Cognitive behavior therapy for somatization disorder: a preliminary investigation.

Patients diagnosed with somatization disorder have high rates of disability and often prove refractory to treatment. This preliminary investigation examines the effect of a 10-session cognitive behavior therapy (CBT) protocol on the physical discomfort and disability of severely impaired somatizers. The severity of patients' physical discomfort and disability was assessed at baseline, post-treatment, and eight months following treatment. Patients reported significant improvement in symptomatology and physical functioning between baseline and post-treatment as well as between baseline and follow-up. The findings suggest that CBT might benefit patients diagnosed with somatization disorder and should be subjected to a controlled treatment trial.

The abused child as parent: the structure and content of physically abused mothers' perceptions of their babies.

OBJECTIVE: The major aim of the study was to provide an empirical answer to the following question: Does a mother's history of being physically abused as a child have a discernible impact on the structure and content of her perceptions and beliefs concerning her own child? METHOD: Free-response memories and current descriptions of babies, self, and significant others such as parents were compared longitudinally in two groups of mothers when their babies were 6 months, 1 year, and 2 years old. One group of mothers consisted of individuals who reported being physically abused as children; the control group consisted of mothers who were not physically abused. The two groups were comparable with respect to age of baby, race, and socioeconomic status. RESULTS: Abused mothers were found to differ significantly from control mothers in the structure and content of their free-response perceptions of their own babies. More specifically, abused mothers lagged behind controls in how well-differentiated were their negative perceptions of their babies. Differentiation in this study is operationally defined as the number of unique clusters that underlie a mother's perceptions of her baby, when social perception data is analyzed using cluster analysis (HICLAS). The greater the number of clusters observed, the greater is the differentiation. On the other hand, abused mothers were comparable to controls with respect to differentiation of positive perceptions of babies. CONCLUSIONS: The findings constitute a discovery about the structural organization of social cognition in mothers at-risk for child abuse. Implications of the findings for theory and future research are briefly discussed, as are limitations of the current study.

Self-complexity and the persistence of depression.

Self-complexity, a measure of the structure of cognition involving the self, was used to predict the persistence of depression in patients diagnosed with major depression. Self-descriptions offered by depressed patients were analyzed using a clustering algorithm to model cognitive structure. Indices of positive and negative self-complexity, derived from the resulting models, were used to predict depressive symptomatology 9 months after the onset of a major depression. Negative self-complexity uniquely predicted subsequent levels of depression even after the effects of initial levels of depression, self-evaluation, and dysfunctional attitudes were statistically removed. Highly complex negative self-representation appears to be associated with poor recovery from a major depressive episode. Future studies examining the relationship between cognition and psychopathology should investigate, in addition to its content, the formal and structural properties of cognition.

Possible selves in major depression.

Ratings of possible selves and resultant self-concept discrepancies were examined in 25 patients diagnosed with major depression and 25 control subjects. Self-concept discrepancies significantly discriminated patients from controls. The presence of negative features in the self-schema was a stronger indicator of depressive symptomatology than was the absence of positive self-appraisal. Depressives' future projections of self were less pessimistic than predicted by cognitive theories of depression.

Dimensions of self-concept: a comparison of heroin and cocaine addicts.

Two groups of drug users on an inner-city inpatient drug detoxification unit were studied: 42 heroin addicts and 47 cocaine addicts. The two groups were compared on personality disorder diagnoses, personality traits, and demographic variables. Cocaine and heroin addicts scored similarly on: 1) number and kind of personality disorder diagnoses, with the exception of antisocial personality; 2) all personality traits measured; 3) positive and negative temperament; 4) description of self-concepts; and 5) positivity and negativity of self-concepts. It was also found that heroin addicts showed significantly higher levels of social deviance than the cocaine group, with significantly more antisocial personality disorder diagnoses, higher levels of social deviance, and lower scores on a Propriety Scale. Character pathology was more heterogeneous among cocaine users. Heroin addicts had used significantly longer and showed less educational and occupational achievement than the cocaine group. Our results also suggest that personality psychopathology in drug addicts is associated with lower self-esteem, more negative self-valuation, and longer duration of use.

Self-complexity, self-evaluation, and depression: an examination of form and content within the self-schema.

Six studies examined the relationship between self-complexity and variables related to self-evaluation. Self-complexity was found to comprise two components: positive self-complexity and negative self-complexity. Positive self-complexity was sensitive to methodological factors, namely, variations in stimulus materials used for self-ratings. Negative self-complexity was relatively stable in the face of different rating stimuli and tasks and was related to trait measures of self-evaluation, psychic distress, and psychopathology. These findings were observed and replicated. Higher negative self-complexity was associated with increases in depression symptoms over time. Higher negative self-complexity also predicted a poorer prognosis and less complete recovery from depression in a clinical sample. Results are discussed in light of related research and possible social-cognitive mechanisms.

Bupropion/nortriptyline combination for refractory depression.

Many patients fail to respond to one or more trials with a single antidepressant. In such cases polypharmacy is often necessary and beneficial, although there may be an increased risk of complications. Four case reports are presented of patients with refractory depression treated successfully with the combination of the tricyclic antidepressant nortriptyline and the newer agent bupropion.

Stress management techniques: are they all equivalent, or do they have specific effects?

This article evaluates the hypothesis that various stress management techniques have specific effects. Studies comparing various techniques are reviewed, as well as previous literature reviews evaluating the effects of individual techniques. There is evidence that cognitively oriented methods have specific cognitive effects, that specific autonomic effects result from autonomically oriented methods, and that specific muscular effects are produced by muscularly oriented methods. Muscle relaxation and/or EMG biofeedback have greater muscular effects and smaller autonomic effects than finger temperature biofeedback and/or autogenic training. EMG biofeedback produces greater effects on particular muscular groups than progressive relaxation, and thermal biofeedback has greater finger temperature effects than autogenic training. Disorders with a predominant muscular component (e.g., tension headaches) are treated more effectively by muscularly oriented methods, while disorders in which autonomic dysfunction predominates (e.g., hypertension, migraine headaches) are more effectively treated by techniques with a strong autonomic component. Anxiety and phobias tend to be most effectively treated by methods with both strong cognitive and behavioral components.

Perception of self and other in major depression.

Previous research on the nature of person perception in depression has been inconclusive. This investigation differs from earlier studies in that extensive free-response descriptions of other people and self were collected from patients with major depression and from nonpsychiatric control Ss. In comparison with control Ss, depressed patients described fewer positive aspects not only of self but also of parents and significant others and reported more negative aspects of these people. Cluster analysis (HICLAS) also showed that more cognitive differentiation of negative self-perceptions (negative self-complexity) was characteristic of clinical depression. In both control Ss and patients, a positive (or negative) view of self was highly correlated (.85 or more) with a positive (or negative) view of parents and significant others. These correlations were significantly stronger than those between self and less important others.

Emotion differentiation. A correlate of symptom severity in major depression.

The relationship of emotion differentiation to symptom severity in depression was investigated. The subjects were 25 patients diagnosed with unipolar major depression. Subjects were clinically assessed using the Schedule for Affective Disorders and Schizophrenia and the Hamilton rating scales for anxiety and depression. In addition, subjects completed a number of self-report measures of symptoms and attitudes. Twelve basic emotion terms were incorporated into free-response attribute lists which subjects used to rate aspects of themselves and of other significant people in their lives. A clustering algorithm (HICLAS) was used to derive a social perception structure from this data for each subject. The differentiation of negative emotion within an individual's structure (NES) was measured by dividing the number of attribute categories containing negative emotions by the total number of categories in that person's structure. The results indicated that NES is a significant correlate of depressive symptomatology independent of self-esteem and other variables. Relatively undifferentiated emotion structure (low NES) was associated with significantly higher levels of depressive symptomatology.

Dimensions of war zone stress. An empirical analysis.

Responses of 142 Vietnam veterans on two frequently employed measures of combat stress were factor analyzed. Four factors emerged, each of which represented an aspect of participation in activities within the Vietnam war zone. One factor in particular, abusive violence, was significantly related to postservice problems of adjustment and was the most powerful predictor of a diagnosis of combat-related posttraumatic stress disorder. Our data suggest that unidimensional models of war zone stress that focus exclusively on exposure to life threat in combat situations are inadequate for characterizing important features of the Vietnam theater that are related to subsequent psychopathology.

Combat-related posttraumatic stress disorder. Patterns of symptomatology in help-seeking Vietnam veterans.

Sixty-one Vietnam veterans who had sought outpatient psychological services were evaluated for posttraumatic stress disorder (PTSD) during two independent diagnostic interviews. Data were analyzed from only those 48 subjects for whom the two diagnoses agreed upon the presence or absence of PTSD. Subjects were administered the Symptom Checklist-90-R, a modified version of the Impact of Event Scale, and two measures of combat stress: the Combat Scale Revised and the Vietnam Experience Scale. Some support was generated for the reliability and validity of the PTSD construct as outlined in DSM-III. In our sample the diagnosis of PTSD was associated with excessive arousal characterized by anxiety, anger, paranoid ideation, intrusive images, and avoidance of stimuli reminiscent of the traumatic stressor. The findings are discussed in relation to previous studies of combat-related PTSD and studies of traumatically stressed civilians.

Psychoanalysis and the hermeneutic turn: a critique of Narrative Truth and Historical Truth.

Through a discussion of Donald Spence's Narrative Truth and Historical Truth, a critical introduction to the hermeneutic or interpretive perspective is presented. Spence's book has generally been assumed to offer a hermeneutic reformulation of psychoanalysis. However, its presuppositions are incompatible with fundamental tenets of contemporary hermeneutic thought, as expressed in the philosophies of Heidegger, Gadamer, and the later Wittgenstein. Spence's basic assumptions are classically empiricist and positivistic. His vision of human experience is essentially associationistic and Humean; it treats experience as involving two processes, the passive reception of raw sense data and a subsequent projection of meaningful interpretation. Spence advocates the gathering of brute data while denying or downplaying the epistemological value of theorizing and of interpretive understandings. These assumptions are contrasted with those of the hemeneutic philosophers. Unlike these philosophers, Spence tends to dichotomize coherence and correspondence theories of truth. As a result, he wavers between relativism (regarding therapeutic interpretations) and objectivism (regarding scientific knowledge).

Gender differences in the relationship between hostility and the type A behavior pattern.

A group of 97 male and 111 female undergraduates completed the Jenkins Activity Survey, the Framingham Type A Scale, the Adjective Checklist Type A Scale, the Spielberger State-Trait Anxiety Inventory, and the Buss-Durkee Hostility Inventory. A factor analysis revealed three dimensions: Anger-Emotionality, Anger-Aggression, and Residual Pattern A. All Type A measures loaded highly on the Type A factor, with the Jenkins Activity Survey loading the highest. The Framingham Type A Scale was related to Anger-Emotionality, the Adjective Checklist Type A Scale was related to Anger-Aggression, and the Jenkins Activity Survey was related to neither of the anger dimensions. Women scored higher than men on Anger-Emotionality and the Guilt, Resentment, and Irritability subscales and lower than men on the Assaultiveness subscale. Women showed higher correlations between Type A and the Guilt subscale, and men between Type A and the Suspiciousness subscale. We conclude that Type A is a multidimensional construct that manifests itself differently in men and women.

Effect of meditation training on aspects of coronary-prone behavior.

52 undergraduates who had volunteered to receive meditation training were placed into either high or low time-urgency groups based on their scores on Factor S of the Jenkins Activity Survey. Subjects then either received training in Clinically Standardized Meditation followed by 3 1/2-wk. of practice or waited for training during that period. Analyses of scores on a time-estimation task and of self-reported hostility during an enforced waiting task indicated that meditation significantly altered subjects' perceptions of the passage of time and reduced impatience and hostility resulting from enforced waiting.