The Role of Perfectionism in Relation to an Intervention to Reduce Anxious and Depressive Symptoms in Children

Research has demonstrated an association between perfectionism and depressive and anxious symptoms in children. We examined whether a school-based program targeting anxious and depressive symptoms would reduce perfectionism, and whether perfectionism would interfere with intervention outcomes. The participants were 78 school-age children identified as at-risk for anxiety and/or depression. At-risk children took part in a randomized controlled trial of a school-based intervention program. Levels of perfectionism, depression, and anxiety were assessed at pre-treatment (Time 1) and again at post-treatment (Time 2) after participating in either a cognitive behavioral group or a structured activity group. Participation in either group was associated with significant reductions in overall levels of self-oriented perfectionism, anxious symptoms, and depressive symptoms. Supplementary analyses indicated that pre-treatment self-oriented perfectionism influenced post-treatment depression scores, suggesting that perfectionism interferes with treatment outcome. Perfectionism in children appeared amenable to group-based intervention, and identifying perfectionism may be important for treating children with depressive symptoms.     

When it is not the patient who pays

This paper looks at the question of third-party payments in psychotherapy and psychoanalysis. This is of particular relevance in Holland, where the Dutch government makes substantial payments for psychoanalytic treatment via a state insurance system. The literature concerning third-party payments is reviewed. Freud himself was inconsistent about this matter and cannot therefore be relied on to give a clear guideline. The majority of writers are heavily in favour of ‘personal sacrifice’ and show a strong bias, especially against insurance payments for fees. These arguments are examined in detail and the two main conclusions are explored, namely that (1) certain unconscious conflicts cannot be mobilised where there is external financing, and (2) that the absence of personal sacrifice engenders too much wish-fulfilment. Both these arguments are rejected as being biased and are found not to stand up to detailed scrutiny.

The effects that different types of payment have on the development of the therapeutic situation, and the different types of transference and countertransference problems that each engenders, are explored. There is some speculation as to the reason for the persistence of this view if it is so patently false. Finally there is some consideration of the positive effects third-party payments can have on psychoanalytic practice.     

The relationship between emotion awareness and somatic complaints in children and adolescents: Investigating the mediating role of anxiety and depression

The objective of this study was to examine if emotion awareness in children and adolescents (age 7-18 years old) is directly related to somatic complaints, and if this relationship holds when considering symptoms of anxiety and depression as mediating factors. A number of questionnaires measuring emotion awareness, symptoms of anxiety and depression and somatic complaints were administered to Dutch schoolchildren (N?=?617). A path model was constructed, with the use of structural equation modelling. The results showed that two aspects of emotion awareness (bodily awareness and differentiating between emotions) contributed to the prediction of somatic complaints. However, this was no longer the case when controlling for symptoms of anxiety and depression. Thus, in this study, no direct relation was found between emotion awareness and somatic complaints. Instead, the relation was perfectly mediated by symptoms of anxiety and depression. The results suggest that focusing only on the relation between emotion awareness and somatic complaints is an oversimplified perspective that falls short as a starting point to find therapeutic solutions for children who suffer from somatic complaints.     

Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?

Antidepressants, in particular newer agents, are among the most widely prescribed medications worldwide with annual sales of billions of dollars. The introduction of these agents in the market has passed through seemingly strict regulatory control. Over a thousand randomized trials have been conducted with antidepressants. Statistically significant benefits have been repeatedly demonstrated and the medical literature is flooded with several hundreds of "positive" trials (both pre-approval and post-approval). However, two recent meta-analyses question this picture. The first meta-analysis used data that were submitted to FDA for the approval of 12 antidepressant drugs. While only half of these trials had formally significant effectiveness, published reports almost ubiquitously claimed significant results. "Negative" trials were either left unpublished or were distorted to present "positive" results. The average benefit of these drugs based on the FDA data was of small magnitude, while the published literature suggested larger benefits. A second meta-analysis using also FDA-submitted data examined the relationship between treatment effect and baseline severity of depression. Drug-placebo differences increased with increasing baseline severity and the difference became large enough to be clinically important only in the very small minority of patient populations with severe major depression. In severe major depression, antidepressants did not become more effective, simply placebo lost effectiveness. These data suggest that antidepressants may be less effective than their wide marketing suggests. Short-term benefits are small and long-term balance of benefits and harms is understudied. I discuss how the use of many small randomized trials with clinically non-relevant outcomes, improper interpretation of statistical significance, manipulated study design, biased selection of study populations, short follow-up, and selective and distorted reporting of results has built and nourished a seemingly evidence-based myth on antidepressant effectiveness and how higher evidence standards, with very large long-term trials and careful prospective meta-analyses of individual-level data may reach closer to the truth and clinically useful evidence.     

The 9th annual INDUS-EM 2013 Emergency Medicine Summit, “Principles,Practices, and Patients,” a level one international meeting,Kerala University of Health Sciences and Jubilee Mission Medical College and Research Institute,Thrissur, Kerala,India, October 23–27, 2013

INDUS-EM is India’s only level one conference imparting and exchanging quality knowledge in acute care. Specifically, in general and specialized emergency care and training in trauma, burns, cardiac, stroke, environmental and disaster medicine. It provides a series of exchanges regarding academic development and implementation of training tools related to developing future academic faculty and residents in Emergency Medicine in India. The INDUS-EM leadership and board of directors invited scholars from multiple institutions to participate in this advanced educational symposium that was held in Thrissur, Kerala in October 2013.     

The relationship between emotion awareness and somatic complaints in children and adolescents: Investigating the mediating role of anxiety and depression

The objective of this study was to examine if emotion awareness in children and adolescents (age 7–18 years old) is directly related to somatic complaints, and if this relationship holds when considering symptoms of anxiety and depression as mediating factors. A number of questionnaires measuring emotion awareness, symptoms of anxiety and depression and somatic complaints were administered to Dutch schoolchildren (N?=?617). A path model was constructed, with the use of structural equation modelling. The results showed that two aspects of emotion awareness (bodily awareness and differentiating between emotions) contributed to the prediction of somatic complaints. However, this was no longer the case when controlling for symptoms of anxiety and depression. Thus, in this study, no direct relation was found between emotion awareness and somatic complaints. Instead, the relation was perfectly mediated by symptoms of anxiety and depression. The results suggest that focusing only on the relation between emotion awareness and somatic complaints is an oversimplified perspective that falls short as a starting point to find therapeutic solutions for children who suffer from somatic complaints.     

Tactical Military Leader Requisite Complexity: Toward a Referent Structure

The U.S. Army has focused on developing leader competencies in order to promote adaptability for asymmetric warfare. Expanding leader adaptive capacity, however, requires integrating competencies with deeper knowledge structures and leader identity. We conduct a three-stage exploratory study using semistructured interviews and three separate samples of experienced combat leaders to assess the organization of tactical leader functional roles. We identify the breadth of roles, tasks, skills, and attributes representative of expert tactical military leaders. We hope to take a first step in circumscribing the requisite cognitive and behavioral complexity required of tactical leaders and thereby provide a referent structure for future research on what constitutes requisite complexity for tactical military leaders.     

An ARC-REM model for accuracy and response time in recognition and recall

This article presents a model for accuracy and response time (RT) in recognition and cued recall, fitted to free-response and signal-to-respond data from Experiment 1 of P. A. Nobel and R. M. Shiffrin (2001). The model posits that recognition operates through parallel activation in a single retrieval step and cued recall operates as a sequential search. Because the data for recognition showed that variations in list length and study time per list had a large effect on accuracy but a small or negligible effect on (a) free-response RT distributions and (b) retrieval dynamics in signal-to-respond, the timing of the recognition decision is based on an assessment of retrieval completion (ARC), rather than on a sufficiency of evidence in favor of 1 of the response options. By assuming within-trial forgetting, the model predicts both the dissociation of accuracy and RT and the finding that errors are slower than correct responses. For cued recall, this model was incorporated as the 1st step in a search consisting of cycles of sampling and recovery.     

The art of model development and testing

Mathematical and computer simulation modeling are often computationally demanding procedures, so much so that even certain parts of these procedures, such as parameter estimation, exceed the capacities and speed of the best modern computer facilities. A good deal of effort has therefore been dedicated to speeding up and making more efficient programs such as those that are meant to find a global minimum of a parameter space. Our experience, however, is that such well-explored technical procedures in fact represent some of the shortest components of the total set of procedures by which models are developed. In this article we discuss what elements take up the lion’s share of development time and speculate on what lessons can be drawn concerning the role of high-performance computing in such enterprises.