Cognition in pregnancy and the first year post‐partum

A longitudinal study measured the performance of a group of 15 pregnant women on tests of verbal memory, divided attention, and focused attention on four occasions (second trimester, third trimester, 6 weeks post‐partum, and 1 year post‐partum) while at the same time obtaining self‐assessment ratings of these cognitive functions. A group of 14 non‐pregnant women was studied at equivalent intervals. The two groups of women did not differ in performance on the objective tests, and there was no change in performance over time except for an improvement in the measure of focused attention from the first to the final testing occasion. However, the self‐assessment ratings showed that in the second trimester, the pregnant women rated themselves as more impaired than before compared with the non‐pregnant women for all three cognitive abilities. To ensure that this difference was not due to the retrospective nature of the comparison of current with previous cognitive ability, a second longitudinal study compared 25 pregnant and 10 non‐pregnant women using daily ratings over a period of 1 week on four occasions during pregnancy and the first year post‐partum. Women in the third trimester of pregnancy reported mild impairments in their focused and divided attention ability and their ability to remember what they had read compared with the non‐pregnant women. The results show that there are perceived cognitive impairments during pregnancy. It is suggested that these may be the result of mild impairments which are not revealed in objective tests because they can be overcome by conscious effort in short periods of testing. Alternatively, the perceptions may not be based on actual impairments but may result from depressed mood or expectations concerning the effect of pregnancy on cognition.     

Women's history of sexual abuse, their sexuality, and sexual self-schemas

In this study, the authors assessed 48 female survivors of child sexual abuse (CSA) and 71 female control participants using measures of adult sexual function, psychological function (i.e., depression and anxiety), and sexual self-schemas. The primary purpose of this study was to examine whether differences existed between women with and without a history of CSA in the way that they viewed themselves as a sexual person and, if so, whether such differences mediated the link between early unwanted sexual experiences and later adult sexuality. CSA survivors were found to view themselves as less romantic and passionate than women who were not abused. In particular, CSA survivors showed an inverse relationship between romantic/passionate sexual self-schemas and negative sexual affect during sexual arousal. The relationship between CSA and negative sexual affect was independent from symptoms of depression and anxiety, suggesting that the impact of CSA on sexual self-schemas may be independent from the impact that the abuse may have in other areas of the survivor's life.     

抑郁倾向大学生的作业期望改变和社会比较特点

抑郁的认知理论认为抑郁患者的自我评价是消极和歪曲的。本研究提出，应从社会比较的角度考察其自我评价特点，在实验情境中，本文比较了抑郁倾向大学生与正常大学生在作业之后作业期望改变的程度。结果发现，成功后，两组被试的社会比较结果没有差别。失败后，①抑郁倾向组的社会比较特点是消极的，自我贬低的；②正常组的社会比较既没有自我贬低，也没有自我提高，是相对积极的。文中就上述结果作了一定讨论。     

Cognitions and their origins in women with anorexia nervosa,normal dieters and female controls

The objective of the study was to develop a semi‐structured interview with which to investigate cognitions and their origins in female patients with anorexia nervosa, normal female dieters and female non‐dieting controls and to explore group differences in cognitions and, where appropriate, the role of early experience in their development. Following piloting, all participants completed the semi‐structured interview and five self‐report questionnaires to assess reliability and validity of the interview. When discussing eating‐related concerns clinical participants reported more eating‐related thoughts than non‐clinical participants. These differences were also evident, although to a slightly lesser extent, when discussing concerns about weight and shape. Clinical participants reported more assumptions relating to eating, and weight and shape as a means to acceptance by self and others, and to control over‐eating than non‐clinical participants. A similar pattern of group difference was reported in degree of belief and associated distress. Clinical participants identified more negative self‐beliefs than non‐clinical participants. A similar pattern of group difference was reported in degree of rational and emotional belief, and associated distress. All clinical participants identified an association between negative early experiences and negative self‐beliefs, and all reported a link between negative self‐beliefs and dieting. There are clear differences in cognitive characteristics between women with anorexia nervosa, normal dieters and non‐dieting female controls. The meaning attached to dieting may also distinguish dieters from those with a clinical eating disorder. Copyright © 2002 John Wiley & Sons, Ltd.     

Dialectic behavioural therapy has an impact on self‐concept clarity and facets of self‐esteem in women with borderline personality disorder

Identity disturbance and an unstable sense of self are core criteria of borderline personality disorder (BPD) and significantly contribute to the suffering of the patient. These impairments are hypothesized to be reflected in low self‐esteem and low self‐concept clarity. The objective of this study was to evaluate the impact of an inpatient dialectic behavioral therapy (DBT) programme on self‐esteem and self‐concept clarity. Forty women with BPD were included in the study. Twenty patients were treated with DBT for 12 weeks in an inpatient setting and 20 patients from the waiting list served as controls. Psychometric scales were used to measure different aspects of self‐esteem, self‐concept clarity and general psychopathology. Patients in the treatment group showed significant enhancement in self‐concept clarity compared with those on the waiting list. Further, the scales of global self‐esteem and, more specifically, the facets of self‐esteem self‐regard, social skills and social confidence were enhanced significantly in the intervention group. Additionally, the treatment had a significant impact on basic self‐esteem in this group. On the other hand, the scale of earning self‐esteem was not significantly abased in patients with BPD and did not show significant changes in the intervention group. Our data provide preliminary evidence that DBT has an impact on several facets of self‐esteem and self‐concept clarity, and thus on identity disturbance, in women with BPD. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: ? Self‐concept clarity, which refers to the BPD criterion identity disturbance, and facets of self‐esteem, are impaired in patients with BPD compared with reference data from healthy controls. ? Our study replicates that depressive symptoms and general psychopathology are improved after a 12‐week DBT programme in BPD patients compared with a waiting list. ? The 12‐week inpatient DBT treatment programme shows significant enhancement in self‐concept clarity and facets of self‐esteem compared with the waiting list. ? Thus, in BPD patients, self‐esteem and the diagnostic criteria identity disturbance, captured by self‐concept clarity, can be influenced with short‐term psychotherapy.     

Interpersonal sensitivities: Their links to mood,anger and gender

This paper explores two interpersonal sensitivities (to rejection and to social put‐down) in a group of 54 depressed men and 50 depressed women. Measures of anhedonia, anxiety, anger, social comparison, and submissive behaviour were also obtained. We found no differences in rejection sensitivity, anger, anhedonia, or anxiety between the sample of depressed men and women. Depressed women rated themselves as more submissive and more inferior than depressed men, and blamed themselves more for being criticized and put‐down by other people. Principal components analysis (PCA) revealed three underlying factors: mood (including anxiety and depression), internalization (related to self‐blame and feelings of low rank), and externalization (related to anger and blaming others for criticism). For both men and women internalization was significantly correlated with depression. However, externalization was negatively related to depression in women, but positively related to depression in men.     

Dependency and self‐criticism in post‐partum depression and anxiety: a case control study

This study investigates the role of self‐criticism and dependency in inpatient post‐partum depressed women (n = 55) and non‐depressed controls (n = 37) as well as the relationship between both personality dimensions and severity of depression and anxiety. As expected, mothers with post‐partum depression showed not only increased levels of depression but also anxiety compared with non‐depressed mothers. Furthermore, they had significantly higher levels of self‐criticism, but not of dependency. In the post‐partum depressed mothers, both personality dimensions were positively associated with severity of depression. However, in non‐depressed mothers, self‐criticism was positively associated with depression, while there was an inverse relationship between dependency and severity of depression. In both samples, self‐criticism, but not dependency, was related to state anxiety. The cross‐sectional nature of this study limits the ability to draw causal conclusions. The study was based on self‐report and conducted in relatively small samples. Copyright © 2009 John Wiley & Sons, Ltd.     

Closeness in relationships as a mediator between sexual abuse in childhood or adolescence and psychopathological outcome in adulthood

The risk of adverse psychological outcomes in adult victims of childhood and adolescent sexual abuse (CSA) has been documented; however, research on possible mediating variables is still required, namely with a clinical perspective. The attachment literature suggests that secure interpersonal relationships may represent such a variable. Twenty‐eight women who had experienced episodes of CSA, and 16 control women, were interviewed using Bremner's Early Trauma Inventory and the DSM‐IV Global Assessment of Functioning; they also responded to Collins' Relationship Scales Questionnaire, evaluating adult attachment representations in terms of Closeness, Dependence and Anxiety. Subjects with an experience of severe abuse reported significantly more interpersonal distance in relationships (low index of Closeness) than other subjects. The index of psychopathological functioning was correlated with both the severity of abuse and attachment (low index of Closeness). Regression analysis on the sample of abused women revealed that attachment predicted psychopathology when abuse was controlled for, whereas abuse did not predict psychopathology when attachment was controlled for. Therefore, preserving a capacity for closeness with attachment figures in adulthood appears to mediate the consequences of CSA on subsequent psychopathological outcome. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: ? The way CSA victims deal with closeness and intimacy in relationships contributes to the quality of psychological outcome in adulthood. ? Treatment strategies for CSA victims should emphasize the enhancement of interpersonal experiences and the strengthening of the subject's sense of closeness to others, intimacy in relationships, and confidence in others.     

Childhood sexual abuse, psychological distress, and medical use among women

OBJECTIVE: This study examined the relationships between reported history of childhood sexual abuse (CSA), psychological distress, and medical utilization among women in a health maintenance organization (HMO) setting. METHODS: Participants were 206 women aged 20 to 63 years who were recruited from an HMO primary care clinic waiting area. Participants were classified, using screening questionnaires and the revised Symptom Checklist 90, as 1) CSA-distressed, 2) distressed only, 3) CSA only, or 4) control participants. Medical utilization rates were generated from the computerized database of the HMO for 1) nonpsychiatric outpatient, 2) psychiatric outpatient, 3) emergency room (ER), and 4) inpatient admissions. RESULTS: CSA-distressed and distressed only groups both used significantly more nonpsychiatric outpatient visits than CSA only and control participants but were not different from one another. CSA only and control participants did not differ on nonpsychiatric outpatient utilization. CSA-distressed participants used significantly more ER visits and were more likely to visit the ER for pain-related complaints than other participants. Among CSA-distressed participants, those who met criteria for physical abuse had significantly more ER visits than those who did not. There were no differences among the four groups in inpatient utilization rates. CONCLUSIONS: Psychological distress is associated with higher outpatient medical utilization, independent of CSA history. History of CSA with concomitant psychological distress is associated with significantly higher ER visits, particularly for those with a history of physical abuse. History of CSA without distress is not associated with elevated rates of medical utilization. Screening for psychological distress, CSA, and physical abuse may help to identify distinct subgroups with unique utilization patterns.     

A grounded theory analysis of the therapeutic relationship with clients sexually abused as children and non‐abused clients

The objective of this study was to investigate whether clients with a history of child sexual abuse (CSA) and non‐abused clients differ in their views of the therapeutic relationship. Two groups of 17 clients receiving psychological therapy, those who reported a history of CSA and a matched group who had not reported abuse, were asked in a semi‐structured interview about what was important to the therapeutic alliance. The accounts of the two groups were analysed using grounded theory, and then compared. The qualitative analysis demonstrated that both groups identified many similar important issues. These included factors relating to the therapist, to therapy itself, and to the client's perception of the relationship. Women in the CSA group emphasized the interpersonal qualities of the therapist and how they felt about their relationship, while the other clients talked more about therapeutic techniques and progress in therapy. Important issues mentioned exclusively by the CSA group included the therapist's commitment, being believed, and the therapist not showing negative reactions. Copyright © 2001 John Wiley & Sons, Ltd.     

Future‐directed thinking and depression in relapsing‐remitting multiple sclerosis

Background. Research has shown that depression is associated with a view of the future characterized by reduced anticipation of future positive experiences, but not necessarily increased anticipation of future negative experiences. The aim of the present study was to investigate how participants with relapsing‐remitting multiple sclerosis (MS) anticipated their future in terms of positive and negative events. Design. A mixed design compared three groups of participants on a measure of future thinking using an adapted verbal fluency paradigm. Methods. Depressed MS participants (N = 14), non‐depressed MS participants (N = 28) and healthy control participants (N = 26) were assessed on their ability to generate future positive and negative experiences. A content analysis was also conducted on the responses generated by the MS depressed and MS non‐depressed groups according to whether or not they were related to MS. Results. The MS depressed group anticipated significantly fewer future positive events than the healthy control group and the MS non‐depressed group. The three groups did not differ in the total numbers of anticipated future negative events, though the MS depressed group did anticipate a significantly higher proportion of MS‐related negative events. Conclusions. Like depressed but physically healthy individuals, the MS depressed group was characterized by a lack of positive thoughts about the future, rather than an increased number of negative thoughts. The clinical implications of these findings are discussed along with recommendations for future research.     

The role of feared possible selves in obsessive–compulsive and related disorders: A comparative analysis of a core cognitive self‐construct in clinical samples

Increasingly, cognitive‐behavioural models have been considering the role of beliefs about the self in the development and maintenance of obsessive–compulsive disorder (OCD), including sensitive domains of self‐concept and feared self‐perceptions. This has led to the development of the Fear of Self Questionnaire (FSQ; Aardema et al., 2013 ), which has shown strong internal consistency, divergent and convergent validity, and found to be a major predictor of unwanted thoughts and impulses (i.e., repugnant obsessions). The current study aimed to investigate fear of self‐perceptions using the FSQ in an OCD sample (n = 144) and related psychological disorders (eating disorders, n = 57; body dysmorphic disorder, n = 33) in comparison to a non‐clinical (n = 141) and clinical comparison group (anxiety/depressive disorders, n = 27). Following an exploratory factor analysis of the scale in the OCD sample, the results showed that participants with OCD in general did not score significantly higher on fear of self‐perceptions than did the clinical comparison participants. However, consistent with previous findings, fear of self was highly characteristic among OCD patients with unwanted repugnant thoughts and impulses. In addition, fear of self‐perceptions were significantly more elevated in those with eating or body dysmorphic disorders relative to the other non‐clinical and clinical groups. The construct of a “feared possible self” may be particularly relevant in disorders where negative self‐perception is a dominant theme, either involving concerns about one's inner self or concerns related to perceived bodily faults.     

A population-based study of depressed mood in middle-aged, Australian-born women

OBJECTIVE: There has been controversy about the relationship between menopause and depression. This study utilizes a unique prospective population-based data set of middle-aged, Australian-born women to identify determinants of depressed mood. DESIGN: The Melbourne Women's Midlife Health Project sample consisted of 438 women aged 45 to 55 at baseline; they were followed annually for 11 years. Of this group, 314 (72%) completed the Center for Epidemiologic Studies Depression Scale (CES-D) scale in year 11 to measure depressed mood. Variables measured at baseline and annually included negative mood (measured with Affectometer) and psychosocial, hormonal, health, and lifestyle factors. RESULTS: Women who had the highest CES-D scores were those who by year 11 were still in the menopause transition stage (had not reached final menstrual period) or had experienced surgical menopause. CES-D correlated with negative mood measured concurrently (r = 0.63) and baseline negative mood (r = 0.37). There was a significant reduction in negative mood for all menopause status groups, but those who experienced surgical menopause showed less reduction than other women. Ever-use or number of years of use of hormone therapy made no difference to CES-D outcome. CES-D was associated with baseline negative attitudes toward aging, mood, and premenstrual complaint experience and annual mood, poor self-rated health, number of bothersome symptoms, and daily hassles. CONCLUSIONS: Women most likely to have higher depressed mood in the age group 57 to 67 are those who have undergone surgical menopause or have menstruated within the last 12 months. Prior negative mood, history of premenstrual complaints, negative attitudes toward aging or menopause, poor health, and daily hassles predict depressed mood.     

An application of an extended health belief model to the prediction of breast self‐examination among women with a family history of breast cancer

Objectives. This study reports an application of the health belief model (HBM) to the prediction of breast self‐examination (BSE) among women with a family history of breast cancer. The study also considered the influence of breast cancer worries and past behaviour. Methods. Eight hundred and thirty‐three women completed questionnaires, based on the HBM, to assess their beliefs about breast cancer and BSE. Of these women, 567 were followed‐up at 9 months when BSE frequency was assessed. Results. Discriminant function analysis was employed to discriminate among infrequent, appropriate and excessive BSE. Two functions were calculated which were predictive of group membership. The first function maximally discriminated between the infrequent BSE group and the other two groups, with infrequent self‐examiners reporting a greater number of self‐efficacy and emotion barriers, fewer benefits and less frequent BSE at Time 1. The second function maximally discriminated between the excessive BSE group and the appropriate BSE group, with excessive self‐examiners reporting higher levels of breast cancer worries and perceived severity and fewer self‐efficacy barriers. Conclusions. The results highlight the importance of focusing on excessive as well as infrequent BSE. Interventions designed to enhance women's confidence in their ability to perform BSE, coupled with attempts to reduce breast cancer worries, may encourage more appropriate and effective BSE.     

Exploring the paths between dysfunctional attitudes towards motherhood and postpartum depressive symptoms: The moderating role of self‐compassion

Better understanding how cognitive processes operate to influence women's depressive symptoms during the postpartum period is crucial for informing preventive and treatment approaches. The present study aimed to examine the relationship between women's dysfunctional attitudes towards motherhood and depressive symptoms, considering the mediating role of negative automatic thoughts and the moderating role of self‐compassion. A sample of 387 women in the postpartum period cross‐sectionally answered a set of questionnaires to assess dysfunctional attitudes towards motherhood, negative automatic thoughts (general and postpartum‐specific), depressive symptoms, and self‐compassion. Women with clinically significant depressive symptoms presented more dysfunctional attitudes towards motherhood, more frequent negative thoughts, and lower self‐compassion. More dysfunctional beliefs about others' judgments and about maternal responsibility were associated with higher depressive symptoms, and this effect occurred through both general and postpartum‐specific thoughts related to the metacognitive appraisal of the thought content. Moreover, these relationships occurred only when women presented low or moderate levels of self‐compassion. These results highlight the need to comprehensively assess women's cognitive variables during the postpartum period with appropriate measures, for the early identification of women with more dysfunctional beliefs about motherhood, who may be at higher risk of depression. Moreover, preventive/treatment approaches should aim not only to challenge women's preexisting dysfunctional beliefs but also to promote a more self‐compassionate attitude towards themselves.     

A qualitative investigation of women's experiences of the self and others in relation to their menstrual cycle

Objectives. This study aimed to compare and contrast detailed accounts of a community sample of women, with prospectively defined low or high premenstrual symptoms, highlighting differences/similarities. Methods. Semi‐structured interviews were conducted with 16 women (9 with ‘low’ and 7 with ‘high’ symptom levels) and analysed using template analysis. Results. ‘Low symptom’ women perceived themselves as generally laid back but demonstrated a need for organization and control in the family environment. They accepted less than perfect relationships, compared themselves favourably to others and perceived themselves as having strong support networks. There was a negative perception of the introduction to menarche but this was coupled with strong maternal support. ‘High symptom’ women showed patterns of perfectionism, an emphasis on self‐sacrifice and unfavourable comparison of self with others. They reported feeling alone, overwhelmed by tasks and experienced relationships as characterized by unresolved tensions. Menarche was viewed as a positive experience but accompanied by low maternal support. Both groups viewed their symptoms as irrational and controllable outside the home, but vented on partner, close family and children. There was acknowledgement of difference from ‘normal’ (‘low’) with an emphasis on the all‐encompassing nature of symptoms (‘high’). Conclusions. Women with high and low menstrual cycle symptoms viewed aspects of themselves and their relationships with others in both similar and different ways. A major issue for high symptom women was that they struggled to tolerate imperfections, both in their own performance or in their relationships with others, potentially emphasizing the role of cognitive appraisals in interventions.     

Does family interrelating change over the course of individual treatment?

Interrelating is a combination of each person's relating towards a specified other and each person's view of the other's relating towards him/her. Negative interrelating is a maladaptive form of interrelating. The study aims to (1) compare the negative interrelating within the families of neurotic and psychotic psychotherapy outpatients; (2) examine whether individual treatment has a beneficial effect upon negative interrelating; (3) examine whether the improvement extends beyond the patients' interrelating with their parents (i.e., between the parents and the patients' sibling and between the parents themselves); and (4) make similar comparisons within a sample of non‐patients. The negative interrelating between the psychotic patients and their parents was more marked than that between the neurotic patients and their parents. The negative interrelating between the patients and their parents dropped significantly over the course of therapy. There were also significant changes in the interrelating between the patients' siblings and their parents and between the parents themselves even though they had not been involved in the therapy. Many of the end of therapy scores of the patients and their parents approached more those of the non‐patients. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: ? It is useful to measure both the negative relating of patients and the negative interrelating between patients and other family members. ? The patients' therapy appears also to benefit the interrelating between those family members who were not involved in the therapy. ? These findings may be more marked in Greek families, in which young adults stay closer to their parents.     

Interpersonal dysfunction in depressed women: impairments independent of depressive symptoms

BACKGROUND: The study explored the generality of interpersonal impairments in depressed women and examined the extent of their independence of current depressive episodes or symptoms. METHODS: 812 community women who were formerly depressed, currently depressed, or never depressed were compared on a variety of indices of interpersonal behavior and beliefs. Information was also obtained from their spouses, adolescent children, and raters. Current depressive mood and sociodemographic factors that might affect social functioning were controlled. RESULTS: Consistent with the hypotheses that interpersonal difficulties are not just consequences of depressive symptoms, formerly but not currently depressed women were significantly more impaired than never-depressed women on nearly all measures. They were less likely to be stably married, had poorer marital satisfaction, reported more spouse coercion and physical injury, had more problematic relationships with their child, friends, and extended family, reported more stressful life events with interpersonal and conflict content, and were more insecure in their beliefs about other people. Their spouses and boyfriends also reported more problems, and were themselves more likely to have diagnosable disorders. However, the groups did not differ in their children's perceptions of maternal warmth or hostility. LIMITATIONS: The cross-sectional design precluded conclusions about the causal direction of the relationship between interpersonal impairment and depressive disorder. Since clinical depression is more often than not followed by subthreshold symptoms that are not captured by standard diagnostic instruments, such symptoms are not easily discernable from preceding or co-existing interpersonal problems. Only women were studied. CONCLUSIONS: Interpersonal impairment is a stable feature of depression, a significant challenge to treatment, and may reflect underlying vulnerability to the onset, and recurrence, of depressive experiences.