Advances in a cognitive behavioural model of body dysmorphic disorder

Body dysmorphic disorder (BDD) is the most distressing and handicapping of all the body image disorders. A cognitive behavioural model of BDD is discussed which incorporates evidence from recent studies and advances in the author’s 1996 conceptual model. The model aims to understand the maintenance of symptoms in BDD, to assist in the process of engagement of therapy and to guide the strategies to use. At the core of BDD is an excessive self-focussed attention on a distorted body image, the negative appraisal of such images leading to rumination, changes in mood and the use of safety behaviours. Evidence for possible risk factors in the development of BDD is also discussed.     

Analysis and treatment of problem behavior evoked by music

The present study investigated the effects of differential negative reinforcement of other behavior (DNRO) on problem behavior evoked by music in a 7-year-old child with pervasive developmental disorder. Following an auditory stimulus assessment, DNRO was used to reduce problem behavior to near-zero levels. Results are discussed in terms of identifying establishing operations to govern treatment options and the use of negative reinforcement when arbitrarily imposed positive reinforcers do not compete with escape from auditory stimulation.     

Effectiveness of an empirically supported treatment for social phobia in the field

This study examined the effectiveness of individual exposure combined with cognitive restructuring for social phobia in a clinical setting as well as the influence of sample restriction criteria on the effect size. Participants were 217 unselected patients with a primary diagnosis of social phobia who were treated by 57 therapists in four outpatient clinics of the Christoph-Dornier-Foundation of Clinical Psychology in Germany. Results 6 weeks after the end of therapy showed highly significant reductions in social phobic fears and avoidance as well as in general anxiety and symptoms of depression. However, patients who dropped out during therapy reported a significantly higher degree of depression. Results did not differ between the four outpatient clinics and are comparable with the average effect-sizes reported by meta-analytic studies of controlled efficacy research, using selected patients. Also, restricting the sample according to the selection criteria often applied in research settings did not result in higher effect sizes for the applied outcome measures. We conclude that individual cognitive behavioural therapy for social phobia can be transported from research settings to the field of mental health.     

The influence of comorbidity on treatment outcome for children and adolescents with anxiety disorders

There have been a growing number of studies showing that cognitive behavioural treatment packages for children with anxiety disorders are highly effective. Clinically, it is often assumed that treatment outcome is less successful, or that treatment needs to be altered when faced with the existence of comorbid conditions. To date, only one study has directly addressed this question in the child anxiety literature. The present study compared the treatment outcome and maintenance following a brief, group program for the reduction of child and adolescent anxiety disorders in anxious children with versus without comorbid disorders. There was no significant difference in response to treatment at the end of the program and few differences at 12-month follow-up. The only indication of an impact of comorbidity was a suggestion that children with a comorbid condition did not do as well at follow-up. However, this result was only shown on some parent-report measures and not on self-report measures. Overall, the results indicate that treatment for child and adolescent anxiety disorders produces broadly comparable results regardless of the existence of comorbid disorders.     

The driving anger expression inventory: a measure of how people express their anger on the road

Four ways people express their anger when driving were identified. Verbal Aggressive Expression (alpha=0.88) assesses verbally aggressive expression of anger (e.g., yelling or cursing at another driver); Personal Physical Aggressive Expression (alpha=0.81), the ways the person uses him/herself to express anger (e.g., trying to get out and tell off or have a physical fight with another driver); Use of the Vehicle to Express Anger (alpha=0.86), the ways the person uses his/her vehicle to express anger (e.g., flashing lights at or cutting another driver off in anger); and Adaptive/Constructive Expression (alpha=0.90), the ways the person copes positively with anger (e.g., focuses on safe driving or tries to relax). Aggressive forms can be summed into Total Aggressive Expression Index (alpha=0.90). Aggressive forms of expression correlated positively with each other (rs=0.39-0.48), but were uncorrelated or correlated negatively with adaptive/constructive expression (rs=-0.02 to -0.22). Aggressive forms of anger expression correlated positively with driving-related anger, aggression, and risky behavior; adaptive/constructive expression tended to correlate negatively with these variables. Differences in the strengths of correlations and regression analyses supported discriminant and incremental validity and suggested forms of anger expression contributed differentially to understanding driving-related behaviors. Theoretical and treatment implications were explored.     

Over-valued ideas: a conceptual analysis

Over-valued ideas are truly a neglected area of psychopathology with few experimental studies published. There is a different emphasis in the USA and Europe regarding their definition. For authors in the USA an over-valued idea has become shorthand for 'poor insight' in the middle of a continuum of obsessional doubts to delusional certainty. Compared to negative thoughts, obsessions and delusions, they are often more resistant to any treatment. A better understanding of over-valued ideas is required if advances are to be made in therapy and for the development of appropriate measures to evaluate the efficacy of novel treatments. A cognitive behavioural model of over-valued ideas is presented which draws upon the philosophical distinction between beliefs and values. It is argued that over-valued ideas are associated with idealised values, which have developed into such an over-riding importance, that they totally define the 'self' or identity of the individual. Idealised values are also characterised by the rigidity with which they are held. Such patients are unable to adapt to different circumstances and ignore the consequences of acting on their value. This analysis leads to a discussion of predictions that can be tested and various strategies that can be used in cognitive behaviour therapy.     

The role of emotions arising from instability in investment behaviour / El papel de la carga emocional de la inestabilidad en el comportamiento de inversión

Abstract

Clear empirical evidence has been found on how significant changes to a person’s environment can alter their behaviour. This is important when considering investments made on the stock exchange as the variations that occur in stock market prices are frequent and continuous. This study analyses the role instability has on individual investors’ behaviour when investing in the stock market. The results suggest that instability in investment situations plays a significant role in individual investors’ behaviour, probably due to the emotional effect provoked by the possibility of suddenly losing savings. This would modify the perception investors have about investing as well as their intentions, attitudes and feelings of control in regards to investment in financial markets, thus hindering the capacity to predict their behaviour.     

Not all who stand tall are proud: Gender differences in the proprioceptive effects of upright posture

Research shows that individuals feel and later perform better when given positive feedback in the context of an upright posture, as opposed to a slumped one, even if unaware that their bodily position is meant to express emotion. We sought to determine whether proprioceptive feedback from body postures operate differently for women and men. Participants received success feedback when in either an upright or slumped posture, which was covertly manipulated. Results showed that for men the effects of posture were intuitive and appropriate: receiving success feedback while upright enhanced performance self-ratings. In contrast, after adopting an upright posture, women went on after success feedback to perform more poorly and make more negative self-ratings, than after adopting a slumped posture. A number of theories are offered as potential explanations for this gender effect.     

Effects of facial expression and gaze direction on approach–avoidance behaviour

Humans must coordinate approach–avoidance behaviours with the social cues that elicit them, such as facial expressions and gaze direction. We hypothesised that when someone is observed looking in a particular direction with a happy expression, the observer would tend to approach that direction, but that when someone is observed looking in a particular direction with a fearful expression, the observer would tend to avoid that direction. Twenty-eight participants viewed stimulus faces with averted gazes and happy or fearful expressions on a computer screen. Participants were asked to grasp (approach) or withdraw from (avoid) a left- or right-hand button depending on the stimulus face's expression. The results were consistent with our hypotheses about avoidance responses, but not with respect to approach responses. Links between social cues and adaptive behaviour are discussed.