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PubMed1980

Psychotherapy of the affective psychoses.

Too few research studies that identify effective therapeutic methods for treatment of psychotic depressions are available. A few studies indicate that cognitive therapy reduces symptoms and may provide prophylaxis in outpatients with moderately severe depressions. Cognitive theory provides a conceptual framework for developing techniques to treat more severely depressed patients. Specific obstacles in the psychotherapy of this group include negatively biased recall of current and past events; difficulties in forming a therapeutic alliance; memory and concentration deficits; hallucinations; delusions; and somatic complaints. This paper presents preliminary attempts to develop and apply cognitive change techniques to some of these difficulties. The role of medication in combination with psychotherapy, the identification of depressions requiring psychotheeapy, and the development of methods specific to psychotherapy with psychotic depressions and promising areas in need of further investigation.

Adolescent↗
PubMed1979

Psychotherapy in the residential treatment of the borderline child.

The concept of borderline diagnosis is defined and the goals of residential treatment are delineated. The specific aims and techniques of psychotherapy are then outlined. Concomitant work with parents is utilized. The importance of working through during termination is noted.

Affective Symptoms↗
PubMed1995

Do cigarette smokers have unrealistic perceptions of their heart attack, cancer, and stroke risks?

This study examined whether perceived risks of heart attack, cancer, and stroke were higher among smokers than nonsmokers; whether smokers were more likely to underestimate these risks; and the demographic correlates of unrealistic risk estimation among smokers. Two thousand seven hundred eight-five patients from 12 North Carolina family practices completed a questionnaire including a health risk appraisal and questions concerning smoking behavior and perceived risks of heart attack, cancer, and stroke. While most smokers accurately perceived their health risks to be greater than nonsmokers', smokers were also more likely to underestimate their risks. This optimistic distortion of risk was associated with age, gender, and education levels. Smokers may not yet understand the magnitude of health risks posed by smoking. These data suggest the need for renewed attention to perceptions of the health risks of smoking. As long as smokers underestimate their risks, they underestimate the imperative to quit.

Adolescent↗
PubMed1995

Confrontations with reality: crisis intervention services for traumatized families after a school bus accident in Norway.

In August 1988 a Swedish schoolbus with 23 children and 11 adult passengers crashed into a tunnel wall in Norway. Twelve children and four parents died, 18 of the passengers survived. The victims' relatives (parents, spouses, siblings, and others) were transported to Norway and given a "confronting" support program at the University hospital in Bergen. The crisis intervention program is described: how the relatives were helped to confront and actively cope with some of the stressful situations from which traumatized families very often are protected. One year later 42 of the relatives answered a questionnaire evaluating the confronting support program that was offered during their stay in Norway. A majority of the respondents did not regret their participation in the program. The answers indicate that passivity and helplessness can be counteracted through a combination of confrontation with reality and emotional support.

Accidents, Traffic↗
PubMed2000

[Psychological stress, knowledge and treatment expectation of parents with a child managed by cochlear implant].

UNLABELLED: ESTABLISHED KNOWLEDGE: It is known that parents of hard-of-hearing children suffer from an increase in psychosocial stress. SCIENTIFIC QUESTION: How does the psychosocial situation of parents with children who have cochlear implants change during rehabilitation? AIM OF STUDY: It was the aim of this study to demonstrate how parents evaluate retrospectively their own psychological well-being during the process of rehabilitation. METHODS AND RESULTS: We interviewed 87 parents by questionnaires which were mailed to them. Fifty-seven mothers and 46 fathers responded (59% return rate). Parents reported a significant increase in stress, as perceived by themselves, after the time of diagnosis. Of the parents, 25% continued to suffer from psychic stress during rehabilitation as could be demonstrated by the SCL-90-R questionnaire criteria. The expectations by parents were realistic prior to implantation but thereafter increased significantly with time. CONCLUSIONS: The psychological state of parents during the critical phase, after a diagnosis of deafness has been made for their child, has to be considered. Even after an initial phase of shock, parents seemed to be stressed to an extent that required therapeutic intervention.

Adaptation, Psychological↗
PubMed1997

[Structural affinities of the incomprehensible in schizophrenic delusion].

Schizophrenic delusion constitutes a fictive reality of its own; moreover, it transforms the originally experienced psychotically incomprehensible into a structure of meaning. It is assumed that the incomprehensible is reified in the actual delusion by means of structural affinities. Reciprocally, it is through these structural affinities that we can approximate hermeneutically to the characteristics of psychotic existence.

Delusions↗
PubMed1998

[The 5 factor model of childhood schizophrenia].

Forty-four first-admission patients with childhood-onset schizophrenia (age at onset < or = 14 years) were examined retrospectively for 30 clinical symptoms using the Positive and Negative Syndrome Scale (PANSS; 15). A principal component analysis with varimax rotation was applied to the full item set of this scale and revealed five orthogonal independent symptom groups: cognition affect, social withdrawal, anti-social behavior, excitement, and reality distortion. In order to validate these psychopathological dimensions we analyzed the relation between the five factor scores and outcome variables (Disability Assessment Schedule, DAS-M; 13) several years after onset: Social withdrawal was correlated with poor outcome; reality distortion was related to good outcome (P < 0.01). A multivariate ANOVA identified group differences in the anti-social behavior factor between acute and insidious onset of illness and between boys and girls; patients with an acute onset scored significantly higher on the excitement factor than those with an insidious onset (P < 0.05). According to our results more than two dimensions are necessary to describe the psychopathology of childhood-onset schizophrenia, similar to adolescent- and adult-onset schizophrenia.

Adolescent↗
PubMed1998

[Depersonalization syndrome after acquired brain damage. Overview based on 3 case reports and the literature and discussion of etiological models].

Depersonalization after brain damage is still only rarely reported and poorly understood. We describe three patients between the ages of 21 and 25 who experienced depersonalization and derealization for periods of 6 weeks to 4 months, two after traumatic brain injury, the third after surgical and radiation treatment of a pineocytoma. Each one believed to be living in a nightmare and thought about committing suicide in order to wake up. One patient developed symptoms as described in Cotard delusion. Aspects of neuroanatomy, psychodynamics, and anthropology are discussed with reference to the literature. Frontal and temporal lesions seem only to play a facilitating role but not to be a necessary condition. There is evidence for additional influence of psychological and premorbid personality factors. Summarizing the current state of information we consider depersonalization with the experience of being in a dream or being dead as a heuristic reaction to brain damage. Similar models have already been discussed in neuropsychological disorders as for instance reduplicative paramnesias, neglect, and anosognosia.

Adult↗
PubMed1995

Cognitive-behavioral treatment of body dysmorphic disorder: a case report.

Body dysmorphic disorder (BDD) refers to preoccupation with an imagined physical defect or the exaggeration of a slight physical anomaly. Since BDD's inclusion in the DSM-III-R, there have been only a handful of reports of its cognitive-behavioral treatment. We describe one successful short-term cognitive-behavioral therapy treatment of a BDD patient whose presenting concern was small hand size. After nine sessions of therapy, the patient evidenced substantial change on indices measuring affective, cognitive, and behavioral facets of BDD. There was also clinically meaningful improvement in overall levels of depression and anxiety. It is suggested that cognitive-behavioral treatment programs for BDD should take into account comorbid conditions such as social phobia, and avoidant personality disorder.

Adult↗
PubMed1993

Reality monitoring in obsessive-compulsive disorder.

Individuals with obsessive-compulsive disorder (OCD) often doubt whether they have performed an action or merely imagined having performed it. Such doubts suggest that OCD patients may have deficits in reality monitoring--the ability to distinguish memories of doing from memories of imagined doing. We compared the reality monitoring abilities of OCD checkers, OCD noncheckers and normal control Ss. Although we found no evidence of reality monitoring deficits in OCD patients, they tended to express less confidence in their memories relative to control Ss. These findings suggest that obsessional doubt may reflect deficits in memory confidence rather than deficits in memory per se.

Adult↗
PubMed1994

The experimental induction of depersonalization and derealization in panic disorder and nonanxious subjects.

The present study evaluated the efficacy of three tasks in inducing depersonalization (DP) and derealization (DR) in three different groups: (a) panic disorder patients who report these symptoms while panicking (PD + DD; n = 10); (b) panic disorder patients never experiencing these symptoms during panic attacks (PD; n = 10); and (c) nonanxious controls (NC; n = 10). Clinical features of the PD+DD and PD Ss were compared as well. Relative to PD Ss, PD + DD Ss evidenced higher levels of depression, trait anxiety, more fear of panic, and had a briefer duration of their disorder. A substantial proportion of NC Ss reported past DP and DR experiences. DP and DR induction procedures were the following: staring at a dot on the wall, staring in a mirror, and silent repetition of one's name. Results indicated two tasks (mirror and dot) successfully elicited these sensations above baseline levels with DP reported more frequently and intensely than DR for all Ss. The PD + DD Ss evidenced greater baseline-to-task increases in DP and DR relative to the other two groups and exhibited a differential fear response, particularly on the dot task, with 30% of these Ss intentionally distracting themselves or terminating the induction.

Adult↗
PubMed1995

Perspectives on depressive realism: implications for cognitive theory of depression.

Beck's cognitive theory of depression has provided a successful description of depressive thinking, with one major exception. The hypothesis that depressed people show biased negative thinking seems contradicted by research indicating that Ss scoring 9 or above on the Beck Depression Inventory were more accurate than their nondepressed counterparts in judging contingencies between their responses and outcomes, seemingly showing "depressive realism". Depressive realism research has attracted attention in numerous areas of psychology, along with critical commentary focused on such issues as whether realism is limited to mild depressive states, whether laboratory tasks are sufficient to document realism, and whether realism is a general characteristic of either depressed or nondepressed people. We analyze the main critiques and show how debates about depressive realism can be heuristic for refinement of cognitive theory of depression.

Attention↗
PubMed1995

Inference processes in obsessive-compulsive disorder: some clinical observations.

In this paper we outline a cognitive model of Obsessive-Compulsive Disorder (OCD) which proposes that the core belief of OCD evolves through a series of illogical inferences. These faulty inference processes involve inferring the plausibility of events on the basis of irrelevant associations, dismissing actual evidence on the grounds of going beyond surface reality to a deeper reality, and finally inferring that a completely fictional narrative is a remote probability. A therapy aimed specifically at changing these inference processes is illustrated with case examples of OCD clients who had not benefited from conventional behavior therapy. The inference based approach (IBA) complements existing cognitive-behavioral therapy but suggests that in certain cases, the conventional cognitive therapy view of OCD beliefs as exaggerated fears of remote possibilities may actually reinforce the obsessional belief since even remote events are real. The IBA on the contrary suggests that an important goal in therapy is to highlight this confusion found in OCD between imagination and reality and illuminate for the OCD client how their compulsions, far from reassuring them about a remote possibility, actually take them further away from reality and reinforce their imaginary doubt.

Adult↗
PubMed1990

Melting chocolate and melting snowmen: analogical reasoning and causal relations.

Children's performance in the classical a:b::c:d analogy task is traditionally very poor prior to the Piagetian stage of formal operations. The interpretation has been that the ability to reason about higher-order relations (the relations between the a:b and c:d parts of the analogy) is late-developing. However, an alternative possibility is that the relations used to date in the analogies are too difficult for younger children. Two experiments presented children aged 3, 4 and 6 years with a:b::c:d analogies which were based on relations of physical causality such as melting and cutting, for example chocolate bar:melted chocolate::snowman:melted snowman. Understanding of these particular causal relations is known to develop between the ages of 3 and 4 years. It was found that even 3-year-olds could solve the classical analogies if they understood the causal relations on which they were based.

Cacao↗