The Negative Core Beliefs Inventory: Development and Psychometric Properties.

Although the core belief construct is central in A. T. Beck's cognitive theory, little empirical research has been conducted to date to establish its psychometric properties as well as the way it explains manifestations of psychopathology. The aims of this study were to develop and provide the first evidence of validity and reliability of a new measure of core beliefs that quantifies negative core beliefs about the self (nCB-S) and negative core beliefs about others (nCB-O). Results indicated that this measure has adequate internal consistency and test-retest reliability. Factor analyses confirmed that nCB-S and nCB-O fall on separate dimensions, and they provided preliminary evidence that nCB-S can be separated further into (a) helplessness/inferiority, (b) helplessness/vulnerability, (c) unlovability, and (d) worthlessness. Consistent with expectations, the scores on the nCB-S and nCB-O scales correlated positively with reports of negative experiences in childhood, attachment styles, anxiety, and depression. These preliminary results suggest that core beliefs can be measured in a reliable and valid manner and that the instrument proposed in this article can be used in studies designed to validate aspects of A. T. Beck's cognitive theory.

Cognitive behavioral therapy for pregnancy loss.

Cognitive-behavioral therapy (CBT) is a system of psychotherapy in which an individualized case formulation drives the strategic delivery of therapeutic interventions that target cognition, emotion, behavior, and the therapeutic relationship. It has the potential to be effective for women who have experienced pregnancy loss, as pregnancy loss often carries profound meaning that disrupts many layers of a woman's belief system, and the associated emotional consequences cannot always be managed using their typical repertoire of coping skills. The distinctive features of CBT are described, as well as 3 typical intervention strategies (i.e., behavioral activation, cognitive restructuring, and mindfulness and acceptance) that are often delivered during the course of CBT with patients who have experienced pregnancy loss. Throughout the article, emphasis is placed on balancing attention to the therapeutic relationship and affective experiencing with the implementation of cognitive and behavioral change strategies. (PsycINFO Database Record

Basic Strategies of Cognitive Behavioral Therapy.

Cognitive behavioral therapy's main strategies are active, problem-focused, and collaborative. Cognitive restructuring is a strategy in which clinicians help patients to identify, evaluate, and modify inaccurate or otherwise unhelpful thinking associated with emotional distress. Behavioral activation provides a framework for patients, particularly those who are depressed, to increase engagement in activities that provide a sense of accomplishment or pleasure. The goal of exposure is for anxious patients to experience an extinction of fear by having planned contact with feared stimuli and situations. Problem solving allows patients to systematically approach and address their life problems by using cognitive and behavioral techniques.

Principles of Supportive Psychotherapy for Perinatal Distress.

Although interpersonal psychotherapy and cognitive behavioral therapy have demonstrated efficacy in the treatment of perinatal distress, supportive psychotherapy has not been as widely studied by researchers. However, the principles of supportive psychotherapy are essential in the treatment of perinatal distress. The purpose of this article is to show that supportive psychotherapy is a plausible intervention that nurses and other maternity care providers can use with women who experience anxiety and depression in the perinatal period.

Depression and Anxiety During Pregnancy: Evaluating the Literature in Support of Clinical Risk-Benefit Decision-Making.

Depression and anxiety during pregnancy are common, and patients and providers are faced with complex decisions regarding various treatment modalities. A structured discussion of the risks and benefits of options with the patient and her support team is recommended to facilitate the decision-making process. This clinically focused review, with emphasis on the last 3 years of published study data, evaluates the major risk categories of medication treatments, namely pregnancy loss, physical malformations, growth impairment, behavioral teratogenicity, and neonatal toxicity. Nonpharmacological treatment options, including neuromodulation and psychotherapy, are also briefly reviewed. Specific recommendations, drawn from the literature and the authors' clinical experience, are also offered to help guide the clinician in decision-making.

Evaluation of the Psychometric Properties of the Cognitive Distortions Questionnaire (CD-Quest) in a Sample of Undergraduate Students.

OBJECTIVE: The aim of the study was to assess the initial psychometric properties of the Cognitive Distortions Questionnaire (CD-Quest) in its Brazilian Portuguese version tested in adult undergraduate students. METHODS: Brazilian undergraduate medical and psychology students comprising the sample (n=184) completed the following measures: Cognitive Distortions Questionnaire, Beck Depression Inventory and Beck Anxiety Inventory. These self-report instruments were administered collectively in classrooms. RESULTS: The Cognitive Distortions Questionnaire showed adequate internal consistency (Cronbach's alpha=0.85) and concurrent validity with Beck Depression Inventory (r=0.65, p<0.001) and Beck Anxiety Inventory (r=0.52, p<0.001). Furthermore, it was able to discriminate between groups possessing depressive (Beck Depression Inventory composite score ≥12) and anxious (Beck Anxiety Inventory composite score ≥ 11) indicators from those not possessing them (p<0.001). Principal components showed the measure was unidimensional, and it explained about 29 percent of the data variance. A confirmatory factor analysis showed that all the regression coefficients are greater than or equal to 0.40 CONCLUSION: The original Brazilian version of the Cognitive Distortions Questionnaire is adequate for use in the context of national undergraduate students and is able to separate different cognitive distortions. However, further studies using clinical samples are needed.

The Postpartum Worry Scale-Revised: continuing validation with a sample of NICU mothers.

This study represents the second validation phase of the Postpartum Worry Scale-Revised (PWS-R). As the PWS-R includes items tapping infant health and development concerns, we compare its psychometric properties with a sample of NICU mothers and the online sample used in the initial validation. We conduct a confirmatory factor analysis (CFA) to fit the latent factor structure previously validated with the online sample to the NICU sample. We also examine the reliability and construct validity of the PWS-R when used with a NICU sample. The PWS-R's reliability remains good and moderate concurrent correlations with theoretically similar constructs are shown with the newly created PWS-R factors. Model testing with the NICU sample reveals a different three factor structure than the four factor structure previously revealed with the online sample. The psychometric findings for the PWS-R provide continuing support for its use as a measure of postpartum worry; however, the differences in factor structure suggest that the PWS-R scores of high risk samples such as NICU parents should not be compared to those of community samples. Next steps in the iterative validation process and recommendations for use are considered, particularly with regard to high-risk samples.

Cognitive Distortions and Suicide Attempts.

Although theorists have posited that suicidal individuals are more likely than non-suicidal individuals to experience cognitive distortions, little empirical work has examined whether those who recently attempted suicide are more likely to engage in cognitive distortions than those who have not recently attempted suicide. In the present study, 111 participants who attempted suicide in the 30 days prior to participation and 57 psychiatric control participants completed measures of cognitive distortions, depression, and hopelessness. Findings support the hypothesis that individuals who recently attempted suicide are more likely than psychiatric controls to experience cognitive distortions, even when controlling for depression and hopelessness. Fortune telling was the only cognitive distortion uniquely associated with suicide attempt status. However, fortune telling was no longer significantly associated with suicide attempt status when controlling for hopelessness. Findings underscore the importance of directly targeting cognitive distortions when treating individuals at risk for suicide.

The Postpartum Worry Scale-Revised: an initial validation of a measure of postpartum worry.

Postpartum anxiety is a condition of concern due to associated difficulties for the mother, her relationships, and her infant's development. We revised one measure of postpartum anxiety symptoms, the Postpartum Worry Scale (PWS) to include items that tap concerns related to infant health and development, important potential domains of postpartum worry. This study presents the initial phase of validation for the PWS-R. An online sample of 1,231 mothers of infants ages birth to 24 months completed the PWS-R as well as a battery of measures. We conducted a split-sample confirmatory factor analysis (CFA) to assess the latent factor structure, and a series of models were tested to refine the measure. The newly constructed factors were correlated with theoretically similar measures to test the construct validity. Initial model testing revealed a four-factor structure (i.e., Relationships, Household, Time Allocations, and Health and Development) that included 13 items. Two-group CFA confirmed the latent factor structure. Theoretically similar measures correlated moderately with the newly created PWS-R factors. The psychometric findings for the PWS-R provide preliminary support for its use as a measure of postpartum worry. Next steps in the iterative validation process are considered. Recommendations for the PWS-R's use in clinical and research contexts are discussed.

Amygdalar volume in borderline personality disorder with and without comorbid post-traumatic stress disorder: a meta-analysis.

INTRODUCTION: Four studies have found a smaller amygdalar volume in patients with borderline personality disorder (BPD) relative to controls, whereas four other studies have found similar amygdalar volume in BPD patients relative to controls. This study aims to compare amygdalar volumes of BPD patients with controls, and also to compare BPD patients with and without post-traumatic stress disorder (PTSD) with controls in order to determine whether PTSD can explain the heterogeneity of findings. METHOD: Systematic review and meta-analysis of magnetic resonance imaging studies that measured amygdalar volumes in BPD patients and healthy controls. FINDINGS: A significant reduction of amygdalar volumes in BPD patients was confirmed (p < .001). However, data from the studies that discriminated BPD patients with and without PTSD indicated that amygdalar volumes were significantly smaller in BPD patients without PTSD relative to controls (left: p = .02; right: p = .05), but not in BPD patients with PTSD relative to controls (left: p = .08; right: p = .20). CONCLUSION: This meta-analysis suggests that amygdalar volumes are reduced in patients with BPD. This pattern is confirmed in BPD patients without PTSD, but not in BPD patients with PTSD, raising the possibility that reduced amygdalar volume in BPD patients cannot be explained by comorbid PTSD.

Characteristics of individuals who make impulsive suicide attempts.

BACKGROUND: Previous research has identified only a few variables that have been associated with making an impulsive suicide attempt. The aim of the current study was to compare individuals who made an impulsive suicide attempt with those who made a premeditated attempt on both previously examined and novel characteristics. METHOD: Participants were classified as making an impulsive or premeditated attempt based on the Suicide Intent Scale (Beck et al., 1974a) and were compared on a number of characteristics relevant to suicidality, psychiatric history, and demographics. RESULTS: Individuals who made an impulsive attempt expected that their attempts would be less lethal; yet the actual lethality of both groups' attempts was similar. Those who made an impulsive attempt were less depressed and hopeless than those who made a premeditated attempt. Participants who made an impulsive attempt were less likely to report a history of childhood sexual abuse and more likely to be diagnosed with an alcohol use disorder than those who made a premeditated attempt. LIMITATIONS: Although the sample size was adequate for bivariate statistics, future studies using larger sample sizes will allow for multivariate analyses of characteristics that differentiate individuals who make impulsive and premeditated attempts. CONCLUSIONS: Clinicians should not minimize the significance of impulsive attempts, as they are associated with a similar level of lethality as premeditated attempts. Focusing mainly on depression and hopelessness as indicators of suicide risk has the potential to under-identify those who are at risk for making impulsive attempts.

Predictors of suicide relative to other deaths in patients with suicide attempts and suicide ideation: a 30-year prospective study.

BACKGROUND: Although there is a large literature that prospectively examines predictors of suicide, low base rates of suicide and imprecision of measurement hinder definitive conclusions from being drawn. METHOD: This study examined predictors of suicide relative to other types of death in a sample of 297 patients who had been hospitalized for suicide ideation or a suicide attempt between 1970 and 1975 and who were confirmed dead in 2005. Many predictors were measured using well-validated assessment instruments. RESULTS: Fifty-five patients had died by suicide. Univariate predictors of an increased risk for eventual suicide included younger age, completion of at least a high school degree, a diagnosis of a psychotic disorder, taking active precautions against discovery during the attempt, and a non-zero score on the suicide item of the Beck Depression Inventory, whereas African American ethnicity was associated with a decreased risk of eventual suicide. Variables that remained significant in a multivariate analysis included younger age, African American ethnicity, and taking active precautions against discovery during the attempt. Risk factors did not vary as a function of whether eventual suicide occurred less than or more than five years after the initial evaluation or by attempter v. ideator status. LIMITATIONS: Despite the attempt to maximize statistical power by following a high-risk sample for 30 years, the number of deaths by suicide was still relatively low. CONCLUSIONS: Taking active precautions against discovery of a suicide attempt has the potential to be an important predictor of eventual suicide and should be assessed by clinicians. Future prospective studies should assess predictors at multiple time points to gain a richer clinical picture of the circumstances surrounding deaths by suicide.

Development of a brief measure of postpartum distress.

BACKGROUND: Previous measures of postpartum distress have focused on depressed mood despite evidence that postpartum anxiety is just as prevalent. The purpose of this study was to develop a new, brief screening measure to identify postpartum distress, defined as symptoms of depression and anxiety. METHODS: In Study 1, potential items were assembled focusing on depressed mood and a variety of anxiety domains to develop a new postpartum distress scale. Women up to 12 months postpartum (n=289) completed the new scale items, the Edinburgh Postpartum Depression Scale (EPDS), and the Mood and Anxiety Symptom Questionnaire (MASQ) on the Internet. In Study 2, women up to 12 months postpartum (n=139) completed the new Postpartum Distress Measure (PDM), the EPDS, the Obsessive-Compulsive Inventory-Revised (OCI-R), and the Relationship Assessment Scale (RAS) to validate the new measure. RESULTS: Data from Study 1 yielded a two-factor solution, and 10 items were selected for the new PDM. Six items were chosen for the PDM general distress scale, and four items for the PDM obsessive-compulsive scale. Data from Study 2 again yielded a two-factor solution, supporting both the general distress and obsessive-compulsive components. Psychometric data suggested that the measure had adequate internal consistency and construct validity. CONCLUSIONS: The 10-item PDM comprises general distress and obsessive-compulsive factors that were obtained from a wider pool of depressive and anxiety items. These data suggest that the PDM may be a helpful tool in identifying a broader range of postpartum distress, including obsessive-compulsive symptoms that were formerly neglected in clinical screening measures. More studies are needed to confirm its clinical utility.

Integrating Motivational Interviewing and Self Determination Theory with Cognitive Behavioral Therapy to Prevent Suicide.

Cognitive Behavioral Therapy (CBT) has been found to be effective in preventing suicide-related behavior. However, it is often difficult to engage patients who are at-risk in treatment. Motivational Interviewing (MI) has been shown to increase treatment engagement and improve treatment outcomes when it is used to complement other treatments. As a general theory of human motivation that is consistent with MI, Self-Determination Theory (SDT) provides a framework for understanding how MI may be added to CBT to increase treatment engagement and effectiveness. In this paper, we use SDT to explain how MI may complement CBT to reduce suicide-related behavior, provide a case example of using MI with a suicidal patient before CBT-based treatment, and explore future directions for research.

White matter hyperintensities and their association with suicidality in major affective disorders: a meta-analysis of magnetic resonance imaging studies.

INTRODUCTION: Individuals who have deep and periventricular white matter hyperintensities may have a higher risk for suicidal behavior. There are mixed results in the literature regarding whether unipolar or bipolar patients who have attempted suicide have more deep white matter hyperintensities (DWMH) or periventricular hyperintensities (PVH) relative to those who have no history of suicide attempts. METHODS: A meta-analysis of studies examining white matter hyperintensities (WMH) in mood disorder patients with and without a history of suicide attempts was performed. RESULTS: Four studies, including a total of 173 patients who attempted suicide and 183 who did not attempt suicide, were included. A significantly higher number of attempters were found to have WMH than non-attempters. Unipolar depressed patients who had attempted suicide had 1.9 times more DWMH and 2.1 times more PVH than those who did not. Bipolar patients who had attempted suicide had 5.4 times more PVH than those who had not. Taken together, unipolar and bipolar patients who had attempted suicide had 2.8 times more DWMH and 4.5 times more PVH than those who had never attempted suicide. CONCLUSION: These findings raise the possibility that WMH are biological substrates of symptoms that lead to suicidal behavior.

Suicide risk factors and mediators between childhood sexual abuse and suicide ideation among male and female suicide attempters.

The current study examined the manner in which childhood sexual abuse (CSA) history relates to risk factors for suicidal behavior among recent suicide attempters (n = 166). Men who recently attempted suicide and endorsed a CSA history had higher scores on measures of hopelessness and suicide ideation than men without a CSA history. Men with a CSA history were also more likely to have made multiple suicide attempts and meet diagnostic criteria for posttraumatic stress disorder and borderline personality disorder. In contrast, there were fewer group differences as a function of CSA history among the female suicide attempters. Hopelessness was a significant mediator between CSA history and suicide ideation in both men and women.

Volumes of the hippocampus and amygdala in patients with borderline personality disorder: a meta-analysis.

Individuals with borderline personality disorder (BPD) often exhibit impulsive and aggressive behavior. The hippocampus and amygdala form part of the limbic system, which plays a central role in controlling such expressions of emotional reactivity. There are mixed results in the literature regarding whether patients with BPD have smaller hippocampal and amygdalar volume relative to healthy controls. To clarify the precise nature of these mixed results, we performed a meta-analysis to aggregate data on the size of the hippocampus and amygdala in patients with BPD. Seven publications involving six studies and a total of 104 patients with BPD and 122 healthy controls were included. A significantly smaller volume was found in both the right and left hippocampi and amygdala of patients with BPD compared to healthy controls. These findings raise the possibility that reduced hippocampal and amygdalar volumes are biological substrates of some symptoms of BPD.

Candidate endophenotypes for genetic studies of suicidal behavior.

Twin, adoption, and family studies have established the heritability of suicide attempts and suicide. Identifying specific suicide diathesis-related genes has proven more difficult. As with psychiatric disorders in general, methodological difficulties include complexity of the phenotype for suicidal behavior and distinguishing suicide diathesis-related genes from genes associated with mood disorders and other suicide-associated psychiatric illness. Adopting an endophenotype approach involving identification of genes associated with heritable intermediate phenotypes, including biological and/or behavioral markers more proximal to genes, is an approach being used for other psychiatric disorders. Therefore, a workshop convened by the American Foundation for Suicide Prevention, the Department of Psychiatry at Columbia University, and the National Institute of Mental Health sought to identify potential target endophenotypes for genetic studies of suicidal behavior. The most promising endophenotypes were trait aggression/impulsivity, early-onset major depression, neurocognitive function, and cortisol social stress response. Other candidate endophenotypes requiring further investigation include serotonergic neurotransmission, second messenger systems, and borderline personality disorder traits.