Followup of psychoanalysis five to ten years after termination: I. Stability of change

Seven out of 17 patients interviewed in a long-term followup of psychoanalysis showed either improvement in psychological functioning or a retention of psychological gains they had made during the course of psychoanalysis. Six patients deteriorated in their psychological functioning, but their gains were restored with subsequent treatment. Four patients deteriorated in psychological functioning without restoration, whether or not treatment was reentered. Neither analysts' assessments at the time of termination nor patients' assessments of themselves or assessments based on psychological tests one year after termination predicted which patients would improve or retain psychological change. No causal generalizations about factors related to psychological change can be made from these data. Different factors in interaction are suggested to account for the stability and instability of psychological change.     

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.     

On the formation and regulation of anger and aggression. A cognitive-neoassociationistic analysis

Noting that a wide variety of unpleasant feelings, including sadness and depression, apparently can give rise to anger and aggression, I propose a cognitive-neoassociationistic model to account for the effects of negative affect on the development of angry feelings and the display of emotional aggression. Negative affect tends to activate ideas, memories, and expressive-motor reactions associated with anger and aggression as well as rudimentary angry feelings. Subsequent thought involving attributions, appraisals, and schematic conceptions can then intensify, suppress, enrich, or differentiate the initial reactions. Bodily reactions as well as emotion-relevant thoughts can activate the other components of the particular emotion network to which they are linked. Research findings consistent with the model are summarized. Experimental findings are also reported indicating that attention to one's negative feelings can lead to a regulation of the overt effects of the negative affect, I argue that the model can integrate the core aspect of the James-Lange theory with the newer cognitive theories of emotion.     

Maudsley Obsessional-Compulsive Inventory: obsessions and compulsions in a nonclinical sample

Obsessive-compulsive disorder is increasingly being studied in nonclinical samples. The self-report instruments used to select these samples, however, have not been validated with a diagnostic interview. This study thus investigated the predictive validity of the Maudsley Obsessional-Compulsive Inventory (MOCI) using the Anxiety Disorders Interview Schedule (ADIS), a semi-structured interview created according to DSM-III guidelines. Four sections of the ADIS--generalized anxiety disorder, simple phobia, social phobia and obsessive-compulsive disorder--were administered to 11 individuals who scored in the top 2% and 11 individuals who scored in the normal range of the MOCI 6-7 months prior to the interview. High nonclinical MOCI scorers reported more frequent and severe obsessions and compulsions as well as greater disturbance by these symptoms. In addition, the high MOCI group experienced more general worry and interference from worry, and more frequent and severe physiological symptoms when they worry. However, the two groups did not differ in terms of simple and social phobia symptoms. High MOCI scorers thus did not report a broad range of anxiety symptoms or fears, but specific obsessions and compulsions. These results provide further support for the validity of the MOCI in nonclinical samples over a 6-7 month interval.     

Psychophysiological outcome of cognitive, behavioral and psychophysiologically-based treatments of agoraphobia

Psychophysiological process and outcome phenomena were analyzed to examine differential temporal patterns within and across cognitive, behavioral and physiologically-based treatments of agoraphobia. Eighty-eight severe and chronic agoraphobics with panic attacks (DSM-III) were randomly assigned to one of three treatments: Paradoxical Intention, Graduated Exposure or Progressive Deep Muscle Relaxation Training. Protocol therapists, whose treatment integrity was objectively monitored, conducted 12 two-hour weekly sessions. All subjects received programmed practice instructions concurrent with their primary treatment. Analyses revealed numerous significant reductions on in vivo psychophysiological measures for the relaxation condition, a few improvements for the exposure treatment and no effects for the paradoxical intention modality. The mediating role of pretreatment physiological reactivity in treatment outcome and follow-up status was examined and revealed no significant associations. Synchrony-desynchrony patterns were found to vary widely according to both treatment phase and the time interval between assessments. No between-group differences were observed on the proportion of synchronizers. However, synchronizers exhibited superior outcome and follow-up compared to desynchronizers on all domains except the physiological measures. Conceptual, methodological and clinical implications of these findings are discussed with recommendations for future research.     

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.     

Processing distinctions between stems and affixes: evidence from a non-fluent aphasic patient

In this paper, we study the ability of a non-fluent aphasic patient, BN, to comprehend morphologically complex words when they appear in utterance contexts. We first establish that he is insensitive to the contextual appropriateness of both derived and inflected words. In a further experiment we show that he has no difficulty processing the stems of complex words and conclude that his problem is with the bound morphemes themselves. We then ask whether this problem is due to his inability to access either the phonological form of a morphologically complex word or its semantic and/or syntactic content. We find that only the access of semantic and syntactic content is impaired. We conclude from these six studies that: (a) BN presents a counter-example to the claim that non-fluent patients have particular difficulty with those aspects of morphology which have a syntactic function; (b) BN processes both derived and inflected words by mapping the sensory input onto the entire full-form of a complex word, but the semantic and syntactic content of the stem alone is accessed and integrated into the context. The semantic and syntactic implications of the suffix are never evaluated. This implies separate representation of the stems and suffixes of some types of morphologically complex words.     

Towards a theory of algorithm-determined cognitive test construction

A rationale for, and data from, a trial of a theory of item generation by algorithms whose origins are cognitive models of task performance are presented. Since Spearman (1904), intelligence has been operationally defined and assessed in human subjects by administering identical test items whose content and order have been fixed only after empirical iterations. In our approach, intelligence is ostensively defined by theoretically determined algorithms used for item construction and presentation. Knowledge of what cognitive factors limit human performance makes it possible to vary within tightly specified parameters those features of the tasks that contribute to difficulty, which we call radicals, to let those components of the tasks that do not contribute to difficulty vary randomly, and to counterbalance aspects of answer production that might induce biases of response. Empirical data are based on the generation of five different short tests demanding only functional literacy as a prerequisite for their execution. Four parallel forms of each test were administered to young male Army recruits whose scores were collated with their Army Entrance Test results, which were not previously known to us. Results show that the parallel, algorithm-generated item sets are statistically invariant, which item generation theory demands; and that the individual tests differentially predict Army Entrance Test scores. We conclude that IQ test performances are parsimoniously explained by individual differences in encoding, comparison and reconstructive memory processes.     

Why families of children with biological deficits require a systems approach.

A number of assumptions related to the systemic therapists' view of family functioning in the case of biological deficit in the child are presented and challenged. The families' behavior, it is argued, may not be primarily responsible for the difficulties of their biologically impaired offspring. Severity of handicap need not be directly linked to stress in these families, nor is avoiding an individual diagnosis helpful to them. To further clarify the relevant issues, the family's "reactions" to a dysfunctional member, along with the professionals' previously unhelpful approaches to dealing with the impairment of these children, are presented. Finally, the therapeutic implications of the position presented in this article are drawn, and specific recommendations for working with these families are offered.