Dysfunctional metacognitions in anorexia nervosa

OBJECTIVE

The aim was to compare women with anorexia nervosa (AN) and without AN in terms of dysfunctional metacognitions.

METHOD

167 Australian women with AN (N=74; mean age 24.3 yrs) and without AN (N=93; mean age 27.3 yrs) completed the Metacognitions Questionnaire-30.

RESULTS

Multivariate analyses revealed that relative to controls, AN patients had higher scores on metacognitive dysfunction: they exhibited low confidence in their cognitive competence, reported obsessively monitoring and striving to control their thoughts, and held negative beliefs about the danger of worrying. Furthermore, this was not due to starvation effects. However, patients did not exhibit significantly more positive beliefs about worry than controls once body mass index had been controlled.

CONCLUSION

Metacognitive dysfunction may play a key role in the maintenance of AN; therefore, metacognitive therapy may be usefully applied to its treatment.

Proximal and distal effects of play on child compliance with a brain-injured parent

Individuals with brain injury may experience severe cognitive and other impairments. For brain-injured parents, such deficits may be associated with child behavior problems, including noncompliance. We assessed the effects of a play period conducted by a brain-injured father on the compliance of his son, who had become uncooperative with his father after the injury. The child consistently demonstrated improved compliance during proximal and distal compliance sessions that followed father-son play periods.

Perception of natural fluctuations in peak flow in asthma: clinical severity and psychological correlates

Two methods of defining perception of asthma-related changes in airflow were compared, and relationships to clinical opinions of severity and assessments of psychological functioning were investigated. Perceived breathlessness (VAB) and peak expiratory flow (PEF) were recorded by 100 subjects for 28 days. Perception was defined by correlation of the two values and by the ratio of maximum change in PEF and related change in VAB. The latter method defined 24 poor perceivers (PP) and 13 exaggerated perceivers (EP), in whom presence of a psychological disorder was high (30% of PP, 54% of EP, compared to 8% of the remainder). Clinical severity in EP was assessed as greater than appeared warranted.

Body image disturbances and their change with videofeedback in anorexia nervosa

Disturbance in the way the body is experienced is a diagnostic criterion for anorexia nervosa, and impedes recovery. A method relatively free of external prompts, to reduce the potential for experimentally induced biases, evaluated body image distortions (BID) in 18 patients with anorexia nervosa soon after admission to an inpatient unit, and 18 normal controls, before and after a videofeedback session. The BID were assessed in the affective and self/social domains by visual analogue scales in which the instructional set oriented subjects to (a) the sensation of fatness (Affective Response, AR), and (b) size compared with other young women (Comparative Size Response, CSR). The AR and CSR were significantly greater than normal in anorexia but decreased significantly with videofeedback, while values for controls were stable. The AR and CSR were only partially independent, indicating overlap of the domains. In anorexia only, the responses were related to two DSM-IV diagnostic criteria for anorexia, fear of gaining weight and health-weight concerns, as well as to drive for thinness and body dissatisfaction. Fear of gaining weight occupied a central position in determining the magnitudes of BID and the other measures, including anxiety and depression.

Group peer review: a questionnaire-based survey

OBJECTIVE

This paper presents the findings from a questionnaire-based survey of psychiatrists designed to elucidate the positive and negative aspects of group peer review and its perceived place in accountability procedures, and to provide information about how accountability through group peer review might be improved.

METHOD

Three hundred and eighty-eight psychiatrists were surveyed via mailout questionnaire. Demographic data, details of groups, and perceptions of beneficial and detrimental effects of group peer review were sought from group participants and non-participants. Attitudes of participants were compared with those of non-participants. Features of groups related to satisfaction in participants were examined.

RESULTS

The majority of the 170 respondents participating in groups regarded peer review as a means of maintaining and improving skills, sharing ideas and methods, receiving constructive criticism and feedback, of educational benefit and an important source of professional accountability. Non-participants, while less positive overall, responded equally that participation in peer review groups would be an effective response to accountability procedures. Potential detrimental effects and problems with the functioning of peer review groups were elucidated.

CONCLUSIONS

Group peer review contributes significantly to professional accountability and education in well-functioning groups. Further strategies for the facilitation of group functioning and for the processing of problems arising in group peer review need to be developed to optimise its contribution to the maintenance and improvement of professional standards.