Diagnostic issues in posttraumatic stress disorder: considerations for the DSM-IV

Four issues of key interest with regard to posttraumatic stress disorder in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) are discussed. These include: (a) how to define the stressor criterion, especially, whether or not the victim's response ought to be included and whether low-magnitude traumas qualify etiologically; (b) the cohesiveness of the syndrome and the validity of items across stressor groups; (c) the position of posttraumatic stress disorder within DSM-IV; and (d) comorbidity with other illnesses.     

Antidepressants in group psychotherapy

This article alerts us to consider depression as a relatively frequent cause of impasse in the course of group psychotherapy. The authors recommend the combined use of antidepressant medication along with group psychotherapy when such depression is confirmed independently outside the group. Common obstacles and pitfalls preventing successful combined treatment are reviewed; the depressive logjam is differentiated from common resistance; and profiles of responders versus nonresponders are described. A rationale of the combined treatment, its results, and implications for group therapists are all delineated.     

Use of the group in resolving the subjective countertransference

Subjective countertransference can sharply limit any group leader's effectiveness. However, a therapist can use the group itself to identify such a bias and to remove it as an influence. A five-step method for doing this is presented. These steps begin with introspection but hinge upon the analyst's turning to the group for the vital information that, in the end, clarifies the analyst's own perceptions and helps him or her free the group from the harmful effects of any bias.     

On the semantic content of subcategorization frames

This paper investigates relations between the meanings of verbs and the syntactic structures in which they appear. This investigation is motivated by the enigmas as to how children discover verb meanings. Well-known problems with unconstrained induction of word meanings from observation of world circumstances suggest that additional constraints or sources of information are required. If there exist strong and reliable parallels between the structural and semantic properties of verbs, then an additional source of information about verb meanings is reliably present in each verb's linguistic context. Five experiments are presented which investigate the following hypothesis regarding the scope of these relations: The closer any two verbs in their semantic structure, the greater the overlap should be in their licensed syntactic structures. To investigate this hypothesis, data of two kinds were collected from different groups of subjects: (a) One group of subjects was asked to judge the semantic relatedness of verbs by selecting the semantic outlier in triads presented to them. (b) A second group of subjects was asked to judge the grammaticality of these same verbs in a large range of syntactic environments. These two types of data were then compared to assess the degree of correspondence in the two partitionings (syntactic and semantic) of the verb set. The findings, overall, support the view that the syntax of verbs is a quite regular, although complex, projection from their semantics. In conclusion, we discuss the kinds of features that are formally marked in syntactic structure and relate these to the problem of verb-vocabulary acquisition in young children.     

Rethinking levels of abstraction in family systems theories.

This article is an attempt to improve the way we conceptualize "levels" in family systems. The first section reframes thinking about levels by identifying an array of different ways of thinking about levels. The next section suggests a parsimonious frame-work for thinking about levels of abstraction in systemic processes. The proposed framework integrates several earlier ways of conceptualizing levels, and helps eliminate some of the confusion, inconsistencies, fragmentation, and limitations of some earlier models. The new framework has three categories that are called Levels I, II, and III. The most abstract level (III) includes phenomena such as family paradigms and values. The intermediate level includes processes such as second-order change, regime, and "meta" processes such as metacommunication and meta-rules. The least abstract level refers to specific processes such as transformation processes and rules. The article concludes with an attempt to demonstrate the usefulness of the proposed framework by showing how it can be used to eliminate a number of conceptual problems in earlier models, improve conceptual clarity, help generate new theoretical insights, and help deal with several controversies in the field.     

Manifestations, acquisition and diagnostic categories of dental fear in a self-referred population

This study aimed to clarify how manifestations and acquisition relate to diagnostic categories of dental fear in a population of self-referred dental fear patients, since diagnostic criteria specifically related to dental fear have not been validated. DSM III-R diagnostic criteria for phobias were used to compare with four existing dental fear diagnostic categories, referred to as the Seattle system. Subjects were 208 persons with dental fear who were telephone interviewed, of whom a subsample of 155 responded to a mailed Dental Anxiety Scale (DAS), State-Trait Anxiety Inventory and a modified FSS-II Geer Fear Scale (GFS). Personal interviews and a Dental Beliefs Scale of perceived trust and social interaction with dentists were also used to evaluate a subsample of 80 patients selected by sex and high dental fear. Results showed that the majority of the 80 patients (66%), suffered from social embarrassment about their dental fear problem and their inability to do something about it. The largest cause of their fear (84%) was reported to be traumatic dental experiences, especially in childhood (70%). A minority of patients (16%) could not isolate traumatic experiences and had a history of general fearfulness or anxiety. Analysis of GFS data for the 155 subjects showed that fear of snakes and injuries were highest among women; heights and injections among men. Fear of blood was rarely reported. Spearman correlations between GFS individual items and DAS scores indicated functional independence between dental fear and common fears such as blood, injections and enclosures in most cases. Only in specific types of dental fear did these results support Rachman and Lopatka's contention that fears are thought to summate.(ABSTRACT TRUNCATED AT 250 WORDS)     

Changes in degree of sclerosis as a function of prophylactic treatment in cancer-prone and CHD-prone probands

One-hundred and ninety-two probands were selected on the basis of personality questionnaires as being cancer-prone (100) or CHD-prone (92). They were then randomly divided into a control and a treatment group, the latter receiving a special kind of behaviour therapy attempting to change the personality patterns in the direction of a healthier, more autonomous personality. Follow-up after 10 and 13 years disclosed significantly lower death rates in probands receiving prophylactic treatment than in controls. Of special interest was the degree of sclerosis in the fundus of the eye, rateds on a 3-point scale. This was significantly higher prior to therapy in the CHD-prone group than in the cancer-prone group. Treatment reduced the degree of sclerosis, particularly in the CHD group; lack of treatment was followed by an increase in sclerosis. Similar but less marked changes were found in the cancer-prone group. Clearly psychological treatment affects significantly bodily functions associated with CHD. Other risk factors considered were systolic and diastolic blood pressure, blood cholesterol and blood sugar, all of which, together with personality, influenced the degree of sclerosis observed.     

The contribution of music vs instructions in the Musical Mood Induction Procedure

The relative contribution of the instructions and the music to the effects of the Musical Mood Induction Procedure (MMIP) were investigated. Using an experimental procedure which minimised covert experimenter bias, subjects performed under both elation and depression mood inductions in one of four conditions: music present or absent by mood change instructions present or absent, using a crossover design. Results indicated that instructions were both necessary and sufficient to produce change on mood sensitive measures. Mood change effects were reduced by controlling for the effect of subjects who responded so as not to ‘louse-up’ the experiment. The MMIP seems to be much less musical than the name implies. Further research is needed to determine which aspects of the instructions contribute most to the changes on mood sensitive measures.     

Assertiveness, social support, and psychological adjustment following spinal cord injury.

Tested predictions that assertiveness and social support would be significantly predictive of psychological adjustment. Furthermore, it was anticipated that assertiveness and certain types of social relationships would differentially interact to predict adjustment, since positive and negative effects of both variables have been noted in prior research. Trained raters interviewed 156 persons receiving either in-patient or out-patient care for cord injuries and administered measures of assertiveness, social support, depression and psychosocial impairment. Persons who reported a keen sense of responsibility for the welfare of another reported more depression and impairment. Persons reporting higher levels of support facilitating social integration and reassuring personal worth were less depressed. Several significant interactions between assertiveness and different social support relationships revealed beneficial and deleterious effects on depressive behavior and impairment secondary to the disability. Results are discussed as they advance theoretical understanding of the effects of assertiveness and social support. Implications for discriminate cue learning in assertion training for persons with physical disability are proposed.