Diagnosing agoraphobia in the context of panic disorder: examining the effect of DSM-IV criteria on diagnostic decision-making

A diagnostic and statistical manual (DSM)-IV diagnosis of agoraphobia in the context of panic disorder (PD) is based on three nosologically sufficient criteria: (1) avoidance, (2) use of companions, and (3) endurance of situations despite distress. Therefore, an agoraphobia diagnosis can be made across an extremely broad range of cases including when there are no avoidance behaviors (e.g., the patient endures the situation). It was hypothesized that clinicians do not weight these criteria equally and that the DSMs individual, sufficient criteria lead to poor inter-rater reliability. Clinicians (N=48) rated hypothetical patients with symptom profiles emphasizing each of these three criteria. Consistent with expectation, clinicians differentially weighted these criteria. Avoidance was relatively more apt to produce a diagnosis when only one criterion was emphasized in clinical vignettes. Inter-rater reliability was poor in instances when only one sufficient criterion was highlighted. Knowledge concerning DSM criteria resulted in a greater rate of agoraphobia endorsement, but knowledge did not account for the overall pattern of findings.     

Fatigue and Quality of Life Following Radiotherapy for Breast Cancer: A Comparative Study

Clinical reports suggest that fatigue is a common and disruptive long-term side effect of radiotherapy; however, there has been little systematic attention given to this phenomenon. The primary aim of this study was to assess fatigue its impact on quality of life in women who had completed radiotherapy for breast cancer. A key feature of this study was the inclusion of a comparison group of women of similar age with no history of cancer. The results indicated that the fatigue experienced by women after radiotherapy for breast cancer was not significantly different in intensity, duration, or disruptiveness from fatigue experienced by healthy women. In addition, radiotherapy recipients reported a quality of life similar to that of the healthy women. For both groups of women greater fatigue was related to a poorer quality of life. These findings suggest that following radiotherapy for breast cancer, women can expect to experience fatigue which is not worse than what they might normally experience. This information may be a useful part of psychoeducational interventions designed for women scheduled to begin radiotherapy for breast cancer.     

Stress and Disease: An examination of psychophysiological effects and alternative treatment approaches

This article examine the psychophysiological relationship between psychosocial stressors and physiological changes. Stress has been shown to cause changes in the human immune system, increasing susceptibility to disease. A selective review of the literature explores this relationship. Alternative treatment modes are being implemented to supplement traditional therapies for the preventative and post hoc care of diseases, particularly those associated with the immunologic system deficiencies which could be related to stress. Implications are explored for implementing biofeedback, guided imagery, and stress management techniques for supplemental treatment in cancer, coronary heart disease, and immunologic diseases such as the acquired immune deficiency syndrome.     

Beyond Abstinence: An Examination of Psychological Well-Being in Members of Narcotics Anonymous

While a growing body of literature supports the role of mutual help organizations in helping members achieve abstinence, fellowships other than Alcoholics Anonymous and outcomes beyond abstinence have been studied far less often. The current study examined recovery-related correlates of psychological well-being in a sample of Narcotics Anonymous (NA) members. Participants (N = 128) were self-identified NA members from across the United States who completed an online survey assessing an array of psychosocial outcomes. Hierarchical regression models assessed whether abstinence duration and other recovery-related variables accounted for significant incremental variance in psychological well-being, over and above several covariates. As a block, abstinence duration and the recovery predictors accounted for significant incremental variance in three of four psychological well-being domains. As a complement to studies on short-term benefits of mutual help organizations, these data suggest ongoing recovery involvement may be positively associated with subjective psychological well-being in NA members.     

Trauma and Health Symptoms in a Community Sample: Examining the Influences of Gender and Daily Stress

Although there is a rich body of literature on trauma and health, limited research has investigated the variables of gender, trauma symptoms, physical health, mental health, and daily stress together in a community sample. Considering the deleterious effects of trauma on health, our overarching inquiry was whether trauma symptoms can predict overall mental and physical health with attention to gender and daily stress as potential moderators. Participants (n = 103; 50.5% women) completed self-report measures of trauma symptoms, mental health, physical health, and daily stress, along with demographic information. Trauma symptoms predicted 25.2% of the variance in general health symptoms. Gender significantly added to the variance accounted for, but daily stress was not significant in the model. Trauma symptoms predicted 37.1% of the variance in mental health symptoms. Daily stress significantly added to the model, but gender did not. Results are interpreted through the integration of family stress theory and feminist frameworks, adding to the literature by further illuminating the relationships between gender, daily stress, health symptoms, and trauma in a community sample.     

Clinical case conceptualizations using clinical factor analysis

This article examines the principles of factor analysis in a non-mathematical manner to utilize its theoretical constructs in a clinical application. Understanding these objective constructs and processes can be useful to therapists subjectively seeking conceptual comprehension of challenging clients. Factoring is discussed, and a case study is provided.     

Thought suppression and memory biases during and after depressive moods

Previous research indicates that formerly depressed individuals engage in high levels of thought suppression that can mask depressive cognitions. However, suppression may also ironically foster a vigilance for unwanted thoughts that promotes uncertainty about ambiguous information and distorts memory. The present study tested this possibility. Formerly dysphoric, currently dysphoric, and never-dysphoric participants listened to a series of statements describing life events that were positive, negative, or ambiguous. In a subsequent recognition phase, participants reviewed a series of statements and rated each for the likelihood that it had been presented earlier. The recognition list included positive and negative disambiguated versions of the original items. Compared to the never-dysphoric group, formerly dysphoric individuals were more likely to endorse negative disambiguations. As predicted, this bias was associated with higher levels of thought suppression and greater uncertainty about the meaning of ambiguous situations, suggesting an ongoing conflict between positive and negative thoughts.