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Biomedical subjects

M J Horowitz

Publications and source records attributed to M J Horowitz.

At least 55 records · Page 3Linked to original sources
PubMed1984

The Stress Response Rating Scale: a clinician's measure for rating the response to serious life-events.

The impact of a serious life-event on an individual's psychological well-being has long been appreciated, but not until recently has it become the subject of more thorough and careful research. Clinical, field, and experimental studies of the effects of potentially distressing life-events have suggested the presence of two primary modes of response: episodes of denial and numbing, oscillating with periods of intrusive thoughts, images, and pangs of emotion. Although self-report measures are available for determining the degree of distress experienced in each of these modes of response, there is no measure that can be used by a clinical observer to assess these same phenomena. We offer the Stress Response Rating Scale (SRRS) as such a measure, and present empirical data to support its reliability and validity. In addition, we present some initial normative data, a discussion of issues encountered in developing the scale, and potential difficulties that may be encountered in its use.

Denial, Psychological↗
PubMed1983

Judging change in psychotherapy. Reliability of clinical formulations.

Careful clinical formulation describing the dimensions of core neurotic conflicts is integral to the practice of psychodynamic psychotherapy. Therefore, a method for reliable and valid formulation is a necessary precursor for the empirical investigation of the impact of such therapy. Our study evaluated a method of outcome assessment based on clinical formulations. Results from 18 patients indicate that independently derived formulations of a central conflict do not agree and that these disagreements in formulation are reflected in disagreements in the change ratings that are based on them. Additional analyses suggested that symptomatic change represents the major component in outcome rating.

Adjustment Disorders↗
PubMed1983

Therapists' actions that influence their perceptions of "good" psychotherapy sessions.

Psychotherapists' and an independent observer's ratings of the "good" to "poor" quality of therapy sessions were correlated with their ratings of various therapist actions. As predicted, significant positive correlations were obtained between the goodness ratings and the emphasis given by therapists to actions encouraging patients' expression of thoughts and feelings and the exploration of their reactions. For a number of other actions, however, therapists and the independent observer disagreed about whether emphasis of the actions correlated with "good" or "poor" sessions. Some possible causes and implications of these differences are discussed.

Adult↗
PubMed1983

The stressful impact of news of risk for premature heart disease.

Efforts at prevention of disease include case-finding of individuals at high risk and offering to these identified people an intervention to reduce their risk. Although the intention of intervention is to reduce risk, the impact of discovering that one is at high risk may also lead to intrusive ideas and feelings that characterize psychological stress response syndromes. The present study examined these issues with a sample of 1,447 men who were advised of their risk for coronary heart disease in the collaborative Multiple Risk Factor Intervention Trial. Comparisons over three yearly data collections between a usual care and special intervention group showed that the special intervention group reported a far greater level of coping and mastery efforts regarding their risk status. This was accompanied by a much smaller tendency to be bothered by intrusive thoughts, but amount of reported upset did not differ. Finally, a small group of men in both groups indicated continuing high levels of upset across the three years. Clinicians are advised to be watchful for these persons for whom mastery of the news appears to be difficult.

Adaptation, Psychological↗
PubMed1983

Regressive alterations of the self concept.

When clinicians formulate a case for treatment by dynamic psychotherapy they include an assessment of ego functions, including the capacity for self symbolization. Terminology for this purpose has been diffusely defined. This paper reviews concepts for describing self symbolization and emphasizes ways of describing the multiplicity of symbols present within any individual. Some regressive transference phenomena during treatment are briefly discussed to illustrate use of the suggested terminology in case formulation.

Adult↗
PubMed1982

Strategic dilemmas and the socialization of psychotherapy researchers.

The design, and especially the sequential organization of psychotherapy research depends not only on the questions asked, but on the standards presented as values to clinician investigators as they get their training. This paper suggests that the socialization of these values has led to a misalignment of preferred design strategies with the questions that must be addressed for progress to be made in psychotherapy research. The author suggests alternative approaches using an ordering strategy from descriptive studies, through associational or correlational designs, before entering into contrast group studies.

Clinical Trials as Topic↗
PubMed1981

Initial psychological response to parental death.

A cohort of patients seeking help at a clinical research center providing time-limited brief therapy for posttraumatic stress disorders was assembled. The single life event experienced by each was death of a parent. A nonequivalent comparison group was gathered by review of hospital death records. Both groups received the same type of evaluation interview and completed the same measures, which were similar to those done for both groups by the clinical interviewer. These data indicated that while both groups contained persons with medium to high distress levels, the patient group was most uniformly composed of such persons; when compared with the field-study group, the patient group had significant and important elevations of distress levels.

Attitude to Death↗
PubMed1981

Stress response syndromes. Recurrent themes.

There is a consensus among clinicians treating patients who have experienced a trauma that a number of common themes emerge. Using a manual that codified ten of these themes, their frequency was measured in the case material of 30 psychotherapy patients treated for posttraumatic stress disorders after bereavement or personal injury. The themes found to be most prominent in bereavement cases included sadness over loss and discomfort over discovered personal vulnerability. In the personal-injury cases, fear of a repetition of the event and feelings of responsibility emerged most frequently. Rage at the source of the trauma figured prominently in both bereavement and personal-injury cases.

Adult↗
PubMed1981

Self-righteous rage and the attribution of blame.

Clear case formulation requires organization of observation into descriptive units. A clinically useful descriptive unit is the state of mind, as related to other common states and to patterns of transition between states. This report describes self-righteous rage, other dominant affect states commonly associated with it, and the incitements to occurrence of this mental state. Careful study of repetitive patterns clarifies some of the explanations for an excessive readiness to enter such states and indicates how to formulate the developmental level of blame-attribution functions in individual patients.

Anger↗
PubMed1981

Patterns of individual change scales.

Measurement of complex modifications in personal functioning is a necessary step to the relevant translation of psychotherapy research into clinical practice. Using an assessment strategy aimed toward decreasing subjective bias, we pursued an inductive clinical approach in constructing the Patterns of Individual Change Scales (PICS) battery. Designed for use with a bereaved population, each of the 13 scales has a unitary focus and hierarchy of functional levels across the domains of symptoms, social relations, and self-concept. Nine experienced clinical judges rated the scales after viewing videotaped evaluation interviews of 18 patients and 18 field subject. In general, the PICS had a suitable range for our borderline through normal population, reached acceptable levels of reliability, and could discriminate among subjects in clinically meaningful ways. Future analyses will consider issues of bias, validity, and generalization.

Adult↗
PubMed1980

Signs and symptoms of posttraumatic stress disorder.

The new diagnostic nomenclature of the American Psychiatric Association (DSM-III) provides well-described categories of stress response syndromes that were not included in the previous nosology. The signs and symptoms of these syndromes used in the descriptive statements have been understood largely in terms of field studies of nonpatient populations and clinical descriptive and impressionistic studies of patient populations. We report quantitative data from the study of a population with post-traumatic stress disorder. The results confirm clinical impressions of the importance and wide prevalence of episodes of intrusive ideas and feelings in states of distress precipitated by serious life events.

Adult↗
PubMed1980

Pathological grief and the activation of latent self-images.

The authors studied the case material for patients treated with either psychoanalysis or brief therapy to examine the basis for the various states of pathological grief after berevavement. They view these states as intensifications or unusual prolongations of states found in normal grief and describe them in terms of the reemergence of self-images and role relationship models that had been held in check by the existence ofthe deceased person. This conclusion concerning preexisting mental schemata leads to an elaboration and partial revision of theories of regression, ambivalence, and introjection as causes of pathological grief.

Adult↗
PubMed1979

A field study of the stress response syndrome. Young women after hysterectomy.

The symptom pattern previously delineated as the stress response syndrome in a mental health setting was hypothesized to be useful in conceptualizing reactions to a traumatic event in a nonpsychiatric patient population. The experience of loss resulting from nonelective hysterectomy for benign disease in women of childbearing age was selected as a relevant field study model. Twenty-eight women were studied one year after hysterectomy, using extensive psychological interviewing by women clinicians and experiential rating scales. Twelve subjects had a mild stress response syndrome, and five subjects had a serious level of intrusive and avoidant symptoms. Increasing severity of response was associated with persisting child-wish, deterioration in sexual functioning, and change in self-concept. Women who did well postoperatively generally had no future wish for children and were actively committed to achievement outside of the home.

Adaptation, Psychological↗
PubMed1979

Analysis of patient states and state transitions.

Psychiatric diagnoses and formulations have classically focused on the chief complaint of the patient as part of a larger pattern of episodes and reactions. This is a form of state analysis in which the problem states of a person are carefully described and distinguished from other states. The authors suggest methods for deepening such formulations by grounding description of problem states in models of other states and models of state transitions. The resultant method of state analysis can be applied to examination of change processes during treatment as well as to initial diagnostic formulations. As an example of its use and possible extension to quantification, state analysis is applied to description of status and change in a person treated by brief psychotherapy. Because state analysis is based on observable behavior and reportable conscious experiences, it serves as a useful beginning point upon which to anchor more extended inferences about psychodynamics.

Emotions↗