attributional style' for positive events with a 'depressogenic attributional style' for negative events, as prescribed by the hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989 Psychological Review, 96, 358-372). The current study presents data demonstrating that depressogenic and enhancing attributional styles interact to predict differential decreases in hopelessness. Implications of these findings and suggestions for future research also are presented.     

The emotional impact and ease of recall of warning signs for suicide: a controlled study

In light of concerns about potential iatrogenic effects of information about suicide, in the current study we examined the emotional impact of reading a list of warning signs for suicide in comparison to comparable lists for heart attacks and diabetes. All participants read two sets of warning signs, with the experimental group reading the suicide warning signs. Results confirm no difference in emotional impact across groups, along with providing evidence that warning signs for suicide are as easy to recall after exposure as warning signs for heart attack. Implications for pubic health campaigns are discussed.     

Warning signs for suicide on the Internet: a descriptive study

The issue of suicide warning signs on the Internet is considered. In addition to reviewing some of the relevant conceptual issues about warning signs, a random sample of Internet sites was selected and reviewed. Warning signs were grouped and agreement across sites was examined, with results confirming broad disparity in what is presented to the public. The implications of a lack of consensus on warning signs for suicide are discussed.     

Social inequalities in suicide mortality: Spain and France, 1980-1982 and 1988-1990

In this study we analyzed the socioeconomic differences in mortality from suicide in the economically active male population aged 25-64 years in Spain and France in 1980-1982 and 1988-1990; in the case of Spain the data came from the Eight Provinces Study (Regidor, Gutierrez-Fisac, & Rodríguez, 1995). Individuals were grouped into four categories: professional/managerial, clerical/sales/ service, agricultural, and manual workers. For 1980-1982, among those aged 25-44, professionals and managers had the lowest risk of mortality in Spain, and clerical/sales/service workers in France. These socioeconomic differences in mortality increased in 1988-1990. In 1980-1982, among those aged 45-64, clerical/ sales/service workers had the lowest risk of mortality from suicide relative to the other occupational groups in both countries, but this difference was not maintained in 1988-1990. Thus, differences in suicide mortality for men by occupational status depended in the present study upon both the nation studied and the time period chosen for study.