Psychopathology,feelings of confinement and helplessness in the dental chair,and relationship to the dentist in patients with disproportionate dental anxiety (DDA)

Nineteen individuals with inordinate fear of dental treatment are presented and discussed with respect to their psychopathology and those aspects of their fear involving feelings of confinement and helplessness in the dental chair, and a negative relationship with the dentist. This material is part of a comprehensive investigation previously reported by the authors into the components and factors contributing to this kind of fear, and the personality and emotional reactions of the individuals suffering from it. The data presented are based on single structured interviews of each patient. Analysis of the patient population suggests division into four major categories: those in whom fear of dental treatment was associated with feelings of inferiority in bodily appearance or function (the largest category); those in whom the fear was associated with neurotic disturbance in which disturbance in body image is not apparent; those in whom the fear was a reflection of a schizophrenic or schizoid process; and those in whom no overt psychopathology was found. The patients in the first category were those who tended most to be afraid of dental treatment due to feelings of confinement or helplessness in the dental chair, or due to a negative relationship with the dentist.     

Personality pathology and cognitive-behavioral treatment of fear of flying

Studies have been inconclusive about the influence of personality pathology on treatment outcome in anxiety disorders. In general, it has been presumed that treatment outcome is negatively influenced by the presence of personality pathology. This is a study of the prevalence of personality pathology among persons who were seeking help for fear of flying. Moreover, the effects of personality pathology on the results of a multimodal, standardized, cognitive-behavioral fear of flying treatment program employed by an agency that specializes in treating people with fear of flying were studied. Personality pathology was determined with a self-report questionnaire, which provides ICD-10 diagnoses of personality disorders and dimensional severity scores for personality pathology. Treatment outcome was assessed with three different fear of flying questionnaires. Based on clinical judgment after individual-case conceptualization, participants (N=922) were assigned to a particular treatment for fear of flying. Self-report data for fear of flying were collected at pretreatment and at 3, 6 and 12-month follow-ups in 659 participants who followed the 2-day treatment program. Moreover, the number of flights made in the year following treatment was determined.The results of this study showed that participants with personality pathology, mainly from cluster C (anxiety), report greater fear of flying before treatment than participants without personality pathology. After treatment fear of flying was significantly reduced. Presence of personality pathology was not predictive of the number of flights after treatment and scores on the VAFAS scale at short or long term. Only on two questionnaires for fear of flying collected at short-term participants with personality pathology obtained significantly higher scores, although the size of the differences was relatively small. It was concluded that participants with personality pathology also benefited from fear of flying treatment and that the presence of personality pathology although cannot be regarded as a contra indication for a standardized, cognitive-behavioral group treatment.     

Personality and emotional response in schizophrenics with persistent auditory hallucination

Personality has been proposed as having a possible effect on the reaction that patients have toward auditory hallucination. However, this factor has not been studied previously. Thus, this study investigated the relationship among demographics, personality, cognition and emotional response in schizophrenics with persistent auditory hallucination. One-hundred and fourteen subjects with persistent auditory hallucination completed the Eysenck Personality Questionnaire, the revised Beliefs about Voices Questionnaire and the Chinese-version Hospital Anxiety and Depression Scale. Structural equation model showed that personality had an effect on beliefs about the hallucination (malevolent or benevolent), which then affected the reaction of patients toward these voices (engages or resists). Their reaction will further affect the anxious or depressed state of the patients. When these hallucinations were categorized into the three levels of omnipotence, beliefs and reactions, the model was more significant than that of one-level model. Persistent auditory hallucination only accounted for a portion of the emotional distress when malevolent or benevolent voices were perceived, and personality characteristics accounted for the remaining emotional distress in schizophrenics. This model helped us understand the relationship between personality, cognition and affective symptoms, such that, when therapists decide what “trait” to change, they can determine at which point to intervene.     

Generalization of effects of dental fear treatment in a self-referred population of odontophobics.

Effects of dental fear treatment on general anxiety and mood in 60 dental phobics with high and low general anxiety were compared with "attention" effects in 75 dental phobics on a waiting list using the Dental Anxiety Scale, a State-Trait Anxiety Inventory and a modified Fear Survey Schedule. Positive effects of the treatment were apparent in reduced dental and general fearfulness as well as elevated mood on numerous measures that paralleled dentist ratings of patient behavior. Ss had less fear of going to the next dentist after the program than before, according to a visual analogue measure. Ninety-three percent of Ss started dental treatment with private dentists within 1 year.     

Postdisaster emotional distress,depression and event-related variables: findings across child and adolescent developmental stages

OBJECTIVE: Developmental approaches have not been widely used in child and adolescent posttraumatic stress disorder research, and little is known about developmental differences in response to postdisaster trauma. Our objective was to investigate postdisaster depression and emotional distress psychopathology across a broad child and adolescent developmental range. METHOD: Six months following a bushfire disaster, 2379 grade 4-12 school students -completed an extensive self-report battery, which included the Impact of Event Scale and the Birleson Depression Inventory. Generalized linear models were constructed to model the effects of multiple covariates on continuous outcome measures of depression and emotional distress. RESULTS: Significant independent predictors of persisting depressive symptoms were increased symptoms of emotional distress; increased symptoms of anxiety; evacuation experience; and school grade. Significant independent predictors of emotional distress were persisting depressive symptoms; perception of threat to self or to parents; evacuation experience; and school grade. Gender was not a significant predictor in either the depression or emotional distress multivariate models. Complex, non-linear relationships between depression, emotional distress and school grade were found. CONCLUSION: This study suggests that important developmental differences in postdisaster psychological responses exist across a broad spectrum of developmental stages in children.     

Impulse control and affect regulation in personality disorders

In borderline and antisocial personality disorder there is a close interaction between affect dysregulation and impulse control disorder. Different approaches are presented that focus on affective responses to experimental stimuli in these personality disorders. Results suggest that in borderline personality disorder intense emotional responses occur in the context of specific stressors, in particular fear of being abandoned. Evidence for a general emotional hyperreactivity was not found; on the contrary, female borderline subjects rather showed reduced emotional arousal. Regarding the psychopathic subtype of antisocial personality disorder, results provided strong support for the theory of emotional detachment, which may predispose to violence through a lack of feeling of fear or also of compassion which could counteract violent impulses. Consequences for psychotherapy in BPD are considered.     

Fear of cognitive dyscontrol in relation to depression symptoms: comparisons between original and alternative measures of anxiety sensitivity

Previous research has found that a facet of anxiety sensitivity (AS), referred to as fear of cognitive dyscontrol or fear of mental incapacitation, is associated with severity of depressed mood. Other research has extended the “fear of fear” concept to include fear of losing control over emotion in general (including depression). Because anxiety and depression share the common feature of general distress (Clark & Watson, 1991. Journal of Abnormal Psychology, 93, 19–30), the present study took a conservative approach and statistically controlled for the effect of trait anxiety and negative affectivity before contributions of AS to depression were examined. In a large college student sample (N=348), facets of the original and alternative measures of AS were evaluated in attempts to predict severity of depression symptoms. Fear of cognitive dyscontrol facets from both measures of AS were significant predictors in the regression analyses. A new set of items reflective of control over emotions was also significant and both cognitive and emotional control added to the prediction of depression symptoms in a complementary fashion. Implications of these findings for identifying a proposed “depression sensitivity” are discussed.     

Ethnicity, family cohesion, religiosity and general emotional distress in patients with schizophrenia and their relatives

This study included a sample of 57 Anglo-American, Latino American, and African American patients with schizophrenia and their family members. Findings indicate that for patients, as hypothesized, increasing perceptions of family cohesion was associated with less general emotional distress and fewer psychiatric symptoms. For family members of Latino and African American descent, greater self-reported family cohesion also appeared to have a protective effect against emotional distress, as hypothesized. However, no association was found between family cohesion and general emotional distress for Anglo-American family members. Interestingly, no relationship was found between patients' and their relatives' views of their family environment. Thus, researchers and clinicians working with families are encouraged to attain separate assessments of the family environment from each individual member. Contrary to expectations, religiosity was not associated with patient or family member emotional distress or with patient psychiatric symptoms. Study implications are discussed.     

The role of emotional functioning in military-related PTSD and its treatment

This two-part study investigated the cross-sectional and across-treatment relationships among measures of emotional functioning and posttraumatic stress disorder (PTSD) symptomatology for veterans receiving specialized treatment for military-related PTSD. Cross-sectional analyses revealed overlap among emotion regulation, affective control, depressive symptoms, and PTSD symptoms at pre-treatment. In regression analyses, fear of losing affective control was most predictive of PTSD symptoms. Bivariate analyses of residualized change scores showed that changes in emotion regulation and fear of losing affective control were associated with changes in PTSD and depressive symptoms across treatment. Regression analyses revealed that changes in fear of losing affective control most strongly predicted changes in PTSD and depressive symptoms. Theoretical and clinical implications are discussed, including an understanding of the differences between emotion regulation and affective control processes. Future research directions are offered, including improved measurement of emotional functioning and longitudinal research delineating the likely bi-directional relationship between emotional functioning and PTSD.     

Emotional reactions to the diagnosis and treatment of early breast cancer

Forty-four patients with early breast cancer were interviewed before mastectomy and on three occasions during the following year about psychiatric symptomatology, and their emotional reactions to various aspects of the illness and its treatment. Eight patients developed symptoms of depressive illness. Thirty-five patients expressed emotional distress related to the diagnosis or the loss of the breast or both. All ten who had adjuvant chemotherapy considered this the most unpleasant aspect of treatment. Post-operative distress could often be predicted by a high score on the General Health Questionnaire, or a high level of expressed concern before the operation.     

Physical symptoms/side effects during breast cancer treatment predict posttreatment distress

Background: Studies suggest that the period following completion of treatment can be distressing for cancer patients. One potentially important predictor of distress is physical symptoms/side effects during treatment.Purpose: A longitudinal, observational design was used to examine whether the number of physical symptoms/side effects experienced during treatment was a correlate of cancer-related distress and general distress 4 months after treatment completion, as measured by the Impact of Events Scale and the Mental Health subscale of the Short Form-36, respectively.Methods: Participants were 151 women who had completed chemotherapy and/or radiotherapy for ductal carcinoma in situ or stage 1 or 2 breast cancer. Hierarchical multiple regression was conducted with relevant sociodemographic, clinical, and psychiatric variables entered as controls.Results: Greater physical symptoms/side effects predicted greater total cancer-related distress, intrusive thoughts, and general distress. Physical symptoms/side effects did not significantly predict avoidance. Follow-up analyses indicated that the relationship between physical symptoms/side effects and general distress was mediated by both total cancer-related distress and intrusive thoughts.Conclusions: These results suggest that patients who experience greater physical symptoms/side effects during treatment are at greater risk for later cancer-related distress and, in turn, general distress. Future research should evaluate whether early intervention with these patients is effective in preventing or reducing distress in the posttreatment period. This work was supported by a grant from the National Cancer Institute (5R01 CA082822).     

Associations between patient characteristics and ratings of treatment milieu

The objective of the study was to investigate associations between patients ratings of their treatment milieu and personal characteristics such as gender, age, educational level, personality disorders, symptom distress, interpersonal problems, global level of functioning, as well as treatment outcome. Data was taken from 908 patients (with mainly personality, mood and anxiety disorders) consecutively admitted to eight day-treatment units. Treatment milieu was measured by Ward Atmosphere Scale for Therapeutic Programs (WAS-TP). Overall level of psychosocial functioning was measured by Global Assessment of Functioning (GAF). Diagnoses and personality traits was measured by the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II), according to DSM-IV. Symptom distress and interpersonal problems was measured by Symptom Checklist 90-R and the Circumplex of Interpersonal Problems, respectively. No substantial associations were found between individual personal characteristics and ratings of the treatment milieu, and no substantial associations were found between ratings of the treatment milieu and treatment outcome or the likelihood of treatment completion. There seems to be no support as to making general inferences about or from individual ratings of the treatment milieu. Possible uses of individual evaluations of treatment milieu are discussed.     

The effectiveness of ziprasidone in treating impaired quality of life in schizophrenia: a 12-month, open-label, flexible-dose, naturalistic observational study of patients undergoing usual care

OBJECTIVE: Health related quality of life (HRQL) has become an important outcome measure in the treatment of psychiatric disorders. This long-term observational study examined ziprasidone-induced improvement in satisfaction with HRQL in schizophrenia patients treated under real-world conditions. METHOD: Seventy schizophrenia patients with persistent symptoms or troublesome side effects were assigned to a 12-month, open-label, flexible-dose (40-160 mg/d), large-scale, naturalistic trial. Outcome measures were taken at baseline, 6, and 12 months, and included the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), severity of symptoms, distress, and side effects. RESULTS: Thirty-two patients fully completed the study protocol. Patients reported poorer general HRQL compared with healthy subjects. At the end of the study, significant improvement in general activity, and satisfaction with life was observed. The effect sizes for these changes were moderate (0.55, and 0.72, respectively). After Bonferroni correction for multiple comparisons improvement in satisfaction with general activity remained significant. No significant changes were noted in other Q-LES-Q dimensions. Improvement in general activity was associated with a reduction in the severity of symptoms and emotional distress, but was unrelated to the ziprasidone daily dose, side effect scores, and concomitantly prescribed antidepressants, anxiolytics, mood stabilizers, or antiparkinson drugs. CONCLUSION: This study indicates that ziprasidone treatment resulted in the improvement of the satisfaction with general activity that tended to increase over time, from month 6 onwards. This effect was associated with reduction in the severity of clinical symptoms, and emotional distress.     

Distinguishing distress and psychopathology among survivors of the Oakland/Berkeley firestorm

Disaster mental health research has historically focused on assessment of psychopathology, using measures of psychiatric symptoms and disorders. The Oakland/Berkeley firestorm provided an opportunity to explore resilience among highly exposed survivors through consideration of psychiatric variables in the context of personality. The Diagnostic Interview Schedule/Disaster Supplement was administered to 62 firestorm survivors at approximately 4, 16, and 39 months and the Temperament and Character Inventory administered at 16 months postdisaster. Few individuals had postdisaster psychopathology (16% with any diagnosis, 5%with PTSD). There was considerable evidence of distress, however, indicated by an abundance of reported posttraumatic symptoms, functional impairments, and endorsement of emotional upset, all of which decreased substantially over time. Group C (avoidance/numbing) posttraumatic symptoms were relatively uncommon and were specifically associated with elevated Self-Transcendence. Groups B (intrusion) and D (hyperarousal) symptoms were prevalent and were associated with high Harm Avoidance and low Self-Directedness. The generally healthy personality profiles of these firestorm survivors reflected their psychological resilience. Examination of symptoms and distress in the context of psychiatric disorders after this disaster demonstrated that symptomatic distress is not inconsistent with psychological resilience. The choice of research focus and methods can provide very different portraits of outcomes post-disaster.     

The structure of emotional and cognitive anxiety symptoms

A sample of 327 patients with primary panic disorder or social phobia completed a questionnaire comprising 77 emotional and cognitive anxiety symptoms from which 12 index scales were constructed. Explorative factor analysis yielded two factors, but confirmatory factor analysis indicated that the factor solution was not invariant across diagnoses. Nevertheless, the two-factor structures fitting data from patients with panic disorder and social phobia, respectively, had similarities in content. The first factor, emotions and cognitive-social concerns, comprised emotional expressions (sadness, fear, and anger), cognitions about cognitive dysfunction (difficulty concentrating, confusion, and loss of control) and social phobic cognitions. It was positively correlated with severity of bodily anxiety symptoms and with the neuroticism personality trait. The second factor, fear of physical sensations, was positively correlated with a cardio-respiratory dimension of bodily anxiety symptoms in panic disorder, lending support to the hypothesis of specific threat-relevant links between bodily symptoms and catastrophic cognitions.     

The relationship between early personality and midlife psychological well-being: evidence from a UK birth cohort study

BACKGROUND: Individual differences in personality influence the occurrence, reporting and outcome of mental health problems across the life course, but little is known about the effects on adult psychological well-being. The aim of this study was to examine long range associations between Eysenck's personality dimensions and psychological well-being in midlife. METHODS: The study sample comprised 1,134 women from the 1946 British birth cohort. Extraversion and neuroticism were assessed using the Maudsley Personality Inventory in adolescence (age 16 years) and early adulthood (age 26). Psychological well-being was assessed at age 52 with a 42-item version of Ryff's Psychological Well-being Scale. Analyses were undertaken within a structural equation modelling framework that allowed for an ordinal treatment of well-being and personality items, and latent variable modelling of longitudinal data on emotional adjustment. The contribution of mental health problems in linking personality variations to later well-being was assessed using a summary measure of mental health (emotional adjustment) created from multiple time-point assessments. RESULTS: Women who were more socially outgoing (extravert) reported higher well-being on all dimensions. Neuroticism was associated with lower well-being on all dimensions. The effect of early neuroticism on midlife well-being was almost entirely mediated through emotional adjustment defined in terms of continuities in psychological/ psychiatric distress. The effect of extraversion was not mediated by emotional adjustment, nor attenuated after adjustment for neuroticism. CONCLUSIONS: Individual differences in extraversion and neuroticism in early adult life influence levels of well-being reported in midlife.     

Factors contributing to therapists' distress after the suicide of a patient

OBJECTIVE: Factors contributing to therapists' severe distress after the suicide of a patient were investigated. METHOD: Therapists for 34 patients who died by suicide completed a semistructured questionnaire about their reactions, wrote case narratives, and participated in a workshop. RESULTS: Thirteen of the 34 therapists were severely distressed. Four factors were identified as sources of severe distress: failure to hospitalize an imminently suicidal patient who then died, a treatment decision the therapist felt contributed to the suicide, negative reactions from the therapist's institution, and fear of a lawsuit by the patient's relatives. Although one emotion was sometimes dominant in the therapist's response to the suicide, severely distressed therapists, compared to others, reported a significantly larger number of intense emotional states. CONCLUSIONS: Over one-third of therapists who experienced a patient's suicide were found to suffer severe distress, pointing to the need for further study of the long-term effects of patient suicide on professional practice.     

Emotional impact of diagnosis and early treatment of lymphomas

Psychiatric morbidity, relevant symptoms and satisfaction with communication were assessed in patients suffering from malignant lymphoma. Before treatment started 15 of 40 patients had clinically significant psychiatric morbidity. Treatment, in its early stages, was not associated with a significant change in mean psychiatric morbidity scores but there was a decrease in ratings of concern about illness and an increase in ratings of nausea. Eleven of 31 patients seen for a second interview reported dissatisfaction with some aspect of communication with the medical staff.The findings suggest that emotional distress can be contained with a policy of frank communication; nevertheless dissatisfaction is common, being associated with initial less concern, good general health and neurotic personality traits. Personality assessment should be incorporated in future studies of doctor-patient communication.