What predicts post‐traumatic stress following spinal cord injury/

Objectives . Spinal cord injury (SCI) is a severe, traumatic event and recently research into the role of post‐traumatic stress disorder (PTSD) subsequent to the injury has become of increasing interest. This study has been conducted in order to investigate potential risk factors for the development of post‐traumatic stress disorder symptoms in those with SCI. Design . This cross‐sectional study used multiple regression analysis to look for associations between post‐traumatic stress symptom severity, SCI‐related factors and previously identified risk factors for PTSD such as dysfunctional cognitions, demographic factors and personality predispositions (neuroticism, alexithymia). Method . A total of 102 participants with SCI completed measures of post‐traumatic stress severity, acceptance of injury, post‐traumatic cognitions, social support, neuroticism and alexithymia. In addition, information about type, level and cause of the SCI was assessed. Results . High levels of post‐traumatic stress symptoms were found. Potential risk factors for the development of PTSD were negative cognitions of self and neuroticism. Variables that added to the variance explained by the models included time since injury and difficulty identifying feelings. Acceptance of injury was mediated by negative cognitions of the self and neuroticism. Conclusions . The study highlights the need for services to be aware of the psychological difficulties experienced by this client group. An important finding is that the acceptance of the injury is mediated by negative cognitions of the self which need to be identified as potential risk factors in order to prevent the development of post‐traumatic symptoms in this population.     

Prospective evaluation of a cognitive vulnerability‐stress model for depression: the interaction of schema self‐structures and negative life events

This study tested the diathesis‐stress component of Beck's (1967) cognitive theory of depression. Initially, participants completed measures assessing cognitive organization of the self‐schema and depressive symptoms. One year later, participants completed measures assessing cognitive organization of the self‐schema, depressive symptoms, and negative life events. Hierarchical multiple regression analyses, controlling for initial depression, indicated that more tightly interconnected negative content was associated with greater elevations in depressive symptoms following the occurrence of life events. More diffusely interconnected positive content for interpersonal self‐referent information also interacted with life events to predict depressive symptoms. Cognitive organization dimensions showed moderate to high stability across the follow‐up, suggesting that they may be trait‐like vulnerability factors. Implications for the cognitive vulnerability‐stress model of depression are discussed. © 2010 Wiley Periodicals, Inc. J Clin Psychol 66:1–17, 2010.     

Parenting style and obsessive‐compulsive symptoms and personality traits in a student sample

There is widespread acceptance of the idea that aspects of parenting such as overprotectiveness and perfectionism contribute to the pathogenesis of obsessive‐compulsive disorder (OCD). Less resolved is whether the important dimensions of parenting are overprotectiveness, lack of acceptance, authoritarian style, discouragement of risk‐taking, and/or induction of guilt. It is also unclear whether different parenting characteristics are associated with the development of symptoms of OCD, compared to the traits of obsessive‐compulsive personality disorder (OCPD). OCD symptoms and OC personality traits were measured in a non‐clinical, student sample and correlated with students' report of parents' acceptance, disciplinary firmness, and psychological control (a construct which included psychological manipulation and guilt‐induction). Following the literature on both clinical and subclinical OCD and OCPD, we predicted that all three scales would correlate with OCD symptoms and OCPD traits. Stepwise regression analysis revealed that psychological control was the unique predictor, controlling for depressive symptoms. Unexpectedly, a controlling parenting style was not selectively associated with classical OC symptoms or OC personality traits. Rather, psychological control was associated with a broad‐spectrum of anxiety and depressive symptoms which cut across diagnostic boundaries. Findings are generally compatible with a single underlying vulnerability to both OCD and OCPD, as well as generalized/social anxiety and depressive symptoms, which can be shaped by cultural and familial factors to a specific clinical presentation. Copyright © 2002 John Wiley & Sons, Ltd.     

Explaining depression symptoms in patients with social anxiety disorder: Do maladaptive metacognitive beliefs play a role?

Social anxiety disorder (SAD) is a major risk factor for developing symptoms of depression. Severity of social anxiety has previously been identified as a risk factor, and cognitive models emphasize dysfunctional schemas and self‐processing as the key vulnerability factors underlying general distress in SAD. However, in the metacognitive model, depressive and other symptoms are related to metacognitive beliefs. The aim of this study was therefore to test the relative contribution of metacognitions when controlling for SAD severity and factors postulated in cognitive models. In a cross‐sectional design, 102 patients diagnosed with primary SAD were included. We found that negative metacognitive beliefs concerning uncontrollability and danger and low confidence in memory emerged as the only factors explaining depressive symptoms in the regression model, suggesting that metacognitive beliefs are associated with increased depressive symptoms in SAD patients.     

Individual differences in resting heart rate variability moderate thought suppression success

Individual differences in heart rate variability (HRV) at rest are thought to represent an individual's capacity for self‐regulation, but it remains unclear whether HRV predicts control over unwanted thoughts. The current study used a thought suppression paradigm in which participants recorded occurrences of a personally relevant intrusive thought over three monitoring periods. Among those instructed to suppress, higher levels of HRV were associated with greater declines in intrusions across the monitoring periods; no such relationship was found among those assigned to a control condition. Resting HRV also interacted with spontaneous thought suppression effort to predict intrusive thought frequency. In both cases, these HRV‐related differences in thought suppression success predicted the generalized distress symptoms common to depression and anxiety. These findings enhance understanding of the relationships between HRV and cognitive control and highlight how individual differences in self‐regulatory capacity impact thought suppression success and emotion regulation.     

A systematic review of the clinical utility of the concept of self‐disgust

This systematic literature review examined the clinical utility of the construct of self‐disgust in understanding mental distress. Specifically, the review assessed whether there is a shared conceptual definition of self‐disgust, the face and construct validity of the quantitative assessment measures of self‐disgust, and the predictive validity of self‐disgust in formulating the development of a range of psychological difficulties. A systematic database search supplemented by manual searches of references and citations identified 31 relevant papers (27 quantitative, 3 qualitative, and 1 mixed). Analysis of qualitative papers indicated a number of shared features in the definition of self‐disgust, including a visceral sense of self‐elicited nausea accompanied by social withdrawal and attempts at cleansing or suppressing aspects of the self. Quantitative assessment measures appeared to capture these dimensions and evidenced good psychometric properties, although some measures may have only partially captured the full self‐disgust construct. Strong relationships were observed between self‐disgust and a range of mental health presentations, in particular, depression, body‐image difficulties, and trauma‐related difficulties. However, these relationships are smaller when the effects of other negative self‐referential emotions were controlled, and stronger conclusions about the predictive validity of self‐disgust are limited by the cross‐sectional nature of many of the studies.     

Self‐management training for people with chronic disease: An exploratory study

Objective: To determine the effectiveness of a community‐based Chronic Disease Self‐management Course (CDC) for UK participants with a range of chronic diseases. Design: The study was a multiple baseline, pre‐test post test design with a sample of 185 participants who attended a CDC delivered in community settings by lay tutors, in the UK. Method: Data were collected by self‐completed questionnaires before attendance and at four‐month follow‐up. Results: The sample comprised 72% women (mean age = 53 years, mean disease duration = 16 years). The main chronic diseases included endometriosis, depression, diabetes, myalgic encephalomyelitis, osteoporosis and polio. Adjusting for baseline values and gender, small to moderate increases were found on cognitive symptom management, self‐efficacy (disease and symptoms) and communication with physician. A similar sized decrease was found on fatigue, and small decreases were evident on anxious and depressed moods, and health distress. There were no changes in the use of health care resources, or on self‐reported exercise behaviour. Conclusion: The results of this exploratory study suggest that self‐management training for people with chronic diseases can offer benefits in terms of enhanced self‐efficacy, greater use of cognitive behavioural techniques, and improvement in some aspects of physical and psychological well‐being.     

A validity and reliability study of the coping self‐efficacy scale

Objectives. Investigate the psychometric characteristics of the coping self‐efficacy (CSE) scale, a 26‐item measure of one's confidence in performing coping behaviors when faced with life challenges. Design. Data came from two randomized clinical trials (N1 = 149, N2 = 199) evaluating a theory‐based Coping Effectiveness Training (CET) intervention in reducing psychological distress and increasing positive mood in persons coping with chronic illness. Methods. The 348 participants were HIV‐seropositive men with depressed mood who have sex with men. Participants were randomly assigned to intervention and comparison conditions and assessed pre‐ and post‐intervention. Outcome variables included the CSE scale, ways of coping, and measures of social support and psychological distress and well‐being. Results. Exploratory (EFA) and confirmatory factor analyses (CFA) revealed a 13‐item reduced form of the CSE scale with three factors: Use problem‐focused coping (6 items, α = .91), stop unpleasant emotions and thoughts (4 items, α = .91), and get support from friends and family (3 items, α = .80). Internal consistency and test–retest reliability are strong for all three factors. Concurrent validity analyses showed these factors assess self‐efficacy for different types of coping. Predictive validity analyses showed that residualized change scores in using problem‐ and emotion‐focused coping skills were predictive of reduced psychological distress and increased psychological well‐being over time. Conclusions. The CSE scale provides a measure of a person's perceived ability to cope effectively with life challenges, as well as a way to assess changes in CSE over time in intervention research.     

Environmental Factors in Obsessive-Compulsive Behavior: Evidence from Discordant and Concordant Monozygotic Twins

To investigate environmental factors that protect against or exacerbate obsessive-compulsive (OC) symptoms, we selected 25 monozygotic (MZ) twin pairs discordant, 17 MZ twin pairs concordant high and 34 MZ pairs concordant low on OC symptoms from a large longitudinal Dutch sample of adult twin pairs and their family members, applying stringent criteria for OC symptomatology. Data were collected on psychopathology, family structure, health, lifestyle, birth complications and life events. Unique environmental factors were studied using within-discordant MZ pair comparisons, whereas between-concordant MZ pair comparisons were used to study environmental factors that are shared by the twins of an MZ pair. The high-scoring MZ twins of the discordant group reported more life events (especially sexual abuse) than their low-scoring twin-siblings. The between-pair comparisons showed lower birth weight in the discordant MZ pairs than in the concordant MZ pairs. Further, the concordant high MZ pairs as well as their spouses had a lower educational level than the two other groups. On scale scores of anxious-depression, neuroticism, and somatic complaints, concordant high MZ pairs showed highest scores, and the discordant MZ pairs scored intermediate, except for neuroticism, on which the high-scoring twins of discordant MZ pairs were equal to the concordant high pairs. Discordance on psychological scale scores between the concordant MZ pairs was evident from 1991 onward, and within the discordant MZ pairs from 1997 onward, confirming previous reports of an association of early-onset OC symptoms with higher genetic load. Parent scores of OC symptoms and anxious-depression suggested intermediate genetic load in the discordant MZ group. In conclusion, this study reports on both unique and shared environmental factors associated with OC symptomatology. Whether these factors operate in addition to or in interaction with genetic disposition is to be elucidated in future studies. Edited by Tatiana Foroud.     

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.     

Dimensions and profiles of the generalized health‐related self‐concept

Objectives We explore the significance of health as a potentially self‐relevant category from the perspective of dynamic self‐concept theory. Our intention was to describe the dimensional structure of the generalized health‐related self‐concept, to identify particular prototypes of health‐related self‐definition, and to see if these prototypes would differ with respect to appraisals of health behaviour and subjective health. Design We conducted a cross‐sectional questionnaire study involving 545 college students (23.3% male) at the mean age of 22 years. Methods The self‐administered questionnaire assessed a relevant spectrum of health‐related cognitions denoting their generalized declarative knowledge about their health (the generalized health‐related self‐concept). Additionally, participants rated their multiple health behaviour, their perceived health, and their anticipated vulnerability. Results A principal components analysis of the health‐related cognitions revealed the following five dimensions: health‐protective dispositions, health‐protective motivation, vulnerability, health‐risky habits, and external, avoidant motivation. A two‐step cluster analysis of the five components identified six profiles of health‐related self‐concept: careless/carefree, omnipotents, risk‐takers, mentally affected, reluctant‐avoidant, and medically fragile. These prototypes could be successfully reclassified (97.6%). The six profiles differed with respect to their health behaviour and subjective health appraisals. Conclusions The dimensional structure represents both resources and deficits with respect to an individual's health‐related self‐concept. An individual's profile of these dimensions might correspond to a characteristic set of particular health needs and motivations. Successful health communications should follow a complementary strategy of affirming the self‐concept.     

Psychological factors that may confer risk for bipolar disorder

Several psychological domains may be dysfunctional in people with bipolar disorder (BD). When dysfunction occurs prior to onset of mood symptoms, it may signify risk for onset of the full syndrome of illness. Among these domains, cognitive dysfunction has received considerable attention as a possible endophenotype for BD, with some suggestion that changes in cognitive function may antedate onset of mood symptoms in individuals at risk for BD. Domains of social cognition, including emotion comprehension, theory of mind, and empathy, along with autobiographical memory, represent understudied aspects of psychological function that may be dysfunctional in people with BD. Temperament and personality factors, such as ruminative tendencies and neuroticism, may also leave some people vulnerable to mood instability. This review summarises the evidence for dysfunction in each of these domains for people with BD and examines whether there is any evidence that this dysfunction antedates the onset of mood symptoms or confers risk for illness.     

Sleep and its associations with perceived and objective cognitive impairment in individuals with multiple sclerosis

Problems with sleep and cognitive impairment are common among people with multiple sclerosis (MS). The present study examined the relationship between self‐reported sleep and both objective and perceived cognitive impairment in MS. Data were obtained from the baseline assessment of a multi‐centre intervention trial (NCT00841321). Participants were 121 individuals with MS. Nearly half (49%) of participants met the criteria for objective cognitive impairment; however, cognitively impaired and unimpaired participants did not differ on any self‐reported sleep measures. Nearly two‐thirds (65%) of participants met the criteria for ‘poor’ sleep, and poorer sleep was significantly associated with greater levels of perceived cognitive impairment. Moreover, the relationships between self‐reported sleep and perceived cognitive impairment were significant beyond the influence of clinical and demographic factors known to influence sleep and cognitive functioning (e.g. age, sex, education level, disability severity, type of MS, disease duration, depression and fatigue). However, self‐reported sleep was not associated with any measures of objective cognitive impairment. Among different types of perceived cognitive impairment, poor self‐reported sleep was most commonly related to worse perceived executive function (e.g. planning/organization) and prospective memory. Results from the present study emphasize that self‐reported sleep is significantly and independently related to perceived cognitive impairment in MS. In terms of clinical implications, interventions focused on improving sleep may help improve perceived cognitive function and quality of life in this population; however, the impact of improved sleep on objective cognitive function requires further investigation.     

Description of women's personality traits and psychological vulnerability prior to choosing hormone replacement therapy

INTRODUCTION: Data suggest that women using hormone replacement therapy (HRT) represent a special subgroup of the general population regarding, for instance, cardiovascular risk factors and education. OBJECTIVE: To analyse if women who choose HRT are characterised a priori by high neuroticism score or by psychological vulnerability. DESIGN: A prospective population-based study was initiated in 1976 with follow-ups in 1981, 1987 and 1996. The population comprises a random sample of 621 women born in 1936 and living in the county of Copenhagen. STUDY METHODS: The analyses are based on data on two sub-cohorts of 268 and 235 women from the large population-based study. These subgroups consist of the women participating in both baselines at 40 and 45 years respectively and at follow-up in 1996. At the age of 40 the women participated in a comprehensive examination, which apart from baseline characteristics included Eysencks personality questionnaire concerning intro/extroversion and neuroticism. At the age of 45, the re-examination of the women included a test for psychological vulnerability. The participants reported whether or not they used HRT at the age of 40, 45, 51 and 60 years. The analyses comprised "never users" of HRT and "future users", defined as women who started HRT subsequent to baseline registration during the observation period. The groups were compared by multivariate statistical methods to adjust for confounding factors. RESULTS: Women with high neuroticism score at the age of 40 were more likely to become users of HRT in the future compared to women with low neuroticism score. At the age of 45, psychologically vulnerable women were more likely to become users of HRT in the future compared to non-vulnerable women. The associations became insignificant when correcting for potential confounders. The study suggests that selection bias among women choosing HRT may also include personality traits.     

Predictors of change in anxiety symptoms of older persons: results from the Longitudinal Aging Study Amsterdam

BACKGROUND: Data on the course of anxiety in late life are scarce. The present study sets out to investigate the course of anxiety, as measured by the HADS-A (Zigmond & Snaith, 1983) in community dwelling older persons, and to evaluate predictive factors for change over 3 years in anxiety symptoms following the vulnerability/stress model. METHOD: Based on the first anxiety assessment, two cohorts were formed: subjects with and subjects without anxiety symptoms. In the non-anxious cohort (N = 1602) we studied risk factors for the development of anxiety symptoms; in the anxious cohort (N = 563) the same factors were evaluated on their predictive value for restitution of symptoms. Risk factors included vulnerability factors (demographics, health status, personality characteristics and social resources) and stressors (life events occurring in between both anxiety assessments). Logistic regression models estimated the effects of vulnerability factors, stress and their interaction on the likelihood of becoming anxious and chronicity of anxiety symptoms. RESULTS: It was indicated that the best predictors for becoming anxious were being female, high neuroticism, hearing/eyesight problems and life-events. Female sex and neuroticism also increased the likelihood of chronicity of anxiety symptoms in older adults, but life events were not related to chronicity. The main stressful event in late life associated with anxiety was death of one's partner. Vulnerability factors and stress added on to each other rather than their interaction being associated with development or chronicity of anxiety. CONCLUSION: The vulnerability/stress model offers a useful framework for organizing risk factors for development and chronicity of anxiety symptoms in older persons, but no support was attained for the hypothesis that vulnerability and stress amplify each others effects. Finally, the results indicate to whom preventive efforts should be directed: persons high in neuroticism, women, and those who experience distressing life events.     

Cognitive correlates of mania risk: are responses to success,positive moods,and manic symptoms distinct or overlapping?

Several measures of cognitive style have been shown to be elevated among persons diagnosed with bipolar disorder and those at risk for bipolar disorder. Several of these scales capture responses to positive affect, success, and hypomanic symptoms. We had two goals: (a) to use factor analyses to assess whether the constructs within these scales were statistically independent and (b) to examine whether the factors identified uniquely related to mania risk. A cross‐national sample of 638 participants completed measures of cognitive style, including the Responses to Positive Affect scale, the Positive Overgeneralization Scale, and the Hypomanic Interpretations Questionnaire. To assess whether these measures might simply reflect more impulsive reactions to positive mood states, participants also completed the Barratt Impulsivity Scale. To measure risk of mania, participants completed the Hypomanic Personality Scale (HPS). Factor analyses suggested seven factors of cognitive style and impulsivity. Four factors uniquely correlated with HPS. That is, risk for mania related to higher scores on separable factors of acting before thinking, being overly positive in interpreting manic symptoms, being overly confident in response to success, and tendencies to dampen positive affect. Current findings suggest the need to consider multifaceted aspects of cognition in refining psychological treatments of bipolar disorder. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65:1–15, 2009.     

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.     

Cognitive adaptation: A comparison of cancer patients and healthy references

Objectives: Taylor's theory of cognitive adaptation proposes that adjustment depends on the ability to sustain and modify illusions (i.e. unrealistic optimism, exaggerated perceptions of control, and self‐aggrandizement) that buffer against threats but also against possible future setbacks. Because the question of whether cancer patients show these illusions has received little attention, the present study compared patients' perceptions of optimism, control, and self‐esteem at different stages of the cancer process with that of healthy references. The effects of these perceptions on psychological distress were also assessed. Design: The present study has a longitudinal design. Including a group of healthy references enabled us to draw more firm conclusions about the effect of cancer upon cognitive perceptions. Methods: The participants were 67 cancer patients and 50 healthy references. Patients filled out questionnaires prior to their first radiotherapy (T1), at 2 weeks (T2), and at 3 months (T3) after completing radiotherapy. Healthy references were assessed at similar intervals. Results: T tests revealed that patients experienced significantly higher levels of optimism and self‐esteem than the healthy reference group. Concerning control, no group differences were found. Importantly, regression analyses showed that lower levels of optimism and control at T1 were predictive of feelings of anxiety at T3. Lower perceived control also predicted depressive symptoms. Conclusion: Results support the theory of cognitive adaptation in that patients are indeed able to respond to cancer with high levels of optimism and self‐esteem and that lower levels of optimism and control are predictive of psychological distress.     

Empirically Supported Forensic Assessment

The field of Forensic Psychology has greatly expanded over the past several decades, including the use of psychological assessment in addressing forensic issues. A number of surveys have been conducted regarding the tests used commonly by forensic psychologists. These surveys show that while tests specifically designed to address forensic issues have proliferated, traditional clinical assessment tests continue to play a crucial role in many forensic evaluations. The current article identifies some of the most salient characteristics of empirically supported forensic tests and provides examples of tests felt to meet each of these five criteria. These criteria include adequate standardization, acceptable reliability and validity, general acceptance within the community of forensic evaluators, availability of test data from cross‐cultural and cross‐ethnic samples, and comparison data relevant to specific forensic populations. Although the guidelines provided in this article provide a helpful framework for evaluating the usefulness of forensic tests, the establishment of a national review panel or workgroup to address this issue would be highly useful, particularly in the potential controversial task of identifying those tests that meet reasonable guidelines to be identified as empirically supported forensic assessment instruments.