The role of defeat and entrapment in depression, anxiety, and suicide

Defeat and entrapment are psychological constructs that have played a central role in evolutionary accounts of depression. These concepts have since been implicated in theoretical accounts of anxiety disorders and suicidality. The current article reports on a systematic review of the existing research investigating the links among defeat, entrapment, and psychopathology in the domains of depression, suicidality, posttraumatic stress disorder (PTSD), and other anxiety syndromes. Fifty-one original research articles were identified and critically reviewed. There was strong convergent evidence for a link with depressive symptoms, across a variety of clinical and nonclinical samples. Preliminary support for an association with suicidality was also observed, with effects not readily explainable in terms of comorbid depression. There was strong evidence for an association between defeat and PTSD, although this may have been partly accounted for by comorbid depression. The findings for other anxiety disorders were less consistent. There was, however, evidence that social anxiety in individuals with psychosis may be related to perceptions of entrapment. Overall, there was evidence that perceptions of defeat and entrapment were closely associated with various forms of human psychopathology. These effects were often in the moderate to large range and superseded the impact of other environmental and psychological stressors on psychopathology. We provide a unified theoretical model of how defeat and entrapment may contribute to these different psychopathological conditions. Clinical implications and avenues for future research are discussed.     

Contextual Inequalities in Religious Youth Programming

Religious congregations are hypothesized to be a community organization affected by contextual inequalities. Survey and interview data are analyzed to investigate the type and prevalence of youth programming in a geographic area. Rather than drawing a sample of religious congregations in the area, the telephone survey was conducted with every congregation located in the three contiguous cities. Coupled with the high response rate (98.9%), this allows for a unique analysis of a total population of congregations in the specified area. In-person interviews were also conducted with religious youth ministers sampled from the broader population of congregations. U.S. Census (American Factfinder, 2000) data on the areas in which the congregations were located was linked to survey and interview data. Results demonstrate contextual effects in religious youth programming, net of denomination, congregation size, and budget. The availability and type of youth programming in different locations relates to the inequalities embedded in these contexts. This study indicates that social disorganization theories apply to religious organizations not in inequalities of the number of congregations located in any particular area but in inequalities in the level of youth programming density available within those congregations.     

Childhood Social Withdrawal,Interpersonal Impairment,and Young Adult Depression: A Mediational Model

Building on interpersonal theories of depression, the current study sought to explore whether early childhood social withdrawal serves as a risk factor for depressive symptoms and diagnoses in young adulthood. The researchers hypothesized that social impairment at age 15 would mediate the association between social withdrawal at age 5 and depression by age 20. This mediational model was tested in a community sample of 702 Australian youth followed from mother’s pregnancy to youth age 20. Structural equation modeling analyses found support for a model in which childhood social withdrawal predicted adolescent social impairment, which, in turn, predicted depression in young adulthood. Additionally, gender was found to moderate the relationship between adolescent social impairment and depression in early adulthood, with females exhibiting a stronger association between social functioning and depression at the symptom and diagnostic level. This study illuminates one potential pathway from early developing social difficulties to later depressive symptoms and disorders.     

Effects of Child Psychopathology on Maternal Depression: The Mediating Role of Child-Related Acute and Chronic Stressors

In light of recent research highlighting the potential effects of children’s behavior on mothers’ mental health, the current study examined 679 mothers and their adolescent children from a community-based sample to determine the effects of youth psychopathology on maternal depression and levels of child-related stress in mothers’ lives. It was hypothesized that the number of past clinical diagnoses in 15-year-old adolescents would predict the presence of maternal depression at youth age 15 and 5 years later, as well as more episodes of maternal depression during the follow-up period. Furthermore, it was hypothesized that increased levels of child-related stress in mothers’ lives would mediate these relationships. Regression analyses indicated that past youth diagnoses do confer risk for the presence of current and future maternal depression, as well as more episodes of maternal depression, and mediation analyses revealed that child-related acute and chronic stress were mediators of the relationship between youth diagnoses and the presence of maternal depression at follow-up. Findings suggest that increased levels of child-related objective stress in mothers’ lives are one mechanism by which children’s psychopathology affects mothers’ future risk for depression.     

Internal attribution of outcome moderates the cortisol response to a cooperative task in women

Several ethological reports have indicated that cooperative behaviors play an adaptive role. However, research has focused on competition in men, and there have been few studies on cooperation. This study aims to analyze the cortisol and psychological responses in women to a cooperative situation compared with a competitive situation in a laboratory context. The sample was distributed into four groups depending on the task and the outcome obtained: Positive cooperation, negative cooperation, competition with victory, and competition with defeat. Our results show that, in comparison with competition, cooperation produces different effects in cortisol, but not in psychological states. Nevertheless, these effects occur only when the task outcome and its appraisal are considered. Only the participants who cooperated and obtained a positive outcome and those who competed and lost showed significant decrements of cortisol. Internal attribution was higher in groups with more stable cortisol levels, suggesting a possible modulator effect of controllability in the way the situation was experienced. These results could be generalized to situations in which negotiation, mediation, and cooperative strategies are relevant for making decisions and/or solving problems.     

African American Women’s Limited Knowledge and Experiences with Genetic Counseling for Hereditary Breast Cancer

Genetic counseling and testing for hereditary breast cancer have the potential benefit of early detection and early interventions in African American women. However, African American women have low use of these services compared to White women. We conducted two focus groups with African American women diagnosed with breast cancer (affected group, n?=?13) and women with at least one first-degree relative with breast/ovarian cancer (unaffected group, n?=?8). A content analysis approach was employed to analyze interview data. Breast cancer survivors had more knowledge about genetic counseling and testing than participants who were unaffected with cancer. However, knowledge about genetic counseling was limited in both groups. Barriers to pursuing genetic counseling and testing included poor understanding of the genetic counseling and testing process, fear of carrying the mutation, concerns about discrimination, and cost. Motivators to participate in genetic counseling and testing included desire to help family members, insurance coverage, and potential of benefiting the larger African American community. Education efforts are needed to increase genetic counseling and testing awareness in the African American community.     

Developmentally Adapted Cognitive Processing Therapy for Adolescents Suffering from Posttraumatic Stress Disorder after Childhood Sexual or Physical Abuse: A Pilot Study

Although childhood sexual abuse and childhood physical abuse (CSA and CPA) have severe psychopathological consequences, there is little evidence supporting psychotherapeutic interventions for adolescents who have experienced CSA or CPA. To provide a treatment tailored to the specific needs of adolescents suffering from abuse-related posttraumatic stress disorder (PTSD), we modified Cognitive Processing Therapy (CPT) by adding new treatment modules and changing the therapy setting. To evaluate the feasibility and efficacy of Developmentally Adapted CPT (D-CPT), we treated 12 adolescents suffering from PTSD secondary to CSA or CPA. Patients were assessed prior to treatment (t0), post-treatment (t1), and 6 weeks after treatment (t2). Assessments included the Clinician-Administered PTSD Scale (CAPS), the UCLA PTSD Index (UCLA), the Children’s Depression Inventory (CDI), the Adolescent Dissociative Experiences Scale (A-DES), and the Borderline Symptom List (BSL-23). MANOVAs revealed that posttraumatic stress measurements and associated symptom measurements significantly differed across time points. When comparing t0 with t2, Cohen’s d was large with respect to the CAPS scores (d = 1.45, p < .001) and the UCLA scores (d = 1.91, p < .001). Cohen’s d had a medium magnitude with respect to the CDI scores (d = .78, p < .001), the A-DES scores (d = 0.64, p < .05), and the BSL-23 scores (d = 0.74, p < .01). D-CPT has the potential to reduce PTSD symptoms and comorbid psychopathology in adolescents with histories of CSA or CPA.     

Psychologists' and counsellors' perspectives on prolonged grief disorder and its inclusion in diagnostic manuals

Introduction: In this research, proposed criteria for what has been termed ‘Prolonged Grief Disorder’ (PGD) (more recently termed, ‘Persistent Complex Bereavement‐Related Disorder’ (PCB‐RD) in the proposed DSM‐V), were presented to psychologists and counsellors. Method: Participants were asked about their views on the ‘disorder’ and whether they considered its inclusion in diagnostic manuals was justified. A total of 185 participants, (147 psychologists, specialist and general, and 38 counsellors) responded to an online survey (part of a larger research project), concerning their attitudes, choices and activities regarding bereavement therapy. In this part of the research, therapists’ perspectives about pathological grief, the recognition of PGD and its inclusion in diagnostic manuals were explored. Fifty‐nine participants took the option of adding written remarks to the survey to expand on their opinions regarding PGD. Results/Conclusions: Tentative support for the inclusion of PGD in diagnostic manuals was given; however many therapists indicated considerable reservations about potential negative repercussions of using such a diagnosis. One‐way between‐groups analysis of variance was undertaken to determine whether participants' opinions varied according to main occupation or specialism; however, no significant difference was found. This research was conducted prior to the latest update to the proposed revision and diagnostic category concerning bereavement in the DSM‐5 of April 2012, but many observations and recommendations concerning PGD made by the therapists participating in this research can be seen to be applicable to PCB‐RD. Implications: The implications of this research for assessing and diagnosing grief, and ways of working with bereaved clients, are discussed.     

Testing the Effectiveness of Brief Behavioral Activation Treatment for Depression—Revised: Changes in Depression,Anxiety, Dysfunctional Attitudes,and Mindfulness

We tested the effectiveness of Brief Behavioral Activation Treatment for Depression-Revised (BATD-R), and its impact on secondary outcomes: anxiety, dysfunctional attitudes, and mindfulness. It was expected that individuals who completed BATD-R would exhibit decreased depression, anxiety, and dysfunctional attitudes, as well as increased mindfulness. A sample of adults with depression (n?=?42) was recruited to complete the 10-week treatment. A healthy control group (n?=?38) was included for comparison. Outcomes (depression, anxiety, dysfunctional attitudes, and mindfulness) were assessed at pre-treatment, post-treatment or 10 weeks for the healthy control group, and three-month follow-up. At pre-treatment, the clinical group reported greater depression, anxiety, and dysfunctional attitudes, and less mindfulness than the healthy control group. At post-treatment, the clinical group reported decreased depressive symptoms, trait anxiety, and dysfunctional attitudes, and increased mindfulness, compared to pre-treatment. The control group did not exhibit changes across the 10 weeks. Clinical and healthy control group post-treatment scores did not differ. At three-month follow-up, the clinical group reported a slight increase in depressive symptoms from post-treatment, but still maintained lower depressive symptoms than pre-treatment. The clinical group maintained treatment gains in dysfunctional attitudes, and mindfulness. Results support the effectiveness of BATD-R and suggest BATD-R may influence dysfunctional attitudes and mindfulness.