Treating co-occurring Axis I disorders in recurrently suicidal women with borderline personality disorder: A 2-year randomized trial of dialectical behavior therapy versus community treatment by experts.

This study evaluated whether dialectical behavior therapy (DBT) was more efficacious than treatment by nonbehavioral psychotherapy experts in reducing co-occurring Axis I disorders among suicidal individuals with borderline personality disorder (BPD). Women with BPD and recent and repeated suicidal and/or self-injurious behavior (n = 101) were randomly assigned to 1 year of DBT or community treatment by experts (CTBE), plus 1 year of follow-up assessment. For substance dependence disorders (SDD), DBT patients were more likely to achieve full remission, spent more time in partial remission, spent less time meeting full criteria, and reported more drug- and alcohol-abstinent days than did CTBE patients. These findings suggest that improvements in co-occurring SDD among suicidal BPD patients are specific to DBT and cannot be attributed to general factors associated with nonbehavioral expert psychotherapy. Further, group differences in SDD remission were not explained by either psychotropic medication usage or changes in BPD criterion behaviors. DBT and CTBE did not significantly differ in the reduction of anxiety disorders, eating disorders, or major depressive disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Variability and predictors of negative mood intensity in patients with borderline personality disorder and recurrent suicidal behavior: Multilevel analyses applied to experience sampling methodology.

Variability in mood swings is a characteristic of borderline personality disorder (BPD) and is associated with suicidal behavior. This study investigated patterns of mood variability and whether such patterns could be predicted from demographic and suicide-related psychological risk factors. Eighty-two adults with BPD and histories of recurrent suicidal behavior were recruited from 3 outpatient psychiatric programs in Canada. Experience sampling methodology (ESM) was used to assess negative mood intensity ratings on a visual analogue scale, 6 random times daily, for 21 days. Three-level models estimated variability between times (52.8%), days (22.2%), and patients (25.1%) and supported a quadratic pattern of daily mood variability. Depression scores predicted variability between patients' initial rating of the day. Average daily mood patterns depended on levels of hopelessness, suicide ideation, and sexual abuse history. Patients reporting moderate to severe sexual abuse and elevated suicide ideation were characterized by worsening moods from early morning up through evening, with little or no relief; patients reporting mild sexual abuse and low suicide ideation reported improved mood throughout the day. These patterns, if replicated in larger ESM studies, may potentially assist the clinician in determining which patients require close monitoring. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing the relations between impulsivity-related traits, suicidality, and nonsuicidal self-injury: A test of the incremental validity of the UPPS model.

Borderline personality disorder (BPD) has received significant attention as a predictor of suicidal behavior (SB) and nonsuicidal self-injury (NSSI). Despite significant promise, trait impulsivity has received less attention. Understanding the relations between impulsivity and SB and NSSI is confounded, unfortunately, by the heterogeneous nature of impulsivity. This study examined the relations among 4 personality pathways to impulsive behavior studied via the UPPS model of impulsivity and SB and NSSI in a residential sample of drug abusers (N = 76). In this study, we tested whether these 4 impulsivity-related traits (i.e., Negative Urgency, Sensation Seeking, Lack of Premeditation, and Lack of Perseverance) provide incremental validity in the statistical prediction of SB and NSSI above and beyond BPD; they do. We also tested whether BPD symptoms provide incremental validity in the prediction of SB and NSSI above and beyond these impulsivity-related traits; they do not. In addition to the main effects of Lack of Premeditation and Negative Urgency, we found evidence of a robust interaction between these 2 personality traits. The current results argue strongly for the consideration of these 2 impulsivity-related domains—alone and in interaction—when attempting to understand and predict SB and NSSI. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Association of daily stressors and salivary cortisol in spinal cord injury.

Objective: Examine the diurnal variation of salivary cortisol in adults with spinal cord injury (SCI) and the effect of stressors on cortisol and mood. Method: Ecological momentary assessment (EMA) to capture cortisol, stress, and mood from 25 persons with SCI and 26 without SCI. Data were analyzed using linear mixed models. Results: There were no systematic differences between groups on missing data. Diurnal variation of cortisol of participants with SCI reflected an expected pattern. No significant group differences for cortisol diurnal pattern, stress, or mood; when group interactions were significant, results indicated lower cortisol reactivity to stress in participants with SCI. Stress had a significant impact on positive, negative and agitated moods. Conclusions: Stress in daily life and its association with cortisol and mood were largely similar between persons with and without SCI. A key methodological contribution is the demonstration of using EMA to collect biological and behavioral data in the field from participants with SCI. The use of EMA in rehabilitation psychology research has great potential to advance our understanding of the dynamics of daily life with disability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support at work, heart rate, and cortisol: A self-monitoring study.

This study assessed the influence of work social support on self-monitored heart rate, blood pressure, and salivary cortisol recorded on 3 work days and 2 leisure days from 61 nurses and 32 accountants (40 men, 53 women). Heart rate and blood pressure were higher during the day at work than in the evening or on leisure days. Cortisol was higher on leisure than work days and was lower in the evening than in the day. Low social support at work was associated with elevated heart rate during the daytime and evening of work days, an effect that persisted after controlling for psychological distress, age, sex, smoking, and physical activity. Work social support was not related to cortisol on work days, but on leisure days cortisol was elevated among individuals reporting high social support. There were few differences between men and women, and no important occupational effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cortisol deviations in people with burnout before and after psychotherapy: A pilot study.

Burnout is characterized by exhaustion, cynicism, and feelings of reduced competence. These complaints may be reflected in disturbances in the main stress regulatory endocrine system: the hypothalamus pituitary adrenal (HPA) axis. In this study, the HPA-axis hormone cortisol was sampled after awakening and during the day in 22 participants with clinical burnout and in 21 healthy controls. The cortisol level after awakening was shown to be significantly lower in the burnout group as compared with the control group. Cortisol levels during the day did not differ. The same sampling procedure was repeated after 14 sessions of psychotherapeutic intervention. The intervention led to a significant reduction in complaints and to an increase of the initially lowered morning cortisol levels. No consistent correlations, however, between the changes in subjective complaints and the change in cortisol parameters were found. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A study of self-injurious and suicidal behavior in a veteran population.

This patient safety improvement study was conducted (1) to establish a database of intentional patient self-injuries and suicidal behavior among veterans in a large urban VA health care system, and (2) to investigate whether there were demographic and/or clinical characteristics of veterans who self-injure that might predict seriousness of suicidal intent and aid in future efforts at prevention. A total of 175 clinician-administered, post self-injury interviews were completed between 2006 and 2008 in a VA health care system in the Northeast. Findings suggest that self-injuries with high suicidal intent were characterized by male gender, older age, planning of self-injury, no wish to be saved, and a negative feeling about having survived. Additional results indicated that staff ratings of patient intent to die were significantly lower than patient self-rated intent to die, a finding that gives rise to questions of whether staff may tend to underestimate patient suicidal intent. Also, although more than 80% of the veterans in this sample considered their self-injurious actions impulsive, planning of self-injury was significantly associated with higher intent to die. Veterans who completed suicide during the study time period were significantly more likely than those who had nonfatal self-injuries to have experienced combat. The implications of these findings are discussed, including whether combat exposure may lead to an acquired capacity for lethal behaviors such as suicide (Joiner, 2005). (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Therapy with facially injured clients: A study of memory, evaluation, and exposure effects.

Although the number of people with facial injury increases due to modern warfare, studies that examine how clinicians are impacted by viewing facial injury are scarce. This study included 63 participants and investigated the impact viewing facial injury would have on recall and evaluation in a simulated therapist–client interaction. A 2 × 2 between-subjects design assessed facial injury status and prior exposure. All conditions were exposed to the same pseudoclient narrative that was delivered via audiotape. Recall of the facts regarding the client's narrative was assessed with 20 multiple-choice questions. Client evaluation was based on 3 factors (sympathy, capability, and likability) that emerged from a 16 statement inventory designed for the current study. A 2 × 2 analysis of variance conducted on the memory measure revealed that participants who had previewed a photo of an uninjured client recalled significantly less from the narrative than conditions without preview to the uninjured client and with preview to the injured client. A multivariate analysis of variance on the evaluation factors revealed no significant effects. Although the authors expected facial injury would have a negative effect on recall, instead facial injury created an enhancement effect. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

MCMI-II personality traits and symptom traits in parents of children with selective mutism: A case-control study.

The etiology of selective mutism (SM) in children is unknown but is regarded as multifactorial. SM is frequently associated with social anxiety and language disorder or delay. The present study addresses SM and social anxiety as a familial phenomenon by comparing self-reported personality traits and symptom traits (Millon Clinical Multiaxial Inventory; T. Millon, 1987) in parents of 50 SM children with control parents. Personality and symptom traits reflecting social anxiety are also explored separately in the parents of SM children with and without a comorbid communication disorder. The results confirm SM and social anxiety as a familial phenomenon. Assessment and treatment planning should take this into account. The family data also suggest different family transmissions of SM and social anxiety in the SM group with and without a comorbid communication disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The assessment of change during the intensive treatment of borderline and schizophrenic young adults.

This study examined change in 90 patients during long-term intensive inpatient treatment. Two types of patients were differentiated: (a) those primarily with anaclitic psychopathology, whose basic preoccupations were with issues of affection, intimacy, and attempts to establish satisfying interpersonal relations; and (b) primarily overideational patients with introjective psychopathology, whose basic preoccupations were with issues of anger, aggression, and self-definition (Blatt, 1974; Blatt & Shichman, 1983). Variables derived from clinical case reports prepared both early on and much later in the treatment process and from independently administered and scored psychological test protocols obtained at these same two times, indicate significant and constructive changes during long-term intensive inpatient treatment. Variables derived from clinical case reports indicated significant improvement in interpersonal relations in both anaclitic and introjective patients; symptom reduction, however, occurred primarily in introjective patients. Variables derived from the independently administered and scored psychological tests support these findings... (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Informed consent with suicidal patients: Rethinking risks in (and out of) treatment.

Informed consent is uniformly accepted as essential to the treatment process. However, the relevant literature has not discussed issues of risk specific to suicidal patients, nor has such information routinely been included in the informed consent process. The implications of including suicide-specific risk information in the informed consent process is discussed and examples provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Shorter term treatment of borderline personality disorder: A developmental, self-, and object relations approach.

After a brief summary of J. F Masterson's developmental, self-, and object relations approach to long-term, intensive psychotherapy of the borderline personality disorder, an adaptation of this approach to shorter term treatment is proposed. The time constraints of abbreviated treatment require the following limited goals for the patient: (a) increased control of maladaptive defenses, (b) learning about the fundamental dynamics related to the focal symptom or problematic behavior, and (c) improved adaptation. Requisite modifications of technique include (a) limited frequency of sessions, (b) focalized treatment, (c) an emphasis on adaptation, and (d) a reliance on confrontation as the primary therapeutic intervention. A brief case study is presented for illustrative purposes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Affect and alcohol use: An ecological momentary assessment study of outpatients with borderline personality disorder.

Alcohol use may be viewed as an attempt (albeit maladaptive) to regulate negative emotional states. We examined associations between both negative and positive affects and alcohol use in outpatient women diagnosed with borderline personality disorder (BPD; n = 74), a prototype of emotional dysregulation, as well as a psychiatric control group of women with current depressive disorder (major depressive disorder/dysthymic disorder [MDD\DYS]; n = 50). Participants completed randomly prompted reports of mood and alcohol use up to six times a day over a 28-day period using electronic diaries. Mean levels of either positive or negative affects did not distinguish between drinkers and nondrinkers in either diagnostic group. However, levels of both negative and positive affects were positively associated with alcohol use at the momentary level in BPD drinkers. More robust findings were obtained with respect to within-person affective variability, which was related to alcohol use in multiple ways. BPD drinkers showed higher within-person variability for most negative affects than BPD nondrinkers; MDD\DYS drinkers in general showed less within-person variability than MDD\DYS nondrinkers for negative affects. Multilevel lagged analyses for BPD drinkers indicated that alcohol use was positively related to variability in all affects, concurrently, but fewer significant effects of affect variability on the next day's drinking or significant effects of alcohol use on the next day's affect variability were observed. Among MDD\DYS drinkers, we observed more significant associations between affect variability on next day's alcohol use and of alcohol use on next day's affect variability. We discuss theoretical and methodological issues relevant to these findings as well as implications for future research. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cognitive appraisals and emotions predict cortisol and immune responses: A meta-analysis of acute laboratory social stressors and emotion inductions.

Models of stress and health suggest that emotions mediate the effects of stress on health; yet meta-analytic reviews have not confirmed these relationships. Categorizations of emotions along broad dimensions such as valence (e.g., positive and negative affect) may obscure important information about the effects of specific emotions on physiology. Within the context of the integrated specificity model, we present a novel theoretical framework that posits that specific emotional responses associated with specific types of environmental demands influence cortisol and immune outcomes in a manner that would have likely promoted the survival of our ancestors. We analyzed experiments from 66 journal articles that directly manipulated social stress or emotions and measured subsequent cortisol or immune responses. Judges rated experiments for the extent to which participants would experience theoretically relevant cognition and affect clustered around five categories: (a) cognitive appraisals, (b) basic emotions, (c) rumination and worry, (d) social threat, and (e) global mood states. As expected, global mood states were unassociated with the effect sizes, whereas exemplars from the other categories were generally associated with effect sizes in the expected manner. The present research suggests that coping strategies that alter appraisals and emotional responses may improve long-term health outcomes. This might be especially relevant for stressors that are acute or imminent, threaten one’s social status, or require extended effort. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of awakening cortisol and psychological distress in diurnal variations in affect: A day reconstruction study.

People often feel unhappy in the morning but better later in the day, and this pattern may be amplified in the distressed. Past work suggests that one function of cortisol is to energize people in the morning. In a study of 174 students, we tested to see whether daily affect patterns, psychological distress, and awakening cortisol levels were interlinked. Affect levels were assessed using the Day Reconstruction Method and psychological distress was measured using the Depression Anxiety Stress Scales. On average, positive affect increased markedly in a linear pattern across the day, whereas negative affect decreased linearly. For the highly distressed, this pattern was stronger for positive affect. Lower than average morning cortisol, as assessed by two saliva samples at waking and two samples 30 min after waking, predicted a clear increasing pattern of positive affect throughout the day. When we examined the interlinkages between affect patterns, distress, and cortisol, our results showed that a pronounced linear increase in positive affect from morning through to evening occurred chiefly among distressed people with below average cortisol levels upon awakening. Psychological distress, although not strongly associated with morning cortisol levels, does appear to interact with cortisol levels to profoundly influence affect. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Do black and white youths differ in levels of psychopathic traits? A meta-analysis of the psychopathy checklist measures.

Putative ethnic group differences in various forms of psychopathology may have important theoretical, clinical, and policy implications. Recently, it has been argued that individuals of African descent are more likely to be psychopathic than those of European descent (R. Lynn, 2002). Preliminary evidence from the Psychopathy Checklist: Youth Version (A. Forth, D. Kosson, & R. Hare, 2003) offers some support for this contention, with Black youths rated as moderately higher (Cohen's d = .61) than White youths in a large institutional sample (n = 945). To examine this issue more exhaustively, the authors meta-analyzed adolescent psychopathy data from several studies (combined N = 2,199) and obtained a much smaller mean difference (dw = .20, p = .03), although considerable heterogeneity was evident among the effect sizes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality traits, perceived risk, and risk-reduction behaviors: A further study of smoking and radon.

Personality traits and risk perceptions were examined as predictors of changes in smoking behavior. Participants (N = 697) were part of a randomized controlled trial of interventions to reduce exposure to the combined hazard of radon and cigarette smoke. Participants with higher perceived risk at baseline for the combination of smoking and radon were more likely to have a more restrictive household smoking ban in place at 12-month follow-up (p p p     

The risk of being shot at: Stress, cortisol secretion, and their impact on memory and perceived learning during reality-based practice for armed officers.

A field experiment was organized during a handgun shooting workshop for armed officers (N = 36). In-depth stress analyses involved anticipatory distress, subjective stress, and salivary cortisol reactivity triggered by reality-based handgun shooting practice and, more specifically, by being in an uncontrollable situation with the risk of being shot at. Subsequently, the study examined to what extent exposure to reality-based stress affected working memory performances and self-perceived active learning. As expected, the risk of being shot at caused more anticipatory distress, subjective stress, and increasingly triggered cortisol secretion. Further results showed that, although stress endurance deteriorated working memory performance, participants in the high-realism group simultaneously self-perceivably learned more (i.e., acquired task-relevant skills and competencies). The dual stress effect may result from the professional appreciation of reality-based practice and increased self-efficacy toward hazardous real-life situations. Balancing the intersection between occupational psychology, cognitive psychology, and psychoneuroendocrinology, this study performed stress research in an important and rarely accessible professional setting. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Interpersonal subtypes and change of interpersonal problems in the treatment of patients with generalized anxiety disorder: A pilot study.

Interpersonal problems are highly relevant to the treatment of generalized anxiety disorder (GAD) patients. Previous studies using the Inventory of Interpersonal Problems identified several interpersonal subtypes in GAD patients. In this study, we wanted to replicate earlier findings of interpersonal subtypes in GAD. We investigated whether these interpersonal subtypes are characterized by different types of interpersonal problems and different levels of interpersonal distress, and we further examined whether they differed with regard to improvement of interpersonal problems after short-term treatment. This study is based on results from a randomized controlled trial that investigated short-term treatments in GAD outpatients. For secondary analysis, interpersonal subtypes were identified by cluster analysis and Inventory of Interpersonal Problems profiles were calculated for both the total sample (N = 52) and the interpersonal subtypes using the Structural Summary Method for Circumplex Data. This study confirmed previous results demonstrating the existence of interpersonal subtypes in GAD. Four interpersonal subtypes were identified: Overly Nurturant, Intrusive, Socially Avoidant, and Nonassertive. Short-term treatment significantly improved interpersonal problems (d = 0.46) within the total GAD sample. Interestingly, the effect sizes of the four clusters differed considerably (d = 0.19–1.24) and the clusters displayed different changes in the two circumplex axes Dominance and Nurturance. Our study indicates that change of interpersonal problems needs to be specifically analyzed, even within homogenous diagnostic groups. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A longitudinal study of conversations with parents about sex and dating during college.

Emerging adulthood is a time of sexual and romantic relationship development as well as change in the parent–child relationship. This study provides a longitudinal analysis of 30 young adults’ (17 women, 13 men) sexual experiences, attitudes about sexuality and dating, and reported conversations with parents about sexuality and dating from the 1st and 4th years of college. Self-report questionnaires revealed increases in general closeness with parents, increases in sexual and dating experiences, and more sexually permissive as well as more gender stereotyped attitudes. Qualitative analyses of individual interviews indicated a movement from unilateral and restrictive sex-based topics to more reciprocal and relationship-focused conversations over time. Gender analyses revealed that young women reported more restrictive sex messages and young men more positive sex messages. Participants also described increased openness and comfort in talking about sexual topics with both mothers and fathers from the 1st to 4th year of college. Overall, the results suggest that prior findings of increased mutuality with parents during the college years extend to the traditionally taboo topic of sexuality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)