Is there a role of depressive symptoms in the fear-avoidance model? A structural equation approach

The fear-avoidance (FA) model has gained widespread acceptance as a conceptual framework for investigating psychological factors such as FA beliefs and avoidance behavior, which contribute to chronic back pain and reduced functioning. Depressive symptoms are supposed to be related to FA beliefs and to foster avoidance behavior. This study aims to investigate the multivariate assumptions of the FA model with a focus on the role of depressive symptoms. A total of N = 360 patients with chronic nonspecific low back pain at admission of inpatient orthopedic rehabilitation participated in the survey. Measures included a numeric pain rating scale, Fear-Avoidance Beliefs Questionnaire, Pain Anxiety Symptoms Scale, Hannover Functional Ability Questionnaire and Patient Health Questionnaire. Using structural equation modeling (SEM), we construed a basic FA model and subsequently extended it by adding symptoms of depression as a covariate. The results of SEM indicated a good model fit for a basic FA model (χ²(263) = 431.069, p < .001, RMSEA = .042, CFI = .964, WRMR = .986). They confirmed the hypothesized relations and supported single mediations of the relationship between pain and functioning by FA beliefs and avoidance behavior. A second model including symptoms of depression as additional covariate (χ²(511) = 722.761, p < .001, RMSEA = .034, CFI = .956, WRMR = .949) showed a high impact of depressive symptoms on all FA model variables leading to a decrease of the FA mediations. The findings provide empirical support for the multivariate FA model and underline the importance of considering depressive symptoms in a multiple-target approach to understand the mechanisms of chronic pain.     

Therapeutischer Stil und psychotherapeutische Behandlung älterer Patienten

Although the clinical field of psychotherapy for elderly patients is gradually developing, there is still a considerable gap in research on the topic. This mainly concerns questions about the characteristics of psychotherapy for elderly people. Based on clinical experience the therapeutic relationship and therapeutic style are of particular importance. This article presents a survey of psychotherapists who were asked with a questionnaire on their therapeutic style in the treatment of both elderly and younger patients. Data analysis showed differences between the two groups of patients concerning therapeutic technique and the assumed impact factors. In addition, differences between behavioral therapists and psychodynamic psychotherapists are important. The findings are discussed in the context of necessary modifications in the treatment of elderly people and training requirements.     

Age-Related Differences in Implicit Learning of Non-Spatial Sequential Patterns

This experiment investigated whether there are age differences in implicit learning of non-spatially arranged sequential patterns. We tested 12 young and 12 old participants for five sessions each in a non-spatial alternating serial reaction time (ASRT) task, in which predictable pattern events alternated with random, unpredictable ones. People of both ages were able to learn the sequence, but older people showed less pattern sensitivity than younger ones. Neither group was able to exhibit declarative knowledge of the pattern or to discriminate between pattern and random sequences on a recognition test, suggesting that the learning was indeed implicit. These findings indicate that the age deficits previously observed in the learning of spatial sequences are not due solely to age-related deficits in visuo-spatial attention or control of eye movements, but rather reflect a more general deficit in the ability to learn subtle sequential regularities.     

Gender Differences in the ABC’s of the Birds and the Bees: What Mothers Teach Young Children About Sexuality and Reproduction

Sexuality education is heavily gendered at adolescence. This study uses data from a national web survey of 631 U.S. mothers of 3 to 6 year old children to test whether similar gender differences exist in what mothers teach their young children about sexuality and reproduction. We test (a) whether mothers will report talking more with daughters or sons about sexuality related issues, and (b) whether mothers will report greater comfort talking about such issues with daughters or sons. We find (a) that mothers talk more to daughters than sons about romantic relationships, reproductive bodies, and morality, but not about sexual abuse or intercourse/pleasure. We find (b) mixed results regarding mothers’ comfort in talking with daughters or sons about sexuality.     

Transference-Focused Psychotherapy for Borderline Adolescents: A Neurobiologically Informed Psychodynamic Psychotherapy

In this article we first contextualize and then outline a model of TFP adapted for working with adolescents with Borderline Personality Disorders. We discuss how to take the normal developmental challenges of adolescence, such as separation-individuation in consideration, and how to support this in the context of the therapeutic work, while at the same time stimulating curiosity through clarification and confronting the adolescent with self-defeating and destructive patterns and dangerous behavior. Furthermore, we give examples of working with split–off parts of self and other representations through clarification to increase self-awareness and confrontations with contradictions within the adolescents communication and nonverbal behavior, with the aim of facilitating the integration of identity.