Effects of cognitive behavioural therapy and return-to-work intervention for patients on sick leave due to stress-related disorders: Results from a randomized trial

The aim of this study was to evaluate specific effects for patients with adjustment or exhaustion disorder, the Stress subgroup (n = 152), regarding symptom severity and sick leave after CBT, a return-to-work intervention (RTW-I), and a combination of them (COMBO), using data from a randomized trial. In the original study, primary care patients on sick leave (N = 211) were randomized to CBT (n = 64), RTW-I (n = 67), or COMBO (n = 80). Blinded Clinician Severity Rating (CSR) of symptoms and sick leave registry data were primary outcomes. Subgroup analyses showed that for the Stress subgroup, CBT led to greater reduction of symptoms than RTW-I posttreatment, but COMBO did not differ from CBT or RTW-I. Regarding sick leave, there was no difference between treatments in the Stress subgroup. An exploratory analysis of the treatment effects in a subgroup of patients with depression, anxiety or insomnia indicates that RTW-I reduced sick leave faster than CBT. We conclude that CBT may be promising as an effective treatment of stress and exhaustion disorder.     

Marital satisfaction in covenant versus standard marriages: Is there a difference?

After the rapid increase of the American divorce rate in the late 20th century, one of the most conspicuous efforts of the marriage movement in the 1990s that was used to increase marital stability was the legislation of the covenant marriage license, a more restricted marriage license issued in three different states of the U.S. To investigate the marital life of newlywed covenant versus standard couples, a large-scale 5-year couple study was conducted between 1998 and 2003 in Louisiana. The present study uses this large-sample, multiple-wave, multiple-group dyadic dataset to examine differences in co-development and divorce rates in 297 covenant and 380 standard mixed-sex couples using a multiple group growth curve modeling and survival analysis. We examined differences in marital trajectories between covenant and standard couples as well as between husbands and wives in each marital group. The results show (1) that the couples in both groups experienced, on average, declines in marital satisfaction, and such a decline was slower in covenant husbands than their wives as well as those in standard marriages, and (2) that co-development in marital satisfaction was more prominent in standard marriages than in covenant marriages, meaning standard couple's marital satisfaction declined at a more similar rate than that of covenant couples. We provide possible explanations and discuss practical implications.     

Relational and physical victimization within friendships: nobody told me there'd be friends like these

In past research, relational and physical forms of peer victimization have been identified that have been shown to be significantly associated with social–psychological maladjustment. These forms of victimization, although studied primarily within the group peer context, also occur within dyadic relationships such as friendships. Gender differences in friend victimization and the association between friend victimization and children's social–psychological adjustment were examined. Results showed that boys were more physically victimized by their friends than were girls. Girls were more relationally than physically victimized by their friends. Friend victimization was related to adjustment difficulties for both boys and girls; however, friend physical victimization was particularly related to boys whereas friend relational victimization was particularly related to girls. The implications of these findings for future research and intervention with victimized children are discussed.     

Combined Individual/Marital Therapy: A Conflict Resolution Framework and Ethical Considerations

This paper illustrates how couple and individual treatment formats can be intertwined. A conflict resolution theoretical framework structures treatment around three goals: (1) relieving symptoms (anger, depression, and marital distress), (2) facilitating resolution of the couple's conflicts, and (3) building communication and conflict resolution skills. The literature review focuses on why combining individual and couple therapy is often important for married clients. Two Bicycles, an illustrative case incorporating both conjoint and individual interventions, is presented and analyzed with regard to when each format seems beneficial. Ethical and practical issues raised by dual format treatment include potential harm, informed consent, dual roles, confidentiality, and time and financial costs.     

The Use of Communication Technology in Private Practice: Ethical Implications and Boundary Dilemmas in Therapy

This study investigates the use of communication technology (CT) by therapists in private practice. CT has exploded in the last decade and therapists have begun to implement this technology in their work. It is important to understand better the types of technology therapists are using and how they decide which devices are most useful for clinical practice. Additionally, the availability of the therapist has long been debated and CT provides media to make therapists readily available. Results show that therapists have boundary concerns and ethical dilemmas regarding CT and often feel unprepared to handle inappropriate out-of-session contacts when they occur.     

Marital Quality, Family Patterns, and Children's Fears and Social Anxiety

This study examined relationships among marital quality, family patterns, and children's fears, and social anxiety. Two types of family patterns were studied, adaptability and cohesion. Mothers of children aged 5–6, drawn from kindergartens in northern Israel, completed Hebrew versions of the ENRICH scale (abridged, for marital quality), FACES-III (adaptability and cohesion), the FSSC-R (fears), and the SASC-R (social anxiety). Family cohesion was negatively correlated with marital quality and positively correlated with children's social anxiety. Marital quality and family adaptability were inversely related to specific children's fears. Children's social anxiety was highly correlated with specific fears. These findings suggest that children from rigid, fused families or low quality marriages may be at risk for high levels of fears and social anxiety.     

对学生学习成绩与社会行为的交叉滞后分析

采用二元交叉滞后回归分析法考察小学四、五年级学生和初中一、二年级学生在21个月中的学校适应与学习成绩之间的关系。结果发现,在同时性测量中,由教师评价获得的中小学生的社交领导能力、定向耐挫能力、果敢性社交技能得分和同伴积极提名分数与他们的学习成绩之间均存在正相关关系,而他们的攻击破坏得分、学习适应不良得分以及小学生的同伴消极提名分均与他们的学习成绩有显著的负相关关系。二元交叉滞后回归分析结果表明,小学生在前测中的社交领导能力得分、攻击破坏得分、定向耐挫得分、学习适应不良得分、果敢性社交技能得分同伴积极和消极提名得分均可以预测21个月后的学习成绩。对中学生来说,这种预测关系只在攻击破坏行为、定向耐挫行为中存在。中小学生的害羞抑制得分和焦虑抑郁得分与他们的学习成绩之间既没有同时性的相关关系,也没有滞后性的预测关系。     

Linking Parents' Work Stress to Children's and Adolescents' Psychological Adjustment

Recent research indicates that parental work stress has implications for the quality of family interaction and, in turn, children's and adolescents' adjustment. Studies in two distinct genres are reviewed: investigations relying on global reports of work demands, family dynamics, and child and adolescent adjustment and studies focusing on within-person comparisons of family interaction on days characterized by high and low work stress. The effects of parental work stress on children's and adolescents' adjustment appear to be indirect. Work stress is linked to parents' feelings of overload and strain, which in turn predict lower parent-child acceptance and higher conflict, processes that in turn are related to less positive adjustment of children and adolescents. In the face of high work stress, withdrawing from family involvement may be adaptive in the short run but ultimately problematic. The strength of these associations depends on parents' personality qualities, parents' coping styles, and work and family circumstances.     

Integrative Family Therapy

This paper describes an integrative approach to marital and family therapy in which psychodynamic (particularly object relations), family systems, and behavioral (particularly cognitive–behavioral) theory are blended in a flexible and tailored therapeutic approach. Human personality in its most significant contexts is a consistent focus. Background factors in the development to the approach and illustrative case materials are included.     

Exploring the Complexities of Familism and Acculturation: Central Constructs for People of Mexican Origin

We examined the relationships between three dimensions of familism: importance of family, family support, and family conflict with acculturation, assessed orthogonally (Mexican and American cultural contributions assessed independently), and the relative contribution these factors make to psychological adjustment among 248 (124 women, 124 men) adults of Mexican origin. After controlling for sociodemographic characteristics, positive associations were found between importance of family and the biculturalism of Mexican and American cultural identity; family support and Mexican cultural identity; but no associations between family conflict and level of acculturation. Psychological well-being was positively associated with Mexican cultural identity and family support, whereas psychological distress was associated with greater family conflict and lower family support. The greater relative contribution of Mexican cultural identity to familism and well-being, and the importance of assessing acculturation orthogonally are discussed. This research was supported in part by a Minority Supplement to National Institute of Mental Health Grant MH47193 to the Research Center on the Psychobiology of Ethnicity, Harbor-UCLA Medical Center and by a research award from Pitzer College to Norma Rodriguez.