Predictors of response and drop-out during intensive dialectical behavior therapy

The purpose of this study was to examine the effectiveness, and predictors of response and drop-out during a four-week course of intensive dialectical behavior therapy (I-DBT) in 447 outpatients suffering from borderline personality disorder (BPD), over a 10-year period. Assessments included a diagnostic interview, the International Personality Disorder Examination Screening Questionnaire, the Beck Depression Inventory, and the Beck Hopelessness Scale. Among these participants, 103 started a second course of treatment. In agreement with previous reports, I-DBT was effective in reducing levels of depression and hopelessness with a trend of increasing effectiveness over the study period. High schizoid scores and low narcissistic score predicted poor response. Treatment completion rate was high, and low education predicted dropout. A discussion on the usefulness of a second course of treatment should be held with patients and staff as it was not effective in reducing depression and hopelessness.     

Family support, family income, and happiness: a 10-year perspective.

This study examined the role of 2 central aspects of family life--income and social support--in predicting concurrent happiness and change in happiness among 274 married adults across a 10-year period. The authors used hierarchical linear modeling to investigate the relationship between family income and happiness. Income had a small, positive impact on happiness, which diminished as income increased. In contrast, family social support, measured by 3 subscales, Cohesion, Expressiveness, and Conflict, showed a substantial, positive association with concurrent happiness, even after controlling for income. Furthermore, family income moderated the association between family social support and concurrent happiness; family social support was more strongly associated with happiness when family income was low than when family income was high. In addition, change in family social support was positively related to change in happiness, whereas change in family income was unrelated to change in happiness. These findings suggest that happiness can change and underscore the importance of exploring more deeply the role that family relationships play in facilitating such change.     

Long-Term Patterns and Predictors of Successful Stressor Resolution in Later Life

At 1 year, 4 years, and 10 years after baseline, late-middle-aged adults reported whether they had successfully resolved their most important stressor of the past year. Compared to individuals who never resolved focal stressors over the 10-year interval, those who always did consistently showed less negative stressor appraisal, less reliance on avoidance coping, and less use of exploratory relative to directed coping responses, independent of type and severity of focal stressor. Less use of exploratory relative to directed coping and having more social resources, fewer health problems, and fewer depressive symptoms at baseline predicted more stressor resolution over the next 10 years. These predictors are promising foci for prospective efforts to optimize ways in which aging adults manage late-life stressors.     

Visual associations to retrieve episodic memory across healthy elderly,mild cognitive impairment,and patients with Alzheimer’s disease

Episodic memory tests need to determine the degree to which patients with moderate to severe memory deficits can still benefit from retrieval support. Especially in the case of Alzheimer’s disease (AD), this may support health care to be more closely aligned with patients’ memory capacities. We investigated whether the different measures of episodic memory of the Visual Association Test-Extended (VAT-E) can provide a more detailed and informative assessment on memory disturbances across a broad range of cognitive decline, from normal to severe impairment as seen in AD, by examining differences in floor effects. The VAT-E consists of 24 pairs of black-and-white line drawings. In a within-group design, we compared score distributions of VAT-E subtests in healthy elderly controls, mild cognitive impairment (MCI), and AD (n = 144), as well as in relation to global cognitive impairment. Paired associate recall showed a floor effect in 41% of MCI patients and 62% of AD patients. Free recall showed a floor effect in 73% of MCI patients and 84% of AD patients. Multiple-choice cued recognition did not show a floor effect in either of the patient groups. We conclude that the VAT-E covers a broad range of episodic memory decline in patients. As expected, paired associate recall was of intermediate difficulty, free recall was most difficult, and multiple-choice cued recognition was least difficult for patients. These varying levels of difficulty enable a more accurate determination of the level of retrieval support that can still benefit patients across a broad range of cognitive decline.     

Analytische und tiefenpsychologisch fundierte Psychotherapien im Gutachterverfahren

Zusammenfassung. Ein Vergleich von 94 Erstberichten der analytischen Psychotherapie und 339 Erstberichten zur tiefenpsychologisch fundierten Psychotherapie im Rahmen der Richtlinienpsychotherapie mit Hilfe der Gutachtenkriterienliste (Rudolf et al. 2002) zeigt in beiden Verfahren sehr ?hnliche Quoten der gutachterlichen Befürwortung oder Nichtbefürwortung. Vergleichbares gilt für eine Gegenüberstellung von 61 analytischen und 147 tiefenpsychologisch fundierten Fortführungsberichten. Zweifel und Bedenken der Gutachter, die sich jedoch nicht auf die Entscheidung von Befürwortung/Nichtbefürwortung der Kostenübernahme auswirken, betreffen in der tiefenpsychologisch fundierten Psychotherapie Merkmale der prognostischen Einsch?tzung bezüglich des gew?hlten Verfahrens und der erkrankten Pers?nlichkeit sowie das Thema der Differentialindikation; bei Fortführungsberichten gelten die Zweifel der bearbeiteten Konfliktdynamik und prognostischen Einsch?tzung. Eine Ungleichbehandlung der beiden Verfahren durch die Gutachter kann aus diesen Daten nicht abgeleitet werden. In der Richtlinienpsychotherapie begründen die Therapeuten den Antrag der Patienten auf Psychotherapie durch einen ausführlichen anonymisierten Bericht über die Erkrankung der Patienten und die geplante Behandlung.

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Comparison of psychoanalytic and psychodynamic expertizes

Summary. On the basis of the criteria for expertizes (Rudof et al. 2002) we compared 94 therapy recommendations after the first assessment for psychoanalytic and 339 first recommendations for psychodynamic therapy, corresponding the psychotherapy guidelines. We found very similar proportions of approving and disapproving psychotherapy. The same result was found when comparing 61 psychoanalytic and 147 psychodynamic reports in the course of the therapies. Doubts and reservations of experts in the case of psychodynamic psychotherapy are first of all related to prognostic assessment of the chosen method and of the disturbed personality including the topic of differential indication. Expertizes about the course of therapies include first of all results about the dynamics of the conflict and prognostics. Our results do not support the opinion, that experts would make a difference along the two methods.

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Anschrift: Prof. Dr. med. G. Rudolf, Psychosomatische Universit?tsklinik, Thibautstra?e 2, 69115 Heidelberg, E-Mail: gerd_rudolf@med.uni-heidelberg.de     

2001 INVITED ADDRESS: The Mystery of Human Context and Coping: An Unraveling of Clues

Community and clinical psychology share a fundamental focus: to understand the interplay between human contexts, coping, and adaptation. To highlight recent progress in this area, I offer a guiding conceptual framework and discuss 8 propositions about environment and coping. The propositions consider such issues as patterns of social climate and coping and their links to personal development and dysfunction, the connections between ongoing life circumstances and intervention programs, the role of personal characteristics in matching individuals and environments, and the value of placing specific settings in an ecological context. I then focus on 8 enigmas, such as how to identify conceptually unifying dimensions of diverse social contexts, how to model the processes involved in person–environment transactions, how to understand the link between adversity and personal growth, how to examine the generality of models across ethnic and cultural groups, and how to enhance positive carryover from intervention programs to ongoing life contexts. I close by addressing some implications of these issues for a vision of a dynamic community psychology.     

Drinking to cope and alcohol use and abuse in unipolar depression: a 10-year model

This study examined drinking to cope with distress and drinking behavior in a baseline sample of 412 unipolar depressed patients assessed 4 times over a 10-year period. Baseline drinking to cope operated prospectively as a risk factor for more alcohol consumption at 1-, 4-, and 10-year follow-ups and for more drinking problems at 1- and 4-year follow-ups. Findings elucidate a key mechanism in this process by showing that drinking to cope strengthened the link between depressive symptoms and drinking behavior. Individuals who had a stronger propensity to drink to cope at baseline showed a stronger connection between depressive symptoms and both alcohol consumption and drinking problems.     

Body-image evaluation and body-image investment among adolescents: a test of sociocultural and social comparison theories

Sociocultural theory and social comparison theory were used to account for variations in body-image evaluation and body-image investment among male and female adolescents (N = 1,543). Exposure to magazines and television programs containing idealistic body imagery as well as frequency of self-comparison to universalistic targets (e.g., fashion models) were measured. Results provided minimal support for sociocultural theory, but fairly strong support for social comparison theory. Specifically, the extent to which males engaged in universalistic social comparison predicted appearance self-esteem, number of diets to gain weight, use of pathogenic weight control practices, and use of steroids to increase muscle mass. For females, universalistic social comparison predicted appearance self-esteem, body dissatisfaction, number of diets to lose weight, and use of pathogenic weight control practices. The possibility that the null effects for sociocultural theory were an artifact of dummy coding for missing data or theoretical interdependence were explored, but did not appear to be valid. Limitations of the present study and directions for future research are outlined.