Biomedical subjects
C R Brewin
Publications and source records attributed to C R Brewin.
Attribution and expressed emotion in the relatives of patients with schizophrenia.
Indexes of expressed emotion (EE) in 58 relatives of patients with schizophrenia were related to those relatives' spontaneously expressed causal beliefs about the illness and about related symptoms and behaviors. Relatives made attributions predominantly to factors external, universal, and uncontrollable from their own perspective, and to factors internal, universal, and uncontrollable from the patient's perspective. Low-EE relatives were similar in their attributions to emotionally overinvolved relatives. Compared with these two groups, critical and/or hostile relatives made more attributions to factors personal to and controllable by the patient. Subsequent analyses suggested that hostile relatives were further characterized by making more attributions to factors internal to the patient and by making attributions with fewer causal elements.
From Freud to cognitive science: a contemporary account of the unconscious.
We present an account of two influential approaches to the unconscious; those of Freud and of cognitive science. It is argued that although Freud's ideas require updating in some respects, in other ways many of them have stood the test of time. We describe the similarities and differences between the two approaches and the attention each pays to innate cognitive and emotional competencies. Finally, we provide a contemporary cognitive account of the unconscious that attempts to combine the best both approaches within an information-processing framework.
Causal attributions and psychiatric symptoms in survivors of the Herald of Free Enterprise disaster.
The aim of the present study was to explore the relationship between causal attributions and psychiatric symptoms in those who survived the capsizing of the Herald of Free Enterprise ferry, two years following the disaster. Internal and controllable attributions for disaster-related experience are strongly related to poorer psychological outcome.
Explanations by professional care staff, optimism and helping behaviour: an application of attribution theory.
It is demonstrated first that staff explanations of problem behaviour can be reliably coded using a modified form of the Attributional Style Questionnaire; and second, that staff explanations are related through staff optimism to anticipated helping behaviour. This supports the hypothesis that, in professional staff, an important determinant of helping is optimism arising from attributions of a patient's problems. The influence of affective judgements, as emphasized in Weiner's (1986) theory of helping behaviour, is not supported.
The assessment of psychiatric disability in the community. A comparison of clinical, staff, and family interviews.
Assessments of some of the symptoms and behaviour problems of long-term psychiatric patients living in the community were obtained independently from clinical interviews with such patients, and from interviews with day staff, residential staff and families caring for them. In general, interviews with residential staff and family members revealed much higher levels of symptoms and behaviour problems than either of the other two interviews. These findings have implications for research and clinical practice including the fact that adequate assessments should include the testimony of family or residential staff.
Patient preferences and randomised clinical trials.
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Needs for care among the relatives of long-term users of day care. A report from the Camberwell High Contact Survey.
We report the results of a survey of the burdens and needs for items of care of 45 supporters of long-term users of psychiatric day care facilities in Camberwell. The supporters reported high levels of disturbed behaviour and low levels of self-care skills in the attenders. They were also subject to high levels of social and economic burden, not all of which could be attributed to the attenders' problems. The needs assessment identified a large number of unmet needs, although the supporters themselves were largely resigned to their situation and expressed little dissatisfaction with the services they were offered. The advantage of conducting this kind of assessment of supporters' needs as a routine part of clinical practice was discussed.
Cognitive change processes in psychotherapy.
Several types of cognitive-behavioral therapy are now practiced that use different sets of theoretical concepts and propose different kinds of change mechanisms. None, however, is directly grounded in experimental research in cognitive and social psychology, and few address basic issues such as the relevance of conscious versus nonconscious cognitive processes and the validity of the self-report data on which therapy depends. Put forward in this article is a model that describes the conscious and nonconscious processing of emotional stimuli and distinguishes between knowledge that is verbally accessible and knowledge that can only be recovered by exposure to situational cues. Also proposed are three mechanisms of cognitive change that involve altering verbally accessible knowledge, the accessibility of nonconscious situational memories, and self-regulatory strategies. These mechanisms are related to the current practices of behavioral and cognitive-behavioral therapists.
The problems of people in long-term psychiatric day care. An introduction to the Camberwell High Contact Survey.
The aims of the Camberwell High Contract Survey (CHCS) were to develop and test a systematic needs assessment procedure and use it to evaluate the services provided to long-term users of day centres and sheltered residential accommodation (excluding hospital wards). This paper describes the background to the study, the sample of 145 attenders and their characteristics, their clinical and social problems and the care provided for them.
Needs for care among the long-term mentally ill: a report from the Camberwell High Contact Survey.
We report the results of a survey of the needs for items of care of 145 long-term users of psychiatric day-hospitals and day-centres in Camberwell. The overall ratio of met to unmet need was almost exactly 5:1. Need was shown to vary according to chronicity, degree of participation, and placement in day-hospital or day-centre. Specific areas of functioning and specific types of care were identified in which there was significant overprovision or underprovision. The utility of our measures, and their ability to identify clinically significant unmet need, are discussed.
Social comparison and depression.
It has been suggested that a central factor in depression is the experience of feeling different from others. This study set out to examine the relationship between pre-attributional consensus judgments, perceived trait discrepancy from others, and depression. As predicted, low consensus judgments concerning hypothetical events and negative self-evaluations relative to others were associated with depression. These results are discussed in terms of related work on attribution theory and social comparison processes.
A comparison of two approaches to the treatment of nocturnal enuresis and the prediction of effectiveness using pre-treatment variables.
This study compared the effectiveness of the enuresis alarm alone with a brief version of Dry Bed Training in treating 74 enuretic children. Both procedures were equally effective, and in the total sample a better response to treatment was predicted by the child's report of being teased by siblings. Maternal anger was associated with a greater drop-out rate.
Cognitive style and depression: symptom-related, event-related or independent provoking factor?
Three models of the relation of negative cognitive style to depression are outlined: (1) a symptom model, where negative cognitions are a symptom of depression, (2) a vulnerability model, where a negative life-event in combination with cognitive vulnerability leads to depression and (3) an alternative aetiologies model, where depression can be precipitated either by stressful life-events or by a negative cognitive style. Differential predictions from the three models were examined in data from a general population survey of 193 mothers where a reliable case identification procedure and life-events interview were used together with measures of attributional style and self-esteem. Results were mostly consistent with the alternative aetiologies model, but also gave some support for the symptom model. In some cases, negative cognitive style may act to increase the risk of depression onset in the absence of life-event stress.
Attributional change during psychotherapy.
Previous research suggests that causal attributions for life-events are involved in the process of recovery from depression. The study assessed depressive symptoms and attributions before and after treatment in 40 clients. Each client received two forms of therapy in a cross-over design: Exploratory (relationship-oriented, interpersonal) therapy, and Prescriptive (cognitive-behavioural) therapy. During the course of treatment, attributions became significantly more unstable, specific and controllable. There was a positive relation between attributional change and change in depression symptoms, with significant correlations occurring on all dimensions, apart from Externality, and on a composite measure.
Media professionals' views of the government's 1987 AIDS campaign.
One hundred and twenty six journalists and programme-makers were interviewed to ascertain their views about the effectiveness of the Government's campaign in early 1987 to inform the public about the risks from Aids. The majority view was that it was a good all-round campaign focused on the public at large and on several at-risk groups. It was also thought to have been acceptable to the public. But a sizeable minority of media professionals felt that more selective targeting would have been desirable, and that the information was not specific enough. Another criticism concerned the lack of an adequate follow-up. There was general agreement that before the campaign the public knew little about Aids, and that afterwards they were better informed, in particular about the prevalence of Aids and the existence of high-risk groups. Overall, however, respondents underestimated the campaign's achievements in increasing knowledge, while overestimating changes in attitudes and behaviour. Recommendations were made about the format and content of TV programmes for future public information campaigns concerning AIDS.
Principles and practice of measuring needs in the long-term mentally ill: the MRC needs for care assessment.
We report the development of a new procedure for assessing the needs for treatment and care of the long-term mentally ill. This procedure covers 21 areas of clinical and social functioning, and in each of these specifies appropriate interventions. Decision rules are described which permit problems in functioning to be primarily classified as a met need, an unmet need, or as involving no need, and which allow the identification of various secondary needs. We report preliminary data on the reliability and validity of this procedure and discuss its potential applications in the care of the long-term mentally ill.