Day treatment of patients with personality disorders: experiences from a Norwegian treatment research network

This study sought to investigate the following research questions: Are time-limited day treatment programs for patients with personality disorder (PD) effective outside resourceful university settings, and what are the overall treatment results when the program is implemented on a larger scale? Do all categories and subtypes of PDs respond favorably to such treatment? How intensive should such day treatment programs be? All patients (n = 1,244) were consecutively admitted to eight different treatment programs in the Norwegian Network of Psychotherapeutic Day Hospitals from 1993 to 2000. Altogether, 1,010 patients were diagnosed with PD. Avoidant, borderline, not otherwise specified (NOS), and paranoid PD were the most common conditions. SCID-II and MINI were used as diagnostic instruments. Outcome measures included GAF Global Assessment of Functioning, (GAF; American Psychiatric Association, 1994), SCL-90R, CIP, Quality of Life, work functioning and parasuicidal behavior, measured at admittance, discharge and 1-year follow up. The attrition rate was 24%. The number of dropouts did not improve over time. As a group, completers with PD improved significantly on all outcome variables from admittance to discharge and improvement was maintained or increased at follow up. Treatment results were best for borderline PD, cluster C patients, PD NOS and No PD, and poorer for cluster A patients. Units with a high treatment dosage did not experience better outcomes than those with a low treatment dosage (10 hours per week). Results from the University unit were not better than those from units at local hospitals or mental health centers.     

The Factor Structure of MASC Youth Report in Norwegian School Children

Identifying children with symptoms of anxiety before they develop clinical disorders is important. The objective of our study was to examine the latent factor structure of the MASC (youth report version) in a large self-selected sample of school children in 4th to 6th grade, and examine if the measure had a comparable factor structure for gender and age. Gender and age differences in anxiety symptoms were also examined. Children (N?=?1686, 53.8% female) were recruited from schools during pretest of an ongoing randomized, controlled, indicative intervention. Latent variable modelling was used to determine the underlying concepts of the MASC. We found good model fit for the four-factor model, however some items on the Harm/Avoidance scale had low factor loadings. Invariance analysis indicated that the MASC had similar factor structure (comparable meaning) for boys and girls and for younger and older children in this sample. Girls scored significantly higher than boys on all subscales and on the Total Anxiety scale. Age differences were only found on the Separation Anxiety scale. Overall, the original four-factor structure of the MASC was confirmed within a large sample of school children and was invariant across gender and age. However, the Harm/avoidance scale warrants some attention. The MASC is a potentially useful measure to be used for screening purposes in a school setting.     

The Creative Personality: A Synthesis and Development of the Creative Person Profile

Several constructs from the research literature on the creative personality were reoperationalized to gain further understanding of the structure of the creative personality and to develop a broad measure of relevant traits (CPP—the Creative Person Profile). From an initial pool of 38 creativity relevant personality constructs, 7 factors were identified and labeled (emotional instability, ambition, associative orientation, motivation, need for originality, agreeableness, and flexibility) in a sample of 481 participants with a mean age of 31.6 years. In a subsample, there were theoretically meaningful correlations between the 5-factor model of personality and 5 of the CPP factors. Moreover, most of the 7 components correlated with at least 1 ability test or self-report criterion of creativity (creative problem solving, remote associates test, ideational fluency, items from a creative activities checklist). Finally, in a discriminant validity study, scores on the 7 factors clearly differentiated between a group of professional artists (n = 69) and the remainder of the sample, and between a group of marketing students (n = 40) and the remainder of the sample.     

Assessment of fear of fear among Agoraphobic patients: The Agoraphobic Cognitions Scale

A self-report scale for the measurement of fear of fear, the Agoraphobic Cognitions Scale (ACS), was psychometrically evaluated. Two samples of inpatients satisfying DSM-III-R criteria for unipolar depressive and/or anxiety disorder were studied. Intercorrelational and factor analyses indicated that the ACS measured three dimensions of fear of fear: fear of bodily incapacitation, fear of losing control, and fear of acting embarrassingly. Three subscales were constructed to measure these dimensions. The subscales proved to have satisfactory internal consistency and criterion-related validity. However, fear of losing control was related not only to other anxiety symptoms, but also to depressive symptomatology. Agoraphobic patients reported more fear of bodily incapacitation and fear of losing control than social phobic, generally anxious, and nonanxious depressed patients. Fear of embarrassing action was higher among agoraphobic and social phobic patients than among generally anxious and nonanxious depressed patients. These results were obtained after controlling for general anxiety and depression level and, thus, support the validity of the fear of fear construct.     

The failing measurement of attitudes: How semantic determinants of individual survey responses come to replace measures of attitude strength

The traditional understanding of data from Likert scales is that the quantifications involved result from measures of attitude strength. Applying a recently proposed semantic theory of survey response, we claim that survey responses tap two different sources: a mixture of attitudes plus the semantic structure of the survey. Exploring the degree to which individual responses are influenced by semantics, we hypothesized that in many cases, information about attitude strength is actually filtered out as noise in the commonly used correlation matrix. We developed a procedure to separate the semantic influence from attitude strength in individual response patterns, and compared these results to, respectively, the observed sample correlation matrices and the semantic similarity structures arising from text analysis algorithms. This was done with four datasets, comprising a total of 7,787 subjects and 27,461,502 observed item pair responses. As we argued, attitude strength seemed to account for much information about the individual respondents. However, this information did not seem to carry over into the observed sample correlation matrices, which instead converged around the semantic structures offered by the survey items. This is potentially disturbing for the traditional understanding of what survey data represent. We argue that this approach contributes to a better understanding of the cognitive processes involved in survey responses. In turn, this could help us make better use of the data that such methods provide.     

Practice-based evidence: patients who did not respond to group analysis

Evidence-based psychotherapy is typically based on treatment outcome for the "average" patient in aggregate designs; reports on individual non-responders are rarely published. In this observational study, we explored factors that might have contributed to non-response in long-term dynamic group psychotherapy. Eight patients (14%) who did not change were compared with 48 treatment responders on clinical variables, and their case stories were retrospectively scrutinized for explanatory factors. The non-responders had less initial distress, stayed for shorter durations in therapy, and were more dissatisfied with their group and therapists. Based on detailed case stories, attempts are made to tease out idiographic hypotheses why each patient did not change during group analysis.     

SINGER, SOCIOBIOLOGY, AND VALUES: PURE REASON VERSUS EMPIRICAL REASON

Abstract. E. O. Wilson argues that we must use scientifically based reason to solve the values dilemma created by the loss of a transcendent foundation for values. Peter Singer allows that sociobiology can help us understand the evolutionary origin of ethics, but denies the claim that sociobiology or any science can furnish us with ultimate ethical principles. We argue that Singer's critique of Wilson's attempt to bridge the gap between fact and value using empirical reason is unconvincing and that Singer's own ethical principle of disinterestedness requires major support from empirical reason and is not sustainable by pure reason alone.     

Meditation-specific prefrontal cortical activation during acem meditation: an fMRI study

Some of the most popular meditation practices emphasize a relaxed focus of attention in which thoughts, images, sensations, and emotions may emerge and pass freely without actively controlling or pursuing them. Several recent studies show that meditation activates frontal brain areas associated with attention focusing and physical relaxation. The objective of the present study was to assess whether brain activation during relaxed focusing on a meditation sound could be distinguished from similar, concentrative control tasks. Brain activation was measured with functional magnetic resonance imaging (fMRI) in experienced practitioners of Acem meditation. Bilateral areas of the inferior frontal gyrus (BA47) were significantly more activated during repetition of a meditation sound than during concentrative meditation-like cognitive tasks. Meditation-specific brain activation did not habituate over time, but increased in strength with continuous meditation bouts. These observations suggest that meditation with a relaxed focus of attention may activate distinct areas of the prefrontal cortex, with implications for the understanding of neurobiological correlates of meditation.     

Causal attributions in clinical subtypes of depression: A longitudinal study of inpatients

The study material comprised inpatients who met DSM-III-R criteria for (a) dysthymia without panic and/or agoraphobia (n=20), (b) major depression without panic and/or agoraphobia (n=26), (c) both major depression and panic with agoraphobia (comorbid patients) (n=17), and (d) panic with agoraphobia without any depressive disorder (n=22). The patients completed the Attributional Style Questionnaire and the Beck Depression Inventory and were assessed on the Comprehensive Psychopathological Rating Scale upon admission to the hospital and at discharge. Some of the self-report scales were also administered at 1-year follow-up. It was assumed that dysthymic patients and patients with both major depression and agoraphobia would exhibit more biased attributions for bad events than purely major depressed and purely agoraphobic patients. However, inconsistent with this hypothesis, obtained group differences could be statistically reduced to differences in depressive symptom level. At each assessment, attributions for bad events correlated significantly with depressive symptom level. Attributional bias tended to decrease during treatment. However, most attribution subscales exhibited moderate stability in terms of correlation across assessments. Attributing bad events to global causes proved to predict later depression.This research was supported by grants from the Halldis and Josef Andresen Legacy.