Although several studies have shown a clear association between childhood adversities and later development of a number of psychiatric disorders, a number of recent reports have cast doubts regarding the aetiological role played by abuse, neglect and loss, arguing that they are neither necessary nor sufficient to account for the development of subsequent psychopathology. In this study, we aimed to investigate the associations and predictive power of childhood adversities on later onset of Axis-I &-II psychiatric conditions and the impact on severity of psychiatric presentation in a large sample of patients. This cross-sectional multi-centre study evaluated patients (N = 1136) recruited in fourteen NHS psychotherapy departments in the UK. Patients were assessed using a number of rater-based questionnaires and self-rated measures. Multiple regression analyses showed that childhood experiences of loss and physical abuse were predictive of severe personality disorder and borderline personality disorder, but not of other less severe PD and Axis-I diagnoses. Sexual abuse predicted later onset of Post-traumatic Stress Disorder. In addition, we found that childhood abusive experiences were strongly associated with severity of psychiatric distress, interpersonal problems and global functioning. Having experienced two or more childhood adversities significantly increased severity of psychiatric distress, interpersonal malfunctioning and CORE scores. 相似文献
Rapid response is considered the most well-established outcome predictor across treatments of binge-eating disorder (BED), including cognitive-behavioral therapy (CBT). This study sought to identify latent trajectories of early change in CBT and compare them to common rapid response classifications. In a multicenter randomized trial, 86 adults with BED (DSM-IV) or subsyndromal BED provided weekly self-reports of binge eating over the first 4 weeks of CBT, which were analyzed to predict binge eating, depression, and body mass index at posttreatment, 6-, and 18-month follow-up. Using latent growth mixture modeling, three patterns of early change—including moderate and low decreasing—as well as low stable binge eating were identified, which significantly predicted binge-eating remission at 6-month follow-up. Other classifications of rapid response based on Receiver Operating Characteristics curve analyses or on the literature (≥ 10% reduction in binge eating at week 1, ≥ 70% reduction in binge eating at week 4) only predicted posttreatment remission or overall depression, respectively. Latent change trajectories, but not other rapid response classifications, predicted binge-eating frequency over time. A fine-grained analysis of change over the first 4 weeks of CBT for BED revealed different trajectories of early change in binge eating that led to an improved prediction of binge-eating outcome, compared to that of common rapid response classifications. Thorough monitoring of early change trajectories during treatment may have clinical utility. 相似文献
Motor imagery requires that actual movements are prevented (i.e., inhibited) from execution. To investigate at what level inhibition takes place in motor imagery, we developed a novel action mode switching paradigm. Participants imagined (indicating only start and end) and executed movements from start buttons to target buttons, and we analyzed trial sequence effects. Trial sequences depended on current action mode (imagination or execution), previous action mode (pure blocks/same mode, mixed blocks/same mode, or mixed blocks/other mode), and movement sequence (action repetition, hand repetition, or hand alternation). Results provided evidence for global inhibition (indicated by switch benefits in execution-imagination (E-I)-sequences in comparison to I-I-sequences), effector-specific inhibition (indicated by hand repetition costs after an imagination trial), and target inhibition (indicated by target repetition benefits in I-I-sequences). No evidence for subthreshold motor activation or action-specific inhibition (inhibition of the movement of an effector to a specific target) was obtained. Two (global inhibition and effector-specific inhibition) of the three observed mechanisms are active inhibition mechanisms. In conclusion, motor imagery is not simply a weaker form of execution, which often is implied in views focusing on similarities between imagination and execution. 相似文献
The study examined the influence of gender-stereotyped stimuli rotated in depth on children’s mental-rotation performance. Participants included 321 elementary school children who completed three-dimensional mental-rotation tasks with either male- or female-stereotyped stimuli (M-MRT-3D/F-MRT-3D). Results suggest that in-depth tasks are very difficult for second graders. No gender effect was found in the mental-rotation performance of 7- to 9-year-old children; however, task understanding indicates gender differences. For fourth graders, a significant interaction of gender and stimulus type could be demonstrated. Furthermore, results indicate that fourth-grade boys tend to guess more often in tasks with stimuli consistent to the respective own gender. In addition, regression analyses showed that next to grade and perceptual speed, the perceived level of stimulus familiarity predicted performance. Considering a possible link between dimensionality and familiarity, the influence of the gender-stereotyped stimuli on children’s confidence and task understanding as well as on transformational processes and strategy efficiency is discussed. 相似文献
This study analyzed the presence of awareness of movement disorders (dyskinesias and hypokinesias) in 25 patients with Parkinson’s disease (PD) and motor fluctuations (dyskinesias, wearing off, on–off fluctuations). Of the few studies that have dealt with this topic, none have analyzed the differences in the awareness of motor deficits by comparing the on and off states using motor scales and an extensive battery of tests to assess cognitive and behavioral functioning.
Methods
PD patients were compared on three different scales that we have devised to measure awareness of movement disorders: Global Awareness of Movement (GAM) Disorders, dyskinesia/hypo-bradykinesia rating scales.
Results
Data showed that PD patients had greater awareness and psychological suffering in the off state than in the on state. In particular, they were troubled by motor disabilities related to hypokinesias and had mood-related symptoms and a perception of disability in activities of daily living. Interestingly, patients only showed a selective reduction of awareness of movement disorders associated with executive functions and related to dyskinesias in the on state, compared to a preserved awareness of hypokinesias in the off state. On the contrary, no association with executive functions was found in the off state.
Conclusion
Our findings suggest that the dopaminergic overstimulation of mesocorticolimbic pathways may cause a dysfunction of prefrontal–subcortical connections related to the impaired insight. 相似文献
Multiple‐choice response formats are troublesome, as an item is often scored as solved simply because the examinee may be lucky at guessing the correct option. Instead of pertinent Item Response Theory models, which take guessing effects into account, this paper considers a psycho‐technological approach to re‐conceptualizing multiple‐choice response formats. The free‐response format is compared with two different multiple‐choice formats: a traditional format with a single correct response option and five distractors (‘1 of 6’), and another with five response options, three of them being distractors and two of them being correct (‘2 of 5’). For the latter format, an item is scored as mastered only if both correct response options and none of the distractors are marked. After the exclusion of a few items, the Rasch model analyses revealed appropriate fit for 188 items altogether. The resulting item‐difficulty parameters were used for comparison. The multiple‐choice format ‘1 of 6’ differs significantly from the multiple‐choice format ‘2 of 5’, while the latter does not differ significantly from the free‐response format. The lower difficulty of items ‘1 of 6’ suggests guessing effects. 相似文献
We examined patterns of trait similarity (assortative mating) in married couples in four cultures, using both self-reports and spouse ratings on versions of the Revised NEO Personality Inventory. There was evidence of a subtle but pervasive perceived contrast bias in the spouse-rating data. However, there was strong agreement across methods of assessment and moderate agreement across cultures in the pattern of results. Most assortment effects were small, but correlations exceeding .40 were seen for a subset of traits, chiefly from the Openness and Agreeableness domains. Except in Russia, where more positive assortment was seen for younger couples, comparisons of younger and older cohorts showed little systematic difference. This suggested that mate selection, rather than convergence over time, accounted for similarity. Future research on personality similarity in dyads can utilize different designs but should assess personality at both domain and the facet levels. 相似文献
The aim of this paper is to empirically assess the reliability of the plan formulation method for couples, a procedure for formulating the case, planning, and monitoring the couple therapies according to control-mastery theory. We hypothesized that when couples are looking for couple therapy, they have an unconscious couple’s plan for the therapy, which includes the couple’s goals; the pathogenic beliefs that the partners want to disprove; the traumas from which these beliefs originated and that the partners want to master; the vicious relational circles that make the couple suffer and that the couple wants to break; the virtuous relational circles that are expressions of the couple’s resources and that the couple wants to fuel; and the relational insights that may help the couple get better. Our study involved 15 couples treated by four experienced therapists. Four raters independently formulated each couple’s plan based on the first three sessions following a standard procedure, and we calculated the intraclass correlation for pooled judges’ ratings. For a subsample of three couples—who before and after treatment had completed the dyadic adjustment scale (DAS) and the outcome questionnaire-45.2 (OQ-45.2)—the compatibility of the therapists’ interventions with the couples’ and partners’ plans was assessed. The relationship between the ratings of compatibility, DAS and OQ-45.2, was assessed. The results showed excellent interjudge reliability for each couple’s plan formulation (average ICC?=?0.82), attesting to the validity of the procedure; and preliminary data on the therapeutic process suggested that therapists’ interventions compatible with couple’s plans could help partners achieve good outcomes.
Zusammenfassung
Die Autorin gibt zun?chst einen kurzen überblick über die bisherige Analyseabbruchsliteratur seit Freuds berühmter Dora-Analyse.
Sie beschreibt die Ver?nderung des Blicks auf Behandlungsabbrüche im Kontext der theoretischen und behandlungstechnischen
Entwicklungen und hebt hervor, dass die unvermeidlich erfolgenden Verstrickungen von Analytikern mit ihren Patienten bei realen
Abbrüchen oder Abbruchsdrohungen heute eher als wichtiges Material und nicht mehr nur als „Kunstfehler“ verstanden und entsprechend
weniger scham- sowie schuldhaft erlebt und durchgearbeitet werden k?nnen.
Es folgt ein Fallbericht über die schwierige Analyse einer jungen Erwachsenen, die einerseits beharrlich an ihrem destruktiven
Agieren auf der Basis ihres narzisstischen Universums und ihrer ?dipalen Verstrickungen festhielt. Andererseits war sie mit
aufrichtigem Erkenntnisinteresse dazu bereit, die dramatischen “enactments” zwischen sich und ihrer Analytikerin (re)konstruktiv
zu verstehen und sich auf ihren immer wieder bedrohlichen Entwicklungsprozess einzulassen. Anhand von mehreren (über den gesamten
Behandlungsverlauf verteilten) Abbruchsinszenierungen beschreibt die Autorin, wie sich über das beharrliche und konkrete Durcharbeiten
dieser Szenen mit der Zeit schrittweise ein tieferes Verst?ndnis für deren Sinn und eine Milderung der Wucht der negativen
Affekte herstellen lie?en. Den besonderen Akzent bei ihrer Behandlungsführung setzt die Autorin auf die Arbeit an und in der
unmittelbaren übertragungsbeziehung zwischen sich und ihrer jungen Patientin: Diese forderte ihre Analytikerin immer wieder
heraus, einerseits „Farbe zu bekennen“ und dabei gleichzeitig ihre analytische Professionalit?t verl?sslich aufrechtzuerhalten.
Dieser behandlungstechnisch komplizierte Balanceakt zwischen Scheitern und Chance wird n?her beschrieben.
Breaking-off-enactments between failure and chance
Abstract
First, an overview of the literature about the breaking off of analyses since Freud's famous Dora case is given. Subsequently,
a since then changed view of breakoffs of treatments is presented, derived from new developments in theory and technique of
treatment. The inevitable entanglements of analysts and patients in case of breakoffs or threats of breaking off are seen,
therefore, nowadays rather as important analytic material instead of viewing it as “malpractice”. They are less loaded with
guilt and shame and so easier to work through. A case study is then presented about the difficult analysis of a young adult
woman, who on the one side was tenaciously clinging to her destructive acting-outs rooting in her narcissistic universe and
her oedipal entanglements. But on the other side she had a genuine interest in getting (re)constructive awareness about the
dramatic enactments between herself and her analyst and to engage in a developmental process which had for her again and again
a menacing quality. The author describes several breakoff-enactments in the course of this analysis, occuring at different
times along the whole treatment, and how their consistent and concrete working through gradually led to a deeper understanding
of their meaning and to a moderating of the vehemence of negative affects. The author's emphasize in her treatment was put
especially on the work in the transference relationship: the patient challenged the analyst repeatedly on the one side to
“come clean” and at the same time to maintain reliably the professional analytic attitude. This complex balancing act between
failure and chance is described in detail.
überarbeitete und erweiterte Fassung eines Vortrags im Dezember 2006 anl?sslich der Ernennung zur DGPT-Lehranalytikerin, gehalten
vor der „Arbeitsgemeinschaft für Integrative Psychoanalyse, Psychotherapie und Psychosomatik Hamburg“ (APH). Ich danke Josef
Hauphoff, Peter Fürstenau und Helmut Junker für ihre konstruktiven fachlichen Anregungen. 相似文献