A longitudinal study of psychosocial distress in breast cancer: prevalence and risk factors

This longitudinal study was conducted among 102 women with non-metastasic breast cancer to identify the time evolution and prevalence of distress at specific times through diagnosis and treatment of disease: preliminary diagnosis, surgery, definitive diagnosis and chemotherapy. Additionally, the study aimed to examine the role of demographic, medical and psychosocial factors on distress. The results indicated that prevalence of distress was higher at initial diagnosis (25%) than the following time points (approximately 17%). The differences inter-individuals in the levels of distress were observed over the four assessments. No relation between distress and demographic and medical factors was found. However, psychosocial aspects were significant risk factors. Patterns of emotional suppression and specific coping responses like helplessness/hopelessness, anxious preoccupation, cognitive avoidance and fatalism were positively related to distress, whereas fighting spirit and perceived social support showed a protective role. Moreover, helplessness/hopelessness and anxious preoccupation jointly predicted 75% of cases and 98% non-cases of distress. Finally, a mediational model between emotional suppression and distress through helplessness/hopelessness was tested. Results support the necessity of routine distress screening all through the illness. Implications of data for psychosocial interventions with breast cancer patients are highlighted.     

Liberalism and the Privatised Family: The Legacy of Rousseau

This article argues that the intellectual legacy of Rousseau is at the root of the failure of 20th century egalitarian theorists such as Rawls and Dworkin to engage intellectually with feminist theorists working within the liberal tradition. Through an extended critique of Rousseau’s delineation of the relationship between liberal citizenship and the private family, it argues that the failure of such liberal theorists to take gender hierarchy seriously is a consequence of their attempt to place the private family outside the sphere not only of politics, but also of justice.     

University psychology clinics in Australia: Their place in professional training

Abstract: There is universal recognition of the need for developmentally appropriate supervised clinical experience in professional psychology training. University clinics were established to provide a bridging function for postgraduate clinical psychology students, assisting the integration of psychological theory and research into real‐world clinical applications and professional identity development. The aim of training in university clinics is to provide opportunities for clinical practice and high‐quality supervision to monitor and shape clinical skills. The experiences gained in external practicum settings complement this initial training but cannot replace it. The recent introduction of Medicare rebates for psychology services has threatened the survival of university clinics because low‐cost psychological treatment is now available from experienced practitioners. This paper provides data on Australian university clinics collected before the introduction of Medicare. Concerted efforts are needed to protect university clinics in order to maintain standards required for accreditation of clinical psychology training programs. The potential impact of the loss of university training clinics is discussed and strategies to ensure their survival are suggested.     

From Theory to Practice: Facing Ethical Challenges as a Clinical Intern

Although formal ethics classes provide a basic foundation in managing ethical dilemmas, professionals often point to their experiences on internship as an important training ground for consolidation of their ethical development. Clinical interns face many personal and professional transitions that can lead to a number of ethical dilemmas. Effective collaboration between administrative staff, supervisors, and interns can create a pragmatic model for negotiating these dilemmas. In this paper, issues related to balancing intern competency with training and patient/client needs, managing dual relationships with supervisory staff, and dealing with differences in orientation are addressed from the perspective of both the site and the intern. We also discuss ways in which problems can arise and how both sides can work together systematically to negotiate those problems. To illustrate this process, we discuss cases involving effective collaboration between interns and sites. Finally, the authors assert the need for formal, empirically supported training in classic ethical issues, but also in contemporary ethical issues arising from the ever-evolving field of mental health service delivery and unique challenges accompanying these advances.     

Training in child and adolescent group therapy: Two surveys and a model

Although group therapy is widely used in the treatment of children and adolescents, there has been little attention paid to establishing training standards and developing comprehensive programs for training psychiatry fellows in child and adolescent group psychotherapy. The authors conducted two surveys of child and adolescent training programs. After reviewing the literature, they present the data from their surveys, compare similarities and differences, and discuss trends. Finally, they propose a model for training in child and adolescent group therapy.     

Does Traumatic Brain Injury Attenuate the Exposure Therapy Process?

Research indicates that exposure therapy is efficacious for combat-related posttraumatic stress disorder (PTSD) comorbid with traumatic brain injury (TBI) as is shown by reduced PTSD treatment outcome scores. What is unknown, however, is whether the process of fear extinction is attenuated in veterans with TBI history. Increased PTSD symptomatology and possible cognitive deficits associated with TBI sequelae may indicate additional or longer exposure sessions to achieve habituation and extinction comparable to individuals without TBI history. As such, a more extensive course of treatment may be necessary to achieve comparable PTSD treatment outcome scores for individuals with TBI history. Using a sample of veterans with combat-related PTSD, some of whom were comorbid for TBI, this study compared process variables considered relevant to successful treatment outcome in exposure therapy. Individuals with and without TBI demonstrated similar rates of fear activation, length and number of exposure sessions, within-session habituation, between-session habituation, and extinction rate; results remained consistent when controlling for differential PTSD symptomatology. Furthermore, results indicated that self-perception of executive dysfunction did not impact the exposure process. Results suggest that individuals with PTSD and TBI history engage successfully and no differently in the exposure therapy process as compared to individuals with PTSD alone. Findings further support exposure therapy as a first-line treatment for combat-related PTSD regardless of TBI history.     

Lexical restructuring in the absence of literacy

Vocabulary growth was suggested to prompt the implementation of increasingly finer-grained lexical representations of spoken words in children (e.g., [Metsala, J. L., & Walley, A. C. (1998). Spoken vocabulary growth and the segmental restructuring of lexical representations: precursors to phonemic awareness and early reading ability. In J. L. Metsala & L. C. Ehri (Eds.), Word recognition in beginning literacy (pp. 89-120). Hillsdale, NJ: Erlbaum.]). Although literacy was not explicitly mentioned in this lexical restructuring hypothesis, the process of learning to read and spell might also have a significant impact on the specification of lexical representations (e.g., [Carroll, J. M., & Snowling, M. J. (2001). The effects of global similarity between stimuli on children’s judgments of rime and alliteration. Applied Psycholinguistics, 22, 327-342.]; [Goswami, U. (2000). Phonological representations, reading development and dyslexia: Towards a cross-linguistic theoretical framework. Dyslexia, 6, 133-151.]). This is what we checked in the present study. We manipulated word frequency and neighborhood density in a gating task (Experiment 1) and a word-identification-in-noise task (Experiment 2) presented to Portuguese literate and illiterate adults. Ex-illiterates were also tested in Experiment 2 in order to disentangle the effects of vocabulary size and literacy. There was an interaction between word frequency and neighborhood density, which was similar in the three groups. These did not differ even for the words that are supposed to undergo lexical restructuring the latest (low frequency words from sparse neighborhoods). Thus, segmental lexical representations seem to develop independently of literacy. While segmental restructuring is not affected by literacy, it constrains the development of phoneme awareness as shown by the fact that, in Experiment 3, neighborhood density modulated the phoneme deletion performance of both illiterates and ex-illiterates.     

Rumination-focused cognitive behaviour therapy for residual depression: a case series

The treatment of chronic and recurrent depression is a priority for the development of new interventions. The maintenance of residual symptoms following acute treatment for depression is a risk factor for both chronic depression and further relapse/recurrence. This open case series provides the first data on a cognitive-behavioural treatment for residual depression that explicitly targets depressive rumination. Rumination has been identified as a key factor in the onset and maintenance of depression, which is found to remain elevated following remission from depression. Fourteen consecutively recruited participants meeting criteria for medication--refractory residual depression [Paykel, E.S., Scott, J., Teasdale, J.D., Johnson, A.L., Garland, A., Moore, R. et al., 1999. Prevention of relapse in residual depression by cognitive therapy--a controlled trial. Archives of General Psychiatry 56, 829-835] were treated individually for up to 12 weekly 60-min sessions. Treatment specifically focused on switching patients from less helpful to more helpful styles of thinking through the use of functional analysis, experiential/imagery exercises and behavioural experiments. Treatment produced significant improvements in depressive symptoms, rumination and co-morbid disorders: 71% responded (50% reduction on Hamilton Depression Rating Scale) and 50% achieved full remission. Treating depressive rumination appears to yield generalised improvement in depression and co-morbidity. This study provides preliminary evidence that rumination-focused CBT may be an efficacious treatment for medication--refractory residual depression.     

Pastoral theologian of the year,William Barr Oglesby,Jr.

This article acknowledging and celebrating William Barr Oglesby, Jr. as Pastoral Theologian of the Year for 1983, was originally published inPastoral Psychology 32(1) in Fall, 1983. As a result of some errors that inadvertently modified both the tone and the meaning of the text, we are republishing this article here in its entirety.