Mutual help groups for widows: a study of the process.
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Female↗
Biomedical subjects
N Wilner
Publications and source records attributed to N Wilner.
Reactions to the death of a parent. Results from patients and field subjects.
The authors studied two groups of persons who had experienced either the death of a mother or father. One group consisted of patients who had sought treatment because of pathological aspects of bereavement. The other group consisted of volunteers selected from a review of hospital death records, which indicated the recent death of their parent. The study used a nonequivalent groups design, where both groups were followed over time. The field subjects were initially seen much sooner after the death than the patients. The patient group received a time-limited dynamic therapy focused on the stress response syndrome induced by the death. At the pretherapy evaluation point, the patient sample had significantly higher levels of symptomatic distress than did the nonpatient sample. The distress declined over a 13-month period, so that patients had comparable levels of distress to that of the field subjects. After adjusting for initial values, the main difference was that patients reduced their avoidant operations more than did the field subjects. Intervening variables were assessed for the prediction of change in symptoms over time as related to the parental death. The variables that showed significant correlations to symptomatic change were cumulative negative life events from varied sources, occupation, social class, developmental level of the self-concept, identity of the deceased parent, and attribution of blame for the death. Social support did not relate to change in symptoms over time.
Adaptation, Psychological↗
The Stress Response Rating Scale: a clinician's measure for rating the response to serious life-events.
The impact of a serious life-event on an individual's psychological well-being has long been appreciated, but not until recently has it become the subject of more thorough and careful research. Clinical, field, and experimental studies of the effects of potentially distressing life-events have suggested the presence of two primary modes of response: episodes of denial and numbing, oscillating with periods of intrusive thoughts, images, and pangs of emotion. Although self-report measures are available for determining the degree of distress experienced in each of these modes of response, there is no measure that can be used by a clinical observer to assess these same phenomena. We offer the Stress Response Rating Scale (SRRS) as such a measure, and present empirical data to support its reliability and validity. In addition, we present some initial normative data, a discussion of issues encountered in developing the scale, and potential difficulties that may be encountered in its use.
Denial, Psychological↗
Initial psychological response to parental death.
A cohort of patients seeking help at a clinical research center providing time-limited brief therapy for posttraumatic stress disorders was assembled. The single life event experienced by each was death of a parent. A nonequivalent comparison group was gathered by review of hospital death records. Both groups received the same type of evaluation interview and completed the same measures, which were similar to those done for both groups by the clinical interviewer. These data indicated that while both groups contained persons with medium to high distress levels, the patient group was most uniformly composed of such persons; when compared with the field-study group, the patient group had significant and important elevations of distress levels.
Attitude to Death↗
Signs and symptoms of posttraumatic stress disorder.
The new diagnostic nomenclature of the American Psychiatric Association (DSM-III) provides well-described categories of stress response syndromes that were not included in the previous nosology. The signs and symptoms of these syndromes used in the descriptive statements have been understood largely in terms of field studies of nonpatient populations and clinical descriptive and impressionistic studies of patient populations. We report quantitative data from the study of a population with post-traumatic stress disorder. The results confirm clinical impressions of the importance and wide prevalence of episodes of intrusive ideas and feelings in states of distress precipitated by serious life events.
Adult↗
Pathological grief and the activation of latent self-images.
The authors studied the case material for patients treated with either psychoanalysis or brief therapy to examine the basis for the various states of pathological grief after berevavement. They view these states as intensifications or unusual prolongations of states found in normal grief and describe them in terms of the reemergence of self-images and role relationship models that had been held in check by the existence ofthe deceased person. This conclusion concerning preexisting mental schemata leads to an elaboration and partial revision of theories of regression, ambivalence, and introjection as causes of pathological grief.
Adult↗
Analysis of patient states and state transitions.
Psychiatric diagnoses and formulations have classically focused on the chief complaint of the patient as part of a larger pattern of episodes and reactions. This is a form of state analysis in which the problem states of a person are carefully described and distinguished from other states. The authors suggest methods for deepening such formulations by grounding description of problem states in models of other states and models of state transitions. The resultant method of state analysis can be applied to examination of change processes during treatment as well as to initial diagnostic formulations. As an example of its use and possible extension to quantification, state analysis is applied to description of status and change in a person treated by brief psychotherapy. Because state analysis is based on observable behavior and reportable conscious experiences, it serves as a useful beginning point upon which to anchor more extended inferences about psychodynamics.
Emotions↗
Impact of Event Scale: a measure of subjective stress.
Clinical, field, and experimental studies of response to potentially stressful life events give concordant findings: there is a general human tendency to undergo episodes of intrusive thinking and periods of avoidance. A scale of current subjective distress, related to a specific event, was based on a list of items composed of commonly reported experiences of intrusion and avoidance. Responses of 66 persons admitted to an outpatient clinic for the treatment of stress response syndromes indicated that the scale had a useful degree of significance and homogeneity. Empirical clusters supported the concept of subscores for intrusions and avoidance responses.
Adaptation, Psychological↗
Stress films, emotion, and cognitive response.
The clinical theory of the repetition compulsion is sometimes taken to mean that neurotic persons, when traumatized, will develop compulsive repetitions of the trauma. Our experiment suggests that there is a more general effect--that various types of persons, after a variety of stressful events, will tend to develop intrusive and stimulus-repetitive thought; the stress itself does not necessarily have to have a negative valence. Equivalent effects were noted after stimuli that aroused positive emotions and after those stimuli that aroused dysphoric affects.
Arousal↗
Intrusive and repetitive thought after a depressing film: a pilot study.
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Arousal↗
Life event questionnaires for measuring presumptive stress.
Cumulative stress from the impact of life events has become an important variable in psychosomatic and psychological research. This article provides both short and long life events questionnaires that add to incidence information the remoteness or recency in time of a given experience. In the weight assignment system that leads to a single presumptive stress score, events remote in time have less influence than recent events. The reliability of weight assignment was checked in subject groups that differed by sex, age, and status. Women weighted life events as more stressful than did men; other differences in groups were less important. In spite of the sex differential, review of these data suggests use of the same weight assignments for all subgroups rather than differential weighting by sex and age. Reliability was also checked by test and retest methods in contrast to common sense expectation, a disappointingly low level of reliability was found. The implications for investigative use of life events questionnaires are discussed.
Adult↗
Scaling the stressfulness of gynecological complaints.
The present study determines the amount of agreement among staff members of a gynecology service in assessing the stressfulness of various gynecological conditions, and the efficacy of these estimates in predicting stress symptomatology among patients. Subjects were 103 patients attending a gynecology clinic during a two month period. We found that the gynecological conditions could be consensually ranked according to stressfulness by staff of the gynecology service but assessments of the magnitude of the stress differed according to the sex and professional affiliation of the rater. Judgements of stressfulness did not predict the presence of certain kinds of emotional reactions among the patient group but the correlations were not high enough to warrant prediction for the individual case.
Adult↗