The moderating role of positive beliefs about worry in the relationship between stressful events and worry

Some theorists suggest that worry is elevated by positive beliefs when stressful events occur. Although several cross-sectional studies have revealed an association between positive beliefs and worry, few longitudinal studies have been conducted on this topic. Moreover, the effect of positive beliefs as a moderator on worry when stressful events occur has not been investigated. Against this background, the present study conducted a two-wave longitudinal survey to examine the moderating role of positive beliefs. One hundred and ninety-four college students voluntarily completed questionnaires. Hierarchical regression analysis showed a prospective relationship between the experience of stressful events and the subjective report of worry. Moreover, this relationship was moderated by an interaction with positive beliefs; stressful events were a stronger predictor of the extent of worry for individuals with a high level of positive beliefs than for those with a low level of positive beliefs. The moderating role of positive beliefs suggests that the level of positive beliefs amplifies the threat of worry caused by stressful events.     

Personality and social attitudes: Evidence for positive-approach motivation

Extensive research has linked general personality factors to social attitudes, but there has been comparatively little work on the roles played by specific approach-avoidance personality factors, especially positive-approach ones. Here we relate such factors to the two main clusters of social attitudes (Right-Wing Authoritarianism, RWA; and Social Dominance Orientation, SDO), and related cognitive constructs (Need for Cognition and Need for Closure). Results revealed: (a) positive-approach motivation is consistently related to both RWA and SDO, with little contribution from negative-avoidance motivation; and (b) negative-avoidance motivation played a part in Need for Cognition (negatively related) and Need for Closure (positively related). These data challenge previous theorizing concerning the role of fear/anxiety in social attitude formation and prejudice more generally. We conclude that, to a larger extent than previously thought, approach-related personality factors underpin the positive reinforcement of social attitudes and prejudice. Our results may help to account for the failure of programmes designed to reduce prejudice which have been based on the reduction of negative emotion and motivation.     

Financial capability,money attitudes and socioeconomic status: Risks for experiencing adverse financial events

The risk of experiencing adverse financial events (e.g. bankruptcy) depends on the world economy and on individual differences in financial and psychological variables. Analysing data from 109,472 British survey respondents, this study reports the risks associated with financial capabilities, money attitudes, and socio-economic status for suffering negative financial outcomes. The results show that (1) socio-economic status is associated with financial capabilities but not with money attitudes; (2) money attitudes and financial capabilities are largely independent; (3) money attitudes and financial capabilities each contribute independently to the risk of experiencing adverse financial outcomes, even after adjusting for socio-economic status; and (4) financial capabilities are greater risk factors of adverse financial outcomes than money attitudes; the latter, however, are likely to be promising targets for interventions.     

APP conference summary

This is an account of the extended assessment of a 22-year-old man who was initially sent for a court report, having been accused of setting fires. He had a history both of delinquency and, importantly, of childhood asthma. Although he proved unable to engage in psychotherapy, some management was provided, such as Winnicott advocates in cases of delinquency. This paper explores the symbolic meanings and functions of the patient's delinquent acts, drawing upon theoretical concepts from Freud, Aichhorn, and Deutsch. Of particular importance is the link between this patient's delinquency, his asthma, and the unresolved mourning for his dead mother which he carried not simply for himself but for his whole family.     

Understanding,respecting and integrating difference in therapeutic practice

The purpose of this paper is to promote thought and discussion around how and why we treat patients in chosen ways. In the present climate practitioners are required to treat patients following NICE guidelines in which cognitive behavioural therapy (CBT) is the treatment of choice in the majority of diagnoses. This paper raises concerns that this may lead to an homogenization of treatment, loss of invaluable skills and understanding from other treatment approaches, and loss to the patient who may be best cared for by a combination of treatments and approaches, most notably patients presenting with complex pathology. This paper aims to present this as a general principle, and by way of example, will focus on coupling two specific treatment orientations, cognitive behavioural therapy with psychodynamic psychotherapy, with the specific diagnosis of obsessive compulsive disorder (OCD).

Methods: Clinical material is drawn from case studies from practice in secondary adult mental health care services within the NHS. All patients were referred to the psychological services for treatment for OCD and provided with 1:1 therapy with UKCP‐registered therapists. Details have been anonymized by describing fictitious cases re‐constructed from clinical material. A theoretical understanding is included which provides both an overview for integrating treatment for the specific example of OCD and is intended by extension to other diagnoses.

Results: Working with the commonalities of therapeutic approaches, and integrating specific skills of CBT and psychodynamic psychotherapy, appears to offer a viable mode of treatment for cases resistant to single‐orientation therapies.

Conclusions: Coupling the skills of different therapies can be effective in treating complex patients that are referred to the secondary mental health services. Conversely, restricting practice to single orientation therapies can lead to an impoverished care for patients and diminution of invaluable therapeutic skills which may become underused, undervalued and lost in the practice of mental health care within the NHS. Acknowledgement of the skills of others, valuing these and learning from each other can help to avoid the defensive reactions of practitioners, where each may defensively retreat to their corners of specialism. Respecting and sharing skills from different orientations, and acknowledging this in the NICE guidelines, is good for both mental health services and patient care and addresses the concerns raised by practitioners exemplified by Bateman (2000 Bateman, A. 2000. Integration in psychotherapy: An evolving reality in personality disorder.. British Journal of Psychotherapy, 17(2): 147–156.  [Google Scholar], p. 147) that ‘psychotherapy continues to be bedeviled by ideological schisms with practitioners apparently ignoring alternative conceptualizations and potentially superior interventions’.     

Digital technology is here to stay and the psychoanalytic community should grapple with it

Digital technologies have revolutionised our lives and are also gradually affecting the way psychoanalytic psychotherapists and their patients interact. The author claims that these changes need to be embraced responsibly and with an open mind by the profession and illustrates some of his own experiences with clinical material.     

Psychotherapy with an adolescent boy who refused medical treatment

In this paper we describe psychotherapeutic work carried out in a paediatric hospital to illustrate the important contribution of a psychoanalytically-oriented approach in a hospital context. The work concerns an adolescent boy who had undergone several surgical operations with the result that some of his natural orifices were obstructed and artificial ones had to be created. He was referred to us because he refused pharmacological and rehabilitative treatment necessary prior to further surgery and his eventual recovery. The boy's experience of loss of control of his life and the more primitive anxieties of not feeling safely contained in his physical and psychic skin emerged and were worked through in the psychotherapeutic relationship. The parallel work with medical staff reduced the risk of splitting and acting out by the patient and professionals. The approach adopted enabled this boy to resume his medical treatment and his developmental process.     

The development of a brief group intervention (Dynamic Interpersonal Therapy) for patients with medically unexplained somatic symptoms: a pilot study

The primary aim of this equivalence study was to compare the outcome of a brief group therapeutic intervention, based on the principles of dynamic interpersonal therapy (DIT) with an intervention based on cognitive behavioural therapy (CBT) in patients suffering from medically unexplained somatic symptoms (MUSS). Participants were 89 patients (aged 18 to 62) who were offered 20 sessions of either DIT or CBT, as central part of a treatment package, consisting of art therapy, psychomotor therapy, social therapy and physical therapy. Measurements were conducted at baseline, 10 weeks and 20 weeks, using self-rating scales measuring the level of anxiety and depression, the severity of medically unexplained symptoms and quality of life. Results showed that CBT and DIT were comparable. The conclusion was that it is recommended to design a larger scale randomised controlled trial to further elaborate the short-term and long-term effects of this novel psychodynamic group therapy for MUSS patients.     

On the nature and standing of psychoanalytic psychotherapy

In this paper, I offer some reflections on the standing of psychoanalytic psychotherapy in the National Health Service (NHS), with special reference to contemporary forms of evidence-based thinking. I consider what may follow when a narrow view of science or psychotherapeutic practice becomes conventional wisdom and assumes dominance. I place stress on the potential loss to NHS psychology and psychiatry if psychoanalytic psychotherapy becomes increasingly marginalized on the one hand, or overly standardized on the other.     

The embodied analyst: from Freud and Reich to relationality

This paper presents the impact of clinical supervision on once-weekly psychoanalytically-informed training psychotherapy. The development of Oedipus complex theory is presented, culminating in Britton's work on the triangular space that opens up by working through the complex. The geometry of psychic space is described to highlight the importance of supervision, especially when training in therapy. The theme of spiders and cobwebs emerging from the clinical material provides a powerful metaphor for the tensions in psychic space. In the course of this training, the trainee therapist was at times less able to benefit fully from supervision, and thus the third position partially collapsed. Vignettes from anonymised clinical work are presented in the three ‘phases’ of this therapeutic process, illustrating the impact of the presence – and relative absence – of supervision.