Optimizing Exposure Therapy for Pathological Health Anxiety: Considerations From the Inhibitory Learning Approach

Exposure therapy has demonstrated its efficacy in the treatment of pathological health anxiety—however, psychotherapy research reveals that many patients do not show a clinically significant change. Therefore, improvements are necessary to optimize psychotherapy for pathological health anxiety. Most treatment rationales refer to habituation during exposure as the central mechanism of change. However, there is evidence that extinction learning is mediated by inhibitory learning processes. Targeting these processes may help to improve treatment outcomes in pathological health anxiety. The aim of this review was to adapt, from the inhibitory learning approach and empirical findings, the most promising strategies for the exposure-based treatment of pathological health anxiety. The exposure-optimizing strategies adapted are expectancy violation, combination, variability in contexts and stimuli, affect labeling, and removal of safety signals. A case example illustrates how to implement these methods for patients with pathological health anxiety.     

Stopping the Nonadherence Cycle: The Clinical and Theoretical Basis for Dialectical Behavior Therapy Adapted for Adolescents With Chronic Medical Illness (DBT-CMI)

Most adolescents with chronic illness do not adhere to their regimen. A novel transdiagnostic adaptation of dialectical behavior therapy (dialectical behavior therapy for chronic medical conditions; DBT-CMI) is presented to improve medical adherence in adolescents. The authors describe the approach of DBT-CMI and the model’s conceptualization of nonadherence, with specific focus on the core concepts of non-adherence across illness in adolescence.DBT-CMI has been piloted in two disease groups with preliminary benefit. DBT-CMI lends itself theoretically as a transdiagnostic approach due to specific skills that target core concepts of nonadherence in adolescence. Future research is warranted on the applicability of DBT-CMI across other pediatric medical conditions to replicate findings and examine long-term outcomes.     

Asthma-specific cognitions,self-focused attention,and fear of negative evaluation in adolescents and young adults diagnosed with childhood-onset asthma

The present study examined the impact of asthma-specific thought intrusion (TI) and thought suppression (TS) on two cognitive-affective variables (self-focused attention and fear of negative evaluation) among adolescents and young adults (AYAs) diagnosed with childhood-onset asthma. Participants were 290 AYAs who completed assessment questionnaires and participated in a written exercise electronically. Asthma-TI and TS were reported by participants following participation in a writing assignment. Asthma-TI was associated with increased private, public, and social anxiety self-focused attention, and greater fear of negative evaluation. Interestingly, asthma-TS was not associated with these same outcome variables. Findings suggest illness-specific cognitions are associated with cognitive-affective variables and it may be important to assess for illness-specific intrusive thoughts following asthma-focused medical appointments. Additionally, findings suggest the importance of assessing asthma-TI and TS separately in order to better understand thoughts about health and psychological functioning.     

Perceived stigma of caregivers: Psychometric evaluation for Devaluation of Consumer Families Scale

Background/Objective: The Devaluation of Consumer Families Scale (DCFS) is commonly used to measure perceived stigma towards family members of people with mental illness. However, its factorial structure has never been confirmed using confirmatory factor analysis (CFA). This study aimed to test the psychometric properties of the DCFS Taiwan version (DCFS-TW). Method: Family caregivers (N=511) completed the DCFS-TW (97 completed the DCFS again after 2 to 4 weeks) and other instruments. CFA, test-retest reliability, internal consistency, concurrent validity, and known-group validity were analyzed. Results: The three-factor structure of the DCFS-TW performed better than the one-factor structure. Test-retest reliability (r = .66) and internal consistency were satisfactory (α = .85); concurrent validity (absolute r = .20 to .58) was acceptable; known-group validity was supported by the significantly different DCFS-TW scores in clinical characteristics (had been vs. had not been hospitalized; had been vs. had not been compulsorily admitted). Conclusions: The DCFS-TW has decent psychometric properties and is suitable for health professionals to measure perceived stigma towards family members of people with mental illness.     

三种压力与创意自我效能感对创造力的影响

以216名初中二年级学生为被试,采用现场实验,探讨个体创意自我效能感在竞争、评价和时间三种压力情境下对创造力的影响。结果发现,三种压力对于总体创造力的影响不同;时间、评价压力分别提高了流畅性和新颖性,竞争压力既提高了流畅性又提高了新颖性,但三种压力情境都降低了变通性;创意自我效能感中间组的学生在压力情境下具有最好的变通表现,而效能感低分组表现最差。     

Transference and dream in illness: waxing psyche, waning body

In times of change, crisis, and illness, the excited points of an individual's personal history are reactivated within the transference and may also be noted by observing countertransference. When there are anomalies in the emotional and imaginal circle of the therapeutic relationship, there is occasion for repetition and/or a transformative opening. In some cases, there is simultaneous treatment of severe developmental fixations and compulsions, and issues of individuation. Images may emerge both from the personal field and from the collective and archetypal imagination. These may be expressions of interpersonal experience, intrapsychic dynamics, and physical as well as psychic state.     

Convergence of Sibling Risk Among Children of Parents with Serious Mental Disorders

We examined child psychiatric diagnoses, behavioral problems, overall symptom impairment, global psychological functioning, intellectual ability, and adaptive behavior in 83 sibling pairs whose mothers were diagnosed with a serious mental disorder. Sibling pairs were assessed for the extent to which they converged on the presence or absence of risk on each adverse outcome and then examined under conditions of high vs. low/moderate family stress. Consistent with the study hypotheses, we found that on each outcome assessed there was evidence for sibling convergence of risk. In addition, family stress was found to significantly moderate sibling risk convergence. The results are discussed in terms of their implications for understanding sibling convergence of risk in these families and for clinical and preventive intervention.     

Some Lessons I Have Learned From 25 Years in Clinical Neuropsychology: A Letter to My Grandchildren

The practice and study of clinical neuropsychology is considered an empirical enterprise. However, such an approach may result in missing the more humanistic or phenomenological side of the experience of brain dysfunction. This addresses a personal journey rather than a professional and scientific one. In doing so, the limits of the discipline and the suffering and value of the experience of the illness are presented. An earlier version of this article was presented as the Presidential Address for the Division 40 (Clinical Neuropsychology) of the American Psychological Association in August of 2003.     

试论中医基础研究中的创造性思维

创造性思维对于中医基础研究非常重要.在中医基础研究中过分依赖高新技术,或者不敢直面问题、遇到困难退缩将阻碍创造性思维.中医基础研究的创造性思维需要研究者在传统知识、现代知识、高新技术与仪器等方面作好充分的准备.为使研究保持正确的方向,在研究中要处理好"已知"与"未知"的关系并以"和"的态度对待学术争论.     

中国近现代社会创造性人物早期的家庭环境与父母教养方式

从家庭环境量表(FES-CV)与父母养育方式评价量表(EMBU)的基本维度,对30位中国近现代社会创造性人物的早期家庭环境与父母教养方式的特点进行考察。结果表明,(1)这些家庭在控制性、组织性、亲密度、独立性、道德宗教观等维度上的平均得分较高,而在矛盾性上的平均得分较低;其家庭环境特点主要表现在家庭的价值观和人际关系、家庭秩序性与家庭活跃性三个方面。(2)上述家庭总体上表现出"严父慈母"的传统教养方式;其父母教养方式主要表现在严厉性与慈爱性两个方面。(3)聚类分析显示,家庭环境可分为低控传统型家庭与高控传统型家庭两类,父母教养方式可分为严厉型教养方式与温暖型教养方式两类。