Self-report questionnaires, behavioral assessment tasks, and an implicit behavior measure: do they predict social anxiety in everyday life?

Social anxiety is commonly assessed with self-report measures. This study aimed to investigate whether maximum anxiety levels during in vivo and virtual reality behavioral assessment tasks (BATs), and implicit approach-avoidance tendencies during the approach-avoidance task (AAT) explain more variation as predictors of daily social anxiety than self-report measures. A total of 62 university students (Mage = 20.79; SD = 4.91) with high levels of social anxiety completed self-report measures on fear of negative evaluation (FNE-B) as well as fear and avoidance in social situations (Liebowitz social anxiety scale-self report), in vivo and virtual reality BATs, and the AAT (independent variables) in the laboratory. On seven consecutive days, social anxiety, experiential avoidance, and negative social events (dependent variables) were assessed. The results revealed that fear of negative evaluation predicted everyday social anxiety and experiential avoidance. Fear and avoidance in social situations only predicted experiential avoidance. Neither implicit approach-avoidance tendencies during the AAT nor maximum anxiety levels during the in vivo and virtual reality BATs predicted any outcome variable. Our results support the use of self-report questionnaires in the assessment of social anxiety.

Advancing psychotherapy and evidence-based psychological interventions

Psychological models of mental disorders guide research into psychological and environmental factors that elicit and maintain mental disorders as well as interventions to reduce them. This paper addresses four areas. (1) Psychological models of mental disorders have become increasingly transdiagnostic, focusing on core cognitive endophenotypes of psychopathology from an integrative cognitive psychology perspective rather than offering explanations for unitary mental disorders. It is argued that psychological interventions for mental disorders will increasingly target specific cognitive dysfunctions rather than symptom-based mental disorders as a result. (2) Psychotherapy research still lacks a comprehensive conceptual framework that brings together the wide variety of findings, models and perspectives. Analysing the state-of-the-art in psychotherapy treatment research, "component analyses" aiming at an optimal identification of core ingredients and the mechanisms of change is highlighted as the core need towards improved efficacy and effectiveness of psychotherapy, and improved translation to routine care. (3) In order to provide more effective psychological interventions to children and adolescents, there is a need to develop new and/or improved psychotherapeutic interventions on the basis of developmental psychopathology research taking into account knowledge of mediators and moderators. Developmental neuroscience research might be instrumental to uncover associated aberrant brain processes in children and adolescents with mental health problems and to better examine mechanisms of their correction by means of psychotherapy and psychological interventions. (4) Psychotherapy research needs to broaden in terms of adoption of large-scale public health strategies and treatments that can be applied to more patients in a simpler and cost-effective way. Increased research on efficacy and moderators of Internet-based treatments and e-mental health tools (e.g. to support "real time" clinical decision-making to prevent treatment failure or relapse) might be one promising way forward.

The need for a behavioural science focus in research on mental health and mental disorders

Psychology as a science offers an enormous diversity of theories, principles, and methodological approaches to understand mental health, abnormal functions and behaviours and mental disorders. A selected overview of the scope, current topics as well as strength and gaps in Psychological Science may help to depict the advances needed to inform future research agendas specifically on mental health and mental disorders. From an integrative psychological perspective, most maladaptive health behaviours and mental disorders can be conceptualized as the result of developmental dysfunctions of psychological functions and processes as well as neurobiological and genetic processes that interact with the environment. The paper presents and discusses an integrative translational model, linking basic and experimental research with clinical research as well as population-based prospective-longitudinal studies. This model provides a conceptual framework to identify how individual vulnerabilities interact with environment over time, and promote critical behaviours that might act as proximal risk factors for ill-health and mental disorders. Within the models framework, such improved knowledge is also expected to better delineate targeted preventive and therapeutic interventions that prevent further escalation in early stages before the full disorder and further complications thereof develop. In contrast to conventional "personalized medicine" that typically targets individual (genetic) variation of patients who already have developed a disease to improve medical treatment, the proposed framework model, linked to a concerted funding programme of the "Science of Behaviour Change", carries the promise of improved diagnosis, treatment and prevention of health-risk behaviour constellations as well as mental disorders.

IMMIGRANTS AND ATTACHMENT STATUS: RESEARCH FINDINGS WITH DUTCH AND BELGIAN IMMIGRANTS IN CALIFORNIA

Although immigrants are an extremely diverse group, adults who emigrate nearly always experience separation from family of origin, extended family and country. This research examines state of mind with respect to attachment, using the Adult Attachment Projective (George & West, 2003; George, West, & Pettem, 1999), and compares the attachment status of adult Californians who still live near their family of origin in the area in which they were born and raised (m 12, f 18) to that of individuals who emigrated from the Netherlands and Belgium as adults to California (m 29, f 41). The findings showed a significant relationship between being an immigrant and unresolved attachment status (n= 100, X2 =5.81, p=< 0.0160) unrelated to time in the US, reason for immigration, being married or single. Implications and limitations of these findings are discussed.

Virtual reality treatment in acrophobia: a comparison with exposure in vivo

The aim of the present study was to evaluate the effectiveness of low-budget virtual reality exposure versus exposure in vivo in a within-group design in 10 individuals suffering from acrophobia. Virtual reality exposure was found to be at least as effective as exposure in vivo on anxiety and avoidance as measured with the Acrophobia Questionnaire (AQ), and even more effective on the Attitude towards Heights Questionnaire (AHQ). The present study shows that virtual reality exposure can be effective with relatively cheap hardware and software on stand-alone computers currently on the market. Further studies are recommended, in which virtual reality exposure is compared with in vivo exposure in a between-group design, thus enabling investigation of the long-term effects of virtual reality treatment.

Interapy, treatment of posttraumatic stress through the Internet: a controlled trial

On-line therapy offers many advantages over face-to-face settings. Interapy includes psycho-education, screening, effect measures and protocol-driven treatment via the Internet for clients. The present paper reports the results of a controlled trial on the Interapy treatment of posttraumatic stress and grief in students, gaining course credits. The participants in the experimental condition (n = 13) improved significantly than the participants in the waiting-list control condition (n = 12), on trauma-related symptoms and general psychopathology. The effect sizes were large. Eighty percent of the treated participants showed clinically significant improvement after treatment. The possibilities for future research with Interapy, including studies into moderating variables, are discussed.

Traumatic distress among support-seeking female victims of stalking

OBJECTIVE

The authors examined the nature and prevalence of stalking behaviors, victims' coping responses, and the psychomedical impact of stalking on its victims.

METHOD

Widely accepted self-report measures, including the 12-item General Health Questionnaire and the Impact of Event Scale, were used to assess characteristics of the stalking history and its outcome in terms of general psychomedical distress and posttraumatic stress in a community study group of 201 female stalking victims.

RESULTS

The majority of the victims had undergone multiple forms of harassment, including threats of violence in 74% (N=148) and actual violence in 55% (N=111). More than half of the victims met the criterion for clinically significant pathology on the General Health QUESTIONNAIRE: Stalking often yielded substantial posttraumatic stress symptoms, commensurate with levels found in other studies of traumatized subjects.

CONCLUSIONS

Support-seeking female stalking victims experience pervasive and persistent threat and intrusion; these experiences lead to high levels of psychological morbidity.

Assessment of self-statements in agoraphobic situations construction and psychometric evaluation of the Agoraphobic Self-Statements Questionnaire (ASQ)

The study describes the development and psychometric evaluation of a self-report questionnaire for use in both treatment-outcome research and process studies: the Agoraphobic Self-Statements Questionnaire (ASQ). The ASQ comprises two subscales: a positive self-statements subscale and a negative self-statements subscale. Confirmatory factor analysis showed that, with the exception of one item, the proposed bidimensional structure of the ASQ reappeared in a second agoraphobic patient sample. Internal consistency of both subscales was satisfactory. Both subscales appeared to be sensitive to change in treatment and discriminated between agoraphobic patients and normal controls. Construct validity of the negative subscale was satisfactory, whilst additional validation of the positive subscale is required. Findings also revealed that positive thinking may serve as a coping device and that the occurrence of negative self-statements might be considered a sine qua non for the occurrence of positive self-statements. It is concluded that the ASQ can contribute to the understanding of cognitive processes during treatment of agoraphobia.

The relationship between traumatic experiences, dissociation, and borderline personality pathology among male forensic patients and prisoners

In the present study the relationship between traumatic experiences, dissociation, and borderline personality disorder pathology is examined in a group of 39 male forensic patients and 192 male prisoners. Sexual and emotional abuse are significantly more common among forensic patients than among prisoners. Patients also report a broader range of different kinds of traumas. Prisoners report significantly more dissociative symptoms. Analyses of the relationship of type of trauma on the one hand and dissociation and borderline personality pathology on the other show that sexual abuse is significantly associated with borderline personality pathology but not with dissociation among the patients. In the prison sample these associations are found only for familial but not extrafamilial sexual abuse. When the subjects are grouped on account of presence or absence of a borderline personality disorder, highly significant differences on dissociation are found between both groups. The results from this study lend support to the hypothesis that sexual abuse is not related to dissociative symptoms but merely to borderline personality pathology. Because most subjects in this study are not patients, these findings are not likely to be confounded by false memories of traumatic events that are recovered by psychotherapy. Furthermore, dissociative symptoms are found to be related to borderline personality pathology and not to the experience of traumatic events.

The Forensic Inpatient Observation Scale (FIOS): development, reliability and validity

INTRODUCTION: Re-offending, as a measure of success in forensic psychiatry, gives no information about other behaviours that may have changed. The development of the Forensic Inpatient Observation Scale (FIOS), an observation instrument to assess the non-offending functioning of forensic patients, is described. STUDY 1: In the first study the development of the initial item pool of the FIOS is described. This resulted in an instrument consisting of 78 items and seven scales. The internal reliability of the scales ranged from 0.78 to 0.91. The inter-rater reliability of the scales varied from 0.50 to 0.85 and the test retest reliability over a period of three weeks was high for most scales, ranging from 0.74 to 0.89. STUDY 2: In the second study the FIOS was developed further in another sample of forensic patients. This time exploratory factor analysis with Varimax rotation and post hoc reliability analysis were applied to determine the factor structure among the items. This resulted in an item pool of 35 items, among which six factors could be distinguished that closely resemble the factor structure of the FIOS in study one: (1) self-care, (2) social behaviour, (3) oppositional behaviour, (4) insight offence/problems, (5) verbal skills and (6) distress. Most items have high loadings on the factor they are assigned; 29 items have a loading of 0.60 or higher. The internal consistency of the scales ranges from 0.73 to 0.91 and the scales appear to be measuring independent constructs. Twenty-five out of the 35 items have an inter-rater correspondence of 90% or higher and 30 out of 35 items have an inter-rater correspondence of 87.5% or higher. The inter-rater reliability on the scale level, however, was somewhat less satisfying with correlations ranging from 0.50 to 0.69. DISCUSSION: It is argued that training the observers on a more regular basis will improve the inter-rater reliability. There is some evidence for the convergent validity of the FIOS. The FIOS has some advantages over existing inpatient scales in that it is developed specifically for forensic patients, it does not particularly focus on axis 1 symptoms but includes oppositional behaviour and attitudes to offending.

Implementing a stress management training: comparative trainer effectiveness

Participants who were recruited from various organizations were randomly assigned to 1 of 2 stress management training (SMT) conditions or an assessment-only control group. The groups in the 1st SMT condition were led by external clinical psychologists. The groups in the 2nd SMT condition were led by individuals who held posts within the organizations involved, referred to as paraprofessionals. Results show favorable effects of the SMT program both in the short term as well as at 6-month follow-up. Results showed no serious differences in effectiveness between trainers. It is argued that, to be effective, the SMT program does not necessarily have to be given by clinical psychologists only but may instead be given by individuals from other professional orientations.

Generalized social phobia versus avoidant personality disorder: differences in psychopathology, personality traits, and social and occupational functioning

Four groups of patients with social phobia (SP) were compared with regard to psychopathologic characteristics, personality traits, and social and occupational functioning. Fifteen persons with discrete social phobia without any personality disorder (DSP), 28 persons with generalized social phobia (GSP) without any personality disorder, 24 persons with GSP with a single diagnosis of avoidant personality disorder (APD), and 23 persons with GSP with more than one PD were included in the present study. APD had higher levels of social phobic avoidance, depressive symptoms, neuroticism, introversion, and social and occupational impairment as compared with GSP. DSP was found to be the least severe condition. OPD was the most impaired on nearly all variables. Logistic regression analyses revealed that introversion and depressive symptoms were able to predict correctly the presence or absence of an APD in 85% of those with social phobia. These findings are discussed in the light of the severity continuum hypothesis of social phobia and APD and recommendations for future research are given.

Internet-mediated, protocol-driven treatment of psychological dysfunction

An Internet system was developed for assessing psychopathology, for on-line, protocol-driven cognitive-behavioural psychological treatment and for measuring the effects of treatment. The system focused on the treatment of post-traumatic stress. The treatment comprised 10 writing sessions (45 min each) over five weeks. Participants were assessed on-line before treatment, after treatment and after six-week follow-up. After treatment the participants had improved significantly in terms of post-traumatic stress symptoms (P < 0.005) and general psychological functioning (P < 0.005), and this was sustained during the follow-up. Nineteen of the 20 participants were clinically recovered after treatment. Reduction in post-traumatic stress symptoms compared favourably to changes in control and experimental groups in trials of similar but face-to-face treatment.

Implementing a stress management training: comparative trainer effectiveness

Participants who were recruited from various organizations were randomly assigned to 1 of 2 stress management training (SMT) conditions or an assessment-only control group. The groups in the 1st SMT condition were led by external clinical psychologists. The groups in the 2nd SMT condition were led by individuals who held posts within the organizations involved, referred to as paraprofessionals. Results show favorable effects of the SMT program both in the short term as well as at 6-month follow-up. Results showed no serious differences in effectiveness between trainers. It is argued that, to be effective, the SMT program does not necessarily have to be given by clinical psychologists only but may instead be given by individuals from other professional orientations.

Stalking--a contemporary challenge for forensic and clinical psychiatry

BACKGROUND

Stalking is causing pervasive and intense personal suffering and is an area of psychiatry that is currently overlooked.

AIMS

To review demographic and clinical characteristics of stalkers as well as the psychological consequences for victims of stalking.

METHOD

A Medline and PsycLit search was conducted on stalking, forensic psychiatry, personality disorders, de Clérambault syndrome and erotomania, with respect to the relevance of the articles selected for stalking.

RESULTS

Stalkers are best thought of as a heterogeneous group whose behaviour can be motivated by different forms of psychopathology, including psychosis and severe personality disorders.

CONCLUSIONS

There is a clear need to arrive at a consensus on a typology of stalkers and associated diagnostic criteria. The effectiveness of psychological and pharmacological treatments have not yet been investigated. Treatment may need to be supplemented with external incentives provided by the legal system.

A comprehensive model of stress. the roles of experienced stress and neuroticism in explaining the stress-distress relationship

BACKGROUND

In this study, a complex theoretical model regarding the stress-distress relationship was evaluated. The various components in the model included experienced stress (daily hassles), psychological distress, neuroticism, problem-focused coping, avoidant coping, satisfaction with received social support and unassertiveness. On the basis of various previous findings, experienced stress was assumed to have a direct effect on psychological distress. In addition, neuroticism was assumed to have a direct effect on psychological distress as well as an indirect effect through its association with experienced stress, problem-focused coping, avoidant coping, satisfaction with social support and unassertiveness. Further, both problem-focused and avoidant coping were assumed to affect the level of psychological distress directly as well as indirectly through their influence on experienced stress. Similarly, satisfaction with social support was assumed to have a direct beneficial effect on psychological distress in addition to an indirect effect through its association with coping and experienced stress. Finally, unassertiveness was assumed to have a direct effect on psychological distress as well as an indirect effect through its influence on experienced stress and coping.

METHODS

A covariance path analysis technique (LISREL) was used.

RESULTS

A considerable predictive power of the model could be demonstrated. Experienced stress and neuroticism turned out to be most predictive of psychological distress. The effects of social support, coping and unassertiveness on psychological distress were seriously attenuated by their common association with neuroticism.

CONCLUSION

Above all, the present findings underscore the need to investigate all variables that are expected to play a role simultaneously so as to be able to take their interdependency into account. It is argued that although such comprehensive models may be more difficult to interpret as of yet, they are likely to more closely resemble reality.

Prediction of treatment outcome in social phobia: a cross-validation

This study was a replication of a study on the prediction of treatment outcome in social phobic patients [Chambless, D. L., Tran, G. Q. Glass, C.R. (1997). Predictors of response to cognitive-behavioral group therapy for social phobia. Journal of Anxiety Disorders, 11 221-240]. Results at the posttest and the 18-months follow-up were analyzed for DSM-III-R social phobic patients, with either a generalized social phobia (n = 50) or a nongeneralized fear, i.e. fear of blushing, trembling or sweating in social situations (n = 26). Predictors were pretreatment depression, personality disorder traits, clinician rated severity of impairment and frequency of negative self-statements during social interactions. The criterium variable was (the residual gain score of) self-reported avoidance of social situations. In line with Chambless et al., pretreatment depression showed some predictive value, but smaller and only at the posttest. Change in the frequency of negative self-statements paralleled, but did not predict, change in social phobia symptoms. In contrast with Chambless et al., clinician rated severity was (slightly) predictive for treatment outcome, whereas avoidant personality traits had reverse correlations with outcome in both subgroups. The results are discussed and directions for further research are given.

Assessment of obsessive-compulsive disorder

Self-report assessment devices of obsessive-compulsive symptoms are widely used by behavior therapists. In the present investigation, psychometric characteristics and concurrent, discriminant, and factorial validity of the Maudsley Obsessional Compulsive Inventory (MOCI) were studied in clinical samples. Test-retest reliability was high. The internal consistency was high for the total score and moderate for the subscales, checking and cleaning. The slowness and doubting subscales appeared to be less useful. The MOCI was found to reliably discriminate between obsessional patients on one hand and normals, patients with anorexia nervosa and anxiety disorders, on the other, but failed to discriminate obsessionals from depressives. Concurrent validity and factorial validity were satisfactory. The MOCI may be used to evaluate effects of treatment, but it is less sensitive than target ratings of obsessional problems.

The effects of a stress-management training program in individuals at risk in the community at large

In this study we examine the effects of a stress-management training program on individuals without serious (mental) health complaints but with an increased chance of developing them as a consequence of stress. Potential subjects were randomly selected from the community at large and, then screened for participation in the training program if some of several (mental) health risk factors could be attributed to them: past life-events, neuroticism, inassertiveness, avoidant coping style and lack of social support. The control group, which did not take part in the training program, consisted of individuals with a similar risk profile as those in the training group. The training program consisted of several stress-management techniques: changing unhealthy life-style, relaxation training, problem-solving training and social skills-training. Multivariate analyses of variance showed that the training group, as compared to the control group, reported significantly less distress, less trait anxiety, less daily hassles, more assertiveness and more satisfaction with social support at follow-up. There were, however, no significant changes found in the coping skills of either group.

Crime-related trauma: psychological distress in victims of bankrobbery

This study examines the relationship between the experience of a traumatic event, that is, a bankrobbery, and its psychological consequences. Two groups of employees of a major commercial bank in the Netherlands participated in this study. One group (n = 310) consisted of subjects who had experienced a bankrobbery and worked in high-frequency bankrobbery areas; the other matched control group (n = 214) consisted of nonrobbed employees from banks in the same area. Victimized subjects displayed more signs of psychological distress than the control subjects, but distress decreased over time. The main findings of this study are that a depressive/avoidant coping style, strong threat perception during the robbery, and additional life events were positively related to posttraumatic distress as assessed by the Impact of Event Scale and the Symptom Check List (SCL-90), and self-esteem was negatively associated with the SCL-90 only.

Treatment Selection: What Do We Know?

In this article we review the main findings in psychotherapy research that can contribute to the two goals of the treatment-selection process: (1) facilitating the first phase of therapy and (2) enhancement of final outcome of therapy. Psychotherapy research that contributes directly to treatment selection is scarce since treatment selection as such is seldom the topic of study. Further, guidelines for the practitioner concerning treatment selection have rarely been formulated. In this review we make the explicit attempt to reformulate research findings into suggestions for the clinician for treatment selection.

The impact of personality disorders on behavioral treatment outcome for social phobia

The impact of personality disorders (PDs) on exposure in vivo treatment for social phobia was investigated in three groups of social phobics: social phobia without any PD (n = 30), social phobia with a single diagnosis of avoidant PD (n = 18) and social phobia with multiple PDs (n = 13). We hypothesized parallel change for social phobia with and without an avoidant PD with the latter group being more impaired before and after treatment. In order to test this hypothesis, confidence intervals for change were computed. In line with our hypothesis, social phobics in all three groups improved significantly during treatment and no interaction effects were found on the repeated MANOVAs. By using a confidence interval, parallel change was found on most measures. The impact of additional anxiety and mood disorders on treatment outcome was investigated separately. The analyses showed that an additional anxiety or mood disorder also did not predict outcome of exposure treatment.

Spouse-aided therapy with depressed patients

Twenty-three non-maritally distressed depressed patients who were married or cohabitating were randomly assigned to either individual behavioral-cognitive therapy or spouse-aided treatment. Both treatment conditions focused on depressed mood, behavioral activity, and dysfunctional cognitions, the difference being that in the spouse-aided treatment the partner was involved in all aspects of treatment, whereas in the individual condition the partner was not involved. MANOVAs revealed that treatment led to statistically significant improvement on depressed mood, behavioral activity, and dysfunctional cognitions. Treatment did not affect relationship variables (marital satisfaction, communication, and expressed emotion) for both spouses. Spouse-aided therapy was as effective as individual cognitive-behavior therapy.

The Survey of Recent Life Experiences: a psychometric evaluation

Hitherto, various critics have claimed that the most commonly used measure for daily hassles is confounded with psychological well-being in both content and format. In order to circumvent such contamination, the Survey of Recent Life Experiences (SRLE) was developed by Kohn and MacDonald (1992). In the present study, the SRLE was psychometrically evaluated within a general sample of the Dutch population. Confirmatory factor analysis showed that, with the exception of one item, the original six-factor structure was strongly replicated. For five of six factors, internal consistency reliabilities proved satisfactory. It is argued that the rather low internal consistency reliability of the sixth factor may be improved if additional items are subjoined. In addition, yielded relationships between the SRLE and other variables were in accordance with previous research. It is therefore argued that the results are in support of cross-cultural construct validity of the SRLE. Future use within other Western European societies is recommended.

The assessment of personality disorders: implications for cognitive and behavior therapy

This article reviews the comorbidity of personality disorders (PDs) and Axis I disorders and discusses implications for assessment and treatment. Pros and cons of various assessment methods are discussed. The co-occurrence of PDs with Axis I disorders is considerable; roughly half of patients with anxiety disorders, depressive disorders or eating disorders received a PD diagnosis. Comorbidity models are discussed and implications for assessment and treatment are provided. Regarding the impact of PDs on cognitive-behavioral treatment outcome for Axis I disorders, conflicting results are found due to differences in assessment methods, treatment strategies, and patient samples. It is argued that additional Axis I pathology should be taken into account when studying the impact of PDs on treatment outcome for the target Axis I disorders. Finally, it is argued that the interpersonal behavior of the PD patient and the therapeutic relationship deserve more attention in the assessment and treatment of patients with PDs.

Individual behavioural-cognitive therapy v. marital therapy for depression in maritally distressed couples

BACKGROUND

Depressed patients are often characterised by marital distress, but few studies investigate the effects of marital therapy on depressed mood and relationship dysfunction.

METHOD

Twenty-seven depressed patients experiencing marital distress were randomly assigned to either individual behavioural-cognitive therapy or marital therapy. The individual treatment condition focused on depressed mood, behavioural activity and dysfunctional cognitions, whereas in the marital condition the partner was involved in the treatment and the focus was on the communication process in the marital relationship. MANOVAs revealed that treatment led to statistically significant improvements in depressed mood, behavioural activity and dysfunctional cognitions, an increase in relationship satisfaction and improvement of communication in patients and spouses. A significant interaction effect was found, showing that marital therapy had more impact on relationship variables than the individual treatment.

CONCLUSION

Both individual cognitive-behaviour therapy and marital therapy lead to less depressive complaints, and both treatment conditions have a positive effect on the relationship, although the effect on the relationship is significantly stronger in couples who were tested by marital therapy compared with patients who were treated individually.

Treatment of fear of blushing, sweating, or trembling. Results at long-term follow-up

This study investigated the long-term effectiveness of cognitive-behavioral treatments for patients with a specific type of social phobia: fear of showing bodily symptoms (blushing, sweating, or trembling). Patients were reassessed 18 months after they had finished one of the following treatments: (a) exposure in vivo followed by cognitive therapy, (b) cognitive therapy followed by exposure in vivo, or (c) a cognitive-behavioral treatment in which both strategies were integrated from the start. All patients were individually treated. Self-report assessments were held before and after treatment and at 3-month and 18-month follow-ups. Repeated measures MANOVAs for the patients who completed the 18-month follow-up (n = 26) demonstrated significant time effects from pretest to follow-up, indicating overall improvement. Between the posttest and the 18-month follow-up, no significant change was observed. No differences among the treatment packages were found, although the cognitive-exposure treatment showed a trend to be less effective than both other treatments.

Treatment of generalized social phobia: results at long-term follow-up

This study investigated the long-term follow-up effectiveness of (cognitive-) behavioural group and individual treatments for generalized social phobia. Patients were reassessed 18 months after they had finished one of the following treatment packages: (1) exposure in vivo; (2) cognitive therapy followed by exposure in vivo; or (3) a cognitive-behavioural treatment in which both strategies were integrated from the start. Half of the patients were individually treated, the other half in a group. Self-report assessments were held before and after treatment and at 3-month and 18-month follow-ups. Repeated measures MANOVAs on the patients who completed the long-term follow-up (n = 50) demonstrated significant time effects, indicating lasting improvement compared with the pretest. Between the posttest and the 18-month follow-up no significant changes were observed. ANCOVAs either with the pretest or the posttest as covariate showed a significant interaction at 18-month follow-up between treatment package and treatment modality on three of the four compound outcome variables. The group treatment with exposure in vivo alone had been the most effective in the longer term, the integrated group treatment the least effective, while the individual treatments had given improvements in-between. Results are qualified in view of numbers of dropouts, additional treatments in the respective treatment conditions, and clinical relevance.

Psychosocial group intervention and the rate of decline of immunological parameters in asymptomatic HIV-infected homosexual men

The aim of the study was to determine changes in the rate of decline of immunological parameters after psychosocial group intervention. Subjects were 26 asymptomatic HIV-infected homosexual men who participated in a cognitive-behavioral group therapy (CBT; n = 14), or an experiential group therapy program (ET; n = 12), both of 15 weeks duration. The outcome measures were changes in the decline of CD4 cell counts, and T cell proliferative responses to anti-CD3 monoclonal antibodies from preintervention to 24 months postintervention. No differences in the rate of decline of CD4 cells or T cell responses between the CBT and ET condition were found, and there were no significant changes in CD4 cell count from pre- to postintervention. However, those subjects who showed larger decreases in distress showed a smaller decline in CD4 cell counts. While the rate of decline in T cell responses was significantly less after both interventions, a similar positive change in T cell responses was found in a comparison group of 149 HIV-infected men with similar demographic, psychosocial and immunological characteristics who did not participate in one of the interventions. We conclude that the psychosocial intervention programs tested here did not cause changes in CD4 cell decline or T cell responses and that decreases in distress were related to increases in CD4 cell counts.

The structure of obsessive-compulsive symptoms

In the present study, the structure of obsessive-compulsive symptoms was investigated by means of the Padua Inventory (PI). Simultaneous Components Analysis on data from obsessive-compulsives (n = 206), patients with other anxiety disorders (n = 222), and a non clinical sample (n = 430) revealed a five-factor solution. These factors are: (I) impulses; (II) washing; (III) checking; (IV) rumination; and (V) precision. Forty-one items were selected as measure of these factors. The reliability for the five subscales, assessing each of the five factors, was found to be satisfactory to excellent. Four subscales (washing, checking, rumination and precision) discriminated between panic disorder patients, social phobics and normals on the one hand and obsessive compulsives on the other. The Impulses subscale discriminated between obsessive-compulsives on the one hand and normals on the other, but not between obsessive-compulsives and social phobics or panic patients. Some evidence in support of the construct validity was found. The Padua Inventory-Revised (41-items) appears to measure the structure of obsessive compulsive symptoms: The main types of behaviours and obsessions as seen clinically are assessed by this questionnaire, apart from obsessional slowness.

The role of negative self-statements during exposure in vivo. A process study of eight panic disorder patients with agoraphobia

The purpose of this study was to evaluate the pattern of cognitive change, and in particular the role of negative self-statements, in relation to improvement during an in vivo exposure treatment. Eight panic disordered patients with agoraphobia, of whom 4 were most and 4 were least improved on a composite measure, were exposed to standardized agoraphobic situations. During the exposure, heart rate, self-statements, and subjective anxiety were registered throughout the sessions. Fixed criteria were set for habituation of heart rate and reduction of subjective anxiety within a session. Results showed that the total frequency of negative self-statements at the start, during, as well as at the end of treatment differentiated best between the most and least improved patients. These results suggest that it may be therapeutically wise to continue exposure therapy not only until habituation of anxiety (subjectively and physiologically) is achieved, but also until the frequency of negative self-statements is reduced until zero.

Cognitive-behavioral and experiential group psychotherapy for HIV-infected homosexual men: a comparative study

The knowledge of being infected with the human immunodeficiency virus type 1 (HIV-1) brings about psychological distress and social problems including anxiety, depression, and social isolation. Participating in psychosocial intervention programs can help to reduce these problems. To date, however, very little is known about the efficacy of different intervention strategies. We implemented a study with a randomized experimental design to investigate the effectiveness of a cognitive-behavioral group psychotherapy (CBT) and an experiential group psychotherapy (ET) program for 39 asymptomatic HIV-infected homosexual men. Both therapies consisted of 17 sessions over a 15-week period. The major finding of this study was that psychosocial intervention, independent of the therapeutic orientation, decreased distress significantly, as compared with a waiting-list control group (WCG). There were no significant changes in the intervention groups as compared with the WCG in coping styles, social support, and emotional expression. Finally, CBT and ET did not differ in their effects on psychological distress or on the other psychosocial variables measured in this study.

Overprediction of fear in panic disorder patients with agoraphobia: does the (mis)match model generalize to exposure in vivo therapy?

The purpose of this study was to test the (mis)match model of Rachman and co-workers during real life exposure therapy in panic disorder patients with agoraphobic avoidance. The results showed that although the patients tended to overpredict their expected fear before the exposure sessions, their predictions did not show a tendency to become more accurate in the course of treatment. After an overprediction predicted fear tended to decrease and self-efficacy tended to increase; after a correct match both predicted fear and self-efficacy remained unchanged. Patients reports of fear tended to decrease within and across exposure sessions regardless of the occurrence of correct or incorrect matches. Patients reported significantly more positive self-statements in underprediction sessions compared to overprediction and correct match sessions. Positive self-statements increased both in underprediction and correct match sessions, but decreased in overprediction sessions. The largest reduction in negative self-statement within an exposure session was found in correct match sessions. The theoretical and clinical relevance of the results are discussed in line of the match/mismatch model of Rachman and co-workers.

The influence of mood on memories of parental rearing practices

Parental rearing styles are often found to be related to adult psychological disorders. In general, conclusions are based on the data of retrospective studies, in which patients' memories of their parents' behaviour are investigated. However, it has been widely recognized that memories may be sensitive to current mood states. The possible mood sensitivity of autobiographic memories is a powerful alternative explanation of the relationship commonly found between parental rearing styles and psychopathology, with implications for the hypothesis of early parenting as a vulnerability factor in the aetiology of such disorders. The present study examined whether memories of parental rearing styles are influenced by present mood. To this aim, both mood and memories of parental rearing styles were assessed on two occasions in a sample of 315 healthy subjects from the general community (Study 1) and in a group of 46 socially phobic patients (Study 2). Results showed that memories of early parenting remained quite stable, even in the face of significant and considerable changes in anxiety, depression, and hostility. The theoretical and practical implications of these findings are discussed.

Exposure with and without cognitive therapy for generalized social phobia: effects of individual and group treatment

Patients with generalized social phobia (n = 73) were randomly allocated to two treatment modalities: (1) group or (2) individual treatment, and to three treatment packages: (1) two blocks of exposure in vivo (2) a block cognitive therapy followed by a block exposure in vivo, or (3) two blocks cognitive-behavioural treatment in which both strategies were integrated from the start. All treatments consisted of 16 sessions, given in two treatment blocks of 4 weeks each, separated by a no-treatment phase of 4 weeks. Self-report assessments were held before and after the treatment blocks and at 3-months follow-up. Significant differences were found between effects of the first treatment block vs those of the 4-weeks waiting-list period. Repeated measures MANOVA's demonstrated significant time effects after both treatment blocks and at follow-up, indicating improvement for the group as a whole. After the first treatment block the integrated treatment did significantly worse than either exposure in vivo or cognitive therapy in decreasing somatic complaints. On the other variables no differences among the treatments were found. At follow-up a significant interaction was found between treatment package and modality on the variable cognitions: largest progress was found in the group treatment with cognitive therapy followed by exposure in vivo; smallest progress was found in the integrated group treatment. Results are discussed and recommendations for further research are given.