The SCL-90-R as a screening instrument for severe personality disturbance among outpatients with mood and anxiety disorders

Our objective was to examine whether the SCL-90-R, a widely used self-report measure of distress and psychopathology, could screen for personality disorders in general and for severe personality disturbance (SPD) in particular, at the time when patients seek treatment for a state (mood or anxiety) disorder. The SCL-90-R was administered to 112 consecutive outpatients with various mood and anxiety disorders. The personality severity index (PSI) score, defined as the mean value of the scores on the SCL-90-R subscales of interpersonal sensitivity, hostility, and paranoid ideation, was compared with the current symptom index (CSI) score, defined as the mean value of the scores on the remaining six SCL-90-R subscales. A positive screen was considered if PSI > CSI. SPD was defined as the presence of any DSM-III-R Cluster A and/or Cluster B personality disorder. The accuracy of the screen was verified by means of the Structured Clinical Interview for DSM-III-R Personality Disorders. The sensitivity of the PSI > CSI criterion to screen for SPD was 89.4%, while its sensitivity to screen for any DSM-III-R personality disorder was 72.9%. The SCL-90-R subscales that contributed the most to the screening discriminability of this SCL-90-R-derived screening measure were hostility, paranoid ideation, somatization, and obsessive-compulsive behavior. The SCL-90-R may be used to screen for SPD in routine work with outpatients with mood and anxiety disorders, but the results of the screening need to be verified because of the possibility of false negatives and false positives, although that possibility is apparently low. These findings may have important prognostic and treatment implications.     

Are some video games associated with more life interference and psychopathology than others? Comparing massively multiplayer online role‐playing games with other forms of video game

Massively multiplayer online role‐playing games (MMORPGs) are a type of video game that is considered to have particular potential to be associated with life interference and psychopathology when played frequently and intensively. This study sought to compare players of MMORPGs with players of other types of video game in terms of problematic use, life interference, and levels of psychopathology. An international sample of 1,945 video game players completed a series of questionnaires online. While MMORPG players reported increased rates of problematic use and life interference compared with non‐MMORPG players, there were no differences in levels of psychopathology. Differences between MMORPG players and non‐MMORPG players appeared to be associated with the increased amounts of time that MMORPG players played for: The amount of time spent playing appeared to mediate the relationships between type of game played and each of the problematic use and life interference variables. The implications of these findings are discussed.     

An Integrative Approach to Somatoform Disorders Combining Interpersonal and Cognitive-behavioral Theory and Techniques

Data regarding the treatment of somatoform disorders suggest that the gains associated with current psychopharmacologic or psychotherapeutic treatments are modest at best. There have been a few moderately effective treatments for selected functional somatic syndromes, but patients who present with multi-system symptoms meeting criteria for the DSM-IV somatoform disorders are notoriously unresponsive to treatment. Experts in the field have advocated several approaches, including interpersonally oriented and cognitive-behavioral therapies, and have emphasized the importance of the provision of reassurance within the doctor-patient relationship. While each individual approach has merit, none is likely to be maximally efficacious as a stand-alone treatment. In this article we describe the theoretical underpinnings and technical aspects of a treatment for somatizing patients that integrates these three elements.     

Does emotional reasoning change during cognitive behavioural therapy for anxiety?

Emotional reasoning refers to the use of subjective emotions, rather than objective evidence, to form conclusions about oneself and the world. It is a key interpretative bias in cognitive models of anxiety disorders and appears to be especially evident in individuals with anxiety disorders. However, the amenability of emotional reasoning to change during treatment has not yet been investigated. We sought to determine whether emotional reasoning tendencies change during a course of routine cognitive-behavioural therapy (CBT). Emotional reasoning tendencies were assessed in 36 individuals with a primary anxiety disorder who were seeking treatment at an outpatient clinic. Changes in anxiety and depressive symptoms as well as emotional reasoning tendencies after 12 sessions of CBT were examined in 25 individuals for whom there was complete data. Emotional reasoning tendencies were evident at pretreatment assessment. Although anxiety and depressive symptoms decreased during CBT, only one of six emotional reasoning interpretative styles (pertaining to conclusions that one is incompetent) changed significantly during the course of therapy. Attrition rates were high and there was not enough information regarding the extent to which therapy specifically focused on addressing emotional reasoning tendencies. Individuals seeking treatment for anxiety disorders appear to engage in emotional reasoning, however routine individual CBT does not appear to result in changes in emotional reasoning tendencies.     

Fear of Death in Hypochondriasis: Bodily Threat and Its Treatment Implications

This article aims to explore the perception of body in hypochondriasis and implications that it has for fear of death and for treatment of hypochondriasis. It is suggested that a sense of threat posed by the body in hypochondriasis is intimately related to the fear of body, expectations of bodily failure, fear of disease and pathological fear of death. Clinical aspects and potential antecedents of these phenomena are discussed in the article. It is emphasized that fear of the body and fear of death should be adequately addressed in the course of treatment, regardless of the nature of the primary treatment approach. Relevant treatment strategies are outlined, with treatment goals including an adoption of the non-threatening perception of one’s body, modification of attitudes and beliefs related to health, illness and death which heighten fear of death, and substantial alleviation or elimination of the pathological fear of death.     

Similarity and cotenability

In this paper I present some difficulties for Lewis’s and similar theories of counterfactuals, and suggest that the problem lies in the notion of absolute similarity. In order to explain the problem, I discuss the relation between Lewis’s and Goodman’s theory, and show that the two theories are not related in the way Lewis thought they were.     

Cognitive factors in panic disorder, agoraphobic avoidance and agoraphobia

There remains a lack of consensus regarding the possibility that especially high levels of panic-related cognitions characterise panic disorder with agoraphobia. We administered the Anxiety Sensitivity Index, the Agoraphobic Cognitions Questionnaire and the Anxious Thoughts and Tendencies Scale as well as measures of agoraphobic avoidance to patients diagnosed with panic disorder with agoraphobia (n=75) and without agoraphobia (n=26). Patients with panic disorder with agoraphobia did not score significantly higher on any of the cognitive variables than did panic disorder patients without agoraphobia. However, most of the cognitive variables showed small to moderate-strength correlations with self-report measures of agoraphobic avoidance. Our findings suggest that anxiety sensitivity, catastrophising of the consequences of panic and a general anxiety-prone cognitive style, although to some extent associated with agoraphobic avoidance, do not discriminate panic disorder with agoraphobia from panic disorder without agoraphobia.