Examining the Clinical Efficacy of Core Transformation: A Randomized Clinical Trial

This randomized clinical trial with a sample of adults (N = 129) from India explored the effects of a single core‐transformation session on symptom experience and psychological growth. The results over the total 8‐week study period indicated significant, moderate overall effect sizes (ds = 0.63 and 0.52) for symptom experience, emotional stability, affect balance, global well‐being, and purpose in life. Implications for research and clinical practice are discussed.     

The goals of psychoanalytic treatment: Conceptual considerations and follow‐up interview evaluation with a former analysand1

There has been a long, ongoing discussion of goals in psychoanalytic treatment. Some analysts are even of the opinion that psychoanalysis ought to be goalless (‘just analysing’). The growing number of outcome studies, however, is in need of a generally accepted set of criteria by which treatment results can be judged. The author proposes a definition of the goals of psychoanalysis that covers four areas: the alleviation of symptoms and complaints, changes in life adjustment, changes in personality structure, and procedural goals such as the resolution of the transference neurosis. She illustrates the relevance of this conceptualization by an empirical study that considers the assessments of 19 psychoanalysts discussing statements made by a former patient about her analytic treatment. On the basis of this case, which comes from the follow‐up study of the DPV (German Psychoanalytical Society), reported by Leuzinger‐Bohleber et al. in 2002, the author demonstrates that psychoanalysts use the criteria defined above implicitly in forming their opinions. Moreover, they arrived at similar judgements regarding the treatment's outcome.     

The structure of childhood obsessions and compulsions: dimensions in an outpatient sample

While obsessive-compulsive disorder (OCD) is defined as a unitary condition, prior research has identified meaningful and distinct symptom dimensions in adult samples. In contrast, there have been no investigations of symptom dimensions in samples of children diagnosed with OCD. The present study sought to address this gap. Children diagnosed with OCD (n = 137) were administered the Children's Yale-Brown Obsessive-Compulsive Scale symptom checklist and severity index. Symptoms were analyzed using principal components analysis. As with adult samples, four factors were identified from the checklist. However, these four factors (compulsions, sexual/aggressive obsessions, superstitions, and hoarding/ordering/somatic concerns) were different in content from adult studies. Further, several symptoms significantly contributed to more than one dimension. Each dimension was significantly correlated with scores from the severity index, with the exception of the obsession score with the hoarding/ordering/somatic concerns factor. Results suggest that there are distinct dimensions of symptoms in childhood OCD, but that these dimensions do not correspond to those identified in adults. Instead, it appears that some factors share variance, and the dimensions themselves are separated based upon developmental trajectories. The dimensions examined may be useful in future treatment studies using pharmacological and/or behavioral interventions.     

Tacit assumptions,countertransference and psychoanalytic technique. Part two: The influence of countertransference on theory and technique

In this article, the author examines bodily symptoms attributed to psychic mediating factors in the light of a psychoanalytic model of affect and sym- bolization. He uses clinical material from a consultation-liaison setting and a psychoanalytic treatment to illustrate how the model might help to understand different bodily symptoms as manifestations of different degrees of failure in the psychic elaboration of affect. On a more personal note, this could be seen as an attempt to understand, using a newly acquired conceptual tool, what went on in his 20 years of experience in the general hospital psychiatry setting.     

Associations amongst disease severity,religious coping and depression in a cohort of Jamaicans with sickle-cell disease

The purpose of this study was to investigate the relationship between disease severity (sickle-cell type and hospital, emergency room and clinic emergency visits (CEU)), religious coping (positive and negative) and depression. This was accomplished through secondary analysis of a data set based on a Comprehensive Sickle Cell Standardized Questionnaire compiled by a multidisciplinary team of professionals from Duke University Medical Centre, and administered to persons with sickle-cell disease being treated at the Sickle Cell Unit on the University of the West Indies Campus between November 2008 and January 2009. Disease severity was not a good predictor of depression within the population. On the other hand, depression was found to correlate with positive and negative religious coping, such that increases in the former were associated with decreases in depression scores; while the reverse was noted for the latter (negative religious coping). The results shed light on issues that could possibly impact the treatment plan for such individuals.     

Am I Abnormal? Relative Rank and Social Norm Effects in Judgments of Anxiety and Depression Symptom Severity

Overdetection and underdetection of depression and anxiety in primary care are common and may partly reflect individuals' misperceptions of the severity of symptoms they experience. Here, we explore how people's judgments about the severity of their own symptoms are influenced by their beliefs about the distribution of symptoms experienced by the rest of the population. We apply the rank‐based decision by sampling cognitive model of judgment to symptom severity. The model proposes that judgments depend on the relative rank of an item within a mental sample of comparable items. It is predicted that judgments of symptom severity will be context dependent and more specifically that an individual's judgments will be invalid to the extent that the individual has inaccurate beliefs about the relevant social context. Two studies found that participants' assessments of symptom severity were rank based. Study 1 elicited participants' beliefs about the social distribution of symptoms and found that participants' judgments of whether they were depressed or anxious were mainly predicted not by their symptoms' objective severity but rather by where participants ranked the severity of their symptoms in comparison with the believed symptoms of others. Study 2 varied symptom distributions experimentally and again found relative rank effects as predicted. It is concluded that the real‐world application of contextual models of judgment requires investigation of individual differences in participants' background beliefs. Copyright © 2012 John Wiley & Sons, Ltd.     

An Evaluation of the Body Dysmorphic Disorder Symptom Scale as a Measure of Treatment Response and Remission in Psychotherapy and Medication Trials

The Body Dysmorphic Disorder Symptom Scale (BDD-SS) is a self-report tool that captures an array of representative behavioral and cognitive symptoms commonly displayed by individuals with BDD. The BDD-SS is regularly used among experts in the field, though its utility as a measure of treatment response has not yet been formally evaluated. Results from two clinical trials of BDD treatment were pooled from an archived database to create a sample of 220 BDD participants who received either psychosocial or medication-based interventions for BDD. We used baseline BDD-SS scores to describe psychometric properties, baseline correlations with other scales to examine the content validity of the BDD-SS, and longitudinal symptom data to evaluate capacity to detect clinically relevant change. Results indicated that the BDD-SS has good psychometric properties and is able to detect symptom change over time, although it showed lower rates of reliable change with treatment relative to the gold standard rater-administered Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS). The BDD-SS offers meaningful information about treatment response in a self-report format and may be particularly useful to employ in clinical practice settings as a means of gathering symptom and treatment response data via self-report when rater-administered interviews are not feasible, although it may underestimate the extent of improvement with treatment.     

Somatosensory amplification as a possible source of subjective symptoms behind modern health worries

The theoretically hypothesized connection between modern health worries (MHWs) and somatosensory amplification (SSA), as well as the factor structure of the Hungarian version of the MHW scale were investigated in a cross-sectional questionnaire study. A total of 163 university students (mean age = 21.3± 2.70 yrs; 44.2% male) and 145 patients (mean age = 49.4±17.51 yrs; 31.7% male) visiting their general practitioners (GPs) completed questionnaires assessing MHWs, SSA, subjective somatic symptoms (PHQ-15), and trait anxiety (STAI-T). The previously described four-factor structure of the MHW scale was confirmed using confirmatory factor analysis (CFA). In the linear regression analysis, participants' age and SSA scores were positively related to MHWs even after controlling for gender, anxiety, and subjective somatic symptom scores. The conclusions are that: MHWs are indicators of cognitive, behavioral and social level of sensitization for health-related concerns; SSA can provide the somatic background process for generation and/or misattribution of subjective somatic symptoms; better understanding of the cognitive-emotional background of MHWs could help to determine possible interventions.     

The Influence of Group Size and Stigma Severity on Social Acceptance: The Case of People with Intellectual Disability Moving into Neighbourhoods

Dutch adults from a nationwide Internet panel (N = 426) were asked to imagine that their next‐door neighbours would move out and that people with intellectual disability would move in. Severity of disability and group size were varied to manipulate intergroup threat. These two factors independently influenced social acceptance and a variety of emotional and behavioural measures. In particular, it was found that a large group with severe disability aroused the strongest negative response, whereas a small group with mild disability aroused the weakest negative response. Small groups with a severe disability and large groups with a mild disability aroused similar and intermediate negative responses. Results are discussed in terms of theories of intergroup threat and stigmatisation. Practical implications for predicting the success of de‐institutionalisation and social integration of groups with special needs are addressed. Copyright © 2011 John Wiley & Sons, Ltd.     

新的视角:从脆弱高自尊看人格障碍症状

从脆弱高自尊视角理解人格障碍症状日益受到研究者的关注。过度的防御是脆弱高自尊的典型特征,不稳定的自我概念建构和不安全的依恋关系影响着脆弱高自尊的形成。偏执、自恋、边缘人格障碍症状的产生、维持和水平与脆弱高自尊有着紧密的联系。未来应更加注意几种脆弱高自尊的相互关系、均衡性及概念的异质性等方面在人格障碍症状领域中的研究。