[S.O.S., social and community psychiatry: operations research].
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Community Mental Health Services↗
Biomedical subjects
R Ladouceur
Publications and source records attributed to R Ladouceur.
Correcting faulty appraisals of obsessional thoughts.
Cognitive techniques are becoming more widely established in the treatment of obsessive-compulsive disorder (OCD). This paper extends previous work by van Oppen and Arntz (1994, Behaviour Research and Therapy, 33, 79-87) on overestimation of threat and excessive responsibility by discussing other types of appraisals that may be involved in OCD, particularly when overt compulsions are absent. Examples are given of types of intervention that may be useful to correct faulty appraisals concerning the overestimation of the importance of thoughts such as thought-action fusion, excessive responsibility, perfectionistic concerns such as the need for absolute certainty, and expectations about anxiety and its consequences.
Arousal↗
Cognitive analysis of unwanted intrusive thoughts and facial hair: an idea before its time?
Durac (1997, Behaviour Research and Therapy, 35, 371-372) recently attempted a cognitive analysis of unwanted intrusive thoughts and the growth of facial hair. Though provocative, there are a number of conceptual, methodological and clinical issues that are inadequately addressed by this paper. Based on a thorough reading of a relevant body of literature from 1963 to 1994, five issues are addressed in a hirsute manner: (1) the origin of the phenomenon, (2) behavioral analysis of unwanted intrusive thoughts and the growth of facial hair (UIFHG), (3) the role of behavioral exercises in the disappearance of unwanted facial hair, (4) the serotonin connection underlying this disorder, and (5) ethical concerns in the treatment of UIFHG. Finally, important theoretical and clinical implications of the cognitive model are not discussed here: they will be reported elsewhere in a more extensive analysis.
Attention↗
[Efficiency of a gambling prevention program for youths: results from the pilot study].
UNLABELLED: A meta-analysis of North American studies indicates that the prevalence rate of pathological gambling varies between 4.4% and 7.4% among adolescents. Pathological gambling is thus not a phenomenon that suddenly appears once youths reach an adult age. On the contrary, significant contact with gambling occurs in childhood adolescence. For this reason, it is important to develop an effective gambling prevention program that will reduce the risk that youths will develop gambling problems. The information promoted in the prevention program our research team created and evaluated here teaches youths to recognize the traps of gambling activities, while enabling them to make an informed decision as to their eventual participation in those activities. The program is based on knowledge and recognition of key indices that can be easily identified as warning signs of a loss of control. It is predicted that youths who participate in this prevention program will improve their knowledge of gambling activities and will develop a more realistic attitude towards those activities than youths from a control group. The experimental group's problem-solving skills are also expected to improve. An experimental design (pre-test, post-test and follow-ups with control group) was used to evaluate the program's effectiveness. Overall, 1193 youths participated in this study. The prevention program involves three 60-minute meetings. The objectives of these meetings are the following: (meeting #1) improve youths' knowledge of gambling activities and help them acquire a more realistic attitude towards these activities; (meeting #2) teach a structured problem-solving approach to resist to peer-pressure; (meeting #3) inform youths of the consequences that may be associated with abusive participation in gambling and teach them to recognize warning signs of a loss of control over gambling habits. DEPENDENT VARIABLES: (a) knowledge of and attitudes towards gambling and gambling activities; (b) problem-solving skills; (c) frequency of participation in gambling activities; (d) discussion with relatives, friends and teachers regarding gambling activities and attention paid towards gambling habits among close friends and family. Participation in the gambling prevention program significantly improves youths' knowledge of the real probabilities of winning and the pitfalls included in gambling activities and favours the development of a more realistic attitude towards these activities. However, the participation in the prevention program does not help to improve their problem-solving skills. Nonetheless, it leads more youths to talk about gambling with their parents and teachers, and enables them to be more aware of the gambling habits of their friends and family. Finally, note that it was impossible to verify any decrease in gambling habits as the majority of participants (62%) were non or very occasional gamblers. However, no iatrogenic effect was observed on the frequency of participation in gambling activities. Aside the positive impact of the program on the attitudes and knowledge of students, participation in the preventive sessions contributed to create a dialogue with adults and increased youths' interest in the gambling habits of their friends and family. These discussions enabled the youths to validate the information they received during class, to consolidate what they learned during the prevention sessions, and favour the dissemination of this knowledge beyond the scope of the academic environment. The results obtained regarding youths' attitudes and knowledge demonstrate that attitude modification takes place progressively. However, once well assimilated, these new attitudes seem to take hold in a fairly durable way. On the other hand, acquisition of knowledge seems to take place immediately after the theoretical concepts are taught. Yet, they slightly decreased before stabilising a few months later. This suggests that assimilation of new knowledge may be optimized by the addition of an intervention session a couple of months after the end of the intervention. Even if it was impossible to verify any decrease in participants' gambling habits, it is possible to think that the impact of participation in the gambling prevention program could be observable and measurable within a few years. However, only a long-term follow-up study would make it possible to assess whether participation in the program does indeed contribute to decreasing gambling habits and the number of youths who regularly participate in gambling activities. Despite the non-significant results observed for problem-solving skills, it seems nonetheless important to include this component, which benefits from great theoretical support, especially within the framework of prevention programs targeting youths. However, the teaching method must be changed in order to maximize the intervention's effectiveness. Despite some methodological limitations observed during the evaluation of this program, the results obtained clearly demonstrate that participation in the prevention program significantly improves youths' attitudes and knowledge regarding gambling activities. The teaching of accurate knowledge and realistic attitudes towards gambling should help youths to recognize the cognitive traps inherent to gambling activities and thus contribute, over the long run, to decrease the number of youths with gambling problems.
Adolescent↗
Structured and free-recall measures of worry themes: effect of order of presentation on worry report.
Structured instruments (SI) or free-recall instruments (FRI) can be used to examine worry themes. In the case where both types are use jointly, order of presentation may influence number and content of free-recall worries. Half of a large undergraduate sample (N = 609) received the SI before the FRI and the other half received them in the opposite order. Highly prevalent worries (i.e., common worries reported by more than 25% of the sample) were more numerous when the FRI was used first. However, moderately prevalent and rare worries (reported by 5% to 24% and 0% to 4% of the sample, respectively) were more numerous when the FRI was administered second. Results are discussed in terms of a possible priming effect produced by SI on moderately prevalent and rare free-recall worries.
Adult↗
Problem solving and problem orientation in generalized anxiety disorder.
The present study's main objective is to examine whether problem orientation and problem-solving skills differ according to generalized anxiety disorder (GAD) symptom level or clinical status (seeking help for GAD). Its secondary goal is to examine whether two cognitive variables (intolerance of uncertainty and beliefs about worry) vary according to GAD symptom level or clinical status. Three groups of subjects participated in the study: (a) nonclinical moderate worriers (N = 15), (b) nonclinical subjects meeting GAD criteria by questionnaire (N = 14), and (c) GAD patients (N = 14). Problem orientation and problem-solving skills were measured with the Social Problem-Solving Inventory (D'Zurilla & Nezu, 1990) and the Problem-Solving Inventory (Heppner & Petersen, 1982), whereas the cognitive variables were assessed with the Intolerance of Uncertainty questionnaire (Freeston, Rhéaume, Letarte, Dugas, & Ladouceur, 1994) and the Why Worry? questionnaire (Freeston, Rhéaume et al., 1994). The results show that problem orientation, intolerance of uncertainty, and beliefs about worry were similar in subjects meeting GAD criteria by questionnaire and GAD patients, whereas moderate worriers had different scores on these variables. Thus, these variables are more highly affected by GAD symptom level than by clinical status. The results also show that problem-solving skills were unaffected by symptom level and clinical status, thereby indicating that knowledge of problem-solving skills is unrelated to both GAD symptom level and GAD clinical status. The findings are discussed in terms of their theoretical and clinical implications.
Adult↗
Worry themes in primary GAD, secondary GAD, and other anxiety disorders.
This study examines worry themes among 87 anxiety disorder patients divided into three groups: (a) 24 primary generalized anxiety disorder (GAD) patients, (b) 25 secondary GAD patients, and (c) 38 other anxiety disorder patients (primarily obsessive-compulsive disorder, social phobia and panic disorder with agoraphobia). Structured and free-recall measures were used to measure five worry themes: relationships, work, finances, physical threat, and the future. Both types of measures revealed that GAD patients worry more about the future than non-GAD patients. Further, post hoc analyses testing for linear relationships indicated that primary GAD patients worry more about the future than secondary GAD patients who in turn worry more about the future than other anxiety disorder patients. The results suggest that although worry about immediate problems may not differentiate GAD patients from other anxiety disorder patients, high levels of worry about future events may be a distinguishing feature of GAD.
Adaptation, Psychological↗
[The evaluation of perceived responsibility among obsessive-compulsive patients].
Although many authors agree that excessive responsibility is associated with Obsessive-Compulsive Disorder (OCD), some believe that the manifestations of responsibility are more easily observed among patients suffering from checking compulsions (36, 42). This study compares a group of obsessive-compulsive patients that have been sub-divided into three groups (washers, checkers, ruminators) with a group of normal volunteers that are healthy with regards to responsibility. The sample consisted of 58 adults who meet diagnostic criteria for OCD and 20 normal individuals. During an individual interview, a clinician administered the ADIS III-R (section on OCD) as well as other instruments in order to precise the diagnosis. The participants then filled out questionnaires that assess symptoms, responsibility, perfectionism and general functioning. The results confirm that OC patients obtain higher scores than the normal group with regards to responsibility. However, no significant difference was found between the three sub-groups of OC patients. Thus, it seems to be pertinent of consider excessive responsibility as a characteristic of OC clients, for checkers and washers, as well as ruminators.
Adult↗
[Evaluation of worry: validation of a French translation of the Penn State Worry Questionnaire].
UNLABELLED: Excessive worry, which is the central feature of Generalized Anxiety Disorder (GAD), is recognized as an important clinical phenomenon with many negative consequences on people's health. For example, studies report that excessive worry is associated with higher frequencies of work absenteeism and medical consultations, increased risk of other anxiety disorders, depression, heart disease, diabetes and cancer. It is thus imperative to develop effective measures to assess worry among adult. Until now, no measures were available in French for the practitioners and researchers to evaluate the tendency to engage in excessive and uncontrollable worry. One of the most frequently used questionnaires to assess worry in English is The Penn State Worry Questionnaire (PSWQ). This self-report measure has been widely studied and has shown excellent psychometric properties among the non-clinical and clinical populations. This manuscript presents the results of three studies evaluating the psychometric properties of a French Translation of the PSWQ, the Questionnaire sur les Inquiétudes de Penn State (QIPS). The first study includes the translation procedures used to create the French version of the questionnaire, the factorial structure, the internal consistency, the quality of the items, and the convergent validity among non-clinical participants. The second study examines the temporal stability, and the convergent and divergent validity of the questionnaire. Finally, the third study investigates the internal consistency, the quality of the items, and the convergent and divergent validity of the questionnaire among GAD patients. Study 1. This study describes the translation procedures used to create the QIPS, the factorial structure, the internal consistency, the quality of the items, and the convergent validity among non-clinical participants. The French version was translated by a group of clinical psychologists with the assistance of a professional translator and a linguist. A back translation procedure was also conducted. Finally, a pilot study confirmed the intelligibility of the questionnaire. French-speaking university students (N = 352) completed a battery of questionnaires during a lecture. The questionnaires were: The Questionnaires sur les Inquiétudes de Penn State, the Intolerance of Uncertainty Questionnaire, the Cognitive Avoidance Questionnaire, the Why Worry Questionnaire-Revised, and the Social Problem-Solving Inventory-Revised. The statistical analyses reveal that the QIPS shows an appropriate factorial structure, an excellent internal consistency and a very good convergent validity. This French Questionnaire thus seems to be suitable to assess the tendency to worry among the nonclinical population. Study 2. This second study examines the temporal stability, and the convergent and divergent validity of the QIPS. The sample includes 95 French-speaking University students who volunteered to complete the QIPS and the Beck anxiety Inventory. Two self-rating questions were also asked to evaluate the percentage of time spent worrying and to what extent does worrying causes a problem. Eighty-six students participated at the second administration of the questionnaires, four weeks later. The results indicate that the QIPS is very stable over time, thus supporting its temporal stability. Different correlations confirm its convergent and divergent validity. It is concluded that the QIPS is a suitable measure of worry in a non-clinical population. Study 3. This study investigates the internal consistency, the quality of the items, and the convergent and divergent validity of the questionnaire among GAD patients. Seventy-seven GAD patients, as defined by the Diagnostic and Statistical Manual of Mental disorders, fourth edition (DSM IV), participated in this study. They completed the QIPS, the Worry Domains Questionnaire, The Worry and Anxiety Questionnaire, the Intolerance of Uncertainty Questionnaire, the Beck Anxiety Inventory, the Beck Depression Inventory, and a daily diary of differents aspects of worry. The results reveal that the QIPS has an excellent internal consistency, a very good convergent and divergent validity. The QIPS thus seems to be suitable to assess the tendency to worry among GAD patients. CONCLUSION: The overall results presented in these studies confirm the excellent psychometric properties of the QIPS. This French questionnaire is a useful tool for clinicians and researchers to assess the tendency to worry among non-clinical and clinical populations.
Adult↗
[Anxiety and physical limitation: a complex relation].
Psychological problems affecting physically handicapped individuals are understudied. However, some studies suggest a higher risk of developing an elevated level of anxiety among these individuals. A previous study reported that people with multiple sclerosis show more anxiety than patients suffering from another type of physical limitations. These results raise questions about the specificity of the link between anxiety and some medical conditions. The aim of the present study is to increase our understanding of manifestations of anxiety associated with degenerative illnesses. Three groups of patients with different physical limitations were compared on their level of anxiety and on various cognitive process. Groups were composed as: 1) 20 patients suffering from multiple sclerosis, 2) 18 patients diagnosed with another degenerative illness (either arthritis, muscular dystrophy or ataxia), and 3) 20 participants presenting a non-degenerative handicap. The 3 groups were not significantly different on age, sex and duration of the physical limitations. Symptoms of anxiety were measured with 3 questionnaires:1) the Hospital Anxiety and Depression Scale, 2) the Penn State Worry Questionnaire, used to assess the tendency to worry, and 3) the Worry Domains Questionnaire, assessing diversity and intensivity of worry themes. In turn, cognitive processes were evaluated with 4 questionnaires: 1) the Acceptance of Disability scale, used to assess the person's level of acceptance regarding a disability, 2) the Interpretation of Disturbing Thoughts questionnaire, an idiographical measure about the interpretation of thoughts associated with a physical handicap, 3) the Intolerance of Uncertainty scale, presenting beliefs about uncertainty and its consequences, and 4) the Cognitive Avoidance questionnaire, to evaluate the tendency of avoiding disturbing thoughts and images. Participants completed all questionnaires alone and the experimenter was available to answer any questions. MANOVAs were used to compare the 3 groups on the studied variables. Statistical analysis revealed no significant differences among groups for symptoms of anxiety and depression, tendency to worry and worry themes. Similarly, no significant differences were obtained on cognitive processes. The multiple sclerosis group and the other degenerative illness group were combined and compared to the non-degenerative handicap group. MANOVAs conducted on symptoms and cognitive processes did not yield any significant differences. Results of the present study seem to indicate that the type of physical limitations is not an indicator of the presence of specific anxiety symptoms or cognitive processes. On an exploratory basis, all participants were compared according to their level of acceptance of disability. Results indicated that a lower level of acceptance was significantly associated with more anxious and depressive symptoms, excessive worries, and a greater intolerance of uncertainty. It seems that acceptance of disability plays a key role in maintaining psychological distress among people with a physical handicap. The influence of intolerance of uncertainty on acceptance of disability needs to be further explored.
Adult↗
[Study of psychometric properties of two new questionnaires assessing beliefs in hypochondriasis in a non-clinical population].
Most instruments focussing on hypochondriasis symptoms do not have for goal to assess beliefs specifically. Instead, these instruments are used to measure specific behaviors. To assess underlying beliefs with these kinds of instruments, you have to extract false beliefs by deduction. In cognitive therapy, it is important to target erroneous beliefs in order to change them. On the other hand, existing instruments are not really suitable to target erroneous health beliefs. Even if some questionnaires are built to assess beliefs directly, it seems that they only measure the conviction of having an illness and do not assess the general health beliefs present in excessive health worriers. However, many researchers argue that this other kind of beliefs are the ones responsible in maintaining hypochondriasis symptoms. Presently, researchers assume that erroneous beliefs can maintain worries about illness among people with hypochondriasis symptoms like false beliefs about worry maintain worries in people with General Anxiety Disorder (GAD). Even if the importance of false beliefs in the maintenance of pathological worries is now recognized, most instruments on hypochondriasis symptoms do not have for goal to assess erroneous beliefs concerning worry about health. For instance, although the questionnaire Why do people worry? (WW) shows good psychometric properties and measures beliefs related to general worries, this questionnaire is not specific enough to correctly evaluate beliefs associated to health worry. A new questionnaire has to emerge in order to assess false beliefs associated to worry about health. This manuscript presents the development and the validation of a new questionnaire: the General Health Beliefs Questionnaire (GHBQ) that assesses general health beliefs, and also presents the development and the validation of a new questionnaire assessing beliefs associated to worry about health: the Why do people Worry about Health? (WW-H) . In this study, the GHBQ's and the WW-H's psychometric qualities and the factorial structure were assessed. More precisely, this study examined the factorial structure, the temporal stability, the convergent, divergent and criteria validities of the GHBQ and the WW-H. Four hundred and twenty nine French-speaking university students (non-clinical participants) completed a battery of questionnaires at the beginning of a class. The questionnaires were: The General Health Beliefs Questionnaire (GHBQ), the Why do people Worry about Health (WW-H), the Illness Worry Scale (IWS), the Beck Depression Inventory-short form (BDI-short form) and the Beck Anxiety Inventory (BAI). A second administration took place three weeks later with the same sample to test the temporal stability of the GHBQ and the WW-H. The principal component analysis with orthogonal rotation (varimax) supports a five components solution for the GHBQ: 1) magical thinking, 2) health, 3) consequences, 4) responsibility, and 5) vulnerability. The principal component analysis with oblique rotation (direct oblimin) (d=0) found a two components solution for the WW-H: 1) utility and 2) magical thinking associated to worries about health. The internal consistency of the GHBQ and the WW-H is excellent (a=.80 and a=.90, respectively). A correlation of 0.49 was found between the GHBQ and the WW-H. The correlation between the GHBQ and the IWS who evaluates the tendency to worry (r=.50) and between the WW-H and the IWS (r=.49) showed that the convergent validity of these questionnaires is adequate. On a three weeks interval, the GHBQ (r=.70) and the WW-H (r=.71) showed a satisfying temporal stability. The means of the high worriers (80 superior percentile at the IWS) (M=38.8, ET=8.93) and the means of the moderate worriers (between the 40 and the 60 percentile at the IWS) (M=32.8, ET=8.00) on the GHBQ have been compared. A significant difference has been found between the two groups [F(1,181)=23,129, p<0,001]. Also, the means of the high worriers (M=27.3, ET=8.59) and the means of the moderate worriers (M=23.8, ET=8.56) on the WW-H haveave been compared. An ANOVA has found a significant difference between these two groups [F(1,180)=7,396, p=0,007]. These results show that general health beliefs and false beliefs associated to worry about health are more often present in high worriers than in moderate worriers. The GHBQ and the WW-H allow psychologists, physicians and psychiatrists to do a quicker and more exhaustive evaluation of general health beliefs and false beliefs associated to worry about health, in less costs. These questionnaires will improve the chances of success of the hypochondriasis' treatment by helping clinicians to detect and correct false beliefs more easily.
Adolescent↗
[The Beck Anxiety Inventory. Psychometric properties of a French translation].
The Beck Anxiety Inventory (Beck, Epstein, Brown, & Steer, 1988) is a 21-item checklist developed with large clinical samples to measure anxiety symptoms associated with DSM III-R (APA, 1987) anxiety disorders. Administration and scoring are rapid; the patient rates symptom intensity during the last seven days on a 0 to 3 scale. The BAI adequately covers the major cognitive, affective, and physiological symptoms of anxiety. Care was taken during scale construction to eliminate items that would be confounded with depression items. The authors demonstrate excellent reliability and appropriate convergent and discriminant validity with other measures of anxiety and depression as well as criterion-related validity with in patient samples (Beck et al., 1988). The properties of the BAI have been further studied by Beck and collaborators as well as by other groups of researchers. Since its appearance in 1988 the BAI has quickly been adopted by clinical researchers in the United States, Canada, and the United Kingdom. Five studies present psychometric data on a French translation of the BAI. The translation process involved alternative versions by three translators, a panel of experts, and pilot testing on a group of 20 volunteers. The first study with university students (N = 72) indicated good internal consistence (Cronbach's alpha = .85) and stability (r = .63) at four weeks. The second study (N = 91) demonstrated convergent and discriminant validity significant positive: correlations with measures of obsessive-compulsive symptoms, irrational beliefs, and depression; significant negative correlations with assertiveness and self-esteem, and non-significant correlations with two measures of social desirability.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗