Predicting physical health: implicit mental health measures versus self-report scales

Unmasking Verbal Defensiveness: The Role of Psychological Threat in Sentence Completion Tests

Shedding light on the validity of sentence completion test (SCT) verbal defensiveness as an index of defensive behavior, the current two-part study examined the relationship between psychological threat and verbal defensiveness among military security and mission-critical team candidates using SCTs. Our study showed that as the threatening nature of SCT stems increased, defensive responses also increased, substantiating the link between psychological threat and defensive behavior. In addition, expert ratings of stem content revealed moderately strong relationships with defensive responses across two different SCTs, irrespective of their structural characteristics. In contrast to previous studies using total verbal defensiveness scores, we examined specific defensive response types and their associations with stem threat ratings, finding that omissions, denial, and comments about the test were linked to stem threat levels. Lastly, our study extends the application of the SCT verbal defensiveness index beyond specialized personnel selection, finding no significant differences in verbal defensiveness based on gender or military status. Overall, these findings contribute to a comprehensive understanding of defensive behavior and its contextual variations.

The Kenny music performance anxiety inventory (K-MPAI): Scale construction, cross-cultural validation, theoretical underpinnings, and diagnostic and therapeutic utility

I commenced my academic exploration of music performance anxiety in a study with opera chorus artists from Opera Australia in 2004. I subsequently postulated a new theory of the aetiology of music performance anxiety and began the development of the Kenny Music Performance Anxiety Inventory (K-MPAI) to assess the hypothesized theoretical constructs underpinning its diverse clinical presentations. I proposed a new definition of music performance anxiety in 2009 and revised the item content of the K-MPAI from 26 to 40 in 2011. Over the ensuing years, many researchers have used the K-MPAI in studies on a wide variety of musicians, including vocalists and instrumentalists, popular and classical musicians, tertiary music students, and professional, solo, orchestral, ensemble, band, and community musicians. To date, the K-MPAI has been reported in more than 400 studies and has been translated into 22 languages. It has been the subject of more than 39 dissertations. In this paper, I examine the research that has used the K-MPAI to assess the theory and to ascertain how well the assessment tool, and its cross-cultural validation have provided evidence for its factorial structure, robustness, and utility. The evidence indicates that the factorial structure remains consistent across cultures and different populations of musicians. It has good discriminative ability and utility for diagnostic purposes. I conclude with some reflections on how the K-MPAI can guide therapeutic interventions and with some thoughts on future directions.

Modest, yet progressive: Effective therapists tend to rate therapeutic change less positively than their patients

Objective: Empirical findings on self-serving biases amongst psychotherapists are inconsistent. We tested in a large naturalistic data set, if therapists are prone to illusory superiority when estimating their patients' outcome and whether this effect is buffered by therapists' effectiveness. Method: A post-hoc analysis with N = 69 therapists, who treated N = 1080 patients, was conducted. Therapists' and patients' mean ratings for therapeutic improvement in the Clinical Global Impression Scale (CGI) were compared. Using a multilevel modelling approach, we further investigated the relation between the patient-therapist divergence in the CGI and actual therapeutic change in the Global Severity Index (GSI) of the Brief Symptom Inventory and in the Satisfaction With Life Scale (SWLS). Results: Ratings in the CGI did not show significant differences between patients' and therapists' assessment of therapeutic change. Lower estimations by therapists, compared to patients' self-report, were associated with greater therapeutic change in GSI and SWLS. Conclusions: Therapists, on a whole, did not seem to be prone to illusory superiority when assessing therapeutic outcome. Contrary, the more modest the therapists' estimation of therapeutic outcome was, the greater the actual therapeutic change.

Chronic fatigue syndrome and the somatic expression of emotional distress: Applying the concept of illusory mental health to address the controversy

OBJECTIVE

The process of somatization in chronic fatigue syndrome (CFS) was investigated using the concept of illusory mental health (IMH). IMH involves self-reporting low emotional distress alongside performance-based assessment of distress.

METHOD

We studied IHM and physical symptoms in 175 women across four groups: (a) CFS plus depression; (b) CFS with no depression (CFS-ND); (c) depressive disorder without CFS; and (d) healthy controls (HC). IMH was assessed using a self-report measure plus the performance-based Early Memory Index (EMI).

RESULTS

CFS-NDs were no more likely to have IMH compared with HCs. Among the CFS-NDs, IMH was associated with more physical symptoms. For CFS-NDs, EMI added meaningfully beyond self-reported mental health in predicting physical symptoms.

CONCLUSION

Findings refute reducing CFS to somatization, but there is a subgroup of CFS whose lacking access to emotional distress is associated with heightened physical symptomatology.

Emotional Regulation in Women with Chronic Fatigue Syndrome and Depression: Internal Representations and Adaptive Defenses

Chronic fatigue syndrome (CFS) presents challenges in differential diagnosis and treatment. Complicating diagnosis is that its symptoms overlap with those of depression. This study applies psychoanalytic concepts to understand emotional regulation (ER) in women with CFS and/or depression. One hundred eighty-six women were assigned to four groups and compared: (a) CFS plus high er depression (CFS-HD); (b) CFS plus lower depression (CFS-LD); (c) depressive disorder (DD); and (d) healthy controls (HC). ER was operationalized by measures of capacity to form internal representations and adaptive defenses. The study's premise was that difficulties metabolizing emotions psychologically would be associated with their greater somatic expression. Some support was found for the hypothesis that CFS participants would exhibit more impairment in representing emotions and in adaptive defenses compared to the DD and HC groups, but this held only for the CFS-HD group. Although CFS-LD participants were expected to be more purely somatizing than the CFS-HD group, they instead showed more sophisticated capacities for ER than that group and recalled less distressing early relationships, revealing more resilience. Still, however, we found support for somatization in some CFS sufferers: Within both the CFS-HD and the CFS-LD groups, weaknesses in representing emotions and in defensive functioning were associated with more severe physical symptoms. Clinically, the heterogeneity of CFS and those who suffer from it indicates the need for individual assessment and depression treatment.

Assessing Anaclitic and Introjective Characteristics Using the SWAP-200 Q-Sort: Concurrent Validity with the Inventory of Interpersonal Problems Circumplex Scales

This investigation's goal was to assess the concurrent validity of the four scales of the Anaclitic and Introjective Depression Assessment (AIDA), a newly developed clinician-rated measure, and the Inventory of Interpersonal Problems Circumplex Scales (IIP-64). The AIDA is composed of Shedler-Westen Assessment Procedure items and is comprised of two primitive and two more mature scales of introjective and anaclitic personality types. Specific predictions of relationships were made and are discussed further in this paper. The participants in this study were 106 outpatients engaged in psychodynamic psychotherapy. Patients completed the IIP-64 upon assessment and were rated by their therapist on the Shedler-Westen Assessment Procedure 200 (SWAP-200). The present findings demonstrated several expected relationships between the SWAP-derived AIDA and the IIP-64. Primitive levels of Anaclitic and Introjective characteristics on the AIDA were related to more difficulties involving Affiliation and Dominance on the IIP. The primitive Introjective-Dismissive (Dismissive Depression) scale was related to difficulties involving high Dominance and low Affiliation. The more adaptive Introjective-Self-Critical (Self-Critical Depression) scale was not related to any interpersonal problem. The more adaptive Anaclitic-Needy (Needy Depression) scale was related to difficulties involving high Affiliation, and the primitive Anaclitic-Submissive (Submissive Depression) scale was associated with difficulties related to high Affiliation, as well as problems related to low Dominance in one of two domains. Our results bolster the concurrent validity of the four AIDA scales and add to current knowledge of the differential interpersonal patterns of individuals with more mature and primitive levels of anaclitic and introjective personality types. Copyright © 2016 John Wiley & Sons, Ltd.

KEY PRACTITIONER MESSAGE

Clinicians can utilize the Anaclitic and Introjective Depression Assessment (AIDA; Rost, Fonagy, & Luyten, 2014), derived from Shedler-Westen Assessment Procedure (SWAP) items, to assess if their patients possess Anaclitic or Introjective characteristics. This measure can also be used to assess if the Anaclitic and Introjective characteristics are of a more primitive or mature nature. Clinicians should be aware that individuals with more primitive levels of Anaclitic and Introjective characteristics experience more difficulties involving Affiliation and Dominance than individuals with more mature levels of personality development. Specifically, the more primitive Introjective individual will likely encounter difficulties involving high Dominance and low Affiliation. The more adaptive Introjective individual will likely not demonstrate difficulties in these areas. The more primitive Anaclitic individual will likely encounter more difficulties related to high Affiliation, as well as problems related to low Dominance. The more adaptive Anaclitic individual also likely will encounter difficulties involving high Affiliation.

Convergent Validity of the Early Memory Index in Two Primary Care Samples

Karliner, Westrich, Shedler, and Mayman (1996) developed the Early Memory Index (EMI) to assess mental health, narrative coherence, and traumatic experiences in reports of early memories. We assessed the convergent validity of EMI scales with data from 103 women from an urban primary care clinic (Study 1) and data from 48 women and 24 men from a suburban primary care clinic (Study 2). Patients provided early memory narratives and completed self-report measures of psychopathology, trauma, and health care utilization. In both studies, lower scores on the Mental Health scale and higher scores on the Traumatic Experiences scale were related to higher scores on measures of psychopathology and childhood trauma. Less consistent associations were found between the Mental Health and Traumatic Experiences scores and measures of health care utilization. The Narrative Coherence scale showed inconsistent relationships across measures in both samples. In analyses assessing the overall fit between hypothesized and actual correlations between EMI scores and measures of psychopathology, severity of trauma symptoms, and health care utilization, the Mental Health scale of the EMI demonstrated stronger convergent validity than the EMI Traumatic Experiences scale. The results provide support for the convergent validity of the Mental Health scale of the EMI.

Mitos e verdades no ensino de técnicas projetivas

O objetivo do presente estudo foi esclarecer mal entendidos comumente encontrados no ensino de técnicas projetivas. Foram desenvolvidos três temas: o mito da exclusividade da psicanálise sobre esses instrumentos, a reavaliação da nomenclatura das técnicas e o mito da ausência de validade. Encontrou-se que há publicações que dão suporte à utilização dessas técnicas por psicólogos de diversas abordagens, exemplificando com um teste desenvolvido pelo behaviorista Skinner. A possibilidade de uma nova terminologia, questionada por outros pesquisadores, foi apresentada. Além disso, a revisão concluiu que as técnicas demonstram cientificidade em diversos contextos da Psicologia.

The impact of level of personality organization on treatment response: a systematic review

This paper provides a systematic review of extant research concerning the association between level of personality organization (PO) and psychotherapy response. Psychotherapy studies that reported a quantifiable association between level of PO and treatment outcome were examined for eligibility. Based on stringent inclusion and exclusion criteria, we identified 18 studies from 13 original data sources. Participants in these studies had a variety of mental disorders, of which mood, anxiety, and personality disorders were the most common. The results of this systematic review converge to suggest that higher initial levels of PO are moderately to strongly associated with better treatment outcome. Some studies indicate that level of PO may interact with the type of intervention (i.e., interpretive versus supportive) in predicting treatment outcome, which suggests the importance of tailoring the level of interpretive work to the level of PO. Yet, at the same time, the limited number of studies available and the heterogeneity of measures used to assess PO in existing research stress the need for further research. Potential implications for clinical practice and guidelines for future research are discussed.

Therapeutic alliance mediates the effect of patient expectancy in dynamic psychotherapy

OBJECTIVES. Patient expectancy has been regarded as an important predictor of psychotherapy outcome, for more than half a century. In recent years, some evidence has emerged indicating that the therapeutic alliance may mediate the association between expectancy and outcome. DESIGN. In this dismantling, randomized clinical study, 100 out-patients who sought psychotherapy due to depression, anxiety, and personality disorders, were assigned to 1 year of dynamic psychotherapy with and without transference interpretation. METHODS. Patients' pre-treatment target expectancies and global expectancy were measured in this clinical trial. Tests of mediation were performed with two patient-rated and one therapist-rated measure of the therapeutic alliance, using regression analyses. Six putative moderators of the mediational paths were explored. RESULTS. Global Optimism was significantly associated with two clinician-rated outcome measures - the Psychodynamic Functioning Scales and Global Assessment of Functioning. Both patient ratings, but not the therapist rating of alliance mediated the association between global expectancy and clinician-rated outcome. None of the putative moderators had a significant effect. CONCLUSION. The results, together with previous findings, indicate that the expectancy-alliance-outcome mediational chain is a general phenomenon, not limited to subgroups of patients or modes of treatment.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Defensive Functioning Scale: a validity study

OBJECTIVE

We assess the convergent and predictive validity of the Defensive Functioning Scale (DFS) with measures of life events, including childhood abuse and adult partner victimization; dimensions of psychopathology, including axis I (depressive) and axis II (borderline personality disorder) symptoms; and quality of object relations.

METHOD

One hundred and ten women from a university-based urban primary care clinic completed a research interview from which defense mechanisms were assessed. The quality of object relations was also assessed from interview data. The women completed self-report measures assessing depression, borderline personality disorder symptoms, childhood physical and sexual abuse, and adult partner physical and sexual victimization.

RESULTS

Inter-rater reliability of the scoring of the DFS levels was good. High adaptive defenses were positively correlated with the quality of object relations and pathological defenses were positively correlated with childhood and adult victimization and symptom measures. Although major image distorting defenses were infrequently used, they were robustly correlated with all study variables. In a stepwise multiple regression analysis, major image distorting defenses, depressive symptoms, and minor image distorting defenses significantly predict childhood victimization, accounting for 37% of the variance. In a second stepwise multiple regression analysis, borderline personality disorder symptoms and disavowal defenses combined to significantly predict adult victimization, accounting for 16% of the variance.

CONCLUSIONS

The DFS demonstrates good convergent validity with axis I and axis II symptoms, as well as with measures of childhood and adult victimization and object relations. The DFS levels add nonredundant information to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition beyond axis I and axis II.

The interactive effects of metabolic syndrome, blood pressure, and mental health in worksite employees

BACKGROUND

Cardiovascular disease (CVD), CVD-related conditions, and mental health disorders are prevalent in the US workforce. We examined associations between metabolic syndrome (METS), blood pressure (BP), and mental health indicators in 1813 employees (25.4% women; 74.6% men) from a large manufacturing firm.

METHODS

Employees participated in a health screen. Biometric measures were body mass index, waist circumference, BP, and fingerstick determinations of blood lipid-lipoproteins and glucose. Mental health was assessed with 5 self-reported questions regarding anger, depression, anxiety, and family and work stress. Multivariate analysis of covariance tested for differences in BP and mental health indicators in employees (370 employees with METS, and 1443 employees without).

RESULTS

Participants were primarily middle-aged (44.8 +/- 0.3 years), overweight (27.9 +/- 0.1 kg/m(2)) men (n = 1352) and women (n = 461) with a resting BP of 122.5 +/- 0.3 mm Hg and 79.8 +/- 0.2 mm Hg, respectively. Diastolic BP (DBP) was found to be 5 mm Hg higher in men with METS compared with men who did not have METS. When questioned, men with higher DBP stated that they often experienced anxiety (n = 39; 91.0 +/- 2 mm Hg) compared with men who reported they rarely experienced anxiety (n = 112; 86.2 +/- 1.9 mm Hg) (P = 0.020). Similarly, systolic BP (SBP) tended to be 4 mm Hg higher in men with METS who stated they often experienced anxiety (n = 39; 138.9 +/- 2 mm Hg) compared with men who reported they rarely experienced anxiety (n = 112; 134.5 +/- 1.2 mm Hg) (P = 0.119). Diastolic BP tended to be 2 mm Hg higher among men with METS who stated they often experienced anger (n = 117; 89.4 +/- 0.9 mm Hg) compared with those who indicated they rarely experienced anger (n = 157; 87.3 +/- 0.8 mm Hg) (P = 0.086), and DBP was 3 mm Hg higher in men with METS who reported overwhelming work stress (n = 83; 89.7 +/- 1.1 mm Hg) compared with those reporting little work stress (n = 79; 86.6 +/- 1.2 mm Hg) (P = 0.176). In contrast, no associations were found between BP and mental health in men without METS, and in women, regardless of the presence or absence of METS (P > 0.05).

CONCLUSIONS

Men with METS who reported higher levels of anxiety, anger, and work stress had higher BP than men without METS, who also reported lower levels of these mental health indicators. The METS appeared to adversely interact with BP and mental health in men at this worksite. Our findings suggest worksite health promotion programs can improve the cardiometabolic and mental health profile of US employees.

The Shedler–Westen Assessment Procedure (SWAP): Making Personality Diagnosis Clinically Meaningful

There is a schism between science and practice in understanding and assessing personality. Approaches derived from the research laboratory often strike clinical practitioners as clinically naive and of dubious clinical relevance. Approaches derived from clinical observation and theory often strike empirical researchers as fanciful speculation. In this article, we describe an approach to personality designed to bridge the science-practice divide. The Shedler-Westen Assessment Procedure (SWAP; Shedler & Westen, 2004a, 2004b; Westen & Shedler, 1999a, 1999b) is an empirically rigorous diagnostic method that preserves the richness and complexity of clinical case description. In this article, we describe its use in diagnosis, case conceptualization, and treatment planning. We review evidence for reliability, validity, and clinical utility. Finally, in the article, we present a system for personality diagnosis, as an alternative to Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) Axis II, that is empirically grounded, clinically relevant, and practical for routine use in both clinical and research contexts.