Trait Anger and Axis I Disorders: Implications for REBT

Anger has a prominent role in basic theories of emotion. And while many psychiatric disorders can be conceived of as emotional disorders (e.g., depressive disorders, anxiety disorders), there are no disorders for which anger is the cardinal feature. We analyzed diagnostic data on 1,687 (as later) psychiatric outpatients and looked at the co-occurrence of high trait anger (as assessed by criterion 8 of Borderline Personality Disorder) and Axis I disorders, and Borderline and Antisocial Personality Disorders. The purpose was to examine whether dysfunctional anger met criteria necessary to be considered a valid diagnostic category. Results showed that high trait anger was not fully accounted for by any particular Axis I diagnosis, or any set of Axis I diagnoses, or by the combination of Axis I diagnoses and Borderline and Antisocial PDs. Trait anger also accounted for significant amounts of unique variance in several indicators of psychiatric impairment and psychosocial functioning. We describe the anger disorder diagnoses of Eckhardt and Deffenbacher (Anger disorders: Definition, diagnosis and treatment. Taylor & Francis, Bristol, PA, 1995), and discuss the implications of those diagnoses for the practice of REBT and CBT.

Illness representations and matching labels with symptoms

Three studies are reported that show that health-relevant information (e.g., blood pressure [BP] or symptoms) initiates an active cognitive search process that results in the construction of an illness representation. Study 1 showed that informing subjects that their BP was elevated affected two attributes of illness representation: identity (label and symptoms), and time line or expected chronology of the health threat. Subjects given a high-BP reading reported symptoms commonly associated with high BP, especially if they attributed the high-BP reading to stress. Study 2 showed that the active search process uses causal information (a third attribute of representations) to give meaning to symptoms. Specifically, subjects used environmental cues to interpret whether familiar, unfamiliar, and ambiguous symptoms were due to illness or to stress. In Study 3 we showed that the constructive process, initiated by a high-BP reading, is directed by prior beliefs about the time line for developing high BP and by the presence of external cues about the stressfulness of the subject's daily life. Subjects who believed BP was labile and that they were under high daily stress or who believed BP was stable and that they were under low daily stress reported more symptoms. The significance of these findings for understanding how people process diagnostic labels and symptom information involved in the construction of illness representations is discussed.     

Germ-line gene therapy and the clinical ethos of medical genetics

Although the ability to perform gene therapy in human germ-line cells is still hypothetical, the rate of progress in molecular and cell biology suggests that it will only be a matter of time before reliable clinical techniques will be within reach. Three sets of arguments are commonly advanced against developing those techniques, respectively pointing to the clinical risks, social dangers and better alternatives. In this paper we analyze those arguments from the perspective of the client-centered ethos that traditionally governs practice in medical genetics. This perspective clarifies the merits of these arguments for geneticists, and suggests useful new directions for the professional discussion of germ-line gene therapy. It suggests, for example, that the much discussed prospect of germ-line therapy in human pre-embryos may always be more problematic for medical genetics than adult germ-line interventions, even though the latter faces greater technical difficulties.     

Solution-focused Couples Therapy Groups: An Empirical Study

The professional literature contains numerous theoretical and case study articles regarding the development and use of solution-focused therapy. However, as with many models of systems-oriented therapy in use with couples, very little has been subjected to empirical investigation. This project was designed to make a contribution to the empirical literature regarding the effectiveness of solution-focused therapy in use with couples' groups. This study utilized pre-test comparisons of treatment and comparison groups, and examined pre- to post-test changes in the scores of the treatment group couples. Twenty-three treatment group couples participated in a six-week solution-focused couples therapy (SFCT) group. A separate group of thirteen couples served as a comparison group. The Dyadic Adjustment Scale (DAS) was used to assess changes in the couples' relationships. Scores on the Marital Status Inventory (MSI), as a pre-test measure indicating the couples' likelihood of divorce, indicated no significant differences between groups. The remaining analyses revealed significant improvement in DAS scores. Self-reports from the couples involved indicate improvement in a variety of areas after completing the six-week solution-focused couples group therapy process.