Improving volitional competence is crucial for the efficacy of psychosomatic therapy: a controlled clinical trial

Extremism and common mental illness: cross-sectional community survey of White British and Pakistani men and women living in England

BACKGROUND

Mental illnesses may explain vulnerability to develop extremist beliefs that can lead to violent protest and terrorism. Yet there is little evidence.

AIMS

To investigate the relationship between mental illnesses and extremist beliefs.

METHOD

Population survey of 618 White British and Pakistani people in England. Extremism was assessed by an established measure of sympathies for violent protest and terrorism (SVPT). Respondents with any positive scores (showing sympathies) were compared with those with all negative scores. We calculated associations between extremist sympathies and ICD-10 diagnoses of depression and dysthymia, and symptoms of anxiety, personality difficulties, autism and post-traumatic stress. Also considered were demographics, life events, social assets, political engagement and criminal convictions.

RESULTS

SVPT were more common in those with major depression with dysthymia (risk ratio 4.07, 95% CI 1.37-12.05, P = 0.01), symptoms of anxiety (risk ratio 1.09, 95% CI 1.03-1.15, P = 0.002) or post-traumatic stress (risk ratio 1.03, 95% CI 1.01-1.05, P = 0.003). At greater risk of SVPT were: young adults (<21 versus ≥21: risk ratio 3.05, 95% CI 1.31-7.06, P = 0.01), White British people (versus Pakistani people: risk ratio 2.24, 95% CI 1.25-4.02, P = 0.007) and those with criminal convictions (risk ratio 2.23, 95% CI 1.01-4.95, P = 0.048). No associations were found with life events, social assets and political engagement.

CONCLUSION

Depression, dysthymia and symptoms of anxiety and post-traumatic stress are associated with extremist sympathies.

Too much of a good thing? Curvilinear relationships between self-calming and autonomic responses in paediatric patients

Based on the theory of self-regulation and the polyvagal theory, we hypothesise a curvilinear relationship between self-regulation and autonomic responses. We report findings of a pilot study that provides support for the proposed hypothesis. For some of the observed cases, the quadratic polynomial regression models the data better than the linear regression model, indicating curvilinear relationships between self-regulation and indicators of autonomic response. Consequences of the hypothesis and its relevance for therapeutic interventions supporting the patients' self-calming system are discussed.

Delay of Gratification, Delay Discounting and their Associations with Age, Episodic Future Thinking, and Future Time Perspective

The delay of gratification (DoG) in children is widely investigated with an experimental procedure originally called the “marshmallow test,” whereas the studies on self-regulation (SR) in adolescents and adults usually use self-report questionnaires. Delay discounting (DD) measures simplify the DoG procedure and focus on monetary rewards. The aim of this study was to investigate age differences in DoG and DD from childhood to old age using a test that is suitable for both children and adults. Furthermore, investigations were conducted on the association between DoG/DD and two future orientation constructs [future time perspective (FTP) and episodic future thinking (EFT)] as well as age differences in these constructs. Participants from five age groups (9–14, 18–25, 35–55, 65–80, 80+) participated in the study (N = 96). While we found no age difference for DoG, DD was the lowest [i.e., self-control (SC) was the highest] in young/middle adults; however, it was the highest (i.e., SC was the lowest) in children and old/oldest adults. Furthermore, we found significant age differences for DD and FTP. As predicted, there were strong correlations between DoG and FTP and between DD and FTP, but not between DoG/DD and EFT. These results indicate that age differences in SR vary across the measures used. Individuals who generally think and act in a future-oriented manner have a stronger ability to delay gratification.

Motivational processes in mild cognitive impairment and Alzheimer's disease: results from the Motivational Reserve in Alzheimer's (MoReA) study

BACKGROUND

Brain reserve, i.e., the ability of the brain to tolerate age- and disease-related changes in a way that cognitive function is still maintained, is assumed to be based on the lifelong training of various abilities. The Motivational Reserve in Alzheimer's (MoReA) is a longitudinal study that aims to examine motivational processes as a protective factor in mild Alzheimer's dementia (AD) and mild cognitive impairment (MCI). This paper presents the results of motivational variables, frequency of diagnoses, and prediction of global cognition as well as depression in a one-year longitudinal study.

METHODS

The sample consists of 64 subjects with MCI and 47 subjects with mild AD at baseline. At baseline, the physical/neurological examinations, standard clinical assessment, neuropsychological testing, and assessment of motivational variables were performed. At follow-up (FU) one year later, neuropsychological testing including cognition, functional abilities, behavioral and affective symptoms, and global clinical assessments of severity have been repeated.

RESULTS

AD cases have lower motivational capacities as measured with a midlife motivation-related occupational score and informant-reported present motivational processes, but do not differ with regard to delay of gratification (DoG) and self-reported motivational processes. DoG and delay discounting (DD) were relatively stable during the measurement interval. However, 20 % of the MCI cases converted to mild AD at FU, and 17 % of the mild AD cases converted to moderate AD. The rate of depression of Alzheimer's disease was 9 at baseline and 21 % at FU, and the rate of apathy was 7 and 14 %, respectively. Global cognition at FU was mainly predicted by baseline global cognition but also by one of the motivational variables (scenario test). Depression at FU was predicted mainly by two motivational variables (self-reported and informant-reported motivational processes).

CONCLUSIONS

This research might inform motivation-related strategies for prevention and early intervention with older people or people at risk for AD.

Psychological vulnerabilities and propensities for involvement in violent extremism

Research on the psychology of terrorism has argued against the idea that most terrorist behavior is caused by mental illness or by a terrorist personality. This article suggests an alternative line of inquiry - an individual psychology of terrorism that explores how otherwise normal mental states and processes, built on characteristic attitudes, dispositions, inclinations, and intentions, might affect a person's propensity for involvement with violent extremist groups and actions. It uses the concepts of "mindset" - a relatively enduring set of attitudes, dispositions, and inclinations - and worldview as the basis of a psychological "climate," within which various vulnerabilities and propensities shape ideas and behaviors in ways that can increase the person's risk or likelihood of involvement in violent extremism.

Depressive symptoms in later life: differential impact of social support and motivational processes on depression in individuals with and without cognitive impairment

This study investigates the role of a motivational process based on a composite of four subcomponents (self-efficacy, decision regulation, activation regulation and motivation regulation), as a mediator of the relationship between social support and depression assessed with the Geriatric Depression Scale in cognitively impaired and unimpaired individuals. Participants were 229 adults with a mean age of 74 years (range: 52-94 years). The sample comprised 64 participants diagnosed with mild cognitive impairment (MCI), 47 participants diagnosed with early-stage Alzheimer's disease (AD), and a group of 118 participants without any cognitive impairment. In this cross-sectional study, bivariate correlations and linear regression models were used to assess the association between the predictor variables and depression. Linear regression models were controlled for age, gender, education, cognitive status, cognitive impairment and activities. In the total sample, social support (β = -0.15, p < 0.05) and motivational processes (β = -0.41, p < 0.001) were significantly associated with depression; the impact of social support was mediated by motivational processes. While motivational processes were associated with depression in all three groups (no impairment: β = -0.61, p < 0.001; MCI: β = -0.28, p < 0.05; early AD: β = -0.30, p < 0.06), social support lost significance (no impairment: β = -0.36, p < 0.001; MCI: β = 0.07, p = 0.59; early AD: β = -0.08, p = 0.62). Based on these findings, it can be argued that the impact of social support on depressive symptoms is attenuated by cerebral deterioration in cognitively impaired individuals, while motivational processes remain relevant.

Stress-stimulated volitional coping competencies and depression in multiple sclerosis

OBJECTIVE

The present study examined the relationship between volitional modes of coping (self-regulation, volitional inhibition, and self-control) and depression in individuals with multiple sclerosis.

METHODS

A cross-sectional study of 121 participants aged 22-60 years with clinically defined MS who were consecutively admitted to a neurological rehabilitation center during a 23-month period. Correlation analyses and hierarchical regressions were conducted to evaluate the predictive value of volitional competencies (Volitional Components Questionnaire, short form, VCQ-S) on depression (Centre for Epidemiologic Studies Depression Scale, CES-D), while controlling for demographic (age, gender, and education) and certain clinical variables (Expanded Disability Status Scale, EDSS; disease duration; and Modified Fatigue Impact Scale, MFIS).

RESULTS

Hierarchical regression analyses of depression revealed a model in which 68% of the variance in the CES-D was explained by daily stress situations (VCQ-S), self-regulation (VCQ-S), fatigue (MFIS), and education. However, when the analysis included only participants who had scored above the cut-off of the CES-D (n=42), the VCQ-S factor volitional inhibition seemed to play a more relevant part in depression. In particular, the VCQ-S scales stimulation of self-access, stimulation of volitional inhibition, self-motivation, and emotional perseverance/state orientation after failure appear to be valuable predictors on CES-D.

CONCLUSIONS

The results suggest that personality-accentuated volitional coping competencies elicited by daily stressful situations could be a relevant factor for depressive mood states in individuals with MS. However, to clarify the exact relationships of this rather circular framework, longitudinal study designs with objective measurements and a stronger focus on MS-specific stressors are needed.

Getting access to the self: Effects of self-management therapy on the development of self-regulation and inhibitory control in obese adolescents

BACKGROUND AND AIMS

This study investigated the role of self-regulation competencies in general and specifically in a food-related context for the control of body weight in a three-year weight loss program.

METHODS

The sample consisted of 30 male and female adolescents (age range: 11-18 years) who participated in a three-year therapy program for severe obesity (mean BMI at the beginning of the intervention was 33.6). Assessment of self-regulation competencies was conducted at three different stages (1(st)-3(rd) graduation/class year). Therefore, three independent groups of adolescents (N = 10) at these different stages were tested (initial-to final-stage of therapy). At the time of testing the BMI of these groups significantly differed from 38.8 to 28.7. Analyses of covariance were performed to determine whether the adolescents also differed in self-regulation skills like "resistance to temptation" and food-related Stroop interference along with ameliorating their energy-balance regulation.

RESULTS

In addition to the main effects of age and body mass index, adolescents further displayed significant improvements of executive functions with respect to resistance to temptation and inhibition.

CONCLUSIONS

Interventions aimed at enhancing energy-balance regulation in adolescents may further benefit from efforts to facilitate executive functions such as self-regulation and food-related cognitive inhibition.

Predictors of dropout among personality disorders in a specialist outpatients psychosocial treatment: a preliminary study

AIM

The aim of this study was to identify factors that may affect treatment retention in a 1-year psychosocial program for adult personality disorders.

METHODS

The sample consists of patients admitted to the Adult Personality Disorder Outpatient Programme of the Bologna Community Mental Health Centre in the period 2003-2008. At the beginning of the program, patients were evaluated through a comprehensive assessment including sociodemographic form, diagnostic interviews and self-report questionnaires. Patients who dropped out from treatment were retrospectively compared with patients who completed the program.

RESULTS

Out of 39 patients enrolled in the program, 20 (51.3%) dropped out and 19 (48.7%) completed the treatment. Out of 20 patients who dropped out, 14 terminated the treatment within the first 2 months. The dropout group and the group which remained showed significant differences in diagnosis (borderline personality disorder [BPD]), demographic data (age, time from first contact with psychiatric services), clinical variable (impulsiveness) and subjective experience (motivation, treatment expectation, therapeutic relation perception and barriers to access). BPD and subjective evaluation were found to be predictors of premature termination in the sample. In detail, BPD patients who experienced a less satisfactory therapeutic relationship and reported many external problems were more likely to drop out of the program.

CONCLUSION

Important factors contributing to dropout were identified, with potential implication for clinical practice. Further efforts need to be made to find ways to retain BPD patients who find the first subjective experience of the service more problematic.

Seven Steps Toward Freedom and Two Ways to Lose It

Psychological approaches often conceptualize “free will” as self-determined decision-making. However, the functional mechanisms potentially underlying volitional freedom or its limitations have barely been elaborated. Starting from a functional definition of volition, we illustrate how personality systems interactions (PSI) theory may contribute to explaining underlying mechanisms of volitional freedom. Specifically, based on neurobiological evidence, this theory postulates that degrees of volitional freedom increase with an increasing involvement of more complex levels of psychological functioning (e.g., from habits and affective impulses toward motives, specific goals, intentions, and more global, personal goals). We will demonstrate how, at a psychological level, demand-related stress limits the pursuit of specific goals, whereas threat-related stress limits self-congruent choice of specific goals. Empirical evidence will be reported that relate to these two possible ways of losing volitional (“top-down”) control. In addition, we report on neurobiological findings supporting the present view of volitional freedom and its limitations.

The Impact of Social and Interpersonal Resources on Adjustment Disorder Symptoms in Older Age

This study investigates self-efficacy and motivation regulation as possible mediators of the relationship between social and interpersonal resources (i.e., social network, social support, social acknowledgment as a victim, and disclosure) and adjustment disorder (AJD) symptoms in a sample of 121 adults aged 65–97 years. AJD was conceptualized as a form of stress-response syndrome, core symptoms of which are intrusions, avoidance, and failure to adapt after having experienced a critical event. Motivational variables mediated the relationship between social acknowledgment and AJD symptoms. Contrary to expectations, motivational variables were not found to mediate the link between reluctance to disclose and AJD symptoms. This study casts new light on the psychological processes that enable older adults to adjust to critical life events and to exhibit resilience, which is important for successful aging.

[Outcome of simultaneous psychosomatic/internal-medicine inpatient care--a naturalistic follow-up study]

OBJECTIVES

The effectiveness of simultaneous psychosomatic and internal-medicine inpatient care has not yet been satisfyingly investigated. What outcome is found in patients treated in a psychosomatic/internal medicine setting? Can we predict a reduction in depression and symptom severity?

METHODS

The study design is prospective and naturalistic. Patients from a psychosomatic/internal-medicine setting and a solely internal-medicine ward filled in self-report questionnaires on the day of admission, five days thereafter, and three months after discharge.

RESULTS

A total of 221 patients from a psychosomatic/internal-medicine setting and 418 patients from a solely internal-medicine ward were included. Patient characteristics differed significantly between the two wards. Treatment was associated with a reduction of depression and somatic symptom severity over time. Depression severity improved more in the psychosomatic/internal-medicine setting than in the internal-medicine ward (ES = 0.37 vs. ES = 0.65). The strongest predictor of improvement of depression and somatic symptom severity was the patients' belief that their physical well-being was influenced by psychological factors (B = 1.44 and 1 = 0.65).

CONCLUSIONS

The results document a differential approach to admission in an integrated psychosomatic/internal medicine setting and underline the favourable course for psychological and somatic symptoms.