Avoidance and depression: the construction of the cognitive-behavioral avoidance scale

Previous research has demonstrated a relationship between avoidance and depression, although the nature of this relationship has been confused by inconsistent definitions of avoidance. Following a review of the construct of avoidance and an examination of past research, a new multidimensional measure of avoidance was developed and validated using an undergraduate student sample (245 females and 146 males). Four reliable factors reflecting combinations of cognitive/behavioral and social/nonsocial dimensions of avoidance were obtained from the factor analysis of the new scale, entitled the "Cognitive-Behavioral Avoidance Scale" (CBAS). The scale showed the predicted relationships with convergent and divergent measures used for construct validation. As predicted, subscales of the CBAS, as well as the overall scale score, were significantly related to the depression and anxiety criterion measures. The findings from this study suggest that avoidance may be an important construct in the psychosocial conceptualization of depression. In addition, this integrated measure of avoidance has potential utility for depression researchers. Suggestions for further scale development and research are provided.     

Higher levels of state depression in masculine than in feminine nations

Studies using identical measures have identified different levels of depression in different countries or cultures. Until now, however, explanations for such differences, other than methodological ones, have not been empirically addressed. It was hypothesized and found that soft or feminine nations in which both women and men are offered equal opportunities for the fulfillment of multiple social roles that are associated with good self-rated health would score significantly lower on national depression levels than tough or masculine societies in which such opportunities exist to a clearly lesser extent. Analyses of data collected in 14 nations in Europe (total N>5000) demonstrated that higher scores on Hofstede's national masculinity index and lower ones on national wealth were independent predictors of higher national depression levels. National trait neuroticism did not mediate the relationship between national masculinity and national depression levels.     

The Göteborg discothèque fire, 1998

Findings from a study of 563 adolescents’ reactions following a discotheque fire that killed 63 young people in Göteborg in October 1998 are presented. The group answered a questionnaire seven months following the disaster. The questionnaire included the Impact of Event Scale (IES) and the Birleson Depression Self‐Rating Scale (DSRS). The level of trauma was found to be very high, while depression scores were less elevated. A little under a third of the students scored above a clinical cut‐off point (> 35) on the IES, indicating high posttraumatic stress levels. Girls evidenced more depression and traumatic stress reactions than boys. Levels of reactions increased with more closeness (knowing victims personally) and if the adolescents were of non‐Swedish origin.     

Pain and Pain-Related Impairment in Adults with Cystic Fibrosis

The Multidimensional Pain Inventory (MPI) was utilized in a sample of adult outpatients with cystic fibrosis (CF) to assess their perception of pain and its psychosocial consequences. Subsequently, the data were compared to the ratings of pain and pain-related impairment in these patients as perceived by two nurses from the CF treatment team, as well as to a quantitative measure of illness severity. The results of these comparisons demonstrate that the majority of adult outpatients with CF reported experiencing lower levels of pain and pain-related impairment than expected, although the male patients tend to report experiencing significantly less impact in these domains than do the female patients. Additionally, the nurses do not underestimate the degree to which patients, especially males, experience pain and pain-related interference from chronic illness. Finally, there was no significant relationship between patients' self-report of pain severity or pain-related interference and an objective measure of disease severity.     

Evaluating the Factor Structure of the MIDI Personality Scale Using Exploratory Structural Equation Modeling

This study investigated the factor structure of the 26‐item Midlife Development Inventory (MIDI) Personality Scale in a sample of 2,720 Americans. It was found that whereas confirmatory factor analysis (CFA) did not provide an acceptable fit to the data, exploratory structural equation modeling (ESEM) provided an acceptable fit. The results of ESEM revealed that the a priori five‐factor structure of personality was generally consistent with the data, and all items had salient loadings on their target factors. ESEM also revealed that some of the items contributed significantly to more than one personality factor. The results are in line with previous research, and indicate that ESEM is more suitable than CFA for the study of personality traits.     

Couple‐based Intervention for Depression: An Effectiveness Study in the National Health Service in England

This study represents an effectiveness study and service evaluation of a cognitive behavioral, couple‐based treatment for depression (BCT‐D) provided in London services that are part of the “Improving Access to Psychological Therapies” (IAPT) program in England. Twenty‐three therapists in community clinics were trained in BCT‐D during a 5‐day workshop, followed by monthly group supervision for 1 year. The BCT‐D treatment outcome findings are based on 63 couples in which at least one partner was depressed and elected to receive BCT‐D. Eighty‐five percent of couples also demonstrated relationship distress, and 49% of the nonclient partners also met caseness for depression or anxiety. Findings demonstrated a recovery rate of 57% with BCT‐D, compared to 41% for all IAPT treatments for depression in London. Nonclient partners who met caseness demonstrated a 48% recovery rate with BCT‐D, although they were not the focus of treatment. BCT‐D was equally effective for clients regardless of the clinical status of the nonclient partner, suggesting its effectiveness in assisting both members of the couple simultaneously. Likewise, treatment was equally effective whether or not both partners reported relationship distress. The findings are promising regarding the successful application of BCT‐D in routine clinical settings.     

The Shift from Monologue to Dialogue in a Couple Therapy Session: Dialogical Investigation of Change from the Therapists’ Point of View

As part of a larger research project on couple therapy for depression, this qualitative case study examines the nature of dialogue. Drawing on Bakhtinian concepts, the investigation shows how the conversation shifts from a monologue to dialogue. Among the findings are: first, the process of listening is integral to the transforming experience. That is, the careful listening of the therapist can evoke new voices, just as the experience of one of the partners’ “listening in” to the conversation between the other partner and the therapist can create movement and new trajectories. The latter is a qualitative difference between dialogic therapy with a couple and that with an individual. Second, the therapist not only acts as creative listener, but as the dialogue unfolds, actively contributes to meaning‐making. Third, the study upholds having a team of researchers as a polyphonic forum and the usefulness of Bakhtinian concepts in clinical research on dialogue in multi‐actor sessions.     

Psychometric qualities of the White Bear Suppression Inventory in a Dutch sample of children and adolescents

The White Bear Suppression Inventory [WBSI; Wegner and Zanakos (1994)] was developed to assess the tendency to suppress unwanted thoughts. Most psychometric studies of the WBSI have included healthy students and adults with obsessive-compulsive disorder. There has been increasing interest in thought suppression in children and adolescents, especially after a traumatic event, but little is known about the psychometric properties of the WBSI for children. The aim of this research was to examine the psychometric qualities of the WBSI in a Dutch sample of children and adolescents. Two studies were conducted. First, the WBSI’s factor structure, internal consistency and test-retest stability were examined in a sample of 203 primary school children (9-13 years). Second, the factor structure and content validity were assessed in 89 children and adolescents (8-18 years) who attended the emergency room after a road traffic accident. Results demonstrated that the WBSI items contribute to a single factor measuring the suppression of unwanted thoughts and that the reliability is satisfactory. Associations between the WBSI and PTSD-symptoms demonstrated sufficient content validity. The findings suggest that the WBSI can appropriately be used in child and adolescent samples.     

Cumulative estrogen exposure and prospective memory in older women

This study looked at cumulative lifetime estrogen exposure, as estimated with a mathematical index (Index of Cumulative Estrogen Exposure (ICEE)) that included variables (length of time on estrogen therapy, age at menarche and menopause, postmenopausal body mass index, time since menopause, nulliparity and duration of breastfeeding) known to influence estrogen levels across the life span, and performance on prospective and retrospective memory measures in a group of 50 postmenopausal women (mean age=69.3years) who, if they were current or former users of estrogen therapy, had started therapy within 5years of menopause. The ICEE was found to be a significant predictor of performance on the Prospective Memory task (F(1)=4.21, p=.046, η(p)(2)=.084). No significant relationship was noted between the ICEE and performance on measures of retrospective memory. The results suggest that the level of cumulative lifetime exposure to estrogen a woman has influences her prospective memory performance later in life and that the influence of reproductive and biological markers of endogenous estrogen exposure are relevant factors to consider when studying the effect of estrogen therapy on cognitive functioning in postmenopausal women. In addition, the finding that performance on a measure of prospective memory, but not performance on measures of retrospective memory, was associated with the ICEE adds further support to the theory that the frontal cortex may be especially sensitive to estrogen.