Interpersonal pathoplasticity in individuals with generalized anxiety disorder.

Recent theories of generalized anxiety disorder (GAD) have emphasized interpersonal and personality functioning as important aspects of the disorder. We examined heterogeneity in interpersonal problems in 2 studies of individuals with GAD (n = 47 and n = 83). Interpersonal subtypes were assessed with the Inventory of Interpersonal Problems–Circumplex (Alden, Wiggins, & Pincus, 1990). Across both studies, individuals with GAD exhibited heterogeneous interpersonal problems, and cluster analyses of these patients' interpersonal characteristics yielded 4 replicable clusters, identified as intrusive, exploitable, cold, and nonassertive subtypes. Consistent with our pathoplasticity hypotheses, clusters did not differ with GAD severity, anxiety severity, or depression severity. Clusters in Study 2 differed on rates of personality disorders, including avoidant personality disorder, further providing support for the validity of interpersonal subtypes. The presence of interpersonal subtypes in GAD may have important implications for treatment planning and efficacy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Interpersonal Problems and the Outcome of Interpersonally Oriented Psychodynamic Treatment of GAD.

The present study tested hypotheses concerning interpersonal problems and the course of brief psychodynamic treatment of generalized anxiety disorder (GAD). The authors found that the largest changes from pre- to post-therapy were evident for the Nonassertive, Exploitable, and Intrusive subscales of the Inventory of Interpersonal Problems. Relatively small changes were seen on the Overly Nurturant subscale, which was hypothesized to be most relevant to GAD. Changes in interpersonal problems were significantly associated with improvement in symptoms and worry. Brief dynamic therapy was not found to uniquely improve interpersonal problems compared with supportive therapy, although the psychodynamic approach was statistically and clinically superior to supportive therapy on symptomatic remission rates. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems.

Clients with generalized anxiety disorder (GAD) received either (1) applied relaxation and self-control desensitization, (2) cognitive therapy, or (3) a combination of these methods. Treatment resulted in significant improvement in anxiety and depression that was maintained for 2 yrs. The large majority no longer met diagnostic criteria; a minority sought further treatment during follow-up. No differences in outcome were found between conditions; review of the GAD therapy literature suggested that this may have been due to strong effects generated by each component condition. Finally, interpersonal difficulties remaining at posttherapy, measured by the Inventory of Interpersonal Problems Circumplex Scales (L. E. Alden, J. S. Wiggins, & A. L. Pincus, 1990) in a subset of clients, were negatively associated with posttherapy and follow-up improvement, suggesting the possible utility of adding interpersonal treatment to cognitive-behavioral therapy to increase therapeutic effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient pretreatment interpersonal problems and therapeutic alliance in short-term cognitive therapy.

The growing consensus regarding the importance of interpersonal process in psychotherapy, as well as of interpersonal factors in self-definition, has underscored the relevance of examining patient interpersonal functioning as it relates to the development of the therapeutic alliance. This study examined the relationship of patient pretreatment interpersonal functioning, as measured by the Inventory of Interpersonal Problems and the Millon Clinical Multiaxial Inventory (MCMI), to the therapeutic alliance, as measured early in treatment by a patient self-report version of the Working Alliance Inventory. On the basis of an interpersonal circumplex interpretation, the results generally indicated that friendly-submissive interpersonal problems were positively related to the development of aspects of the alliance and that hostile-dominant problems were negatively related to the development of aspects of the alliance early in short-term cognitive therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self- and Peer Perspectives on Pathological Personality Traits and Interpersonal Problems.

This study compares the relationship between personality disorders and interpersonal problems as obtained by self-report and peer-report measures. Participants (N=393) were administered self- and peer-report versions of the Peer Inventory for Personality Disorder and the Inventory of Interpersonal Problems-64. Canonical analyses demonstrated similar relationships between personality disorder features and interpersonal problems as measured by either self or peer. Analyses between self and peer found little shared variance across sources, indicating a large method variance. Results indicate that although similar constructs are identified by self and peers in their understanding of personality pathology and associated interpersonal problems, self-report information overlaps very little with information obtained from peers, underscoring the importance of obtaining multiple sources of information. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relation of rigidity across relationships with symptoms and functioning: An investigation with the revised Central Relationship Questionnaire.

The belief that rigidity across relationships is related to greater symptoms and poorer functioning commonly informs the practice of many psychodynamic and interpersonal therapists. Using a profile correlation approach, the authors tested this hypothesis in a sample of 250 clients and 90 undergraduate control participants. Symptoms and functioning were assessed with the Inventory of Interpersonal Problems (IIP; L. M. Horowitz, L. E. Alden, J. S. Wiggins, A. L. Pincus, 2000), Global Assessment of Functioning Scale (American Psychiatric Association, 2000), and Brief Symptom Inventory (L. R. Derogatis, & N. Melisaratos, 1983). A revised version of the empirically derived Central Relationship Questionnaire (CRQ; J. P. Barber, C. Foltz, & R. M. Weinryb, 1998) was used to measure interpersonal patterns. Revisions were made to the CRQ to increase the interpersonal dimensions it captured, reduce its length, and model a higher order factor structure. The psychometric properties of the revised CRQ were found to be adequate. Rigidity, as measured with the CRQ, was not related to rigidity measured with the IIP (amplitude) and did not differ significantly among individuals with different interpersonal problems or Diagnostic and Statistical Manual of Mental Disorders, 4th edition (American Psychiatric Association, 2000) diagnoses. Contrary to theory, however, greater rigidity across relationships was related to fewer symptoms and interpersonal problems. These relations did not appear due to the valence or the extremeness of the interpersonal patterns used in the estimation of rigidity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development and validation of a measure of interpersonal strengths: The Inventory of Interpersonal Strengths.

An Inventory of Interpersonal Strengths (IIS) was developed and validated in a series of large college student samples. Based on interpersonal theory and associated methods, the IIS was designed to assess positive characteristics representing the full range of interpersonal domains, including those generally thought to have negative qualities (e.g., introversion, coldness, submissiveness). The 8 subscales (octants) of the 64-item IIS demonstrated good circumplex features and reliability. Tests comparing Big 5 interpersonal factors, Inventory of Interpersonal Problems (IIP), Battery of Interpersonal Capabilities (BIC), and other interpersonal measures demonstrated convergent and discriminant validity and shared interpersonal structure. The IIS accounted for significant additional variance in life satisfaction and quality of personal relationships beyond the IIP and the BIC. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of cognitive-behavioral therapy for generalized anxiety disorder with integrated techniques from emotion-focused and interpersonal therapies.

Objective: Recent models suggest that generalized anxiety disorder (GAD) symptoms may be maintained by emotional processing avoidance and interpersonal problems. Method: This is the first randomized controlled trial to test directly whether cognitive-behavioral therapy (CBT) could be augmented with the addition of a module targeting interpersonal problems and emotional processing. Eighty-three primarily White participants (mean age = 37) with a principle diagnosis of GAD were recruited from the community. Participants were assigned randomly to CBT plus supportive listening (n = 40) or to CBT plus interpersonal and emotional processing therapy (n = 43) within a study using an additive design. Doctoral-level psychologists with full-time private practices treated participants in an outpatient clinic. Using blind assessors, participants were assessed at pretreatment, posttreatment, 6-month, 1-year, and 2-year follow-up with a composite of self-report and assessor-rated GAD symptom measures (the Penn State Worry Questionnaire; T. J. Meyer, M. L. Miller, R. L. Metzger, & T. D. Borkovec, 1990; Hamilton Anxiety Rating Scale; M. Hamilton, 1959; assessor severity rating; State–Trait Anxiety Inventory-Trait Version; C. D. Spielberger, R. L. Gorsuch, R. Lushene, P. R. Vagg, & G. A. Jacobs, 1983) as well as with indices of clinically significant change. Results: Mixed models analysis of all randomized participants showed very large within-treatment effect sizes for both treatments (CI = [?.40, ?.28], d = 1.86) with no significant differences at post (CI = [?.09, .07], d = .07) or 2-year follow-up (CI = [?.01, .01]), d = .12). There was also no statistical difference between compared treatments on clinically significant change based on chi-square analysis. Conclusions: Interpersonal and emotional processing techniques may not augment CBT for all GAD participants. Trial Registry name: Clinical Trials.gov, Identifier: NCT00951652. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Sex differences in interpersonal problems: A circumplex analysis.

The structure and magnitude of sex differences in interpersonal problems across several data sets were examined, guided by the interpersonal circumplex model and the structural summary method. Data were self-reported interpersonal difficulties, assessed with the 64-item version of the Inventory of Interpersonal Problems (IIP; L. M. Horowitz, S. E. Rosenberg, B. A. Baer, G. Ure?o, & V. S. Villase?or, 1988). In Study 1, the authors focused on sex differences at the level of specific interpersonal complaints (item level). In Study 2, the authors examined sex differences in octant scores of the IIP circumplex (scale level), in a reanalysis of archival data. The structural summary method was used to identify points of maximum difference between men and women in the interpersonal continuum and to estimate effect sizes. Results from the 2 studies converged in suggesting a dimension of difference involving problems in Hostile-Dominance vs. Friendly-Submission. The magnitude of effect size was consistent with previous reports in the personality literature. These sex differences appeared to be best explained by a one-dimensional model. Findings were generally consistent across 3 different types of samples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal problems, attachment styles, and outcome in brief dynamic psychotherapy

The Inventory of Interpersonal Problems (IIP) has been used to identify dysfunctional patterns in interpersonal interactions. Interpersonal problems can be organized in two dimensions, and the two-dimensional space can be divided into eight equal sectors (octants). Subscales of the IIP describe each of these octants. The instrument has been used to identify (a) interpersonal problems that are discussed most often in a brief dynamic psychotherapy and (b) problems that are treated most easily. The results show that problems in the "exploitable" octant improve most frequently, whereas problems in the "dominating," "vindictive," and "cold" octants do not improve as readily. Attachment styles in adulthood were examined (following a model proposed by Bowlby), and different attachment styles were found to correspond to different types of interpersonal problems. Finally, these variables were related to the ability to describe other people clearly. The article also discusses implications for brief dynamic psychotherapy.     

Rejoinder: Therapists, patients, and alliance development.

Responding to critical points raised by J. Holmes (2009) and G. Silberschatz (2009), the article “Therapists’ Attachment, Patients’ Interpersonal Problems, and Alliance Development Over Time in Inpatient Psychotherapy,” by U. Dinger, M. Strack, T. Sachsse, and H. Schauenburg (2009), is discussed. With regard to their particular study, the authors reflect upon the relevance of findings from the German-specific inpatient psychotherapy setting for treatment in other settings, as well as on the specific role of interpersonal problems in this sample. In addition, the authors discuss the clinical relevance of their findings, as well the clinical usefulness of the present state of research on alliance development. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Circumplex structure and personality disorder correlates of the Interpersonal Problems Model (IIP-C): Construct validity and clinical implications.

This study assessed the construct validity of the circumplex model of the Inventory of Interpersonal Problems (IIP-C) in Norwegian clinical and nonclinical samples. Structure was examined by evaluating the fit of the circumplex model to data obtained by the IIP-C. Observer-rated personality disorder criteria (DSM-IV, Axis II) were used as external correlates. The reliability of the IIP-C scales was acceptable and in the same range as in the original version. A multisample analysis strategy did not support an invariant circumplex model across the 2 groups. However, the estimated structures reflected mostly the same circular pattern of a quasi-circumplex model in the 2 groups. Departures from the ideal model were of negligible practical significance. The validity results examining personality disorder correlates of the IIP-C generally conformed to predictions, providing direct evidence for agreement between self-report and expert judgments of interpersonal problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The factorial structure of the Dutch translation of the Inventory of Interpersonal Problems: A test of the long and short versions.

In this article, the authors study the factorial structure of 2 versions (64 items and 32 items) of the Dutch translation of the Inventory of Interpersonal Problems (IIP; L. M. Horowitz, L. E. Alden, J. S. Wiggins, & A. L. Pincus, 2000) in both a clinical sample (n = 382) and a student sample (n = 287). First, the authors test whether both inventories are constituted by correlated uni-dimensional subscales, and they conclude that this is true only for the short version. Second, the authors study whether the correlations between the subscales follow a circumplex pattern. This proves to be true for both versions. Coefficients alpha and correlations between the IIP-64 and IIP-32 subscales are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eyelid movements and mental activity at sleep onset

Interpersonal problems are frequently a source of distress for individuals and the focus of psychotherapeutic interventions. A self-report circumplex measure, the Inventory of Interpersonal Problems Circumplex (IIP-C), was modified for this investigation to acquire peer report data on interpersonal problems to help assess the validity of self-reported problems. The peer report data replicated the circumplex model of the IIP-C and when general interpersonal distress was removed (by ipsatizing), the data suggested that peers observed more domineering, vindictive, and emotionally cold types of problems than self-report (ipsatized) data. Individuals reported more other-pleasing, overly nurturant types of problems than peers observed. The findings both support the validity of the IIP-C and describe discrepancies in self- versus peer reported interpersonal problems. The results also describe differences in the general interpersonal distress factor accounted for by ipsatizing versus removing the general factor from unipsatized data. The results describe implications for clinicians and others assessing interpersonal problems.     

Interpersonal problems of Vietnam combat veterans with symptoms of posttraumatic stress disorder.

274 male veterans seeking treatment for substance abuse were divided on the basis of combat experience and DSM-III criteria of posttraumatic stress disorder (PTSD). Ss with evidence of PTSD were compared with a non-PTSD group of Vietnam combat veterans and a noncombat group of Vietnam-era veterans on measures of specific interpersonal problems using the Horowitz Interpersonal Problem Inventory, traditional measures of family and social adjustment, and the MMPI. The PTSD group scored significantly higher on clusters of problems dealing with intimacy and sociability than did either of the comparison groups. PTSD Ss also scored higher on the MMPI scales of Paranoia, Psychopathic Deviate, Social Introversion, Social Maladjustment, Family Problems, and Manifest Hostility, but did not differ from other groups on Family Environment Scale variables. Results, which were not attributable to premilitary adjustment differences or to confounding demographic variables, are compared to previous studies, and research questions that remain outstanding are discussed. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal types among psychiatric patients.

The aims of the study were to isolate some of the main interpersonal behavior types within a sample of nonpsychotic psychiatric patients in psychotherapy, to determine the constancy of the isolated types across the 3 subsamples of 150 cases, and to identify any systematic differences among them. Each patient was described by his therapists on the 15 factors of the Interpersonal Behavior Inventory. The 4 replicated types were (1) inhibited, submissive, abasive; (2) agreeable, nurturant, sociable; (3) hostile, mistrustful, detached; (4) dominant, competitive, exhibitionistic. Some diagnositc and occupational differences were found. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal profiles and neurotic symptoms: Are they associated with each other?

The idea that neurotic symptoms are determined by interpersonal characteristics is of central importance for psychoanalytic theory, diagnostics, and treatment. In the present paper, the hypotheses were tested that (1) in general, neurotic symptoms are associated with interpersonal problems and (2) more specific, that a hysterical and an obsessional interpersonal dimension underlie the field of neurotic symptoms and that both dimensions are associated with specific types of neurotic symptoms. In a first study, the hysterical and obsessional interpersonal profiles were mapped by correlating clinicians' ratings on hysteria and obsessional neurosis with the scales of the IIP-64 interpersonal circumplex in a sample of neurotic outpatients. Hysteria was associated with nonassertive, overly accommodating, and self-sacrificing interpersonal behavior and obsessional neurosis was associated with vindictive and cold interpersonal behavior. In a second study, associations of these interpersonal profiles with different SCL-90-R neurotic symptom clusters were investigated in a second sample of neurotic patients and in student sample. The results showed that both interpersonal profiles were significantly associated with a wide range of neurotic symptoms. However, the hypothesized differential associations of the hysterical and obsessional interpersonal profile with distinguished types of neurotic symptoms were not observed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genetic and environmental influences on interpersonal cognitions and associations with depressive symptoms in 8-year-old twins.

Less is known about depression in children than in adults. This study integrates fields by combining cognitive and interpersonal research investigating childhood depression symptoms through the use of a genetic framework. Three research questions are addressed. First, what are the associations among interpersonal cognitions, anxiety, and depression? Second, what are the relative magnitudes of genetic and environmental influences on interpersonal cognitions? Third, to what extent do genetic and environmental influences explain associations between interpersonal cognitions and depression? Three hundred pairs of 8-year-old twins reported on symptoms of depression and anxiety by completing the Children's Depression Inventory and the Screen for Childhood Anxiety-Related Emotional Disorders. The authors examined interpersonal cognitions with the Children's Expectation of Social Behaviors and the Perceptions of Peers and Self Questionnaires. Interpersonal cognitions were more strongly correlated with depression (mean r = .35) than with anxiety (mean r = .13). Genetic influence on interpersonal cognitions was small (M = 3%), and associations between interpersonal cognitions and depression were mainly explained by environmental influences. These latter findings may result from interpersonal cognitions in young children, reflecting life experiences as opposed to trait-like cognitive biases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identification of patients at risk for nonresponse and negative outcome in psychotherapy.

This study evaluated the use of pretherapy patient variables as correlates of 3 categorical types of outcome: negative response (negative change of more than 1 normative SEest on depression measure): nonresponse (change within?±?1 SEest on depression measure); and positive response (positive change of more than 1 SEest on depression measure) to psychotherapy among 62 patients with major depressive disorder. By using 4 scales from the Brief Symptom Inventory, the Inventory of Interpersonal Problems, age, and sex, 75.8% of the Ss were correctly classified into the 3 groups. Negative responders were characterized by high levels of interpersonal difficulty and low levels of subjective distress. Nonresponders displayed moderate levels of both interpersonal difficulties and subjective distress. Positive responders displayed high levels of both interpersonal difficulties and subjective distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)