The effects of rational-emotive therapy and relaxation training on premenstrual syndrome: A preliminary study

Six female subjects who were between 31 and 44 years of age attended a premenstrual syndrome (PMS) clinic and participated in a group therapy program designed to alleviate their premenstrual symptoms. Rational-emotive therapy (RET) and relaxation training were offered in addition to ongoing progesterone treatment in an effort to alleviate severe psychological symptoms thought to be occasioned by the hormonal changes occurring during the premenstrual week. Pre-treatment assessments were carried out using Moos' Menstrual Distress Questionnaire, Broadbent's Cognitive Failures Questionnaire, and Eysenck's Personality Questionnaire. Additionally, levels of self-reported psychological and physical menstrual distress symptoms were estimated by the subjects at each premenstruum throughout the ten-week therapy program. At the end of the ten week therapy program hormone treatment was discontinued. Significant pre-test to post-test differences were found in a number of psychological and physical symptoms of menstrual distress, in cognitive functioning and neuroticism, following the combined group treatment. Improvements in psychological functioning during premenstruum were observed at a one-year follow-up. RET and relaxation together with hormonal therapy produced a substantial reduction in PMS symptoms in comparison with drug treatment alone.     

Homeless men and women: Commonalities and a service gender gap

Gender differences among homeless persons on a host of variables were examined. A stratified random sample of 248 homeless persons staying in shelters in St. Louis provided data for the study. More similarities than differences between men and women were found. However, men tended to be homeless for longer periods and were more likely than women to sleep on the streets. Men were also more likely than women to have a drinking problem and to have been convicted of a crime. Men were less likely than women to ever have been married and to be caring for dependent children. The most striking gender differences occurred on service utilization variables; women were much more likely than men to have received social services. Comparison of our data with previous studies and potential explanations for the gender gap in service utilization are offered.     

Adult Attachment Ratings (AAR): An Item Response Theory Analysis

The Adult Attachment Ratings (AAR) include 3 scales for anxious, ambivalent attachment (excessive dependency, interpersonal ambivalence, and compulsive care-giving), 3 for avoidant attachment (rigid self-control, defensive separation, and emotional detachment), and 1 for secure attachment. The scales include items (ranging from 6–16 in their original form) scored by raters using a 3-point format (0 = absent, 1 = present, and 2 = strongly present) and summed to produce a total score. Item response theory (IRT) analyses were conducted with data from 414 participants recruited from psychiatric outpatient, medical, and community settings to identify the most informative items from each scale. The IRT results allowed us to shorten the scales to 5-item versions that are more precise and easier to rate because of their brevity. In general, the effective range of measurement for the scales was 0 to +2 SDs for each of the attachment constructs; that is, from average to high levels of attachment problems. Evidence for convergent and discriminant validity of the scales was investigated by comparing them with the Experiences of Close Relationships–Revised (ECR–R) scale and the Kobak Attachment Q-sort. The best consensus among self-reports on the ECR–R, informant ratings on the ECR–R, and expert judgments on the Q-sort and the AAR emerged for anxious, ambivalent attachment. Given the good psychometric characteristics of the scale for secure attachment, however, this measure alone might provide a simple alternative to more elaborate procedures for some measurement purposes. Conversion tables are provided for the 7 scales to facilitate transformation from raw scores to IRT-calibrated (theta) scores.     

Voluntary Control of Behavior and Responsibility

Malpractice insurance rates have created a crisis in American medicine. Rates are rising and reimbursements are not keeping pace. In response, physicians in the states hardest hit by this crisis are feeling compelled to take political action, and the current action of choice seems to be physician strikes. While the malpractice insurance crisis is acknowledged to be severe, does it justify the extreme action of a physician walkout? Should physicians engage in this type of collective action, and what are the costs to patients and the profession when such action is taken? I will offer three related arguments against physician strikes that constitute a prima facie prohibition against such action: first, strikes are intended to cause harm to patients; second, strikes are an affront to the physician-patient relationship; and, third, strikes risk decreasing the public's respect for the medical profession. As with any prima facie obligation, there are justifying conditions that may override the moral prohibition, but I will argue that the current malpractice crisis does not rise to the level of such a justifying condition. While the malpractice crisis demands and justifies a political response on the part of the nation's physicians, strikes and slow-downs are not an ethically justified means to the legitimate end of controlling insurance costs.     

Using Clinician-Rated Five-Factor Model Data to Score the DSM–IV Personality Disorders

Proposals suggest that many or all of the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM–IV]; American Psychiatric Association, 1994) personality disorders (PDs) may be omitted from the DSM (5th ed.; DSM–V) and replaced with a dimensional trait model of personality pathology (Krueger, Skodol, Livesley, Shrout, &; Huang, 2007 Krueger, R. F., Skodol, A. E., Livesley, W. J., Shrout, P. E. and Huang, Y. 2007. Synthesizing dimensional and categorical approaches to personality disorders: Refining the research agenda for DSM-V Axis II. International Journal of Methods in Psychiatric Research, 16: 65–73. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]; Skodol, 2009 Skodol, A. 2009. Emerging DSM-V perspectives on personality disorders. Plenary address presented at the Eleventh International ISSPD Congress. August2009, New York, New York.  [Google Scholar]). Several authors have expressed concerns that this may be difficult for clinicians and researchers who are more comfortable with the extant PD diagnoses. In this study, we tested whether clinician ratings of traits from the Five-factor model (FFM; Costa &; McCrae, 1990) can be used to recreate DSM–IV PDs. Using a sample of 130 clinical outpatients, we tested the convergent and discriminant validity of the FFM PD counts in relation to consensus ratings of the DSM–IV PDs. We then examined whether the FFM and DSM–IV PD scores correlate in similar ways with self-reported personality traits from the Schedule for Nonadaptive and Adaptive Personality (Clark, 1993 Clark, L. A. 1993. Manual for the Schedule for Nonadaptive and Adaptive Personality (SNAP), Minneapolis: University of Minnesota Press.  [Google Scholar]). Finally, we tested the clinical utility of the FFM PD counts in relation to functional impairment. Overall, the FFM PD counts, scored using clinician ratings of the FFM traits, appeared to function like the DSM–IV PDs, thus suggesting that the use of a dimensional trait model of personality in the DSM–V may still allow for an assessment of the DSM–IV PD constructs.     

Building a Tool to Identify Risk for Lynch Syndrome Among Individuals Presenting for Screening Colonoscopy

The goal of this work was to build and pilot-test a user-friendly Lynch syndrome risk assessment tool among individuals presenting for routine screening colonoscopy. Participants included adults presenting to a private practice-based, open-access endoscopy unit. Working with health literacy experts and gastroenterologists, and based on established criteria, we developed a simplified tool to assess Lynch syndrome risk, pre-procedure. A pilot-test of the tool assessed its: 1) clinical utility; 2) patient-reported usability; and 3) feasibility. The tool, in paper format, was written at a 9th grade reading level and included instructions for use followed by seven Lynch syndrome risk-related questions, structured such that one “Yes” response signified potential risk. A pilot-test of the tool among 334 patients revealed that 29 met criteria for Lynch syndrome risk. Of these, following telephone review of their responses, risk was confirmed in 9 patients (3% of total). The tool was reported as easy-to-use and was seen as feasible for use. Limitations include: 1) the need for infrastructure to distribute and collect the tool and 2) the availability of knowledgeable staff to review tool responses, confirm risk, and facilitate appropriate referral for genetic counseling. These data suggest that the tool affects assessment of Lynch syndrome risk among the routine colon cancer screening population.     

Hurricane Katrina's impact on the mental health of adolescent female offenders

Abstract

Exposure to multiple traumatic events and high rates of mental health problems are common among juvenile offenders. This study draws on Conservation of Resources (COR) stress theory to examine the impact of a specific trauma, Hurricane Katrina, relative to other adverse life events, on the mental health of female adolescent offenders in Mississippi. Teenage girls (N=258, 69% African American) were recruited from four juvenile detention centers and the state training school. Participants were interviewed about the occurrence and timing of adverse life events and hurricane-related experiences and completed a self-administered mental health assessment. Hierarchical linear regression models were used to identify predictors of anxiety and depression. Pre-hurricane family stressors, pre-hurricane traumatic events, hurricane-related property damage, and receipt of hurricane-related financial assistance significantly predicted symptoms of anxiety and depression. Findings support COR theory. Family stressors had the greatest influence on symptoms of anxiety and depression, highlighting the need for family based services that address the multiple, inter-related problems and challenges in the lives of female juvenile offenders.     

Impact of close family members on older adults' early response to depression treatment

This study of 130 depressed older adults and their spouses or adult children examined the impact of caregiver burden specific to patients' depressive symptoms on patients' response to antidepressant treatment. Primary care patients completed medical, psychiatric, and neuropsychological assessments prior to treatment, and interviews were conducted with their identified family member. As hypothesized, caregivers' depression-specific burden predicted greater depression severity for the patient at the 6th week of treatment after accounting for patients' pretreatment characteristics, caregivers' depressive symptoms, and caregivers' relationship satisfaction. Future research may identify family attitudes and behaviors that stem from burden and compromise older adults' ability to recover from depression.     

How do holidays influence relationship processes and outcomes? Examining the instigating and catalytic effects of Valentine's Day

Might Valentine's Day, despite its marketing as a holiday to enhance romantic relationships, paradoxically facilitate their demise? Because Valentine's Day provides a useful opportunity for exploring the potential influences of recurring culture‐wide events on relationships, we asked college students in romantic relationships about relationship stability, quality, beliefs, and processes, both 1 week prior to and 1 week after Valentine's Day. As predicted, those participating during the time period straddling Valentine's Day were more likely to break up than were those participating in comparison time periods. This increase in relationship dissolution appeared attributable to the catalyzing effect that Valentine's Day had on moderately strong and weak relationships already on a downward trajectory: These relationships were particularly likely to dissolve during the Valentine's Day period. We view this research as a useful illustration of how to conceptualize and empirically investigate the effects of holidays and other cultural events on relationship dynamics and outcomes.     

Boundary Considerations Between Doctoral Students and Master's Students

Counselor educators have a responsibility to teach students about boundary issues and multiple relationships. In addition to counselor–client concerns, there has been increased attention to faculty–student multiple relationships. Like faculty, doctoral students in counselor education programs often engage in roles with master's‐level students in which they hold a position of authority. This article reviews the professional literature on multiple relationships and boundary issues within counselor preparation programs and applies the research to boundary considerations between graduate students. Potentially fruitful areas for research are also suggested.