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PubMed1984

Staff responses to the pregnancy of a therapist on an inpatient unit.

The author interviewed staff on three psychiatric wards to elicit their response to pregnant colleagues. Staff expressed particular concern about protecting the pregnant women from possible patient assaults. Some staff members were overprotective or unwilling to express anger directly toward the pregnant staff members. Staff also reported increases in jealousy, maternal transference and countertransference, anxiety about the impending separation, flirting with the pregnant women, and joking about sex. The author compares these findings with reports from outpatient settings and discusses potential implications.

Adaptation, Psychological↗

PubMed1990

Patients' and caregivers' adaptation to improvement in schizophrenia.

Treatment of poorly functioning schizophrenic patients with antidepressant medication may lead to a relatively rapid increase in their level of activity, autonomy, and assertiveness. Caregivers who had been accustomed to the patients' more blunted affect and docile behavior may perceive this change as an increase in hostility. Patients who do not know how to express anger and other strong feelings appropriately may also find changes in their level of assertiveness to be stressful. The authors illustrate these problems with case examples and suggest that psychoeducation, regular contact with the treatment team, and training in communication can help both patients and caregivers adjust to the patients' improved condition.

Adult↗

PubMed1997

Disability and family burden in obsessive-compulsive disorder.

This paper reviews 2 aspects of obsessive-compulsive disorder (OCD): impairment in functioning and family burden associated with OCD. Impairment is evident from epidemiological and clinical studies in several areas, particularly in occupational and social maladjustment. Clinic outpatients show a range of impairment associated with OCD, while hospitalized patients exhibit consistently severe disabilities that rival those of patients with schizophrenia. Although behaviourally and medication-treated patients improve in adjustment levels, there is some evidence of persistent impairment, particularly in social and work functioning. Several studies support extensive family involvement and accommodation of OCD symptoms, as well as the considerable burden placed on families who reduce their social activities and increase their isolation and distress. Findings are equivocal regarding OCD and marital distress. Predictors of treatment outcome do not include marital dissatisfaction, but may include expressed anger and criticism. With regard to treatment, family support groups are popular but untested interventions, and family-assisted individual and group behaviour therapy have demonstrated good outcomes in limited trials.

Cost of Illness↗

PubMed2000

Psychological and sport-specific characteristics of football players.

It is hypothesized that players of different levels of play might differ not only in their football skills but also in their way of playing football and with respect to psychological factors such as concentration, reaction time, or competitive anxiety. The psychological characteristics of a player might influence his way of playing football (in particular with respect to fair play) and also his risk of injury. A group of 588 football players were studied by questionnaire; additionally, reaction time tests were performed. Psychological characteristics were assessed by three established self-evaluation questionnaires: the Athletic Coping Skills Inventory, the State Competitive Anxiety Test, and the State-Trait-Anger-Expression-Inventory. Football-specific characteristics that were investigated included playing experience and positions played, style of play, number of training hours and games, as well as aspects of fair play. Reaction time was tested twice: without the influence of physical exercise and immediately after a 12-minute run. A significant reduction in reaction time was observed after physical exercise. In high-level players, the reaction time immediately after the 12-minute run was significantly shorter than it was in low-level players. The questionnaire answers given regarding fair play clearly indicated that fair play is not paid sufficient respect. The relationship between psychological characteristics and attitudes toward fair play was analyzed and discussed.

Adolescent↗

PubMed1995

Comparability and validity of computerized adaptive testing with the MMPI-2.

The comparability and validity of a computerized adaptive (CA) Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were assessed in a sample of 571 undergraduate college students. The CA MMPI-2 administered adaptively Scales L, E the 10 clinical scales, and the 15 content scales, utilizing the countdown method (Butcher, Keller, & Bacon, 1985). All subjects completed the MMPI-2 twice, with three experimental conditions: booklet test-retest, booklet-CA, and conventional computerized (CC)-CA. Profiles across administration modalities show a high degree of similarity, providing evidence for the comparability of the three forms. Correlations between MMPI-2 scales and other psychometric measures (Beck Depression Inventory; Symptom Checklist-Revised; State-Trait Anxiety and Anger Scales; and the Anger Expression Scale) support the validity of the CA MMPI-2. Substantial item savings may be realized with the implementation of the countdown procedure.

Journal Article↗

PubMed2004

Handling unexpected distress on the telephone: the development of interdisciplinary training.

St Nicholas's Hospice recognized that its non-clinical staff needed support and guidance regarding the management of particularly difficult telephone conversations. It is understandable that patients and family members who are experiencing extreme uncertainty, fear and worry might express anger and despair, however, non-clinical staff were troubled by having to handle such raw emotions on the telephone. Despite palliative care excelling at counselling skills and training in breaking bad news, no material or courses exist to help these staff handle unanticipated distress on the telephone. A training session was established and, unexpectedly, many clinical staff enrolled. Although a formal in-depth evaluation did not take place, participant feedback suggested it was equally beneficial to non-clinical and clinical staff. A key element of the apparent success was the interprofessional, interagency, interpersonal sharing and exchange of ideas.

Attitude of Health Personnel↗

PubMed2003

Characteristics of violent bars and bar patrons.

OBJECTIVE: The present analysis is an attempt to examine the characteristics of bars in which violence occurs while accounting for the personalities of the clientele that frequent the bar. It is proposed that an explanation of why violence occurs at certain bars requires examining the characteristics of the bars, the personalities of the clientele, and how these two types of variables act together in order to give rise to aggressive behavior. METHOD: We conducted interviews with frequent bar patrons (n = 327), assessing participants on a number of individual differences related to aggression and drinking behavior as well as on characteristics of the usual bar that they attend. Bars were categorized into violent bars (n = 256) or nonviolent bars (n = 71) based on participant responses. RESULTS: Participants' age, alcohol dependence and anger expression differentiated those who frequented violent bars from those who frequented nonviolent bars. The relationship of these individual differences to bar type was mediated by a number of characteristics of the bar itself, including noise, temperature, the presence of bouncers, the gender of the workers, the presence of billiards and illegal activities in the bar. CONCLUSIONS: The results indicate that individuals having certain personality characteristics are attracted to bar environments that promote antinormative behaviors such as violence. However, it seems to be the characteristics of the bars that are the strongest predictors of violence.

Adult↗

PubMed1994

Underage female DUI offenders: personality characteristics, psychosocial stressors, alcohol and other drug use, and driving-risk.

164 underage female DUI offenders were evaluated on measures of personality, driving-risk, psychosocial stressors, alcohol and other drug use, alcohol abuse, and symptoms of depression. Empirical classification of 10 groups represented five distinct types. 31 youth who were classified as Antisocial exhibited highest rates of alcohol misuse, other drug use, deviant driving behavior, traffic offenses and accidents, and psychosocial stressors. About 56% or 92 appeared to experience impaired functioning serious enough to warrant interventions more intense than educational classes. A measure of driving-risk developed and used in studies of male adults, the Donovan Research Questionnaire, did not appear to differentiate driving-risk among the young women. In contrast to male drivers, who often expressed anger or aggression through driving, most subjects appeared to react to emotion-eliciting stimuli with feelings of low self-worth or dysphoric affect rather than anger. Specialized screening suitable for young female DUI offenders should be considered.

Accidents, Traffic↗

PubMed2005

Psychometric properties of the Trauma Stages of Recovery.

Of the trauma theories available, Herman's has captured the essential features common to most traumatic etiologies. Continued development of this theory has included dimensions within stages of recovery. The Trauma States of Recovery is presented here as a way of assessing stages of recovery and inherent components. Three samples of about 500 college students each and a clinical sample (n=34) were recruited. Independent principal components analyses, employing a scree plot, gave a five-component solution accounting for 40.2% of the total variance. The component solution employed Promax rotation for the correlated components. The five components were named Emotional Awareness and Control, Symptom Mastery, Coping, Memory, and Relationships. Internal consistencies, test-retest reliability, and split-half reliability were acceptable. Response bias was low. Convergent validity (with various subscales from the Beck Depression Inventory, the Self-esteem Scale, the Spielberger Anger-Expression Scale, and the Dissociative Experiences Scale) and discriminant validity (with various subscales of the AIDS Knowledge and Attitudes Survey and Jackson's Personality Research Form Dominance Scale) were promising. The Trauma Stages of Recovery also significantly discriminated between clinical and nonclinical samples on three of the five components, Symptom Mastery, Coping, and Memory.

Adaptation, Psychological↗

PubMed1992

Family psychoeducation: chronic psychiatrically ill Caribbean patients.

This article described a method of patient and family intervention designed for psychotic patients who are prone to relapse. Issues addressed in a monthly group meeting were designed to clarify, inform, and support families on the facts of schizophrenia and bipolar disorder. This format succeeded in improving the rate of recidivism in the population of Caribbean patients because it clarified distortions of the nature of the illnesses and made obvious that medication compliance was separate and did not intrude on the culture and belief systems. Family dynamics were not a focus in this psychoeducation program, but alliances, boundaries, and process did change over the course of the 6 months of the program. Family members were engaged relatively easily and responded when it was clear there was no intention to intrude on culture or personal beliefs. Many expressed anger and frustrations that such a program had not been offered before, especially those families whose relatives had experienced multiple readmissions. The questionnaires clearly illustrated an increase in knowledge and understanding about the illness, and this correlated with reduced recidivism. A major effort is made to maintain contact with patients and their families following discharge from the day hospital for up to 3 years to ensure their follow-through. Follow-up phone calls ensure 100% follow-up. For the past few years, we have found that ongoing contact is also useful on a reduced frequency to reinforce the concepts communicated initially.

Adolescent↗

PubMed2004

Combined dialectical behavior therapy and fluoxetine in the treatment of borderline personality disorder.

BACKGROUND: This study examines the therapeutic effect of fluoxetine, a selective serotonin reuptake inhibitor, added to dialectical behavior therapy (DBT), an empirically supported psychosocial therapy, for the treatment of borderline personality disorder. METHOD: This is a 12-week, randomized, double-blind, placebo-controlled study of patients with borderline personality disorder (identified using the Structured Clinical Interview for DSM-IV Axis II Disorders). All subjects received individual and group DBT. Of the 20 subjects that completed treatment, 9 were randomly assigned to receive up to 40 mg/day of fluoxetine and 11 were randomly assigned to the placebo condition. Subjects were evaluated at baseline and at week 10 or 11 on self-report measures of depression, anxiety, anger expression, dissociation, and global functioning. The study was conducted between January 1998 and February 2000. RESULTS: Time-by-group interaction effects revealed no significant group differences in scores from pre-treatment to posttreatment on any measure. However, within the DBT/placebo group, there were significant pretreatment/posttreatment differences in the direction of improvement on all measures. No significant pre-treatment/posttreatment differences were found within the DBT/fluoxetine condition. CONCLUSION: The data suggest that adding fluoxetine to an efficacious psychosocial treatment does not provide any additional benefits. Further studies with larger sample sizes are warranted.

Adult↗

PubMed1999

[Domestic violence in Caracas: social and cultural predictors].

The article gives an account of the results of a research intended to know violence reported by individual between couples and towards children and also to establish the importance of social (sex, income, education, civil status, work status, gun license, alcohol abuse, attraction to violent TV programs) and cultural (social norms about aggression between couples and children punishment, and capacity to express anger and handle conflicts in a non-violent ways) predictors in such behavior. The information is based on a survey applied to Caracas Metropolitan Area (CMA) inhabitants between 18 and 70 years of age (n = 1,297) selected by probabilistic, biphasic, and tetra-stage sampling, and at random following the Politz method. The instrument was a questionnaire with on scale answers Likert type. The information was treated with multi-varying statistical analysis, using the association technique between two variables by means of the Chi-square test, with conditional independence log-linear for three variables. The results suggest relatively low violence levels between couples and towards children. Regarding children, women tend to be more violent with them, most probably explained by factors relating income and unemployment. It was found that the bigger the accord with the norm to discipline children with physical violence, the bigger the frequency of violent behavior towards them. On the contrary, the bigger the conviction to be skilled in handling situations without violence, the lesser the frequency of violent behavior. Regarding violence between couples no association was found with the sex variable, but one can certainly talk about violent couples, which is related to the way of coupling, unemployment, and lack of formal education. From the norm point of view, a relationship between belief in the norms and violent behavior is observed, although these norms and attitudes are measured by the ability of the couple of control himself/herself and act in a non-violent way.

Adolescent↗

PubMed2003

Critical race theory speaks to the sociology of mental health: mental health problems produced by racial stratification.

The sociology of mental health focuses on the epidemiology, etiology, correlates, and consequences of mental health (i.e., psychiatric disorder and symptoms, psychological distress, and subjective well-being) in an attempt to describe and explain how social structure influences an individual's psychological health. Critical race theory describes and explains iterative ways in which race is socially constructed across micro- and macro-levels, and how it determines life chances implicating the mundane and extraordinary in the continuance of racial stratification (i.e., racism). This paper invoked critical race theory to inform the sociology of mental health's approach to studying race and mental health by conceptualizing five hypothetical mental health problems that could exist because of racial stratification. These problems were: (1) nihilistic tendencies, (2) anti-self issues, (3) suppressed anger expression, (4) delusional denial tendencies, and (5) extreme racial paranoia. Mental health problems such as these and undocumented others can only be recognized given awareness of the social and personal implications of racial stratification.

Humans↗

PubMed1992

Psycho-educative group psychotherapy for Jewish child-survivors of the Holocaust and non-Jewish child-survivors of Japanese concentration camps.

The authors describe the application of a form of group psychotherapy for middle aged patients with a past history of being child-survivors of the Second World War. In a group of Jewish survivors, the group members initially expressed anger at the perpetrators, while a group of Dutch-Indonesian survivors of Japanese concentration camps were less able to do so. Therapy was helpful in working through these and other stages of progression until the group members were able to look at their own present lives and think of their futures. Overall results of the group psychotherapy are presented. Despite the patients' age and past traumatic experiences, psycho-educative group psychotherapy was helpful for both groups.

Concentration Camps↗

PubMed1992

Psychological improvement in infertile women after behavioral treatment: a replication.

OBJECTIVE: To replicate previously reported psychological improvements in infertile women attending a group behavioral treatment program. DESIGN: Psychological and demographic data were collected before entering and again upon completion of a behavioral medicine program on a second cohort of patients. SETTING: The program was offered in the Division of Behavioral Medicine, an outpatient clinic of the Department of Medicine at New England Deaconess Hospital. All patients were receiving care from infertility specialists not affiliated with this hospital. PATIENTS: Fifty two self-referred women receiving medical treatment for infertility attended the program. INTERVENTION: A 10-week group behavioral treatment program. MAIN OUTCOME MEASURES: Three validated psychological instruments. RESULTS: Psychological improvement was statistically significant (Profile of Mood States Tension/Anxiety: P less than 0.0001; Depression/Dejection: P less than 0.0122; Vigor/Activity: P less than 0.0431; Confusion/Bewilderment: P less than 0.0057; Spielberger Anger Expression: P less than 0.0013; Spielberger State Anxiety: P less than 0.0037, and Trait Anxiety: P less than 0.0001). CONCLUSIONS: Behavioral treatment is associated with significant decreases in negative psychological symptoms.

Adult↗

PubMed1991

Biobehavioral factors in Cardiac Arrhythmia Pilot Study (CAPS). Review and examination.

The behavioral studies component of the multicenter Cardiac Arrhythmia Pilot Study (CAPS) was designed to examine the relation of biobehavioral factors and frequency of ventricular premature complexes (VPCs), efficacy of antiarrhythmic therapy, and disease end points in a study population that had experienced recent myocardial infarction and significant ventricular ectopy. Biobehavioral factors included both psychosocial (depression, anxiety, social support, type A behavior, mood, defensiveness, and anger expressiveness) and psychophysiological (heart rate and blood pressure reactivity to a videogame stressor) variables. Data were collected at baseline and at 3-, 6-, 9-, and 12-month follow-ups. Of the 502 patients enrolled in CAPS, 353 participated in the behavioral studies component. At baseline, assessments of psychosocial variables revealed the CAPS study population to be generally similar to other heart disease populations, and no relation between these variables and psychophysiological reactivity or arrhythmias was found. At follow-up among patients assigned to the placebo condition, biobehavioral variables were not related to levels of VPCs or VPC suppression. Cox regression analyses revealed that type B behavior, depression, and reduced heart rate reactivity were associated with increased clinical events, even after controlling for baseline left ventricular ejection fraction, myocardial infarction before the qualifying event, use of beta-blockers, use of digitalis, Q wave of qualifying myocardial infarction, and presence of unsustained ventricular tachycardia on baseline electrocardiogram. It is hypothesized that the relation among reduced heart rate reactivity, depression, and clinical events is mediated by diminished cardiac vagal tone.

Anti-Arrhythmia Agents↗

PubMed1991

[Psycho-social precursors of arterial hypertension in men and women in light of clinical cohort studies].

Following two prevalence studies of arterial hypertension carried out at 5-year interval on 6487 adult inhabitants of Ochota District, Warsaw, screening for new cases was performed at the end of the five- or ten-year observation period. Interviews were collected from 472 incident and unknown prevalence cases and 499 randomly chosen non-cases regarding social and work conditions, selected behavioral traits and personal habits. The risk of hypertension was more closely associated with blue collar social status, poor economic self-assessment and repetitive type of work in women than men. In males, but not females, higher risk was connected with expressed anger followed by feeling of guilt, but no otherwise suppressed anger was predictive of hypertension. In both sexes the incidence of the disease was higher among people reporting less life events, and with less involvement in the household and/or professional activities.

Cohort Studies↗

PubMed1981

Psychologic and behavioral correlates of anorexia nervosa.

Female patients with anorexia nervosa (N = 34) were compared with two control groups of nonorganically ill, nonpsychotic female psychiatric patients. One control group was matched on several demographic variables; the other group was unmatched. Profiles on the Minnesota Multiphasic Personality Inventory indicated less psychologic disturbance among the anorectic patients than in the matched control sample, but more feelings of turmoil or distress than were reported in studies of adolescent medical patients and high school seniors. Anorectic patients were described by ward personnel as less physically capable and more timid than controls; they also displayed less heterosexual interest, interacted less often with both peers and staff, were viewed as being unhappier, and were described as expressing anger in relatively passive ways.

Adolescent↗