The relationship of appraisal and coping to chronic illness adjustment

There is evidence that adaptation to chronic illness may be affected by psychological factors, especially how patients appraise and cope with the stress of their illness. The purpose of the present study was to examine the relationship of stress appraisal and coping responses to multiple behavioral indices of illness adjustment among patients with diverse chronic medical conditions. One hundred and one patients admitted to a multidisciplinary medicine/psychiatry unit completed measures of functional impairment, depression, symptom severity, and the Ways of Coping Checklist--Revised. Hierarchical regression analyses indicated that emotion-focused coping was positively related to poor psychosocial adjustment and depression after controlling for physician rated disease severity. Appraising chronic illness as holding one back predicted greater emotion-focused coping responses and poorer adjustment to illness. The use of problem-focused coping strategies was generally unrelated to illness adjustment. These findings suggest the presence of an emotion-focused coping triad consisting of wishful thinking, self blame, and avoidance, all of which appear to be maladaptive strategies when coping with chronic medical conditions. Implications for coping skills training and the need for longitudinal research is discussed.     

Followup of psychoanalysis five to ten years after termination: III. The relation between the resolution of the transference and the patient-analyst match

As part of a long-term followup study of the outcome of psychoanalysis, we examined the relation between the extent of resolution of the transference at termination and the characteristics of the patient-analyst match. For twelve of the seventeen patients interviewed five to ten years after termination of psychoanalysis, the researchers found that the patient-analyst match played a role in the outcome of the analysis. Illustrations of the influence of the match in cases where the transference was resolved and those where it was not are presented.     

Is agoraphobia harder to treat? A comparison of agoraphobics' and simple phobics' response to treatment

Agoraphobia is reputed to be more difficult to treat than simple phobia. In a test of this supposition, 38 agoraphobics and 19 simple phobics were each given 10 sessions of graduated in vivo exposure. They were assessed before and after therapy using a behavioral avoidance test, behavioral diaries, and self-report measures. Analysis of covariance revealed unequivocal posttest differences only on self-assessed disability level; agoraphobics had changed less in their report of global disability immediately following treatment but not at follow-up. Sixty-eight percent of the simple phobics showed clinically significant improvement on avoidance of the Main Phobia, compared with 34% of the agoraphobics. On three other outcome measures, including more precise behavioral measures of phobia, agoraphobics and simple phobics responded equivalently to treatment. Given clinicians' impression about the comparative difficulty in treating agoraphobic clients, fewer differences in treatment response were obtained than were expected. Several possible explanations for this discrepancy are discussed.     

Types and correlates of blood/injury-related vasovagal syncope

This study investigated by interview, the initial syncopal episode of 103 blood/injury-related vasovagal fainters in order to examine two competing hypotheses concerning their origins. Graham (Circulation, 23, 901-906, 1961) postulated that the faint resulted when sympathetic nervous system (SNS) activity ceased on termination of a threat, leaving parasympathetic nervous system (PNS) activation unopposed. Engel [Fainting (2nd edn), 1962; Annals of Internal Medicine, 89, 901-906, 1978] proposed that when in the face of threat with SNS activation, escape is blocked, the PNS becomes activated as the conservation-withdrawal response, leading to syncope. We found cases clearly conforming to each of these formulations as well as some with characteristics of both, and some who fainted in response to blood or injury but with no perception of threat. The Graham and Engel types did not differ in terms of fear or avoidance of blood, injury, or medically-related situations nor did they differ in the frequency with which their parents reported blood/injury-related syncopal episodes. It is proposed that both may be activated by a common psychological mechanism involving cessation of a defensive posture. In contrast, the non-threat fainters showed significantly less medically-related avoidance and had a greater percentage (94%) of parents with positive faint histories.     

Alcohol and correspondence between self-report and physiological measures of anxiety

The present study was designed to determine the main effects of alcohol intoxication on self-report and physiological measures of anxiety. Second, we aimed to assess the role of the Marlowe-Crowne Social Desirability (MCSD) scale in predicting the relationship between self-report and physiological indices of anxiety irrespective of drink content. A final purpose of the study was to determine whether the MCSD could account for discrepancies in the effects of alcohol on the two anxiety response systems. Subjects were male social drinkers who received an 0.70 g/kg dose of alcohol or placebo. Results indicated that irrespective of drink content, subjects with high MCSD scores reported lower levels of anxiety than did subjects with low MCSD scores. This relationship was not evident for heart rate. These results for measures of anxiety were not influenced by drink content.     

Psychoanalytic observation

The recent focus on empathy as the essential activity in psychoanalytic data gathering has underemphasized the complexity of psychoanalytic observation and has failed to identify what truly makes it unique among modes of psychological investigation. It is a process that includes introspection and empathy. However, it also includes the analyst's observation of the patient's behavior, and particularly verbal behavior, in a way that is not necessarily empathic. The psychoanalytic use of introspection and behavioral observation together, as they are modified by the analysand's free association and the analyst's evenly hovering attention, provides a unique method of data gathering. The transient, mutually related regressions of analyst and analysand which partly constitute the analyzing instrument modify the field of observation available to both, providing better access to derivatives of the analysand's unconscious mental functioning. This more complex concept of psychoanalytic observation, as opposed to that in which empathy is predominant, has important implications for psychoanalytic training, clinical work, and theory.     

Ethical and malpractice issues in hospital practice

Ethical and malpractice issues arising in hospital practice are reviewed. Topics include (a) preparation and authorization to carry out clinical responsibilities, (b) personnel procedures, (c) financial and political forces influencing hospital policies, (d) billing procedures, (e) clinical procedures for responding to patients' needs, (f) confidentiality, (g) discrimination, (h) internship and training issues, (i) sexual abuse of patients, and (j) staff conflicts influencing patient care.     

Dynamic operations of thought systems

Our research program focuses on thought systems consisting of a core event that might befall a person and other topics evoked in free associating on this event, mostly its salient antecedents and consequences. We theorize that the pattern of salient antecedents and consequences evoked by the core event are related to its judged desirability and likelihood by several adaptive principles, such that when a change is directly induced in one part of the belief system it produces predictable remote adjustments in other parts. In a first experiment we manipulated the core event's judged desirability or likelihood and tested for predicted remote effects on the salience of antecedents and consequences. A second experiment conversely manipulated the salience of antecedents or consequences and tested for predicted remote effects on the core event's judged desirability and likelihood.     

Psychological assessment versus psychological testing. Validation from Binet to the school, clinic, and courtroom

Increasingly, psychological assessment is conducted with clients and patients involved in child custody and personal injury litigation. Clinical neuropsychologists are being asked sophisticated questions by attorneys regarding the validity of practitioners' most highly respected tests. Research reviewed here bears on the validity of test-buttressed clinical opinions, including research related to the following psychometric properties of individual test scores: standard errors of measurement, test-retest stability and subtest-to-subtest intercorrelations. The highest and the lowest subtest scores used as indices, respectively, of an individual's premorbid level of cognitive functioning and the degree of current impairment from that presumed earlier level is not justified when used in isolation from the life history and current medical findings. Although many practitioners use information from the wider research, courtroom experience suggests that a number do not; contrariwise, the attempt of Faust and Ziskin (1988a) to undermine the courtroom testimony of every psychologist who serves as an expert witness is also criticized.     

Convergent and Discriminant Validity of FACES-III: Family Adaptability and Cohesion

Research on earlier versions of the Family Adaptability and Cohesion Evaluation Scales (FACES) has ostensibly shown that the scales lack discriminant and convergent validity (23). However, these studies have defined convergence as agreement between family members or as agreement between family members and family therapists. Such definitions confound real differences between respondents' perceptions of the family with the notion of convergent validity. In the current study, we take a different approach to construct validity. Multiple measures of family adaptability, cohesion, and talkativeness were administered to two family members (insiders) and two significant others (outsiders). The two insiders' responses were averaged together, as were the two outsiders' responses. Using confirmatory factor analysis, we demonstrated that family adaptability, cohesion, and talkativeness are distinct traits, and that the different sources of information about these traits, including FACES-III (24), have convergent validity.