Family Unification with Reactive Attachment Disorder Children: A Brief Treatment

This is a case study of a family with a child (age eight) with reactive attachment disorder and the subsequent individual and family therapy. Treatment of choice for the child was Eye Movement Desensitization and Reprocessing (EMDR) and supportive educational counseling for the parents and family. Qualitative evaluation of the process demonstrated that the parents observed an instant change in the child's attitude. The child reported that she felt better about family, school, and truthfulness, and stated about the therapy: It opened a window for me. A 12-month evaluation demonstrated continued positive effects.     

Touching Mortality, Touching Strength: Clinical Work with Dying Patients

This paper outlines some of the special stresses that must be shouldered by clinicians—physicians, nurses, chaplains, social workers, pastoral staff, and others—whose work focuses on dying and extremely vulnerable patients. The utility of a theory of generative death anxiety as a framework for interpreting the nature of these special stresses is suggested. Three common burnout reactions are examined. The paper concludes that positive acceptance of personal mortality may help clinicians avoid burnout and lead to better therapeutic practice. This framework for interpreting therapeutic practice demonstrates the integral role spirituality plays in work with this particular patient group.     

A case study of borderline anxiety andthe process of analytic transformation

Borderline patients present particular treatment problems and require close, devoted understanding of their often chaotic and shifting intrapsychic conflicts. Many of these patients act out, making it difficult to maintain an analytic process. In fact, many terminate early on. When they do stay for longer periods, they exhibit particular constellations of defense, anxiety, and conflict. One extensive case report is used to examine the overlapping cycles of treatment with this population. Frequently, self-destructive acting-out is present in the transference and extratransference. This acting-out is often followed by the self-destructive, antichange attitude of the death instinct. These ways of relating to the self and the object are mobilized within the vehicle of projective identification and are best understood as primitive defenses against core fantasies of loss and persecution. These issues of loss and fear are the final and vital phase of treatment with borderline patients, who are often able to make major fundamental changes in their internal sphere, but only if patient and analyst can tolerate and understand these three levels of intrapsychic experience.     

Ruminative coping and post-event processing in social anxiety

Cognitive models of social anxiety implicate various factors in the initiation and maintenance of socially anxious states, including anticipatory processing, self-focused attention and post-event processing. The present study focused on post-event processing, which is a post-mortem analysis following a social event that is described as ruminative in nature and serves to maintain social anxiety. Participants (N=112; 64 women, 48 men) were presented with vignettes that involved making mistakes in public and were instructed to record their thoughts to allow for the examination of the content of post-event processing. Ruminative coping and distraction were assessed via self-report. Results indicated that participants high in social anxiety (n=55) were more likely to ruminate and less likely to distract when faced with socially anxious stressors compared to those low in social anxiety (n=57). Further, as hypothesized, participants high in social anxiety recorded more negative thoughts and more upward counterfactual thoughts ('if only' type thoughts on how things could have been better; associated with negative affect) compared to those low in social anxiety. These results are discussed in terms of cognitive models of social anxiety.     

Recommendations for the Treatment of Hypochondriac Patients

Hypochondriasis is a debilitating condition in which patients are persistently preoccupied with the possibility of being seriously ill. Its is a costly problem for the health care system whose treatment has not received systematic attention until recently. Although based on few controlled studies, results indicated that various brief cognitive-behavioral techniques produce significant changes in illness fears and attitudes. A list of therapeutic questions that require further study is presented and some indications for both therapists and patients are given.     

Emotion Socialization in Families of Children With an Anxiety Disorder

Compared emotion socialization in 26 children with anxiety disorders ages 8–12 years and their mothers to 26 nonclinical counterparts without psychopathology. Children and their mothers participated in an emotion interaction task in which they discussed occasions when the child felt worry, sadness, and anger. Responses were coded for length of discussion, proportion of words spoken by child vs. mother, frequency of positive and negative emotion words, explanatory discussion of emotion, and maternal facilitation of emotion discussion. Children and their mothers also completed the Expressiveness and Control scales of the Family Environment Scale. Results indicated that mothers of children with an anxiety disorder spoke less frequently than their child, used significantly fewer positive emotion words, and discouraged their childrens emotion discussions more than did mothers of nonclinical children. Nonclinical children and their mothers indicated significantly more emotional expressiveness in their families than did children with an anxiety disorder and their mothers. These results highlight the potential role of truncated family emotional expressivity in the emotional development and functioning of children with an anxiety disorder.     

The Beck Anxiety Inventory in Older Adults With Generalized Anxiety Disorder

The authors investigated the psychometric properties of the Beck Anxiety Inventory (BAI) in a sample of 75 older generalized anxiety disorder (GAD) patients and a comparison group of 32 older adults without significant psychopathology. Internal consistency was above .80, and the BAI showed evidence of convergent validity in both groups. Evidence for discriminant validity with respect to measures of depression was weaker. Two items, fearing the worst and nervousness, correctly distinguished 86.5% of patients with GAD and 93.8% of the normal controls. Medical comorbidity was associated with somatic but not cognitive anxiety symptoms in the normal older sample. Overall, results indicate the limitations of the BAI in assessing anxiety symptoms in older adults and suggest the need for use of an instrument focusing on cognitive aspects of anxiety.     

Selective Mutism in Children: Comparison to Youths With and Without Anxiety Disorders

Fifteen children with selective mutism (SM), 15 children with anxiety disorders (AD) without selective mutism, and 15 children without anxiety disorders or selective mutism (CN) were compared to examine the relationship between selective mutism and anxiety. Data were collected from children (age 4–10 years), parents, teachers, and clinicians. Results indicated that children with SM closely resemble children with AD. All children with SM received a diagnosis of social anxiety disorder and 53% received a diagnosis for an additional anxiety disorder. In addition, the SM and AD groups differed substantially from controls with respect to parent- and teacher-rated internalizing behavior problems. No differences among the groups were found with respect to parent-and teacher-reported externalizing behavior problems. The results are consistent with prior research emphasizing the association between selective mutism and anxiety disorders, and suggest that selective mutism may be conceptualized, assessed, and treated as an anxiety-related problem.     

Norwegian versions of the Living with Asthma Questionnaire (LWAQ) and Asthma Bother Profile (ABP), validation and comparison of two asthma groups

The Living with Asthma Questionnaire (LWAQ) and the Asthma Bother Profile (ABP) were translated into Norwegian using conventional back translation procedures, and completed by 30 asthma outpatients and 30 asthma patients admitted to inpatient rehabilitation. Reliability (Cronbach's alpha and retest-reliability) was shown to be good for both scales. Validity was established by showing significantly poorer health in the rehabilitation sample, and correlations with state and trait anxiety. The Norwegian translations are reliable and valid versions of the original questionnaires.