On ‘the fear of death’ as the primary anxiety: How and why Klein differs from Freud

It is well known that Melanie Klein held the view that ‘fear of death’ is the primary source of anxiety and that her position is explicitly opposed to that of Sigmund Freud, who maintained that that fear cannot in any way or form be a source of anxiety. In a previous article on Freud's Inhibitions, Symptoms and Anxiety (Blass, 2013), the author argued that, counter to what is commonly portrayed in the literature, Freud's considerations for rejecting the fear of death as a source of anxiety were based on relational and experiential factors that are usually associated with Kleinian psychoanalysis. In light of this affinity of Freud with Klein a question arises as to the actual source of their differences in this context. The present paper offers an answer to this question. The author first presents some of her earlier findings on what led Freud to reject the fear of death as a source of anxiety and then turns to investigate Klein's considerations for accepting it. This takes us beyond her explicit statements on this matter and sheds new light on the relationship of her views regarding death and anxiety and those of Freud. In turn this deepens the understanding of the relationship of Freud and Klein's conceptualizations of the psyche and its internal object relations, pointing to both surprising common ground and foundational differences.     

Restructuring the health care system in british columbia: The experience of the shaughnessy hospital employees

Abstract

The impact of the Shaughnessy Hospital closure on a sample of full-time health care employees (n = 59) is examined within the context of the restructuring of the British Columbia health care system. Employee concerns focused on lack of consultation, concern for patients, and their own well being. Results from a repeated measures ANOVA (pre- and post-closure) revealed that the negative emotions (e.g., anxious, distressed, angry, nervous) associated with the closure did not dissipate until a full year after the announcement of the hospital closure. A pooled time series analysis (n = 177) found that both social support and positive coping activities were associated with greater coping effectiveness, perceptions of justice, and fewer sick days. The study findings suggest that health care organizations going through closure or restructuring activities should explore interventions which improve communication, develop supervisory support, provide employee assistance or counseling, and offer training interventions which help employees to maintain a positive mental outlook.     

Does personality moderate the relationship between stress and health behavior? Expanding the nomological network of the five-factor model

The present study tested the hypothesis that personality would moderate the stress to health behavior relationship. Using a community sample, 706 adults (Mean age = 37 years) were administered a set of five-factor model adjective rating scales, measures of stress and distress (i.e., negative life stress, physical symptom intensity, negative mood), health behaviors, as well as a demographic questionnaire. Using hierarchical multiple regression, Openness to Experience, Extraversion, and Neuroticism were found to moderate the stress to health behavior relationship. Supplementary analyses were conducted to determine if the five-factors would also moderate a life event to distress relationship. While several main effects were found, Conscientiousness was found to buffer the stress to distress connection. The factors that may influence both moderator models, suggestions for integration, and future research are discussed.     

Reducing the Risk of Internalizing Symptoms among High‐risk Hispanic Youth through a Family Intervention: A Randomized Controlled Trial

Familias Unidas is an intervention that has been found to be efficacious in preventing and reducing substance use, sexual risk, and problem behaviors among Hispanic youth. While it does not specifically target youth internalizing symptoms, the intervention works to strengthen parenting and family factors associated with reduced risk of internalizing symptoms (i.e., depression, anxiety symptoms). This study examines the effects of Familias Unidas on internalizing symptoms among high‐risk youth, as well as the role of family level factors in the intervention's effects. A total of 242 12–17‐year‐old Hispanic youth with a history of delinquency and their primary caregivers were recruited from the school and juvenile justice systems, and randomly assigned to the Familias Unidas intervention or community practice control. A linear latent growth model was used to examine intervention effects on the trajectory of adolescent internalizing symptoms from baseline to 6 and 12 months post‐baseline. Results show that the Familias Unidas intervention was more efficacious than control in reducing youth internalizing symptoms. Baseline youth externalizing and internalizing symptoms did not moderate the intervention's effects on the trajectory of youth internalizing symptoms. While parent – adolescent communication did not significantly moderate the intervention's effects, changes in parent – adolescent communication mediated the intervention's effects on internalizing symptoms, showing stronger intervention effects for youth starting with poorer communication. Findings indicate that the Familias Unidas intervention can reduce internalizing symptoms among high‐risk Hispanic youth, and that improving parent – youth communication, a protective family factor, may be one of the mechanisms by which the intervention influences youth internalizing symptoms.     

Is there a role of depressive symptoms in the fear-avoidance model? A structural equation approach

The fear-avoidance (FA) model has gained widespread acceptance as a conceptual framework for investigating psychological factors such as FA beliefs and avoidance behavior, which contribute to chronic back pain and reduced functioning. Depressive symptoms are supposed to be related to FA beliefs and to foster avoidance behavior. This study aims to investigate the multivariate assumptions of the FA model with a focus on the role of depressive symptoms. A total of N = 360 patients with chronic nonspecific low back pain at admission of inpatient orthopedic rehabilitation participated in the survey. Measures included a numeric pain rating scale, Fear-Avoidance Beliefs Questionnaire, Pain Anxiety Symptoms Scale, Hannover Functional Ability Questionnaire and Patient Health Questionnaire. Using structural equation modeling (SEM), we construed a basic FA model and subsequently extended it by adding symptoms of depression as a covariate. The results of SEM indicated a good model fit for a basic FA model (χ²(263) = 431.069, p < .001, RMSEA = .042, CFI = .964, WRMR = .986). They confirmed the hypothesized relations and supported single mediations of the relationship between pain and functioning by FA beliefs and avoidance behavior. A second model including symptoms of depression as additional covariate (χ²(511) = 722.761, p < .001, RMSEA = .034, CFI = .956, WRMR = .949) showed a high impact of depressive symptoms on all FA model variables leading to a decrease of the FA mediations. The findings provide empirical support for the multivariate FA model and underline the importance of considering depressive symptoms in a multiple-target approach to understand the mechanisms of chronic pain.     

Causal attributions in premenstrual syndrome

Abstract

The relationship between causal attributions and symptoms was investigated with self-report inventories in patients with premenstrual syndrome (n=38) and controls (n=26) during the premenstrual as well as the intermenstrual phase of the cycle. Patients with prospectively confirmed premenstrual exacerbations of physical and psychological symptoms more frequently attributed their complaints during premenstruum to the cycle than was the case during the intermenstrual period. Controls showed no differences in types of explanations for complaints in either phase of the cycle. It appeared that patients used not only the menstrual cycle, but also psychological distress and physical exertion, more often then controls as an explanation for complaints during both phases of the cycle. Implications of the finding that patients used medical as well as non-medical explanations for complaints during the cycle are discussed with regard to treatment strategies for PMS.     

Applying Cluster Analysis to Define a Typology of Chronic Fatigue Syndrome in a Medically-Evaluated,Random Community Sample

This study involved a randomly selected, medically-evaluated, community-based sample of 166 individuals with chronic fatigue. Participants diagnosed with chronic fatigue syndrome and medically-explained chronic fatigue reported significantly more severe fatigue following exertion than the idiopathic chronic fatigue group, and participants with medically-explained chronic fatigue also reported significantly more severe fatigue following exertion than the psychiatrically-explained chronic fatigue group. A cluster analysis was performed to define a typology of chronic fatigue symptomatology for participants diagnosed with chronic fatigue syndrome. Three clusters emerged. Cluster 1 contained only one participant with chronic fatigue syndrome and was characterized by relatively low post-exertional fatigue. Cluster 2 contained a small proportion of individuals with chronic fatigue syndrome and was characterized by most severe post-exertional fatigue and most improvement in fatigue following rest. Cluster 3 contained the highest proportion of individuals with chronic fatigue syndrome, and was characterized by high post-exertional fatigue and fatigue not alleviated by rest.     

Performance on the dimensional change card sort and backward digit span by young children with autism without intellectual disability

The early development of executive function (EF) and its relation to autism symptom expression is of considerable theoretical interest, particularly in children without general cognitive delay. Executive function was tested in 23 children with autism spectrum disorders (ASD) without intellectual disability and 20 age- and IQ-matched typically developing children. Even though performance was equivalent between the two groups on tests of general intelligence, flexibility in card sorting was lower for children with ASD. Verbal working memory during the backward digit span did not differ between groups. Among children with ASD, poorer performance on card sorting distinguished a subgroup with worse social-communication functioning above and beyond IQ. Controlling for IQ social and repetitive symptoms of ASD did not differ based on card sorting ability.     

Personality, anxiety and functional dysphonia

Psychological factors are considered for the predisposition and perpetuation of functional dysphonia. In the present study 61 patients with functional dysphonia were compared with 61 healthy controls, matched by age, sex, and occupation with respect to Cloninger’s personality model, mood, and anxiety.The patients with functional dysphonia presented significantly higher scores than the healthy controls with respect to “harm avoidance” (HA); depressive symptoms; symptoms of unspecific and general anxiety; symptoms of specific anxiety concerning “health”, “illness”, and “extraversion versus introversion”. No significant differences were found in “novelty seeking” (NS), “reward dependence” (RD), “persistence” (PE), or in state-anxiety and anxiety of social situations. These results were found considering univariate and multivariate analyses and confirm the relationship of psychological factors such as personality traits, mood, and anxiety on one hand and conversion disorder in general and functional dysphonia in particular on the other hand. This important relationship should be considered in the diagnostic and therapeutic interventions of functional dysphonia.     

Assessment of psychopathology across and within cultures: issues and findings

Research based information on the impact of culture on psychopathology is reviewed, with particular reference to depression, somatization, schizophrenia, anxiety, and dissociation. A number of worldwide constants in the incidence and mode of expression of psychological disorders are identified, especially in relation to schizophrenia and depression. The scope of variation of psychopathological manifestations across cultures is impressive. Two tasks for future investigations involve the determination of the generic relationship between psychological disturbance and culture and the specification of links between cultural characteristics and psychopathology. To this end, hypotheses are advanced pertaining to the cultural dimensions investigated by Hofstede and their possible reflection in psychiatric symptomatology. It is concluded that the interrelationship of culture and psychopathology should be studied in context and that observer, institution, and community variables should be investigated together with the person's experience of distress and disability.