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[Construction, reliability and validity of Feelings of Unreality Inventory].

The present research assumed that a feeling of unreality is the defining characteristic of depersonalization phenomena. In Survey 1, two scales were constructed: the State Feelings of Unreality Scale for measuring a feeling of unreality as a transitory state and the Trait Feelings of Unreality Scale for assessing individual differences in disposition to experience that state. Both scales had high internal consistency. The Trait Feelings of Unreality Scale had sufficient test-retest reliability. In Survey 2, the Trait Feelings of Unreality Scale was found to be moderately correlated to level of maladjustment. Survey 3 showed that those higher in State Feelings of Unreality experienced greater negative affect. The results of Surveys 2 and 3 supported the construct validity of the Trait Feelings of Unreality Scale and the State Feelings of Unreality Scale, respectively.

Adolescent↗

Mental imagery and perception in hallucination-prone individuals.

College students screened for hallucination-proneness using the Launay-Slade Hallucination Scale (LSHS) were compared on measures of self-report vividness of imagery and on behavioral measures of imagery and perception (visual and auditory). Specifically, we tested the hypothesis whether hallucination-prone individuals would show smaller differences between imagery and perception performance, which may be indicative of increased sensory characteristics of mental images. We replicated earlier findings of higher self-report imagery ratings in the high hallucination-prone group. However, the two groups did not differ on five of six behavioral imagery-perception comparisons. On one visual task, hallucination-proneness was associated with larger imagery-perception differences. Our results reveal a dissociation between the level of subjective experience and the information processing level. Although vividness of mental images may be subjectively associated with mild hallucinatory experiences, we suggest that cognitive processes associated with reality discrimination rather than increased perceptual characteristics of mental images may play a role at the information processing level.

Adult↗

Dementia in elderly patients: can the 3R mental stimulation programme improve mental status?

The aim of this study was to determine whether the 3R mental stimulation programme can improve the mental status score (MSS) of a group of patients with dementia attending a day care centre. Fifteen patients with dementia attending a day care centre were exposed to the 3R stimulation programme over eight weeks while 15 controls were not. All patients from both groups were subjected to pre- and post-exposure questionnaires modified from the Mental Status Questionnaire of Kahn et al. A mental status score (MSS) was thus calculated on both occasions. All patients in the exposed group showed an improved mental status score, with the mean 'pre-exposure' and 'post-exposure' scores of 4.4 and 7.3, respectively (p < 0.001; paired t test). In contrast, the mental status scores of 12 control patients had deteriorated and mean 'pre-exposure' and 'post-exposure' scores were 4.1 and 3.4, respectively (p < 0.05; paired t test). Using multiple covariance analysis, the adjusted 'post-exposure' mean mental status score was 7.1 for the exposed and 3.6 for the controlled group (p < 0.001). The 3R programme appears to be effective for short-term mental stimulation of demented elderly people.

Aged↗

A cognitive approach to measuring and modifying delusions.

The present paper summarizes and integrates with the existing literature the results of three studies we have conducted on the measurement and modification of delusions. The findings of two of these studies have been presented previously; the third is briefly reported here. A total of 12 people with delusions took part. Ten participated in two investigations that used between-subject multiple-baseline designs; the remaining two, each of whom held three distinct delusions, took part in a study using an across-beliefs multiple-baseline design. A variety of dimensions of delusional experience were monitored over baseline periods of at least 4 weeks, and two distinct cognitive interventions were used: a structured verbal challenge and a planned empirical test. Our focus in the present article is on intervention and the process of change as people come to question and sometimes reject their delusions. We also address related issues, including problems of measurement (i.e. demand characteristics, independent validation), the connection between depression and delusions and the prediction of treatment response. We conclude with specific recommendations for cognitive therapy for delusions.

Adult↗

Reality orientation versus sheltered workshops as treatment for the institutionalized aging.

The effects of two psychosocial treatments, Reality Orientation and Sheltered Workshops, were evaluated against an assessment-only control. Thirty nursing home residents (mean age, 64.4 years) were randomly assigned to one of two groups in one of the three experimental conditions. Residents assigned to therapy conditions met for 15 group sessions led by trained nursing home personnel. Program effects were assessed before and after treatment using three variables: the Life Satisfaction Index-A, nurses' ratings, and behavior observations. The Sheltered Workshop treatment produced significant gains in Life Satisfaction Index-A scores and staff perceived social interest; Reality Orientation resulted in nonsignificant decrements in Life Satisfaction Index-A scores. Neither treatment produced effects on observer-rated on-ward behavior. The results underscore the importance of empirically evaluating therapy effects with the institutionalized aging and suggest that Sheltered Workshops may be more beneficial for this population than has previously been recognized.

Adult↗

Intellectual realism: the role of children's interpretations of pictures and perceptual verbs.

Intellectual realism refers to the tendency of young children to indicate incorrectly all that is present in an object array when asked to indicate only what they can see of it from a particular perspective. 3 experiments tested and confirmed the hypotheses that children's interpretation of (a) pictorial conventions and of (b) the expression "look like" may increase this tendency. The results of this and other studies suggest that young children's difficulties with adult pictorial conventions, with the wording of task instructions, and with the concept of a momentary, view-determined appearance can all lead to intellectual realism errors.

Child, Preschool↗

["I am but mad north-north-west"--Hamlet's portrayed delusion].

Whereas science refers to the real world existing independently and conditioned by cause and effect, the world of literature is fictitious, created by the artist in our imagination by means of language, an artefact conditioned by aesthetic laws, a world sui generis. Accordingly, Hamlet is no person, but a literary figure, doing, saying, thinking and feeling only what the poet dictated him word for word. The essential difference between the two worlds is often overlooked. That "blind spot" has a long-standing tradition in European intellectual history and goes back i.a. to the German "Hamlet experience" in the eighteenth, the "Hamlet fever" and the felt spiritual kinship (Seelenverwandtschaft) in the nineteenth century. Teleological literary criticism, centering around Hamlet's "character" and isolating his psychologically evaluated monologues (e.g. Bradley), refrained from Hamlet's fictionality and role-play and led to blurring beyond recognition the boundaries between real person and literary figure (e.g. Freud, Jones) and assisted in reducing a dramatic role to a medical case history. Speaking of Hamlet, one has to start from Shakespeare's text, our subject matter. A dramatic play being a plot turned into dialogue, the poet's vocabulary used (but indirectly also the vocabulary not used) is particularly informative. When referring to Hamlet's "antic disposition", Shakespeare uses a wide range of over 20 different terms, the most frequented being mad/madness (44 times). Evidence of primary importance are the five occasions after the apparition of his father's ghost, when Hamlet speaks of hist "madness" as an assumed role. In Act I "madness occurs first as a mere possibility when Hamlet informs his friends, he might "put an antic disposition on"; in Act II vis-a-vis Rosencrantz and Guildenstern ("I am but mad north-north-west") it is his deliberate action under certain conditions; in Act III it occurs thrice, first in his declaration of intent ("They are coming to the play, I must be idle" (i.e. "mad"), next in answering the king ("I fare of the chamaeleon's dish"), and once again in a particularly explicit distinction for his mother ("I am essentially not in madness, but mad in craft"). The evidence of all other instances of mad/madness represented here corroborates these findings: madness as an adopted role and not as a character trait. - It should also be noted that Shakespeare's main source (Belleforests adaptation of the Amleth-story from Saxo Grammaticus) already knew of the motive of stimulated madness as a cover for revenge. Hamlet assumes the role of a "madman" in order to have full scope for action, first, to test by help of the "play in the play" the truth of his father's apparition as a ghost demanding revenge as well as the actual guilt of Claudius and, when that is established, for preparing and executing his revenge. By acting himself, Hamlet becomes guilty and (Shakespeare having chosen the dramatic genre of tragedy) pays for his success with his life. Considering the constant border-crossings between the spheres of real persons and fictive literary figures in psychological approaches to Hamlet, we stressed the essential difference of a literary work of art from real life. At the same time, the inherent limitations of that difference must be shown as well. Although the world of belles lettres is fictive and non-existent in reality, it does not play in a vacuum. It is fed, in many ways, by the poet's experience of his own days as well as by the work's position within the realm of literary tradition (genre, sources, etc.). It is perhaps easy, to insist on the self-contained nature of literature, making literary criticism an arcane activity of a few elected professionals. The price to pay would be, as Laurence Lerner points out, that great literature will no longer tell us anything about life, and the poet's subtle insights, his wisdom, his understanding of the soul and of the world cease to enrich the general read

Delusions↗

Strategic retrieval and the frontal lobes: evidence from confabulation and amnesia.

Confabulation and amnesia are considered disorders of episodic but not of semantic memory. To test the limits of this view, retrieval from episodic and semantic memory was investigated in eight confabulating and nine non-confabulating amnesic subjects, and in 17 matched control subjects, by using a personal and an historical version of the Crovitz [Unconstrained search in long-term memory, Paper presented at the meeting of the Psychonomic Society, St Louis, MO, 1973] cue-word test. In response to cue words such as letter or battle subjects had to describe in detail, respectively, a related event from their personal lives or from history before their birth. We found that a subset of amnesic subjects, those with presumed damage or dysfunction in the region of the ventromedial frontal cortex, would confabulate in response to these cues. Their confabulations involved semantic, historical memories, as much as episodic, personal ones: and that distortions of content were at least as common as those of time. Even when not confabulating, they had much more difficulty than other amnesic subjects in recovering memories related to these cues. In confabulating, as compared to non-confabulating, amnesic subjects, prompting led to an increase in confabulations but also to greater recovery of veridical memories. By comparison, non-confabulating amnesic subjects whose memory loss was as severe as that of the confabulators, had a milder deficit on the personal as well as the historical cue-word test. They benefited from prompting somewhat more than matched control subjects. These results suggest that confabulation is associated with impaired strategic retrieval processes resulting from damage in the region of the ventromedial frontal cortex. These strategic retrieval processes help initiate and guide search in episodic and in semantic memory and they help monitor and organize the output from those systems.

Adult↗

Wanting to be it: children's understanding of intentions underlying pretense.

How children understand the mental state of pretense has recently become an active area of inquiry, with some research suggesting that young children do not understand that pretending is based on mentally representing some alternate state of affairs. Because intention is thought to be understood earlier than mental representation generally, these experiments tested whether children understand pretense intentions at an earlier age than they understand pretense mental representations. Children were told about a character's intentions and conflicting actions, and were asked about the character's pretense. Across 5 experiments, children did not demonstrate appreciation that intention is crucial to pretense. Various methodological factors that might have compromised the results were examined, but to no effect.

Chi-Square Distribution↗

Childhood behavioral precursors of adult symptom dimensions in schizophrenia.

The present investigation tested the hypothesis that childhood behavioral problems are differentially associated with clinical symptoms in adult-onset schizophrenia. Parents of 29 schizophrenic patients completed questionnaires concerning (1) the childhood behaviors of all their offspring from birth through 15 years of age, and (2) the symptomatology of their schizophrenic offspring. The childhood behavior scale was a modified version of Achenbach's Child Behavior Checklist (1991). Scores were derived for six childhood behavior problem factors: Withdrawal, Anxiety/Depression, Social Problems, Thought Problems, Attention Problems, and Aggression/Delinquency. Ratings of symptoms were based on parental versions of Andreasen's Scale for the Assessment of Positive Symptoms (SAPS; 1983) and Scale for the Assessment of Negative Symptoms (SANS; 1981). Symptomatology scores were computed from the SANS and SAPS following Malla et al.'s (1993) and Liddle's (1987b) tri-dimensional concept of schizophrenia: Reality Distortion, Psychomotor Poverty and Cognitive Disorganization. Regression analyses were conducted to examine the relation between childhood behavior and adult symptomatology in the schizophrenic patients. The results indicated that the Psychomotor Poverty and Cognitive Disorganization dimensions in adult patients are positively associated with Withdrawn behavior and inversely associated with Anxious/Depressed characteristics in childhood. The results are discussed in light of the distinction between primary and secondary negative symptoms, and the three dimension concept of schizophrenia.

Adolescent↗

Paranoid and nonparanoid schizophrenia: drive dominated thinking and thought pathology at two phases of disorder.

A sample of acutely hospitalized paranoid and nonparanoid schizophrenics and another sample of paranoid and nonparanoid schizophrenics studied at follow-up were compared on measures of cognitive functioning, disordered thinking, and drive dominated thinking using the WAIS, the Rorschach test, the object sorting test, and an overall index of outcome functioning (N = 67). Results suggested that cognitive regression is related more to acute psychological disturbance than to the presence or absence of paranoia, that the presence of socialized drive dominated thinking during the acute phase is related to better posthospital adjustment at follow-up, and that paranoid schizophrenics show better cognitive functioning after the acute phase. Results did not support the theory that suggests an etiological relation between homosexual conflict and paranoia.

Adult↗

Perceptual defense mechanisms in Crohn's disease and panic disorder.

The defense organization of Crohn's disease and Panic Disorder was studied with a well-validated tachistoscopic paradigm, the Defense Mechanism Test. Three sex- and age-matched groups of 34 subjects (Crohn, Panic, and Nonclinical) were compared on the main codings of defense. Crohn patients were characterized by stereotypy and lack of recognition of the threat. The Panic group presented clearly higher frequencies of protocols with repression, isolation, and disappearance of the threat. Especially was the strongest variant of isolation, barrier-isolation, typical of the defensive substructure of panic patients.

Adult↗

Ego Function Assessment of substance abusers: standardization and reliability.

This study examined the reliability of Ego Function Assessment in a self-report inventory which yields 12 function measures. 89 substance abusers in an urban treatment facility completed the inventory; 81 completed the inventory again after 2 wk. Test protocols of the first administration were assessed for interitem consistency utilizing a hierarchical algorithm which revised scales to yield optimal alphas. Retest scores were used to evaluate the stability of the 12 scales over 2 wk. Standardization, reliability, and stability data are presented for the original and revised scales. The possibility of response sets in the items are explored, and data patterns are discussed in terms of state vs trait issues in ego functioning.

Adult↗

Predicting dyadic adjustment from general and relationship-specific beliefs.

The cognitive mediation model of human psychological functioning has received increasing attention by researchers studying the role of cognitive variables in relationship distress. This study is an examination of the role of general irrational beliefs, as measured by the Irrational Beliefs Test (IBT; Jones, 1968), and relationship-specific irrational beliefs, as measured by the Relationship Belief Questionnaire (RBQ; Romans & DeBord, 1994), in predicting the perceived quality of relationships by married or cohabiting couples. Results indicated that respondents who reported higher levels of relationship-specific irrational beliefs also reported higher levels of dyadic adjustment; but contrary to expectation, higher levels of general irrational beliefs correlated with lower levels of dyadic adjustment. Implications of these findings are discussed in relation to the depressive realism hypothesis.

Adaptation, Psychological↗

Small-scale deceit: deception as a marker of two-, three-, and four-year-olds' early theories of mind.

This research report summarizes the results of a study into the abilities of 2-, 3-, and 4-year-old children to deceptively lead others into false beliefs, and is intended to help arbitrate a growing controversy as to when young persons first acquire some theory-like understanding of other minds. Utilizing a novel hide-and-seek board game as a context within which to observe children's spontaneous use of deceptive strategies, a total of 50 subjects between the ages of 2 1/2 and 5 were tested. In contrast to the competing findings of others, which are claimed to establish that children younger than approximately 4 suffer a cognitive deficit that wholly blocks them from the possibility of entertaining any sort of contrastive beliefs about beliefs, the results of this study show that even 2 1/2-year-olds are capable of already successfully employing a range of deceptive strategies that both trade upon an awareness of the possibility of false beliefs and presuppose some already operative theory of mind.

Attention↗

Cognitive restructuring in the treatment of social phobia. Efficacy and mode of action.

Cognitive restructuring (CR) is commonly used to treat social phobia, although its contribution to treatment efficacy has not been established. CR requires the person to think about and discuss feared social events with his or her therapist and thus entails some degree of exposure to social stimuli. CR also is thought to enhance the efficacy of therapeutic exposure exercises (EXP). Four predictions were tested based on this model: Relative to a control intervention matched for the exposure inherent in CR, CR is more effective in (1) reducing social phobia, (2) reducing negative social cognitions, (3) increasing positive cognitions, and (4) enhancing the effects of subsequent EXP. People with generalized social phobia (N = 60) were randomly assigned to CR followed by EXP or to a control intervention followed by EXP. Support was found for predictions 1 to 3, but not 4.

Adult↗

A pilot study of exposure control of chronic auditory hallucinations in schizophrenia.

BACKGROUND: Many patients complain less of their auditory hallucinations per se than of lack of control of the experiences. There is reason to believe that a non-distraction (exposure) approach could help patients gain more control over persistent auditory hallucinations and teach them that their experience is a form of thinking and has no external source. This study is a pilot test of that idea. METHOD: Five DSM-III-R schizophrenic outpatients with medication-resistant auditory hallucinations improved with a mean of 31 hour-long sessions over 3 months of therapist-guided exposure to their hallucinations and situations likely to evoke them. RESULTS: Improvement was greatest in patients' anxiety and sense of control over their hallucinations, less in social use of leisure and hallucinating time. CONCLUSIONS: These mildly encouraging pilot results warrant a controlled study of exposure for drug-resistant chronic auditory hallucinations and other psychotic experiences which are associated with anxious avoidance.

Anxiety↗

The defensive function of persecutory delusions. Evidence from attribution tasks.

Abnormalities of 'social' reasoning were investigated in patients suffering from persecutory delusions and in matched depressed and normal controls using transparent (obvious) and opaque (unobvious) tests of attributional style. Whereas depressed and normal subjects yielded similar causal inferences for both attributional measures, the deluded subjects showed a marked shift in internality, attributing negative outcomes to external causes on the transparent Attributional Style Questionnaire but, on the more opaque Pragmatic Inference Task, attributing negative outcomes to internal causes and thus showing a cognitive style resembling that of the depressed group. This finding, interpreted in terms of explicit versus implicit judgements, supports the hypothesis that delusions function as a defence against underlying feelings of low self-esteem.

Adult↗