Painfully reassuring? The effects of validation on emotions and adherence in a pain test.

Communicating reassurance to patients with musculoskeletal pain complaints, but no red flags, presents a dilemma of dampening worry while refraining from reinforcing undue pain behaviors. Previous research shows that reassurance does not decrease negative affect and may be perceived as not taking the symptoms seriously. Validation offers an alternative where the patient's experiences and feelings are acknowledged and has demonstrated, for other problems, a decrease in arousal which may set the stage for behavioral change. The purpose of this study was to investigate experimentally whether validation, as compared to invalidation, impacts on emotions and adherence during repeated pain tests. To this end, 50 participants were randomized to either a validation or invalidation condition. Each participant was told they would undergo four pain trials involving holding a bucket at arm's length to tolerance. During the inter-trial interval, the experimenter provided validating or invalidating responses according to the randomization. As a proxy measure of adherence subjects were asked to engage in an additional pain test. Results indicated that validation relative to invalidation resulted in significantly more positive affect and significantly less worry. Both groups had reductions in negative affect over the trials, but there were no difference between the groups on negative affect or pain. However, adherence was more than twice as high in the validation group as compared to invalidation. These results show that a relatively simple validation procedure had significant and positive effects on emotion and increased adherence. Further research should extend these findings and explore their clinical application.

Dialectical behavior therapy--family skills training.

Over the past three decades, family interventions have become important components of treatment for a number of psychiatric disorders. To date, however, there has been no family treatment designed specifically for borderline personality disorder patients and their relatives. This article describes one short-term family intervention called Dialectical Behavior Therapy-Family Skills Training. Based on Linehan's Dialectical Behavior Therapy (DBT), borderline patients' behavioral patterns are thought to result from a lifelong transaction between emotional vulnerability and invalidating features of the social and familial environment. Individual DBT focuses on reducing individual emotion dysregulation and vulnerability and enhancing individual stability. The complementary family interventions proposed in this article aim to: 1) provide all family members an understanding of borderline behavioral patterns in a clear, nonjudgmental way; 2) enhance the contributions of all family members to a mutually validating environment; and 3) address all family members' emotion regulation and interpersonal skills deficits.

Causes and consequences: individual distress in the context of couple interactions.

The covarying relationship between individual distress and couple interactions provides justification for developing a system to classify couple interactional behaviors. This system is proposed as an alternative to the Diagnostic and Statistical Manual of Mental Disorders (e.g., 4th ed.; DSM-IV; American Psychiatric Association, 1994) system, whose problems include reliance on linear models of causality, atheoretical classification of individual syndromes, and poor predictive validity and treatment utility. These difficulties may be resolved by using an alternative classification model of couple interactions, at least for many distressed individuals and couples. An example of a model for classifying couple interactions (including distressed individual behavior) is presented. The potential benefits of theoretical consistency, implied treatment-matching strategies, increased predictive validity and enhanced treatment utility of such an alternative classification system are discussed, along with guidelines for the further development and testing of couple interaction classification alternatives to the DSM nosology.

Couple therapy as a treatment for depression: II. The effects of relationship quality and therapy on depressive relapse.

This study investigated the effects of behavioral couple therapy, cognitive-behavioral therapy, and their combination on female depression 6 and 12 months after therapy ended. We predicted that couples receiving a behavioral couple treatment would be less likely to relapse than those receiving a cognitive-behavioral treatment for the depressed spouse alone. Relapse rates, however, did not discriminate between treatments at any follow-up point. Reductions in husband and wife dysphoria and increases in wife facilitative behavior during therapy predicted recovery. Moreover, high rates of husbands' facilitative behavior at posttest were associated with wife recovery and predicted low levels of depression at the 1-year follow-up.

Marital therapy as a treatment for depression.

The purpose of this study was to compare cognitive-behavioral therapy (CT; n = 20), behavioral marital therapy (BMT; n = 19), and a treatment combining BMT and CT (CO; n = 21) in the alleviation of wives' depression and the enhancement of marital satisfaction. BMT was less effective than CT for depression in maritally nondistressed couples, whereas for maritally distressed couples the two treatments were equally effective. BMT was the only treatment to have a significant positive impact on relationship satisfaction in distressed couples, whereas CO was the only treatment to enhance the marital satisfaction of nondistressed couples. On marital interaction measures CO was the only treatment to significantly reduce both husband and wife aversive behavior and to significantly increase wife facilitative behavior.

The effect of anticonvulsants on the dexamethasone suppression test.

Rates of non-suppression on the DST were compared in 19 psychiatric inpatients and anticonvulsants and 38 psychiatric inpatients not on anticonvulsants who were matched for age, sex, and diagnosis. Patients on anticonvulsants had a significantly higher rate of nonsuppression.

Family functioning and suicidal behavior in psychiatric inpatients with major depression.

Family functioning was compared between suicide-attempting and nonsuicidal depressed inpatients in order to further understand psychosocial determinants of suicidal behavior. Suicidal behavior was strongly associated with a discrepancy between the patient's perception of his/her family and the perception held by other family members. Suicide-attempting depressed inpatients perceived their family functioning to be worse than did their families. Suicidal patients also viewed their families more negatively than did depressed nonsuicidal inpatients, who actually viewed their family functioning more positively than did their family members. The clinical implications of these findings are discussed.

Consistency of pituitary-adrenocortical function across multiple psychiatric hospitalizations.

The dexamethasone suppression test (DST) was done in 53 psychiatric patients during at least two separate hospital admissions. The agreement between DST results on both admissions exceeded chance expectations: 69.8% of all patients and 72.3% of those with major depression had consistent DST results.