Standardized assessment of relationship functioning in OEF/OIF Veterans with and without PTSD

Posttraumatic Stress Disorder (PTSD) is associated with difficulties in intimate relationships, with most prior research examining associations with continuous, single-dimension, and often-unstandardized measures of general relationship quality or aggression. Standardized, well-normed assessments that include multiple couple problem areas could provide more precise information about the presence and specific nature of clinically significant concerns in patient care settings. This investigation aimed to replicate findings regarding increased difficulties in relationship functioning among Operations Enduring and Iraqi Freedom Veterans with PTSD and their romantic partners, specifically using a standardized assessment that permits identification of cases of clinically significant general couple distress and difficulties across multiple problem areas. We compared 32 male Veterans with PTSD and 33 without PTSD, and their romantic partners on reports of several problem areas using the revised Marital Satisfaction Inventory (MSI-R). All participants underwent structured diagnostic interviewing. PTSD couples reported clinically significant levels of relationship distress several times more frequently than comparison couples, both for general distress and across all specific problem areas (e.g., aggressive behavior, quality of leisure time together, sexual functioning, conflicts about finances and child rearing). The most notable problem areas for PTSD couples were affective and problem-solving communication. These results replicate associations of PTSD with general couple discord and multiple specific areas of couple difficulties and extend them by documenting the clinical severity of these problems. Mental health providers may consider incorporating standardized couple assessments into their evaluations of Veterans’ functioning. Couple therapies may consider using such measures to prioritize targets for treatment.     

Korean Immigrant Women's Journey from Abused Wives to Self-Reliant Women

Today's adolescent girls experience sociocultural pressures and life stressors which result in negative mental health outcomes, including binge eating. The purpose of this article is to present a model of psychotherapy for adolescent girls who engage in binge eating. The components in this model include: (a) Feminist Therapy to emphasize client empowerment and the importance of sociocultural context in understanding girls’ concerns; (b) Cognitive Behavior Therapy to help clients to eliminate dieting and to cope with pressures for attaining the beauty ideal; (c) Dialectical Behavior Therapy to assist clients in coping with emotions; and (d) Interpersonal Therapy to help clients improve relational transitions and disputes.     

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No abstract available for this article.     

Marital role strain,illness intrusiveness,and their impact on marital and individual adjustment in end-stage renal disease

Abstract

A marital role theory approach was used to investigate individual psychosocial well-being and marital adjustment in 89 end-stage renal disease (ESRD) patients and their spouses. Four different patient groups were selected according to a continuum of clinical milestones in the treatment of ESRD, including pre-dialysis (n=17), incenter dialysis (n=18), home dialysis (n=19), and posttransplant patients (n=17). A nephrology clinic control group (n=18) was also included. Standardized instruments were employed to investigate marital role strain (Marital Role Questionnaire, KDS-15), marital adjustment (Locke-Wallace Marital Adjustment Test), subjective well-being (Affect Balance Scale, Rosenberg Self-Esteem Inventory), and psychopathology (Symptom Checklist 90-R). Hierarchical multiple regression analyses provided strong and consistent support for the major hypotheses relating elevated marital role strain to compromised marital adjustment and individual well-being. Further analyses demonstrated that increased perceived intrusiveness of ESRD was significantly related to greater marital role strain, poorer marital adjustment, and decreased individual well-being. This is consistent with the idea that perceived intrusiveness may be an important mediator of marital role strain and of coping with chronic illness. “Objective” intrusiveness, defined in terms of patient group, was not significantly related to marital or individual well-being. These findings support a dyadic approach to the psychosocial study of chronic illness.     

Emotional approach coping: Gender differences on psychological adjustment in young to middle-aged cancer survivors

Objective : The effect of emotional approach coping (EAC) varies by gender. However, this gender difference has not yet been investigated in cancer survivors. We investigated whether the effects of two kinds of EAC – emotional processing (EP) and emotional expression (EE) – vary by gender and whether EAC has effects above and beyond the effect of other coping strategies.

Design : EAC and other coping strategies were assessed at baseline in a sample of 248 young to middle-aged adult (between the age of 22 and 55) cancer survivors. One hundred and sixty-six survivors responded to psychological adjustment one year later.

Results : EAC had different relationships with Time 2 adjustment in men and women. Hierarchical regression analyses showed that for men, EE predicted lower intrusive thoughts and, for women, EP was associated with higher positive affect when other coping strategies and EE were controlled.

Conclusion : Gender differences held true in cancer survivors, and EAC was effective when other coping strategies were controlled. Further, EE was effective in reducing negative adjustment in men while EP was helpful in promoting positive adjustment in women.     

Validation of a new multidimensional health locus of control scale (form c) in asthma research

Abstract

This study developed and validated an Asthma Multidimensional Health Locus of Control (AMHLC) scale using 186 asthmatics aged 13 to 55 years recruited from 46 pharmacies in the Hunter Valley, Australia. The construct validity and internal consistency of the scale were demonstrated using principal components factor analysis and Cronbach's alpha respectively. Although correlations were modest, findings indicate that asthmatics with higher “Powerful Others” locus of control perceived they had a better quality of doctor-patient relationship; the opposite was found for those with higher “Chance” scores. Powerful Others orientation was also associated with expectations and valuation of services doctors' provide. Knowledge of asthma was not related in the expected direction with the new scale, nor were clinical indices of asthma severity. Younger asthmatics had higher Chance scores while older asthmatics tended toward higher Powerful Others orientation. Overall, the AMHLC instrument achieved suitable measurement properties to allow further investigation of health care behavior in people with asthma.     

Type a behaviour pattern as a risk factor after myocardial infarction: A review

Abstract

This paper is a response to Eiser's (1996) call for a unifying theoretical perspective that would bridge the gap between 'individualistic and ‘social’ approaches to studying human social behaviour in general, and health behaviour in particular. While agreeing with Eiser's premise that it makes no sense to study cognition, affect, and behaviour independently of social context, the present paper takes issue with certain features of his argument that a connectionist approach provides the needed unifying theoretical framework. It is suggested that if connectionism can describe the psychological processes underlying social behavior better than non-connectionist theories, this would provide more compelling evidence of its value than claims that it affords new theoretical insights.     

The impact of assuming the primary caregiver role following traumatic spinal cord injury: An interpretative phenomenological analysis of the spouse's experience

This study aimed to explore the lived experience of assuming the primary caregiver role in a group of spouses of individuals living with a traumatic spinal cord injury (SCI) (injuries ranged from paraplegia to quadriplegia). Individual in-depth interviews were conducted with 11 participants who were both the spouse and primary caregiver of an individual with a SCI; of these, 10 were female and 1 was male. All interviews were transcribed verbatim and were subjected to interpretative phenomenological analysis (IPA). Here we present three inter-related master themes: ‘The emotional impact of SCI’; ‘Post-injury shift in relationship dynamics’ and ‘Impact of caregiving on identity’. Regarding the emotional impact of spinal injury, participants reported an almost instantaneous sense of loss, emptiness and grief during the injured person's rehabilitative period and feelings of anxiety were reported in anticipation of their return to the family home. A distinct change in role from spouse and lover to care provider was reported and this ultimately contributed to relationship change and a loss of former identity. The findings are discussed in relation to extant caregiver literature and recommendations for future caregiver support are highlighted.     

Relations between acceptance of multiple sclerosis and positive and negative adjustments

This study examines relations between acceptance as defined in Acceptance and Commitment Therapy (ACT) and adjustment to multiple sclerosis (MS). A first step in this investigation was the development of a measure of acceptance of MS called the MS Acceptance Questionnaire (MSAQ). Consistent with prior findings and theoretical propositions, it was predicted that acceptance would be associated with better adjustment to MS (lower distress and higher positive affect, life satisfaction and marital adjustment and better health). A total of 128 persons with MS completed measures of demographics, illness and adjustment at Time 1 and measures of acceptance and adjustment 12 months later (Time 2). Factor analyses of the MSAQ revealed two factors, action and willingness. Associations between the MSAQ and other validated acceptance measures supported convergent validity. As predicted, after controlling for the effects of initial adjustment and relevant demographic and illness variables, greater acceptance was related to better adjustment, although the action factor emerged as the strongest predictor of better adjustment. This is the first study to examine the role of acceptance (as defined in ACT) in adjusting to MS over time and as such provides a first step for further investigation of acceptance in MS.     

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.