Introducing Assertiveness Training in Hungary

Abstract

The preliminary results of an evaluation of a systematic assertiveness training programme (based on a cognitive-behavioural approach) in psychiatric care in Hungary are presented. The method adopted was specific to the Hungarian/Middle-European circumstances since people had difficulty in exercising their personal rights in the past. In groups of “neurotic” patients and comparison subjects three questionnaires (the Rathus-scale (R), the Assertiveness Inventory (AI) and the Uncertainty Questionnaire (UQ)) were administered at the beginning and at the end of the treatment. The training programme consisted of eight sessions with an emphasis on education about assertiveness and on the practice of skills such as saying “no” or standing up for oneself. A statistical analysis indicated significant improvement in the social skills of the participants, while an item analysis showed high internal consistency in all three questionnaires, and a concurrent validity analysis revealed a strong correlation between the Rathus-scale and the Assertiveness Inventory. The results indicate that assertiveness training can be used effectively in mental health care in Hungary.     

Combining Pharmacotherapy with Cognitive‐Behavioral Interventions for Obsessive‐Compulsive Disorder

This paper reviews the evidence‐based literature concerning the efficacy and effectiveness of cognitive behavior therapy (CBT), drug treatment and their combination for obsessive‐compulsive disorder (OCD). After a brief outline of the seminal studies, the state of the art is presented with reference to the consensual recommendations proposed in the last 10 years. Management of OCD rests on potent selective serotonin re‐uptake inhibitors and CBT, used separately, sequentially, or concurrently. A hierarchical model for clinical decision‐making is reported. With greater severity of OCD, it is recommended to add medications. However, the response rate is still too low in many patients, and some patients remain refractory to any kind of treatment. This stresses the importance of joint efforts of psychological and biological teams to develop new treatments.     

Comorbidity and Internet-Delivered Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders

Internet-delivered transdiagnostic anxiety interventions aim to reduce symptoms across several anxiety disorders using one treatment protocol. However, it is unclear whether comorbidity affects outcomes of such treatment. This study re-examined data from a recent randomised controlled trial (N = 129) that evaluated the efficacy of an Internet-delivered transdiagnostic cognitive behavioural therapy (iCBT) intervention for participants with principal diagnoses of generalised anxiety disorder (GAD), social phobia (SP) panic disorder and agoraphobia (PDA), of whom 72% met criteria for a comorbid anxiety disorder or depression. Participants were divided into two groups based on whether or not they had a comorbid disorder before treatment. Participants with comorbid conditions reported higher symptom levels at pre-treatment, post-treatment, and follow-up across a range of measures. Both groups showed significant reductions in symptoms over treatment; however, participants with comorbid disorders showed greater reductions in measures of GAD, PDA, SP, depression, and neuroticism. In addition, treatment significantly reduced the number of comorbid diagnoses at follow-up. These results indicate transdiagnostic iCBT protocols have the potential to reduce comorbidity.     

Mindfulness-based cognitive therapy for the treatment of current depressive symptoms: a meta-analysis

ABSTRACT

Mindfulness-based cognitive therapy (MBCT) appears to be a promising intervention for the prevention of relapse in major depressive disorder, but its efficacy in patients with current depressive symptoms is less clear. Randomized clinical trials of MBCT for adult patients with current depressive symptoms were included (k = 13, N = 1046). Comparison conditions were coded based on whether they were intended to be therapeutic (specific active controls) or not (non-specific controls). MBCT was superior to non-specific controls at post-treatment (k = 10, d = 0.71, 95% confidence interval [CI] [0.47, 0.96]), although not at longest follow-up (k = 2, d = 1.47, [?0.71, 3.65], mean follow-up = 5.70 months across all studies with follow-up). MBCT did not differ from other active therapies at post-treatment (k = 6, d = 0.002, [?0.43, 0.44]) and longest follow-up (k = 4, d = 0.26, [?0.24, 0.75]). There was some evidence that studies with higher methodological quality showed smaller effects at post-treatment, but no evidence that effects varied by inclusion criterion. The impact of publication bias appeared minimal. MBCT seems to be efficacious for samples with current depressive symptoms at post-treatment, although a limited number of studies tested the long-term effects of this therapy.     

Internet-Delivered Acceptance and Values-Based Exposure Treatment for Fibromyalgia: A Pilot Study

Background: Acceptance and commitment therapy (ACT) is a promising treatment option for fibromyalgia (FM). Studies have shown that many cognitive behavioral protocols can be transferred to the Internet with sustained efficacy. However, no study has investigated the effect on an Internet-delivered ACT-based protocol for FM. This study evaluated the efficacy, acceptability, and the health economic effects of an Internet-delivered acceptance and values-based exposure treatment for FM. Methods: This open pilot trial included 41 self-referred women with a FM diagnosis. The 10-week Internet-delivered treatment included acceptance, mindfulness, work with life-values, and systematic exposure to FM symptoms and FM-related situations. Participants also had regular contact with an assigned online therapist. Assessments were made at pretreatment, post-treatment, and 6-month follow-up. Results: The treatment was completed by 70% of the participants. Attrition rates were low, with 98% completing the post-treatment assessment and 90% completing the 6-month follow-up assessment. Multiple imputations were used to replace missing values. Pre- to post-treatment within-group effect sizes were in the moderate to large range (Cohen's d = 0.62–1.56) on measures of FM symptoms and impact, disability, quality of life, depression, anxiety, fatigue, and psychological flexibility. All improvements were maintained at follow-up. Economical analyses revealed significant societal cost reductions that offset the treatment costs within 2 months of treatment completion. Conclusions: An Internet-delivered psychological treatment based on acceptance and exposure principles seems to be an efficacious, acceptable, and cost-effective treatment for FM. Randomized controlled trials are needed to confirm these results.     

网络自我表露的类型、功能及其影响因素

网络自我表露是自我表露在网络空间的延伸.本研究对网络自我表露提出整合性界定,并将其从形式、程度和表达方式三种角度予以分类.网络自我表露对个体存在积极和消极两方面的影响.网络自我表露的产生和发展受社会文化、网络环境、性别、年龄和个体心理等因素的影响.认知实验研究、影响因素的深入探讨、新兴网络媒体的自我表露现象、跨文化研究和特殊群体的网络自我表露等可以成为今后的研究取向.     

儿童抑郁认知易感性的发展特点

相对稳定的负性认知特征会使个体容易发生抑郁,被称为抑郁认知易感性.文章总结并对比当前关于抑郁认知易感性的稳定性与可变性的观点,提出从儿童发展早期开始研究认知易感性因素的必要性.接着回顾消极归因方式、功能失调态度和冗思这三种认知易感性因素在儿童期的表现及其前期心理特征,试图找到抑郁认知易感性在个体发展中的连续性.建议今后探讨认知易感性因素在不同年龄的发展特点,关注发展早期认知易感性因素的测量.     

幸福的体验效用与非理性决策行为的偏差机制

基于体验效用的幸福包括预期幸福、即时幸福和回忆幸福,这三者有极其重要的本质差异,导致决策偏差和非理性。本研究运用行为科学和认知神经科学相结合的研究方法,首次从行为层次—信息加工层次—脑神经层次三个层面,立体地开展幸福感的体验效用与非理性决策行为研究。研究计划分为三个部分:(1)预期幸福、即时幸福和回忆幸福的本质特点和行为规律;(2)三种体验效用产生偏差的认知心理机制;(3)体验效用与非理性决策偏差的脑神经机制。通过系列研究,拟解决三个关键问题:(1)在人类判断与决策过程中,预期、即时和回忆三种效用是如何影响人们的判断与决策?(2)三种体验效用出现偏差的信息加工特点和脑神经机制究竟是什么?(3)三种效用的偏差规律及对政府公共政策的启示。对这些问题的深入探讨,不仅对决策理论研究的发展是一个贡献;对政府管理制定有效的公共政策,避免"牺牲体验追求指标",解决"幸福悖论",同样有很强的实践指导意义。     

Cognitive reappraisal and secondary control coping: associations with working memory,positive and negative affect,and symptoms of anxiety/depression

Abstract

The current study examined the relations of measures of cognitive reappraisal and secondary control coping with working memory abilities, positive and negative affect, and symptoms of anxiety and depression in young adults (N=124). Results indicate significant relations between working memory abilities and reports of secondary control coping and between reports of secondary control coping and cognitive reappraisal. Associations were also found between measures of secondary control coping and cognitive reappraisal and positive and negative affect and symptoms of depression and anxiety. Further, the findings suggest that reports of cognitive reappraisal may be more strongly predictive of positive affect whereas secondary control coping may be more strongly predictive of negative affect and symptoms of depression and anxiety. Overall, the results suggest that current measures of secondary control coping and cognitive reappraisal capture related but distinct constructs and suggest that the assessment of working memory may be more strongly related to secondary control coping in predicting individual differences in distress.     

History and Analysis of Delayed Discovery Statutes of Limitations in Adult Survivor Litigation

Summary

In this chapter, attorney Mary R. Williams examines how while Childhood Sexual Abuse (CSA) cases share many of the types of facts for which delayed discovery, mental incapacity, equitable estoppel and other legal statutes of limitations doctrines were created, the combination of factors of CSA cases, including unusual social dynamics and long-term psychological effects, does not fit exactly with any of these legal doctrines. She explores the historical development of delayed discovery statutes of limitations, evaluates the different types of statutes and case law, and analyzes the problematic use of the concept of repression in legislation. This chapter interprets her ground-breaking state-by-state tabulations of delayed discovery statutes of limitations and reported appellate decisions on limitations in CSA actions, published in this volume as appendices A, B, and C.