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Saturday 14th July 2007

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Adult Anxiety
Cross Cultural & Global Issues
Eating Disorders
Sex, Marital & Family Relationships
Adult Psychosis
Adult Trauma
Therapeutic & Applied Issues

Adult Anxiety
English Programme
"A Life Without Turbulence - I Enjoy Flying
Again"
Latinka Basara, Veljko Djordjevic, , Darko
Marcinko, University Hospital Zagreb
Lately, it seems that the number of people coping with
fear of flying is increasing. Some authors (Van Germen,
Diekstra, Arondeus & Wolfger, 2004)) attribute the
increase to the political and social events that have had a
great impact on our perception of flying security.
Something that has been enjoyed in the past and viewed
as a fast and pleasant way to travel is now a way to open
yourself to diseases, terrorism and generally perceived as
a risk behavior. Person with fear of flying experiences
high levels of anxiety and discomfort, days, weeks even
moths before the flight. In that time it is necessary to try
to reduce all symptoms in order for him/her to function
adequately and to prevent dependency on alcohol or
tranquilizers to overcome the distress. Cognitivebehavioral treatment of fear of flying includes behavioral
(relaxation, behavior experiment, exposure...) and
cognitive techniques (identification of automatic negative
thoughts, dysfunctional schemas, irrational beliefs and
distortions). Exposure in vivo has proven to be the most
effective psychological technique for the treatment of
phobias in general (Bothell, Soma, Garcia-Palacios,
Query & Banes, 2004; Emmelkamp & Kuipers, 1985;
Marks, 1987;Oest, Brandberg & Alm, 1997) and we used
it in our treatment as well. Our patient, a 31 year old
male, has earlier been treated with medications
(tranquilizers) and after several months we started oncea-week CBT treatment which also included pre-treatment
diagnostic evaluation (using psychological clinical tests,
instruments to measure type of fears, intensity and
avoidant behaviors). Patient was asked to keep a diary of
negative (distorted) automatic thoughts, sensations,
emotions and maladaptive behaviors concerning flying.
Together with the patient we constructed a hierarchy of
feared situations regarding flying with SUDs (subjective
units of distress) rating from 1-10. Along with cognitive
interventions, we started with behavioral techniques
(relaxation, exposure in vivo, which, in the beginning,
included going to the airport, having a session at the
airport, watching the planes take of and land as well as
simply watching a plane in the sky). Exposure in
imagination was included in the later sessions. Three
meetings were organized with an official pilot with the
purpose to expose the patient to all the official information
concerning flying security, procedures and measures.
Cognitive interventions were used during and after these
meetings. In the beginning of the treatment patient was
experiencing high levels of anxiety (rating 9 or 10 on a
scale from 0-10) months before the actual flight and for
the last year was avoiding all opportunities to fly. After
four moths of treatment he reported of much lower
anxiety levels planning and thinking about flying (the day
before the flight anxiety was rated 2 on a scale rating
from 0 -10) , he reported excitement and joy rather than
anticipatory anxiety. He reported no negative thoughts or
arbitrary predictions during the flight, and no safety
behaviors. After the flight he attributed the successful
flight not to pure luck as before, but to an expected
outcome. A four month cognitive bihevioral treatment of
fear of flying included cognitive and behavioral
interventions based on identifying and working on
cognitive distortions and maladaptive assumptions,
ongoing relaxation, exposure in vivo (both to the situation
and information provided by the pilot) and exposure in
imagination. After the treatment, patient's experienced
fear rated 2 (on a scale rating from 0-10) which is about
5x lower than before the treatment. Right now he is
looking forward to his next flight, feeling only excitement
and joy to keep up with his exposures in vivo.

Hypochondriasis or health anxiety disorder? A comparison study of CBT outpatients with


hypochondriasis, anxiety and somatoform
disorders

Gaby Bleichhardt, ; Florian Weck, University of


Mainz Germany
Due to the preparation of DSM-V, a lively debate on those
disorders currently classified as somatoform disorders
takes place. Concerning hypochondriasis, some
researchers argue that it is better classified among the
anxiety disorders and more suitably called health anxiety
disorder. In this study, a total sample of 273 outpatients of
a German CBT centre (anxiety disorders N=190;
somatoform disorders N=33; hypochondriasis N=50) was
assessed by DSM-IV diagnostic interviews, Brief
Symptom Inventory (BSI), Beck Depression Inventory
(BDI) and a demographic questionnaire at the beginning
and end of treatment. Results show several differences
between the hypochondriasis and somatoform sample:
Hypochondriasis patients are younger (t=4.8; p<.001) and
show a trend for higher anxiety (BSI subscale; t=1.8;
p<.10). However, the hypochondriasis and anxiety
samples also differ in some aspects: hypochondriasis
patients have higher scores on somatisation (BSI
subscale; t=2.2; p<.05), lower scores on phobic anxiety
(BSI subscale; t=5.8; p<.001) and they are more satisfied
with their partnership (t=2.1; p<.05). Further analyses on
comorbidity patterns and therapy outcomes will be
presented. Interpreting these results, both classifications
would have almost equal pros and cons. However, the
psychopathologic mechanisms underlying
hypochondriasis argue for a classification among the
anxiety disorders.

Memory Confidence, Responsibility


Perceptions and Repeated Checking:
Comparisons in OCD and Control Samples
Mark Boschen, ; Dean Vuksanovic, Griffith
University Australia
Repeated checking has been repeatedly associated with
memory distrust. We sought to extend previous research
using a computer-based checking task by incorporating a
group of 15 individuals with OCD, and examining the
effect of increased perceived responsibility. Participants
were asked to repeatedly check a virtual stovetop, with
half the participants also placed under a condition of high
perceived responsibility. Our observations replicated
previous research showing that the act of repeatedly
checking leads to reductions in memory vividness, detail
and confidence, without accompanying reductions in
memory accuracy. Furthermore, while a sense of
increased personal responsibility had little effect on a
student control sample, it led to a significant further
deterioration in memory confidence in individuals with
OCD. These results suggest that in people with OCD,
normal reductions in memory confidence over repeated
trials are exacerbated and intensified by inflated
responsibility perceptions.

Clinical effects of a self-assertive group


treatment on patients suffering from social
phobia
Maria Boucherie, Laurence Borras, Stella
Warczyk,; Eliana Goza, Delphine Morand, ;
Philippe Huguelet, University Hospitals of
Geneva Switzerland
Assertiveness basically means the ability to express your
thoughts and feelings in a way that clearly states your
needs and keeps the lines of communication open with
the other (Ryan and Travis, 2000). Persons suffering from
social phobia have a lower self-assertiveness than normal
population. A self-assertive group treatment, based on the
cognitive-behavioural model, aimed at reducing social
phobia through behavioural experiencing and cognitive
restructuration. This study investigates the therapeutic
factors influencing the outcome of patients suffering from
social phobia. Thirty patients (22 women and 8 men,
mean age=37) who were diagnosed with social phobia
according to DSM IV criteria were chosen as subjects.
The following scales were used to evaluate their
symptomatology: Beck Depression Inventory (BDI-21),
State Trait Anxiety Inventory (STAI Y-A and Y-B), Rathus
Assertiveness Schedule (RAS), Liebowitz Social Anxiety
Scale (LSAS) and Social Self-Esteem Inventory (SSEI).
The patients filled these 5 scales before treatment, just

after the 12 group sessions, and 6 months later.


Statistical analyses (Paired Samples T-Test) were used.
Results indicated that all patients significantly improved
on the 5 scales except for the STAI Y-A. The most
significant improvement concerned depression ( p=.000),
anxiety (STAI Y-B) ( p=.000), social self-esteem ( p=.000)
and assertiveness( p=.000). At the 6 months follow-up,
the improvement persisted significantly for all patients on
every scale. This assertiveness group seemed to improve
the symptomatology of patients suffering from social
phobia. The results suggest which therapeutic factors
and components should be highlighted in cognitive
behavioural group treatment for social phobia and pointed
out that the assertiveness component is a behaviour that
can be learned and reinforced through evenly assertive
training.

The Expression of Anxiety Symptoms in Daily


Life
Leslie Brown,; Paul Silvia, Thomas Kwapil, ; Inez
Myin-Germeys, University of North Carolina at
Greensboro USA
Anxious individuals experience psychological distress and
potentially impairing physiological symptoms, but a
paucity of research has examined the impact of the
symptoms on daily life. The present study employed the
experience sampling method (ESM) to explore the
expression of anxiety symptoms in daily lives of 201
college students. After completing paper-and pencil
questionnaires in the laboratory, including the Beck
Anxiety Inventory (BAI), participants were issued a PDA
that signaled them randomly eight times daily for one
week to complete a brief questionnaire inquiring about
their affect, cognitions, activities and social encounters.
Consistent with our hypotheses, anxiety symptoms were
associated with impairment in daily functioning.
Specifically, anxious participants experienced more
negative affect-including feelings of sadness, selfconsciousness, and irritability-and less positive affect in
daily life. Furthermore, anxiety symptoms were
associated with disengagement from activities and social
relationships in daily life. ESM appears to be a promising
method for examining the expression of anxiety
symptoms in daily life.

Comparison of the effectiveness of two


anxiety induction procedures in older adults.
Isabel Cabrera, Ignacio Montorio, Universidad
Autnoma de Madrid; Roberto Nuevo, Hospital
Universitario de La Princesa; Mara MrquezGonzlez, Gema Prez-Rojo, Universidad
Autnoma de Madrid Spain
Over the last decades there has been an increasing
interest in studying the relations between emotion,
cognition and behaviour. As a result, several techniques
have been developed to experimentally induce mood
states. The induction of mood states is a relevant tool for
clinical investigation, as it allows the experimental
analysis of mood effects on cognitive processes. Effective
anxiety mood induction procedures could help researches
to shed light on theoretical issues of cognitive models of
anxiety and to improve the design and development of
cognitive therapies for anxiety disorders. Although several
procedures have been proposed for inducing anxiety in
younger people, it seems that, apparently, there have not
been empirical works analyzing their relative
effectiveness with older adults. The goal of the present
study was to compare the effectiveness of two anxious
mood induction procedures in older adults. Sample was
composed by 57 persons recruited in day-care centers for
older adults, with ages between 60 and 86 years (mean =
69.35, SD = 6.78). The 75.4 % of the sample were
women. Subjects were randomly assigned to one of three
conditions: A) Velten plus Music plus Incubation, B) Film
plus Incubation, or C) Neutral. 40 anxiety and neutral
statements adapted from Velten were used. Music was a
5 minutes piece from the Ligeti's Requiem and the film
was 10 minutes of anxiety scenes of different films. Preand post- assessments of subjective state anxiety (scales
of Tension and Vigour of the Profile of Mood States
POMS and two Visual Analogue Scales for mood state
and nervousness), physiological responses (heart rate

and skin conductance) and a behavioural variable


(counting speed). There were not significant differences
between conditions in the pre-induction measures. After
the anxiety induction, there were significant differences
between the condition A and the control group in both the
VAS of mood state (p= .006) and that of nervousness (p=
.022), as well as in the POMS Tension sub-scale (p=
.001), without significant differences found for the rest of
variables and conditions. Several one-way mixed
ANOVAs 2 x 3 (Time= pre-post x Condition) were
performed. The main effect for the variable Time was only
statistically significant for the behavioural measure
showing that, independently of the Condition, subjects
seem to decrease their level anxiety. There were
significant interaction effects between Time and Condition
for the VAS of mood state (F (2, 54) =6.1, p< .004), VAS
of nervousness (F (2, 54) =5.7, p< .006), and Tension
POMS sub-scale (F (2, 54) =7.8, p< .001). Simple
contrasts pointed out that the differences for these three
dependent variables were between A and C condition,
specifically: subjects in condition A increased their level of
anxiety to a higher degree in these variables, as
compared to subjects in the condition C. The results of
this study suggest that the procedure for inducing anxiety
consisting of self-referential statements and music
(condition A) produces higher changes on the emotional
state. Despite the lack of differences in
psychophysiological measures, this procedure can be
proposed as an efficient method for experimentally
inducing anxiety in studies with older adults

Social Anxiety, maladaptive cognitive


schemas, and gender
Esther Calvete, University of Deusto; Izaskun
Orue, University of Deusto
Social anxiety is a relevant psychological problem, which
affects a high rate of population. Previous studies have
indicated that social anxiety is linked with a variety of
cognitions, such as perceived self-incompetence to deal
with social situations, and worry about rejection by others.
Young (1999) proposed a number of maladaptive
schemas, which are hypothetically developed during
childhood and elaborated throughout one's lifetime.
According to Young's schema theory, these schemas
often form the core of the individual's self-concept and
define his/her vision of his/her relationships with others.
In this study we assessed the relationship between
maladaptive cognitive schemas and symptoms of anxiety
in a broad range of social situations. Because previous
studies have showed gender differences both in cognitive
schemas and social anxiety, we also tested whether the
influence of cognitive schemas on anxiety was moderated
by gender. 550 university students (300 women and 250
men) completed measures of social anxiety symptoms
(CISO-AR, Caballo et al., 2006), and cognitive schemas
(SQ-SF, Young & Brown, 1994). Schemas related to
impaired autonomy, other-directedness and overvigilance
were positively associated with anxiety in a number of
social situations. These situations included social
encounters in which people reject or ignore the individual,
speaking/ performing in public, and interactions with the
opposite sex. A series of hierarchical multiple regression
analyses indicated that the association between the
cognitive schemas and social anxiety was moderated by
gender, with the impact of negative schemas higher
among men. These results contribute to understand the
role of Young's maladaptive schemas in social anxiety
from a gender perspective. Cognitions consisting of low
self-efficacy, an excessive focus on the desires and
responses of others, at the expense of one's own needs,
and unrealistic expectations about performance should be
the focus of cognitive assessment and therapy with
socially anxious patients.

College Students' Test anxiety


Ana Carvalhal de Melo, Jos Pinto Gouveia
Psychology Faculty of Coimbra University,
Anabela Pereira Aveiro University, Cludia
Figueiredo Psychology Faculty of Coimbra
University Portugal
The presence Exams Anxiety is a critical event that
occurs in the life of many college student affecting their
academic success with serious impact in their social e
personal life (Sarason & Sarason, 1990; Zeidner, 1998).
This study intents to contribute for the analysis of the
impact of the high levels of anxiety on the quality of life
and well-being of college students, as well as to
investigate into the psychological variables that contribute
in a more significant manner towards the presence of
anxiety on exams in college education. The investigation
we are presenting here was conducted in 2006 in
different colleges of Portugal. To participate, 358 students
answered a questioner with different psychological
measures validated for Portuguese population (ECCAE Cognition and behaviour scale in Anxiety Exams; BSI Brief Symptoms Inventory; Losc - Levels of Self Criticism
Scale; TAI - Test Anxiety Inventory; SIPAAS - Social
Interaction and Performance Anxiety and Avoidance).
Although this study took place within a non-clinical
atmosphere and has an exploratory character, it was
seen that the group of students with the highest levels of
anxiety differs from their colleagues as to the type and as
to the fact that they were attending a course that was not

their first choice [?2(1)=11.543; p=.000]. Besides this,


high anxiety also appears associates to recourse to
psychological or psychiatric help [?2(1)=8.226; p=.004]. It
was also possible to find that that high levels of selfcriticism, social and general Anxiety and somatic
symptoms were, in a regression equation, statistical
significant predictors of Exam Anxiety [R2= .513; R2
adj.=.492; F(14, 331)=24.878; p=.000]. The results
pointed the importance of attending in student's cognition
while development this disturbance. This is a real
problem that needs to be treated with careful attention by
the college counsellors.

Group Cognitive Therapy For The Treatment


Of Obsessive-Compulsive Disorder:
Psychotherapeutic Implications And Results
Claudia Castaeiras, Fernando Garca, ;
Vernica Rial; Hctor Fernndez-Alvarez, AIGLE
Foundation
The present paper is part of a multicentric programme for
the treatment of OCD which main aim is to find out some
answers to questions like the following ones: How many
distinct OCD subtypes should be reasonably postulated?;
Are there different cognitive and meta-cognitive factors
underlying these subtypes?; Which are the implications of
the OCD heterogeneity on the treatment response and
comorbidity? One of the specific aims is to contribute with
controlled evidences about the usefulness of a specific
cognitive treatment for OCD taking into account the
subtypes of the disorder as well as the psychotherapeutic
setting: individual cognitive therapy, and group cognitive
therapy. Sample: 10 OCD patients diagnosed by Semistructured diagnostic interview.
Method: Two psychotherapeutic groups -16 sessionswith two therapists were carried out. Patients were
assessed pre and post treatment using the following
instruments: PI-WSUR, OCI-R, Y-BOCS, In-PIOS, TCQ,
WBSI, and ICO. Group cognitive therapy for the
treatment of obsessive-compulsive disorder will be
described with its psychoeducational, cognitive
restructuring and relapse prevention components.
Cognitive restructuring includes working on eight
cognitive biases: thoughts over valuation, inflated
responsibility, thought action fusion - moral subtype,
thought action fusion - probability subtype, controlling,
danger over estimation, uncertainty intolerance, and
perfectionism. Results derived from pre-post treatment
assessments were analyzed and compared between
groups. Discussion: the research implications of the
findings are discussed. Limitations and directions for
future research are also discussed.

Group Cognitive Behavior Therapy for


Japanese Patients with Social Anxiety
Disorder: Outcomes and Their Predictors
Junwen Chen, Yumi Nakano, Tetsuji Ietzugu, ;
Sei Ogawa, Norio Watanabe, Yumiko Noda,
Toshi A. Furukawa, Nagoya City University
Graduate School of Medical Sciences Japan
A number of studies have provided strong evidence for
the use of cognitive behavior therapy (CBT) in the
treatment of social anxiety disorder (SAD). However,
most of the reported studies are from Europe and North
America. Whether comparable treatment outcomes can
be achieved in non-Western clinical settings remains
unproven. The present study aims to report the outcomes
of CBT program for SAD at Nagoya City University
Hospital, Japan, and to examine the baseline predictors
of the outcomes of Japanese patients with SAD receiving
CBT. Subjects were 57 consecutive patients (mean age:
30.4 years, SD=10.3) with DSM-IV SAD who participated
in group-based CBT program for SA. The program is
based on Clark & Wells' model of SAD and consists of 16
2-hour sessions. The main components include 1)
psychoeducation, 2) deriving individualized version of the
model, 3) experiment to drop safety behaviors and selffocused attention, 4) attention training, 5) video feedback
to modify distorted self-imagery, 6) behavioral
experiments, and 7) cognitive restructuring. Three or four
patients were treated in groups led by two therapists.
Before starting the program, patients were assessed with
Structured Clinical Interview for DSM-IV as well as an
extensive questionnaire battery, which was also
completed at the end of treatment. The questionnaires
included 8 self-reported and 1 clinician-administered
measures to assess various aspects of SAD
symptomatology and functional impairment (SPS, SIAS,
FQ-sp, FNE, BFNE, LSAS, WHLS), broader
psychopathology in general (SCL-90-R), and premorbid
personality (NEO-FFI). Of the 57 patients who agreed to
undergo treatment, 6 (10.5%) dropped out during
treatment. According to the criteria by Bandelow et al. (in
press), percentages of patients with symptomatic
response and remission were 33.3% (N=19) and 21.1%
(N=12) respectively. Analyses of treatment outcomes
revealed the percentage of reduction in most of the
symptom measures were 22 to 33 for treatment
completers (effect size: 0.59-1.18), while 20 to 29 for all
the participants (intent-to-treat: ITT; effect size: 0.471.01). However, lower percentage of reduction were seen
in FNE (completers: 11.9%; ITT: 9.7%) and fear of social
interaction subscale of LSAS (completers: 11.1%, ITT:

10.1%). Finally, identifying possible predictors of


treatment response in the treatment completers showed
that none of the pretreatment variables were significant
predictors of scores of LSAS at post treatment. The
present study demonstrated that a comprehensive CBT
program for SAD is feasible and effective in a Japanese
clinical setting. The CBT program appears to be equally
acceptable to Japanese patients with SAD as to Western
patients, because our dropout rates (10.5%) are
comparable to or somewhat lower than those reported in
Western studies. Second, the reduction in SAD
symptomatology in our cohort also appears to be
comparable to that observed in Western clinical settings.
However, our results also suggested that in comparison
with the performance subscales of LSAS, improvements
were more difficult on scores of social interaction
subscales for SAD patients in Japan.

Effectiveness of cognitive group treatment for


Obsessive-Compulsive Disorder
Larsson Christina, M.Teresa Querol, Clinic
University Hospital, Valencia; Elena Cabedo,
Outpatients Mental Health Clinic, Valencia;
Amparo Belloch, University of Valencia Spain
The efficacy of individual cognitive therapy (CT) for
obsessive-compulsive disorder (OCD) has been only
recently investigated, and the results are as promising as
those reported with the more firmly established exposure
and response prevention. However, little empirical
evidences had been reported about the efficacy of CT
delivered at group format. The group therapy has some
advantages on the individual therapy, especially in terms
of costs and resources, and for this reason to analyze
their efficacy for OCD should be a matter of systematic
research. Therefore, the objective of this study is to
examine the effectiveness of group cognitive treatment
(GCT) for OCD on symptoms and metacognitive changes
(dysfunctional beliefs, and thought control strategies
OCD-related). With this aim, we applied a specific
cognitive-based group treatment program to 13 OCD
patients (all meeting current DSM-IV Axis I main
diagnosis criteria for OCD). Six patients were included in
the first treatment group, and 7 in the second. One
patient in this later group dropped out. All of them were
treated at the Outpatient Public Mental Health Service of
the Clinical University Hospital of Valencia (Spain).
Twelve patients completed the treatment. Their mean age
was 40,67 years, 66,7 % were women, and their disorder
was severe (mean pre-treatment Y-BOCS score= 26). All
patients were under some form of psychopharmacological
treatment before their admission to group treatment. It
was required that the medication regimen remained
stable for at least 3 months before the psychological
treatment, and not to increase it during the treatment. The
GCT program lasted 16 sessions. The sequence was the
following: ten once-weekly 120-minute sessions followed
by six twice-weekly 120-minute session. The objective of
the sessions was to help the patients to identify,
challenge and modify their dysfunctional appraisals and
beliefs related to their obsessions using cognitive
techniques and behavioural experiments. It was observed
a significant decrease between pre- and post treatment
scores for OCD symptoms (Y-BOCS), dysfunctional
beliefs (ICO total score and its subscales: responsibility,
importance of thoughts, thought-action fusion likelihood,
thought action fusion moral, importance of controlling
thoughts, danger, intolerance to uncertainty and
perfectionism) and the general strategy of suppression
(WBSI). These changes were associated to large size
effects in most of the cases with the only exceptions of
importance of thoughts and thought action fusion
likelihood. The percentage of patients that showed a
clinically significant improvement (post-treatment Y-BOCS
score = 12 and a decrease of at least 6 points between
pre and post treatment score) was 80 %. The percentage
of recovered patients (post-treatment Y-BOCS score = 7
and a decrease of at least 6 points between pre and post
treatment score) was 61,5%. These results are promising
and comparable to the reported by individual applications
of CT. However, the limited number of patients and the
absence of data about the stability of the observed
changes (follow-up), advise us to continue working on
this area, which as far as we know remains being a very
scarcely investigated issue.

Childhood Learning History, Anxiety


Sensitivity, and Cognitive Vulnerability to
Panic Disorder
Jonathan Cohen, Ferkauf Graduate School of
Psychology, Yeshiva University; Lata Mcginn,
Ferkauf Graduate School of Psychology, Yeshiva
University
The cognitive model of panic disorder (PD) emphasizes
an individual's learning history as one of the earliest
influences affecting vulnerability to panic and anxiety
throughout the lifetime. Negative beliefs and fear are
assumed to develop from childhood experiences which
sensitize the individual to the dangerousness of anxiety
and arousal symptoms (Chorpita & Barlow, 1998; Barlow,
2000; Bouton, Mineka, & Barlow, 2001; Barlow, 2002).
This study seeks to extend previous research (Ehlers,
1993; Watt et al, 1998; Stewart et al, 2001) by

investigating the relationship between childhood learning


history with anxiety as a distal vulnerability to the
development of panic and the severity of panic
symptomatology in adulthood. The Anxiety Sensitivity
Index (ASI) has traditionally been the instrument of
choice to measure one's beliefs about the harmfulness of
anxiety sensations. Recent findings (Watt et al, 1998;
Stewart, 2001) suggest that the ASI is a more general
reflection of fear of body sensations. We hypothesized
that the ASI will be less sensitive in distinguishing
panickers from those without a panic attack history than
measures that specifically tap somatic anxiety symptoms
such as the BSQ. Specifically, we predict that a
childhood learning history with reinforcement and/or
modeling of anxiety symptoms will be associated with
severity of panic symptomatology. In line with Watt et al.'s
findings, we also expect that AS will be related to both
learning histories of anxiety (arousal) and non-arousal
symptoms. Third, we expect that the more panic
symptom-specific BSQ will only relate with childhood
learning experiences with anxiety specific symptoms.
Lastly, we predict that in people with a history of panic
attacks, BSQ scores will be more highly correlated with
panic symptoms than AS. We present data on 129
participants recruited from private business offices in
Long Island, NY. Volunteers ranged in ages between 18
and 77. Participants were contacted during the months of
September, 2005 through March, 2006 via a contact
person in each office who distributed the questionnaire to
every employee in that business. Participants who agreed
to participate filled out a packet of self-report measures
that included a cover page containing a description of the
study, instructions on how to complete the questionnaires
and to return the completed packets to the designated
contact person. Informed consent information was
included in the cover sheet. Volunteers were told that
they were participating in a study that investigates the
relationship between childhood experiences and anxiety
Measures: Learning History Questionnaire (LHQ), Anxiety
Sensitivity Index (ASI), Body Sensations Questionnaire
(BSQ), Panic Attack Questionnaire-Revised (PAQ-R). We
found that retrospectively reported childhood learning
experiences with anxiety symptoms were significantly
associated with severity of panic symptoms in adulthood.
These findings were observed in those who reported
learning history of anxiety and in self-reported panickers.
Also, the ASI did not significantly correlate with panic
severity among self-reported panickers whereas the BSQ
did. Our results suggest that Childhood Learning History
is associated with panic symptoms and hence may be a
distal vulnerability factor for the development of panic
disorder. Our findings also suggest that Anxiety Sensitivity
may be a more general vulnerability factor and not
specific to Panic Disorder. Furthermore, our data suggest
that the assessment of cognitive vulnerability to panic
disorder may be enhanced by the use of measures such
as the BSQ which tap fears specific to panic symptoms.

The treatment of magical ideation in


Obsessive-Compulsive Disorder
Einstein Danielle, University of Sydney and
Westmead Hospital; Ross Menzies, University of
Sydney; Tamsen St Clare, Westmead Hospital;
Juliette Drobny, Westmead Hospital Australia
In this study two participants diagnosed with ObsessiveCompulsive Disorder received a trial treatment targeting
magical thinking. The intervention consisted of a series of
procedures designed to undermine superstitious/magical
ideation without targeting obsessions or compulsions. The
procedures involved critical analysis of the following
material 1) a free astrology offer; 2) a horoscope
prediction exercise; 3) a description of 4 different cultural
explanations of the origin of fire; 4) an instructive guide
for tarot card readers; 5) a report of a UFO sighting; 6) a
video-clip describing a cult festival; 7) a description of a
hoax channeler and 8) a superstition exercise. The
Padua Inventory (PI, Sanavio, 1988), the Maudsley
Obsessional-Compulsive Inventory (MOCI, Hodgson &
Rachman, 1977), the Obsessive Compulsive Inventory
(OCI; Foa, Kozak, Salkovskis, Coles & Amir, 1998), the
Magical Ideation Scale (MI, Eckblad & Chapman, 1983),
the Lucky Behaviours (Lbeh) and Lucky Beliefs (LBel)
Scales (Frost et al., 1993) and the Thought Action Fusion
- Revised scale (TAF-R, Shafran, Thordarson &
Rachman, 1996) were administered pre treatment, post
treatment and at 3 month follow up. Treatment results
were described according to the twofold criterion of
Jacobson, Follette & Revenstorf (1984).As hypothesized,
the treatment successfully altered superstitious and
magical thinking tendencies, and produced clinically
significant change on a range of obsessive compulsive
measures. The study builds on previous research pointing
to the potential importance of magical ideation as a
causal or mediating factor in OCD. Clearly further work
needs to be done to investigate how the present package
would compliment existing procedures for the treatment
of OCD. The package should be the most relevant for
individuals presenting with high levels of magical thinking
who have previously been shown to be poor responders
to standard treatment of the disorder.

PASTA - Prevention of Adolescent Social &


Test Anxiety: CBT vs Bias ReTraining
Eva de Hullu, Esther Sportel, University Medical
Center Groningen; Maaike Nauta, ; Peter J.de
Jong, University of Groningen Netherlands
Both social anxiety and test anxiety share a core concern:
fear of negative evaluation. These anxious concerns
typically develop during adolescence (Gullone & King,
1993). Social and test anxiety have a large impact on
current and future functioning, like school drop-out,
depression and alcohol abuse (Nauta, 2005; Wittchen,
Stein, & Kessler, 1999). Prevention of social and test
anxiety is of great importance, therefore the PASTA
project was designed tot test the efficacy of two easily
accessible interventions. The focus of this presentation is
on the layout of the project, providing an overview of the
background, method and potential clinical implications of
this study. The PASTA project took off in the summer of
2006 and aims at the reduction of social and test anxiety
among secondary school children in the Northern part of
the Netherlands, with the purpose of preventing later
social phobia and other mental disorders. 2300 Children
of age 12-15 will be screened for social and test anxiety
symptoms. The 225 high - but not clinical - scoring
adolescents will be randomly assigned to one of three
conditions: a CBT-training, a Bias-ReTraining (BRT), and
the control condition (no intervention). The CBT training
consists of 12 weekly two-hour small group meetings, in
which participants receive psychoeducation, learn models
of cognitive therapy (e.g. abc schemes), and practice
exposure tasks. BRT consists of 24 internet-based
sessions, during which subjects perform computer tasks
intended to change attentional and interpretation bias.
Measures will be explicit (self-report questionnaires on
anxiety, depression, temperament and behavior and
structured anxiety interviews with both parents and
children) as well as implicit (self-esteem Implicit
Association Test (IAT), social and test anxiety IAT,
interpretation and attentional bias assessment). Measures
will be taken at multiple points in time: before and directly
after intervention, and after 6, 12 and 24 months. The last
measure will include the large group (N=2300) that was
screened initially, in order to assess the adequacy of our
selection criteria and to examine the development of
anxiety disorders in this group.

The Effectiveness of Cognitive Behavioral


Therapy vs. Interpersonal Psychotherapy in
Panic Disorder with Agoraphobia: A
Randomized Controlled Trial
Linsey Diels, ; Arnoud Arntz, y; Marcus J.H.
Huibers, Department of Medical, Clinical, and
Experimental Psychology Netherlands
CBT has proven to be an effective empirically based
treatment approach for panic disorder with agoraphobia in
which exposure in vivo and challenging specific
cognitions are important elements. It is assumed that
panic attacks are the result of an interaction between
cognitive and physiological processes. Usually, the first
panic attacks seem to arise during times of increased life
stress, such as interpersonal conflicts (Pollard, Pollard, &
Corn, 1989). Thus, treatment approaches that focus on
interpersonal problems may also be effective. Results of
previous studies comparing CBT and non-prescriptive
therapies focusing on life stressors are mixed (Craske,
Maidenberg, & Bystritsky, 1995; Shear, Pilkonis, Cloitre, &
Leon, 1994). However, an open pilot study yielded
promising results for IPT for panic, a structured and
manualized therapy emphasising interpersonal context of
the client (Lipsitz et al., 2006). In the current study the
effectiveness of IPT and CBT treatment for panic disorder
patients with agoraphobia are compared. Participants
were recruited at the Academic Community Mental Health
Centre Maastricht. In total 91 patients with a main
diagnosis of panic disorder with severe/moderate
agoraphobia were included. After a pre-treatment
assessment, patients were randomly allocated to IPT
(n=43) or CBT (n=48). Therapy consisted of 12 1-hr
weekly sessions. Further assessments took place
immediately after therapy, at 1-month follow-up, and at 6month follow-up. Primary outcome measures are panic
free status (defined with panic diaries) and performance
on an idiosyncratic behavioral test. Secondary outcomes
are severity of panic and agoraphobia, cognitive
measures, interpersonal functioning, and general
psychopathology. Data are now being analyzed.
Preliminary results support the superior status of CBT in
the treatment of panic disorder with agoraphobia.
Possibly, exposure is a necessary component in the
treatment of agoraphobic panic-disordered patients. We
await the results of an ongoing trial in which we compare
CBT and IPT in panic patients without agoraphobia.

The role of Attention Training in the treatment


of Social Phobia
Juliet Donald, Maree Abbott, The University of
Sydney Australia
Social Phobia is a psychological condition characterized
by a marked and persistent fear of social or performance
situations in which embarrassment may occur. The widely
accepted model of Social Phobia (Rapee and Heimberg,

1997) sees the condition as the result of a number of


cognitive, behavioural and physiological factors in which
cognitive processing errors lead to misinterpretations of
self and performance in the social setting. The standard
form of Cognitive Therapy (CT) used in the current
treatments for social phobia addresses these cognitive
errors and has been shown to produce a reduction in fear
and threat appraisals through cognitive restructuring. An
alternative model for social phobia (Clark and Wells,
1995) addresses self focused attention as the primary
contributing factor. According to this model, preferential
allocation of attentional resources unto the self leads to a
reduction in the ability to accurately interpret the social
situation in terms of threat to self. While the cognitive
model recognises attentional process as a maintaining
factor in social phobia, it is not the primary focus of
Cognitive Therapy. Since current treatments do not
address the role played by attentional resources, an
alternate form of treatment was developed, known as
Attention Training (ATT). Case studies (Wells, et al, 1997)
have found that ATT is effective in treating social phobia,
however the small sample sizes do not allow for the
results to be generalised. Larger studies have evaluated
the effectiveness of ATT (Woody, et al., 1997; Mulkens et
al., 2001; Hoffman, 2000) and found that it is effective in
reducing self focused attention and producing cognitive
change. However these studies used ATT in combination
with other treatment techniques such as exposure and
did not provide a clear understating of the individual
effectiveness of attention training alone. Therefore, a
study has yet to be undertaken that evaluates the
independent effectiveness of ATT. In addition, current
literature is unclear on the impact cognitive therapy has
on levels of self focused attention or the method in which
ATT can produce cognitive shift. The present study aims
to evaluate the role played by ATT in treating social
phobia, and compare its overall effectiveness in
comparison to the currently used Cognitive Therapy,
measuring shift in the domains of cognition and
attentional focus. The computerised version of the CIDI
was used to assess participants for a primary diagnosis
of Social Phobia. Participants were then randomly
allocated to a 6 week treatment group, either Cognitive
Therapy or Attention Training. Before and after treatment,
participants completed a battery of questionnaires
assessing Social Phobia severity. On a weekly basis
throughout treatment, participants completed a tracking
measure, which recorded strength of social phobic
cognitions, level of avoidance and degrees of self
focused attention. Data collection is currently underway,
and is scheduled to be 2/3rds completed by May 2007.
The categories of data collection include treatment
outcome analyses and tracking of change over the
treatment period. The outcome data of this study will be
important in comparing the effectiveness of cognitive
therapy and attention training in treating social Phobia.
While there is some evidence to suggest that attention
training produces cognitive change, the process by which
this change takes place is previously undocumented. The
results from the tracking measures will provide a clearer
understanding the role played by attention training in
treating this disorder. This research will further clarify the
comparative effectiveness of cognitive therapy and
attention training, with specific focus on the manner in
which attention training produces therapeutic outcomes.

Sleep Disorders and Obsessive-Compulsive


Disorder
Lynne Drummond, St. George's, University of
London; Shashi Rani, SW London and St
George's Mental Health NHS trust; Katharina
Wulff, Imperial College, University of London;
Josephine Sibanda, Sarah White, St. George's,
University of London; Naomi Fineberg, QE11
Hosptial, Welwyn Garden City, Herts.; Hamid
Ghodse, St. George's, University of London
It has long been recognised by clinicians that some
patients with severe Obsessive-Compulsive Disorder
(OCD) have difficulties in getting up in the morning and
spend most of the night engaged in compulsive rituals. It
appears that a significant number of OCD sufferers have
a condition known as Delayed Sleep Phase Shift (DSPS)
but this has only recently been described. Our group
found that in a retrospective analysis of patients admitted
to a specialist unit, 17 % met criteria for DSPS. Those
most likely to be affected were younger and had an
earlier age of onset of their OCD symptoms
(Mukhopadhyay et al, 2004) A subsequent prospective
study found that almost half of the patients admitted had
evidence of DSPS. Younger patients; those who were
male and those with the most profound OCD symptoms
were most frequently affected (Turner et al., 2004). It was
decided to repeat a prospective analysis but include
actigraphy and measures of urinary melatonin and
cortisol to obtain a more reliable marker of sleep phase
disturbance to examine whether this was a biological
phenomenon or a learned behaviour. Successive
admissions to the OCD Specialist Unit with OCD (DSM
1V) were invited to participate. This Unit has been
described elsewhere (Drummond, 1993; Drummond et al,
2006). Standard measures of severity of OCD and
depression were administered. Patients were asked to
wear an actigraph and keep a sleep diary for 2 weeks.

Sleep records were kept by nursing staff. Urine samples


were analysed for melatonin and cortisol. Nine patients
have completed actigraphic recordings so far, of which
seven exhibited severely disturbed rest and activity
patterns. Specifically, patients showed abnormally high
nocturnal activity throughout the night, a low interdaily
stability (IS = 0.407 0.111, n = 7) as well as a low restactivity amplitude (RA) across day and night (RA = 0.702
0.04, n = 5). These parameters indicate that the restactivity regularity is severely disrupted in these patients.
Extremely delayed and polyphasic sleep and activity
phases were found in two patients suggesting changes in
the circadian timing of rest-activity rhythms. Examples of
these will be presented as well as the psychometric and
urinalysis data. DSP and other abnormal sleep patterns
are common in the most profoundly ill OCD patients.
They are associated with sleep-related neuroendocrinological changes. The neurobiological clinical
implications of these findings merit further exploration

Dimensions of obessional beliefs: Is the


factor structure of the Obsessive Beliefs
Questionnaire (OBQ) replicable?
Andrea Ertle, Ruhr-University Bochum; Antje
Bohne, Westfaelische Wilhelms-Universitaet,
Mnster; Karina Wahl, Universitaetsklinikum
Schleswig Holstein, Luebeck Gerrmany
The starting point for the cognitive behavioral model of
OCD (e.g., Salkovskis, 1985; Frost & Steketee, 2002) is
the evidence, that most people experience intrusive
thoughts from time to time (Salkovskis & Harrison, 1984;
Rachman & de Silva, 1978; Parkinson & Rachman,
1981). The difference between normal intrusive thoughts
and clinical obsessions does not lie in the occurrence of
the intrusion itself but in the person's appraisal of its
significance. Thus, a means of assessing these
appraisals and underlying beliefs in a reliable and valid
way presents the basis for research on the cognitivebehavioral model of OCD as well as for case
conceptualizing and treatment of the disorder. The OBQ
was developed by the Obsessive Compulsive Cognitions
Working Group (OCCWG, 2003, 2005) to assess six
beliefs considered critical to the pathogenesis of
obsessive compulsive disorder (OCD) that have been
integrated into three factors/scales: Responsibility and
Threat Estimation (establishing factor 1), Perfectionism
and Intolerance of Uncertainty (factor 2), and Importance
of Thoughts and Control of Thoughts (factor 3). The aim
of this study was to evaluate the factor structure of the 44
item version of the OBQ. Three samples completed a
battery of questionnaires comprising measures of
different cognitive constructs (dysfunctional beliefs,
rumination, worry) as well as panic, depression and OCD
symptoms. First, a confirmatory factor analysis was
carried out on a mixed community and student sample
(N=241). Secondly, a parallel analysis (Horn, 1965;
Enzmann, 1997) was used to determine the number of
factors to extract and an exploratory factor analysis was
undertaken. A second student sample (N=180) and a
clinical sample (N=160) were used to crossvalidate the
results, again in a confirmatory framework. Correlative
were then applied to evaluate the evidence for
convergent and discriminant validity of the scales. The
OCCWG's (2005) recent three factor model fits the data
poorly. Using the parallel analysis, four highly correlated
factors emerged which represent the four beliefs of the
first two OCCWG factors. Evidence was provided for
convergent and discriminant validity of the newly
assembled four scales. In sum, these results indicate that
the OBQ subscales rather assess a general tendency to
hold irrational beliefs than distinct constructs specific to
OCD. The questionnaire presents a useful instrument for
measuring features relevant but not specific to OCD.
Further work needs to be done to identify cognitive
domains that are specific to OCD.

Temperament and character dimensions in


patients with social phobia: Patterns of
change following treatments?
Mrtberg Ewa, Susanne Bejerot,; Anna berg
Wistedt, Karolinska Institute, St Gran
Trait-based studies of personality patterns in social
phobia could provide additional diagnostic information,
which would be useful for evaluation and further
treatment planning. The aim of this study was to examine
Temperament and Character Inventory (TCI) profiles in
patients with social phobia (DSM-IV) and to outline
patterns of change following intensive group cognitive
therapy (IGCT), individual cognitive therapy (ICT) and
treatment as usual (TAU). One hundred patients recruited
by advertisements in local papers were randomized to
IGCT, ICT and TAU. Patients (n=59) who completed
diagnostic evaluation and TCI assessments at baseline
and 1-year follow-up were examined in this study.
Patients differed from healthy controls in novelty seeking
(NS), harm avoidance (HA), self-directedness (SD),
cooperativeness (C) and self-transcendence (ST).
Treatments overall were associated with decrease in HA,
while increase in SD was observed after psychotherapy
only. Reduced social anxiety was correlated with
decrease in HA and increase in SD. High HA at baseline
was related to poor treatment outcome in all treatments.

Patients with social phobia show a temperamental


vulnerability for developing anxiety and character traits
associated with personality disorder. Successful treatment
is related to decrease in HA and increase in SD.
Pronounced levels of HA at baseline may suggest a need
for extensive treatment in order to achieve remission.

Shy people: fussy or fearful?


Rebatini Ezio, Giovanni Maria Ruggiero, l;
Sandra Sassaroli, Psicoterapia Cognitiva e
Ricerca Cognitive Psychotherapy School
The aim of the present study is to investigate the
correlation between perfectionistic and intolerance of
uncertainty beliefs and social phobic attitudes in a
nonclinical sample. we recruited a sample of 66 subjects,
19 males and 43 females, mean age 32.5 years. Method:
individuals fulfilled the Self-esteem Rosenberg scale, the
Multidimensional Perfectionism Scale and the
Intolerance of Uncertainty Scale to measure uncertainty
intolerance and the Brief social Phobia Scale. the
predictive power of intolerance of uncertainty on social
phobics symptoms was higher that of perfectionism.
social phobia may be related more with fearfulness than
with fussiness.

Hoarding With and Without Depression


Laura Fabricant, Smith College; Randy Frost,
Smith College; Gail Steketee, Boston University;
David Tolin, The Institute of Living, Hartford USA
Compulsive hoarding is a disabling condition that has
been defined as the acquisition of, and failure to discard
a large number of possessions that appear to be useless
or of limited value (Frost & Hartl, 1996). The
manifestations of this disorder are heterogeneous,
including acquisition, difficulty discarding, and clutter or
disorganization. Similarly, hoarding appears co-morbid
with a range of disorders (Samuels et al., 2002). Major
depressive disorder is one of the most frequent co-morbid
conditions (Steketee & Frost, 2003). Depression not only
complicates the clinical picture, but also makes treatment
more difficult (Steketee & Frost, 2003). To date, there
have been no efforts to determine whether cases comorbid for hoarding and depression are different from
cases not co-morbid for depression. In the present study,
we administered structured diagnostic interviews (Anxiety
Disorders Interview Schedule) to a sample of 104
carefully defined hoarding clients. In addition, we
examined other co-morbidity, anxiety, hoarding severity,
ADHD symptoms, and perfectionism, comparing those
with and without depression. Fifty-seven percent of the
cases were co-morbid for depression. Participants with a
current diagnosis of MDD demonstrated higher levels of
hoarding severity on all three measures of hoarding
severity compared to non-depressed hoarding
participants. More specifically, those who were depressed
had significantly higher scores on the Clutter Image
Rating, the Saving Inventory Revised clutter subscale,
and on all subscales of the Activities of Daily LivingHoarding. No significant differences were observed
between depressed and non-depressed participants on
self-report measures of ADHD or perfectionism.
Furthermore, no significant differences were found
between the two groups in diagnostic co-morbidity with
social phobia or generalized anxiety disorder. Implications
for the psychopathology and treatment of hoarding will be
discussed.

Compulsive hoarding: strategies for


aversiveness reduction in behavior therapy
Mnica Ferreira Gomes, Regina Christina,
Private Practice
Compulsive hoarding is characterized by the lack of
behavior control in the acquisition, saving and discart of
objects accompanied by significant distress and social
impairment. It will be presented and discussed the case
of a 45 year-old woman, with complaints related to an
extreme difficulty in discarding and organizing a large
quantity of objects at home. The patient was already
under medication and behavior therapy for the treatment
of depression. Due to the fact that regular sessions in the
office weren't enough to change pathological patterns of
hoarding, it was decided to implement a therapistassisted program in the patient's natural environament.
Initial assesment of the patient suggested a high
frequency of avoidance or escape from organizing,
cleaning and discarding objects. Those behaviors were
maintened by negative reinforcement and elicited intense
emotional distress. In other terms, manipulating,
verbalizing and/or thinking about the physical
environament usually resulted in emotional distress and
avoidance/ escape behaviors. The Saving InventoryRevised suggested that the main objectives of therapy
should be the organization of the clutter and the discard
of unecessary objects. Acquisition wasn't a relevant
problem. In order to reduce aversiveness, prevent
escape/avoidance and increase treatment adherence,
the sessions were based upon the following principles:
definition of minimal goals, intense therapeutic support
during activities, initial choice of items that elicited
minimum negative emotions, reduction of self-criticism, a
therapeutic relationship based in trust, mutual agreement

and respect, a non-judgemental attitude, allied to some


humour and self-acceptance. The Saving InventoryRevised was applied after the end of treatment (a total of
25 weekly sessions, 2 hrs. long each). It was achieved a
significant improvement in the capacity of dealing with the
clutter (classifying, organizing and discarding) with
minimal emotional distress and almost no behavioral
avoidance. The patient's self-report revealed a general
increase in well-being, home organization and a positive
self-description. Additionally, removal of clutter resulted in
the increase of social gatherings at the patient's home.

Prevalence rates of different fears and


specific phobias in the Netherlands
Oosterink Floor, Ad de Jongh, ; Johan
Hoogstraten, Department of Social Dentistry and
Behavioural Sciences and Centre for Special
Dental Care MNetherlands
Despite the common perception that fears are fairly
widespread, the available information about the
prevalence of different fears in the general population
derives almost entirely from US studies (Agras, Sylvester,
& Oliveau, 1969; Curtis, Magee, Wittchen, & Kessler,
1998; Fiset, Milgrom, Weinstein, & Melnick, 1989). This in
contrast with data on prevalence rates of fears among
European citizens which are almost completely lacking.
With regard to specific phobias there have been only four
large-scale epidemiological studies that have focused
solely on phobia prevalence (Agras et al., 1969; Eaton,
Dryman, & Weissman, 1991; Curtis, et al., 1998;
Fredrikson, Annas, Fischer, & Wik, 1996). Of these
studies only one was conducted in Europe, and this
study was also the only study using DSM-IV criteria
(Fredrikson et al, 1996). Another issue is the classification
of fears. Six groups of researchers have studied the
factor structure of phobic fears. These studies are not
univocally consistent with the DSM-IV taxonomy of
subtypes of specific phobia as in some studies some
fears load at unexpected clusters. The first aim of present
study was to estimate the point prevalence of eleven
different fears and subtypes of specific phobias using
DSM-IV-TR criteria in two independent samples taken
from the Dutch population (n=1959). A second purpose
was to assess the factor structure of the fear severity
data, and to determine the fit of the phobias in the factor
solution. 0 0 The findings will be presented and discussed
in the light of the results of previous studies on the
prevalence of fears and phobias.

Psychometric validation of the ThoughtAction Fusion Scale in an Iranian sample


Elham Foroughi, University of Melbourne; Giti
Shams, Roozbeh Hospital, Tehran University of
Medical Sciences; Iran, Michael Kyrios,
Swinburne University of Technologhy Australia
Thought-action fusion (TAF) refers to a set of cognitive
biases that are considered to play a role in the
development and maintenance of obsessive-compulsive
disorder (OCD) phenomena. The construct of TAF is
comprised of two main components: the first bias,
referred to as TAF-likelihood, implies that thinking about
an unacceptable or disturbing event makes it more likely
to happen. The second bias, termed TAF-Morality,
pertains to the belief that having an unacceptable or
disturbing thoughts, images or impulses is the moral
equivalent of carrying out the unacceptable or disturbing
action. Both components can lead to the tendency to
overvalue the significance and the consequences of one's
thoughts. Central to the cognitive formulation of OCD is
the premise that such faulty beliefs and appraisals of
thoughts are responsible for the transformation of neutral
intrusive phenomena into obsessional phenomena
(Shafran, Thordarson & Rachman, 1996). Consistent with
these theoretical assertions, researchers have found that
there is correlational evidence showing a robust
connection between measures of TAF and OCD
symptoms. These findings have been replicated in
empirical and experimental research with clinical as well
as non-clinical populations, thus providing strong support
for the contention that TAF plays a role in the
psychopathology of OCD (Berle & Starcevic, 2005). In
addition, recent studies have emerged which indicate
there maybe cross-cultural differences in the pattern of
correlations between TAF factors and the OCD
symptoms, suggesting that cultural features such as
religious affiliation may account for some of the observed
differences (Yorulmaz, Yilmaz & Gencoz, 2004). The aim
of this study was to investigate the relationship between
measures of TAF and OCD phenomena in Iranian clinical
and non-clinical samples, the first such study to be
carried out in this non-western population. Forty-five outpatients diagnosed with OCD, 125 adults from the
general community, and 215 undergraduate students
participated in this study. All participants completed
Iranian versions of questionnaires assessing mood,
obsessive-compulsive symptoms and TAF. This study
sought to explore the factor structure, reliability and
validity of the TAF scale in this sample. Similarities in
previously reported factor structure and psychometrics
properties were found for the TAF scale, with both TAF
factors demonstrating good internal consistency in the
clinical and non-clinical samples. Preliminarily

correlational analysis revealed significant positive


correlations between TAF and OCD symptom measures
for the combined samples, with these correlations
remaining significant even when sample-group
membership and mood factors (depression and anxiety)
were controlled. The results of this study support the
inclusion of the concept of TAF in theoretical formulations
of OCD and in the development of appropriate treatment
programs for OCD patients in Iran. However, further
research in the cross-cultural validation of the TAF
phenomena is recommended, in order to attain a better
understanding about the influences of specific aspects of
culture on such OCD-related cognitions. Such crosscultural research is necessary in order to verify or further
develop existing cognitive models and measures within
specific cultural contexts.

The construction of a Cognitive-Behavioral


Model of Obsessive-Compulsive Disorder
Itaru Fukui, Tokyo Kasei University; Hiroaki Yano,
Goodwill Forsight; Natuki Takabayashi, Harada
Mental Clinic; Kyoko Noguchi, Tokyo Kasei
University Japan
The purpose of the present research was to develop a
questionnaire to measure schemas and symptoms of
Obsessive-Compulseive Disorder (OCD) and to construct
a cognitive-behavioral model of OCD that explains the
relation between the schemas and symptoms of OCD.
After the selection of the items for measuring the
schemas and symptoms of OCD and factor analysis of
these items, the Obsessive-Compulsive Disorder Schema
Scale (OSS) and the Obsessive-Compulsive Disorder
Symptom Inventory (ODSI) were developed. The OSS
had six subscales (overestimation of thought, thoughtreality fusion, perfectionism, overestimation of
responsibility, control of mental activity, and high stadards
for self), and was composed of 36 items. The ODSI had
five subscales (doubting, ordering and arranging,
checking, pollution and washing, and impulsion), and was
composed of 35 items. The subjects were 469 University
Students (male 260, female 209) who answered to the
above two questionnaires. By covariance structure
analysis using the scores of OSS and ODSI, it was
revealed that the doubting symtoms was caused by the
perfectionism, overestimation of responsibility, and
thought-reality fusion schemas, the ordering and
arranging symtoms was caused by the high standards for
self and overestimation of thought schemas and the
doubting symtom, and the pollution and washing
symptom was caused by the perfectionism shema and
ordering and arraging and doubting symptoms. It was
also showm that the checking symptom was caused by
the thought-reality fusion schema and the ordering and
arranging and dobting symptoms, and that the impulsion
symptom was caused by the high standards for self and
overestimation of thought schemas and doubting
symptom. Based upon these findings, a new cognitivebehavioral model of OCD that explains the causal
relationship between the schemas and symptoms of OCD
was constructed.

Videotaped experiments to drop safety


behaviors and self-focused attention in social
anxiety disorder: Do they change subjective
and objective evaluations?
Toshi Furukawa, Yumi Tetsuji Ietsugu, ; Junwen
Chen, Sei Ogawa, Tadashi Funayama, Norio
Watanabe, Nagoya City University Japan
Although cognitive-behavior therapy (CBT) has been
shown to be more effective for social anxiety disorder
(SAD) than control treatments, some patients do not
benefit from it and many remain symptomatic. The past
decade has seen significant progress in the theories and
treatments that specifically target the maintaining factors
in SAD. The CBT program at Nagoya City University
Hospital has also evolved along these advancements and
now consists of 1) individualized modeling of SAD
according to Clark & Wells (1) with particular emphasis
on idiosyncratic in-situation safety behaviors, 2) attention
training, 3) videotaped experiments to drop safety
behaviors and self-focused attention, 4) cognitive
restructuring, 5) videotaped role plays and feedback in
the session, 6) graded exposures within the framework of
behavior experiments out of the session, and 7) assertion
training when individually indicated. The present study
focuses on the 3rd component above and reports the
changes in the subjective and objective evaluations of the
role plays through the videotaped experiments. Subjects
were a consecutive series of patients with DSM-IV SAD
who participated in our group CBT program for SAD since
May 2005 when we introduced the videotaped
experiments. In the experiments patients are first
requested to role play a moderately anxiety-provoking
situation while maximizing their idiosyncratic safety
behavior and while directing as much attention as
possible towards self (how they feel internally, how they
may look and what others may be thinking of them).
Before the role plays patients are asked to predict their
feared outcome in behavioral terms and right after this
role play they indicate how anxious they felt, how anxious
they think they looked, how self-focused they were, how
certain they are that the predicted outcome happened,

and how they rate their performance overall, all on the


scale from 0 to 100. We scored the average of these
ratings such that the higher the average, the better the
rating. Next, they are requested to repeat the same role
play but this time dropping the safety behavior and with
attention directed towards the outside and towards the
task at hand. After this role play the patients are asked to
answer the same questions as above. When patients
return the next week, they are asked how much postevent processing they had engaged in during the week
and now to remember as vividly as possible the role
plays from last week and fill in the same questions. The
patients finally watch the videos and are requested to rate
their own performances as objectively as possible as if
they were performed by actors/actresses and not by
themselves. The other group members also rate the
performances for each other. For the first 16 patients, the
average ratings of the performance with safety behavior
and self-focused attention were 32.0 when rated
subjectively on the spot, 32.6 when rated subjectively 1
week later, 51.3 when rated objectively by watching self
on the video, and 67.9 when rated by peer patients.
When they drop their safety behaviors and self-focused
attention, the ratings were 50.7, 44.7, 66.0 and 87.5
respectively. The results indicate 1) all the evaluations,
subjective on the day, subjective one week later, objective
by watching self on video and objective by peer patients,
were higher without safety behaviors and self-focused
attention than with (One patient claimed with a sigh of
relief right after doing the second role play, Oh, my, I had
been doing this for years and had thought that I could not
face the situation without doing this. But actually I felt
much better, much less anxious when I didn't do it!); 2)
one week later the subjective self-evaluations tended to
deteriorate, especially for the role play without safety
behavior, most probably due to post-event processing for
the temporary successfulness; 3) objective ratings by
watching self on the video were almost always higher
than subjective self-ratings (Another patient said, I had
been thinking that I was shaking like hell but it didn't
show! When a patient still claimed, for example, that she
was speaking with too low a voice, we replayed the video
and instructed her to compare her voice with the voice of
other members in the video, in which she found, No
difference It's a real surprise.); and 4) objective ratings
by other group members were again almost always
higher than objective self-ratings (Most of the patients
mumble, I cannot believe this.).

Pill placebo can augment cognitive-behavior


therapy for panic disorder
Toshi Furukawa, Norio Watanabe, Ichiro Omori,
Nagoya City University; Japan and Rachel
Churchill, Institute of Psychiatry UK
The observed treatment effect, i.e. the change from
baseline till endpoint, is traditionally thought to be due to
four factors: regression towards the mean, natural course
of disease, placebo effect, and specific effects of the
intervention on the target condition. Whether adding pillplacebo to specific psychotherapy enhances its
effectiveness is an empirically and theoretically interesting
question. Some may assume that a specifically effective
treatment has already realized all the above-mentioned
four components and therefore addition of a pill placebo
cannot enhance its effect. On the other hand, some may
suspect that addition of pill placebo may subtract from
psychological treatment because it may undermine the
active commitment of the patient to follow psychological
interventions. Still others may argue that psychotherapy
and pharmacotherapy placebo work through different
mechanisms and can therefore be additive or synergistic.
We sought to examine this issue by performing a
systematic review and meta-analysis of randomised
controlled trials (RCTs) that directly compared cognitivebehavior therapy (CBT) alone against CBT plus pill
placebo in the treatment of panic disorder. We performed
electronic search of the Cochrane Collaboration
Depression, Anxiety and Neurosis Controlled Trials
Register (CCDANCTR), and complementary search of
the Cochrane Central Register of Controlled Trials
(CENTRAL) and MEDLINE. No language restriction was
imposed. Two independent reviewers identified the
eligible studies, examined their quality and extracted the
data. Our primary outcome was response, i.e.
substantial improvement from baseline as defined by the
original investigators. Relative risks (RR) and their 95%
confidence intervals were calculated using the random
effects model. We identified three relevant RCTs. At the
end of the acute phase treatment, patients who received
CBT plus placebo were 1.26 (95%CI: 1.02 to 1.55) times
more likely to respond than those who received CBT
alone. At follow-up this superiority of CBT plus placebo
appeared to persisit, with the RR for response of 1.22
(0.90 to 1.64). The present report represents the first
systematic empirical examination of the effect of adding
pill placebo to empirically-supported psychotherapy. It
found that, for panic disorder with or without agoraphobia,
pill placebo enhances CBT during the acute phase
treatment and that this additive effect appears to persist
after the acute phase treatment. There are several
theoretical and clinical implications from our findings.
Firstly, in contrast to some old claims (1), taking a pill
placebo did not undermine the effectiveness of
psychological intervention but, much to the contrary, it

enhanced its effectiveness. Secondly this is a very strong


argument against the recently claimed null hypothesis of
placebo effect in general (2, 3). Clinically it may point to
some further room for enhancing the psychotherapeutic
approach for panic disorder. 1. Uhlenhuth EH, Lipman
RS, Covi L: Combined pharmacotherapy and
psychotherapy. J Nerv Ment Dis 1969; 148(1):52-64 2.
Hrobjartsson A, Gotzsche PC: Is the placebo powerless?
An analysis of clinical trials comparing placebo with no
treatment. N Engl J Med 2001; 344(21):1594-602 3.
Hrobjartsson A, Gotzsche PC: Is the placebo powerless?
Update of a systematic review with 52 new randomized
trials comparing placebo with no treatment. J Intern Med
2004; 256(2):91-100

Gender difference in dimensions of the


Japanese version of the Anxiety Sensitivity
Index
Hirokazu Furukawa, Hirofumi Matsuoka, Go
Yamauchi, Shun Nakajima, Yuji Sakano,
University of Hokkaido Japan
Anxiety sensitivity(AS)is an individual beliefs that anxietyrelated symptoms can have harmful consequences.In
addition,elevated AS is thought to play an important role
in panic disorder (Taylor,1995).AS is measured using the
Anxiety Sensitivity Index (ASI:Reiss et al.,1986).Recent
studies reported gender differences in dimensions of ASI
(Foot & Koszycki,2004;Stewart et
al.,1997).However,gender difference in dimensions of the
Japanese version of the ASI has not been clarified. The
purpose of this study is to examine the gender difference
in dimensions of the Japanese version of the ASI. The
Japanese version of the ASI was completed by 554
undergraduate students(males:N =187, females:N
=367).The Japanese version of the ASI was consisted of
16 items,and has a single higher-order factor(global
AS)and three lower-order factors(fear of physical
symptoms,fear of psychological symptoms,and fear of
illness).Each item is rated from 0 to 4,where 0 = not at
all,and 4 = very much.The Japanese version of the ASI
has good reliability and validity(Muranaka et al.,2001).
Comparison of the ASI score between males and females
revealed that females showed significant higher fear of
physical symptoms score than
males(t[552]=3.56,p<.001).In contrast,ASI total score,fear
of psychological symptoms score,and fear of illness score
had no significant differences between males and
females(ASI total:t[552]=1.77,ns;fear of psychological
symptoms:t[552]=.81,ns;fear of illness t[552]=.78,ns ).
The purpose of this study was to examine the gender
difference in dimensions of the Japanese version of the
ASI.The result of this study indicates that females score
is higher than males on fear of physical symptoms
measured by the Japanese version of the ASI.These
findings have implications for understanding the cause of
panic disorder.The evidence suggest that panic disorder
is more prevalent in females than males(Weissman et
al.,1999)and that catastrophic misinterpretations of bodily
sensations are important cognitive variable in panic
disorder(Clark,1986).Our findings suggest the hypothesis
that the increased prevalence of panic disorder in
females may occur because fear of physical symptoms is
higher than males. In summary,the present results
provide further support for the notion that females scored
higher the lower-order physical concerns factor than
males(Stewart et al.,1997).Future research should
attempt to replicate these findings of gender difference
using adequately large sample size of males.

What factors are important in the


development of anxiety and why?
Bridie Gallagher and Sam Cartwright-Hatton,
University of Manchester UK
The current study investigated the perceived parenting
styles that best predict anxiety in a sample of young
adults and examined the role of dysfunctional cognition in
the relationship between parenting and anxiety. The
majority of the literature examining the role of parenting in
the development of anxiety has focussed on the concepts
of Warmth and Control and numerous studies have
demonstrated a link between parental Overcontrol and/or
decreased warmth and anxiety in both adult and child
populations. However, the inconsistent findings of selfreport studies have led to the conclusion that these
parenting styles may be less useful in clinical and
theoretical applications (Wood et al 2003). However
recent research has begun to demonstrate the
effectiveness of reducing harsh and inconsistent
discipline in ameliorating symptoms of anxiety,
(Cartwright-Hatton et al 2004). Therefore, it appears that
discipline style might also be a useful construct in
understanding the relationship of parental factors to
anxiety. The present study uses retrospective measures
of parenting styles (warmth, control, overprotection and
rejection) and also measures of discipline styles, in order
to determine if they are predictive of trait anxiety in late
adolescence. In addition, measures of cognitive
dysfunction were taken, in order to examine their
relationship with parenting factors and to test the
assumption of many etiological models, that suboptimal
parenting leads to anxiety through the development of a
negative cognitive style. One hundred and sixty eight 1618 year olds were recruited from a Sixth Form College in

Greater Manchester and from a first year Psychology


course at the University of Manchester. All completed
three measures of parenting; the Parental Bonding
Instrument (PBI); the shortened EMBU; and the
Childrearing Styles Questionnaire (CSQ, adapted from
the Arnold Parenting Scale for retrospective use with
young adults). They also completed the Spielberger
STAI-T as a measure of current trait anxiety and
measures of cognitive dysfunction including the Cognitive
Error Questionnaire (CEQ) the Meta-Cognitions
Questionnaire (MCQ-30) and the Thought Control
Questionnaire (TCQ). The data were analysed using
multiple regression, with the CSQ Overreactivity, PBI
Care, EMBU Overprotection and EMBU Rejection as
regressors and trait anxiety as the dependent variable.
The regression was a modest fit but the overall model
was significant. Only the effect of Parental Discipline
Style, (in particular Overreactivity) as measured by the
CSQ was significant. A second regression demonstrated
that dysfunctional cognitive style operated as a mediator
between parental disciplinary style and current trait
anxiety. The findings suggest that retrospectively reported
parental discipline style predicts current anxiety in 16-18
year olds, (in particular inconsistent or overreactive
discipline,) and further research into the relationship
between anxiety and parental discipline style is
warranted. Preliminary evidence also suggests that
harsh discipline practices might lead to anxiety through
the mediating role of distorted cognitions, lending support
to etiological models of anxiety.

Cognitive-behavioral group therapy in


generalized anxiety disorder : preliminary
results from an outpatients sample.
Salvador Gallart, Salvador Miret, Francesc
Abella, Hospital Santa Maria
Generalized Anxiety Disorder (GAD) has attracted
growing interest because of its lifetime prevalence,
comorbidity and course to chronicity. Cognitive-Behavioral
Therapy (CBT) has been the preferred option to treat
anxiety (Borkovec & Costello, 1993 ; Barlow et al., 1998).
Some authors have reported Group Therapy (GT)
implementation in anxiety disorders (Goldstein & Wolpe,
1971; Wolberg, 1988) for its results and efficiency. The
combination of these two approaches appears as a
therapeutic possibility for GAD. Aim: To assess changes
in anxiety levels in patients with GAD following a CBT-GT
program in a naturalistic context of outpatients follow-up
at a Mental Health Centre 24 probands (12 male /12
female) with a mean age of 43.6(10.1)/ 36.5(8.8)
diagnosed with GAD (DSM-IV-TR) were included in a
CBT-GT program. Reports were collected from 3 editions
(period 2004-06) of the program at the Mental Health
Centre, area of Lleida (Catalunya, Spain). Groups were
composed of an average 10 patients/year. Therapy
consisted of 25 semi-structured sessions in a CBT
framework (Deffenbacher & Suinn, 1982 ; Brown et al.,
1993 ; Dugas & Ladoucer, 1997). The program sessions
included : i) disorder and treatment psychoeducational
issues, ii) relaxation and breathing techniques, iii)
cognitive therapy, iv) exposure, and v) problem solving
and social skills. Patients were tested --STAI (State-Trait
Anxiety Inventory ; Spielberger et al., 1970), BDI (Beck
Depression Inventory ; Beck et al., 1961) and ISRA
(Inventario de Situaciones y Respuestas de Ansiedad ;
Miguel-Tobal & Cano-Videl, 2002)-- in the beginning and
at the end of the therapy in order to assess changes in
their anxiety levels. Patients improvement was statistically
significant in many tests as follows : STAI-trait (p= 0.01).
ISRA-normal scale: Cognitive (p=0.01); Physiological
(p=0.02); Total (p=0.03). ISRA-clinical scale: Physiological
(p=0.01). ISRA-normal scale, specific factors: F1, anxiety
against evaluation (p=0.02); F2, interpersonal anxiety
(p=0.02); F4, anxiety against usual situations (p=0.01).
ISRA-clinical scale, specific factors: F2, interpersonal
anxiety (p=0.03); F4, anxiety against usual situations (p=
0.04). In addition, many other measurements showed a
trend to significance. In spite of our limited study (mainly
for the reduced sample size and for the absence of a
control group) our results show : 1) a clear global
improvement in the patients' anxiety levels; 2) patients
appreciate benefits of therapy and subjective amelioration
; 3) therapy provides them with tools to counteract
discomfort caused by the anxiety disorder. In conclusion,
group therapy of cognitive-behavioral orientation appears
as an efficient therapeutic approach in outpatients
affected by generalized anxiety disorder. Larger trials will
be required to determine whether the results of this study
are reliable.

Action-versus-State-Orientation' and
Successful Treatment of Anxiety
Edgar Geissner, Psychosomatic Hospital
'Roseneck', University of Munich; Madlen Kraft,
Petra Ivert, Psychosomatic Hospital 'Roseneck'
Germany
Patients with anxiety disorders participating in a cognitivebehaviorally oriented treatment program gained in
different ways, as clinical observations show. Difficulties
can result from comorbid disorders, reduced self esteem
to successfully stand anxiety provoking situations,
negative expectations, or style of attribution and

motivation. The study examines if the trait-like variable of


Action-Orientation (versus State-Orientation) in some
extent is responsible for succesful coping with the anxiety
problem. 'Action-versus-State-Orientation' comprises
three facets: (a) Action-Orientation after failure or
unsuccessful result: Persons high on this facet continue
in their efforts to strive for the goal they undertook, (b)
Action-Orientation in planning and realizing plans; (c)
Action-Orientation during activities. 130 patients with
anxiety disorders (panic disorder, agoraphobia;
standardized diagnoses by IDCL) participated in the
study. Patients filled out questionnaires measuring
different aspects of anxiety disorders (cognitions,
symptoms of avoidance behavior, bodily symptoms) by
means of standardized diagnostic tools (BAI, ACQ, MI,
BSQ, SCL). The construct 'Action-versus-StateOrientation' was measured by the original questionnaire
HAKEMP by Julius Kuhl. Patients were examined 4
times: application for therapy (3 months before),
admission to program, discharge, 6 months after
completing program. Intervention was in an inpatient
format (problem solving group therapy, cognitive therapy,
situations provoking symptoms of panic, multiple
exposures against avoidance behavior). Results show an
overall effect of the treatment approach tested. All anxiety
measures proved to be significant at end of treatment and
at 6-months follow-up. Interestingly, patients improved
further between treatment and follow-up. Results
concerning 'Action-versus-State-Orientation' revealed a
different pattern: The facet 'Action-Orientation after failure
or unsuccessful result' could be improved substantially at
every point of measurement. 'Action-Orientation in
planning and realizing plans' was substantially better at 6months follow-up than before, showing that during
therapy sessions persons feel they are guided by
therapists and not have to do by their own, but have to do
so after discharge. In contrast, there was no change in
the facet 'Action-Orientation during activities'. Correlations
between measures of anxiety and 'Action-versus-StateOrientation' were enhancend form one time of
measuremnet to the next one showing a more and more
systematic relationship. The more subjects exert 'ActionOrientation' the less their anxiety. Regression analyses
revealed that anxiety at follow-up is best predicted form
increase in 'Action-Orientation after failure' and from
increase in 'Action-Orientation in planning'. The trait-like
personal facet of 'Action-versus-State-Orientation' proved
to be a substantial aspect in long term psychotherapy
effects. Patients who learn to deal with failure and first
unsuccessful results can be motivated to keep on going.
Raising competencies in staying on the way can be an
important aspect of perseverance and positive balance of
own efforts. Also helpful in successful dealing with anxiety
is Action-Orientation in planning and acting. Aspects of
'Action-Orientation' in so far should be further considered
and controlled for within anxiety therapy.

Self-Worth in Obsessive Compulsive


Domains: An Exploratory Study of Self-Worth
and OCD Symptoms in a Non-Clinical Spanish
Sample
Garcia-Soriano Gemma, University of Valencia;
David Clark, University of New Brunswick;
Canada Amparo Belloch, University of Valencia;
Carmen Morillo, University of Valencia Spain
Although cognitive behavioral models of obsessive
compulsive disorder (OCD) have become widely
accepted, much less is known about the possibility of
cognitive vulnerability to OCD. Recently it has been
proposed that deficiencies or heightened sensitivities in
certain aspects of self-worth might predispose individuals
to engage in faulty appraisals of significance when
experiencing unwanted intrusive thoughts consistent with
these self-worth issues (Doron, Kyrios, & Moulding,
2006; Garca-Soriano et al., 2006; Rowa, 2003).
Unfortunately there are no measures of self-worth issues
that focus on OCD-relevant domains such as cleanliness,
disease, doubt, correctness, hoarding, moality, sexuality
and the like. Moreover the recent research on self-worth
contingencies by Crocker (2002) provides a possible self
theory for development of an OCD-relevant measure of
self-worth. The present study reports on the development
of a OCD-relevant self-worth questionnaire based on an
adaptation of the Contingencies of Self-Worth Scale to 7
primary OCD domains. The Obsessional Concerns and
Self-Questionnaire (OCSQ, Verson 1) is a self-report
questionnaire with 80 statements (e.g. I feel a loss of
self-respect when I have disobeyed my religious or moral
values). Five hundred and sixty three Spanish
community individuals completed the OCSQ Version 1
and a battery of questionnaires that assessed OCD
(CBOCI, OCI-R), depression (BDI-II), anxiety (BAI,
PSWQ), intrusive thoughts frequency (INPIOs) and selfesteem (RSE, CSW). Data reduction resulted on an
OCSQ Version 2 of 39 items with a good reliability
(a=0.92; CCI 7-14 days=0.91, range= 0.89-0.93). The
OCSQ showed higher correlations with questionnaires
measuring contingencies of the self than with generalized
self-esteem, depressive or anxious symptoms. Moreover,
no relationship with social desirability was found. A series
of exploratory principal component factor analyses with
oblique rotation (Promax) were conducted. A four-factor
solution was retained: (1) morality/religion/sex (11 items;
a=0.85); (2) hoarding (9 items; a=0.81); (3) dirt,

contamination, order, symmetry, doubts, & checking (9


items; a=0.81); and (4) harm/ aggression/ injury (items;
a=0.82). The OCSQ hoarding factor showed the highest
correlations with the frequency of unwanted intrusive
thoughts (measured with the INPIO)s; checking OITs
(r=0.40; p=0.001), order (r=0.41; p=0.001), and
contamination (r=0.41; p=0.001) symptoms. Low
correlations were found between the OCSQ factors and
the frequency of aggressive, sexual, or religious OITs
(measured by the INPIOs). Subclinical OCD subjects
(>75 of the OCI and CBOCI; n=128) showed higher
OCSQ scores than the low obsessional participants
(n=433). The results found some initial evidence that selfworth contingencies in OCD relevant life domains might
be related to obsession-relevant intrusive thoughts . The
psychometric properties of the OCSQ are satisfactory, but
further research is needed with OCD patients.

Prevalence, Features and Diagnostic


Classification of Trichotillomania
Marta Ghisi, Ezio Sanavio, University of Padova,
Italy
Trichotillomania consists in chronic hair pulling. The
prevalence rates of trichotillomania range from 0.6% to
15%, depending on the rigidity of the diagnostic criteria of
DSM-IV-TR; females pull hair more frequently than males.
In the last versions of the DSM trichotillomania is included
among impulse-control disorders not elsewhere classified.
Nevertheless, the present diagnostic category is not
adequate for trichotillomania according to several
authors. Since in the Italian literature there are no studies
on trichotillomania, it has been retained important to
perform a preliminary study in order to assess: 1) the
prevalence of hair pulling, using different diagnostic
criteria reported in the literature; 2) the males:females
ratio; 3) three hypotheses concerning different diagnostic
classifications for trichotillomania as one of the obsessive
compulsive spectrum disorders, or one of the impulsive
compulsive spectrum disorders, or as a variant of
obsessive compulsive disorder. The sample included 520
subjects from the Italian community. The total sample was
then divided into two groups: the first group included 86
subjects that present hair pulling at least once a week not
for aesthetic purposes. The second group was made of
363 subjects without hair pulling behaviors. Subjects
completed the socio-demographic schedule and the
following questionnaires: Impulsive Disorders
Questionnaire, developed ad hoc, assessing several
impulsive behaviors and, in particular, hair pulling;
Rosenberg Self Esteem, measuring self-esteem; Beck
Anxiety Inventory, assessing the severity of symptoms of
anxiety; Scale for Interpersonal Behavior-Short Form,
measuring the interpersonal abilities; Beck Depression
Inventory, assessing the severity of depressive
symptoms; Obsessive Beliefs Questionnaire, assessing
dysfunctional beliefs clustered around the six cognitive
domains crucial in obsessive compulsive disorder; Padua
Inventory, measuring obsessive compulsive symptoms. If
only hair pulling at least once a week not for aesthetic
purpose is used as selection criterion, the prevalence of
pullers is 16.5% (N=86), with a males:females ratio of
1:1.1. If DSM-IV-TR criterion B (tension before pulling) or
C (feeling of relief or pleasure during pulling) are used
beyond hair pulling as selection criterion, the prevalence
of hair pullers drops to 7.5% (N=39), with a
males:females ratio of 1:1.3. If a more rigid selection
criterion is used, that is, hair pulling and both criteria B
and C, the prevalence of hair pullers is 2.1% (N=11), with
a males:females ratio of 1:1.4. The puller group
evidenced a more serious obsessive compulsive
symptomatology than the no puller group and obsessive
compulsive symptomatology resulted a predictive factor
of trichotillomania behaviour. Nevertheless, the hair
pulling behaviour resulted to be strongly correlated to the
impulsive symptomatology, and the puller group
evidenced a more severe impulsive symptomatology,
beyond obsessive compulsive symptomatology, than the
no puller group. The results regarding prevalence ratio of
hair pulling, seem to be corroborated by the studies
suggesting that criteria B and C of DSM-IV-TR might be
too rigid and restrictive. The prevalence data obtained in
the present study indicate a smaller gender difference as
compared with that reported in the literature. Furthermore
results corroborate the existence of an association
between hair pulling and obsessive compulsive and
impulsive features, supporting the hypothesis of
diagnostic classification of trichotillomania as belonging to
the impulsive-compulsive spectrum disorder.

A case of manias explained by its description


Maura Gongora, Karina Ambrozio, Universidade
Estadual de Londrina; Grazielle Noro,
The Obsessive Compulsive Disorder has been explained
based on two general hypotheses. In the first one, the
thoughts and repetitive actions are kept because they
reduce anxiety states. In the second one, these
behaviors are considered byproducts of deficits in social
and interpersonal repertory. This study reports a clinical
case, in which the client with typical OCD complaints
attended 18 weekly sessions. However, the
understanding of the case differs from those tendencies
above presented. Here is a report of a Physical
Education university student, aged 20 years old,

searched professional help bringing the complaint of a 2year persistent occurrence of what was named by her as
'manias'. The environmental evaluation of the complaint
was based on registration and reports of the client during
sessions. Further, the content was compared to the
concerning literature. Two different types of mania were
described. The first was the repetition of parts of routine
behavior chains. The client felt uncontrollably pushed to
repeating these actions. Another type of mania was
related to usual but unpleasant thoughts, followed by
varied actions. According to the client, those actions
would allow her to escape from unpleasant thoughts,
even though she could not tell any functional relation
between such behaviors and her thoughts. There were
not any meaningful levels of proved anxiety or social
abilities deficit, although these items were investigated.
Therefore, the traditional explanations for the case were
set aside. A reasonable hypothesis was once the client
started to live apart from her family, she could spend
more time by herself. Also, the client attended a university
program which was related to the study of the human
body and its functions. These two new environmental
variables made it possible for the client to drive more
attention to her body sensations and perceptions, hidden
behaviors and to the stimulation produced by the
repetition of routine actions. From driving her attention to
them, she possibly started to manipulate them. She was
able to establish, during these attempts, superstitious
relations between unpleasant thoughts and some public
behaviors. It resulted in some disorganization of both,
thoughts and behavior chains, what was noticed by the
client as 'something strange'. On the other side, the
stimulation itself, produced by the actions seemed to be
strong reinforcements to her behavior of repeated
actions. The intervention was based on the functional
analysis which consisted of 1) developing a repertory of
behavioral self-description along with the client, 2)
providing the client with normality boundaries of public
and hidden behaviors, 3) decreasing the level of
importance and attention to the manias and, finally, 4)
developing self-control over the behavior of manias and
the acceptance of undesirable feelings. The results were
1) an abrupt decrease of some maniac responses, 2) the
client allowed herself to feel and think about unpleasant
usual things. Although some of those still happened, they
were understood as an usual behavior. It is important to
attempt, in this case, to the functional understanding
based on the description of contingencies, even when
different from literature.

Validation of the Obsessive-Compulsive


Inventory-Revised (OCI-R) in a German
sample of patients with OCD
Sascha Gnner, Psychosomatic Clinic of Bad
Drkheim; Rainer Leonhart, University of
Freiburg; Willi Ecker, Institute of Behaviour
Therapy (IFKV) Germany
The OCI-R [Psychological Assessment 2002;14:485-496]
is a brief, psychometrically sound scale measuring the
major symptoms of patients with obsessive-compulsive
disorder (OCD) on six dimensions: checking, washing,
ordering, hoarding, obsessing and neutralizing. It has
good convergent validity, differentiates well between
patients with OCD, clinical as well as non-clinical controls
and is sensitive to treatment effects. Convergent validity
of the subscales and discriminant validity need further
exploration. A high correlation was found between the
OCI-R total score and the Beck Depression Inventory
(BDI; r =.70). A German OCI-R version has not been
examined until now. Reliability and validity of an
authorised German version of the OCI-R were examined
in a sample of 175 patients with OCD (154 outpatients
and 21 inpatients). The patients were diagnosed by
experienced psychotherapists via an interview that
utilized the International Diagnostic Checklists. Padua
Inventory-Revised (PI-R), Yale-Brown ObsessiveCompulsive Scale (Y-BOCS; self-report form), Symmetry,
Ordering and Arranging Questionnaire (SOAQ),
Multidimensional Perfectionism Scale (MPS), BDI, Beck
Anxiety Inventory (BAI) and Penn State Worry
Questionnaire (PSWQ) were administered to determine
convergent and discriminant validity. Patients completed
the questionnaires shortly after admission or at the
beginning of outpatient therapy. The full scale and five of
six subscales had excellent internal consistency (a-range:
.83-.95; neutralizing: a =.76). A confirmatory factor
analysis (CFA, using Structural Equation Modelling; SEM)
replicated the original six-factor structure. All global fit
indices suggested a good fit for the model (RMSEA
=.055; NFI =.919; TLI =.957; CFI =.970). The local fit
indices showed an excellent fit for 5 subscales (Squared
Multiple Correlations, SMC-range =.51-.92; average
percentage of Variance Extraced, VE-range =.64-.86;
Fornell-Lacker-Ratio-range =.05-.37). Neutralizing
fulfilled the criteria for just 3 of 4 local fit indices (SMC
>.60; VE >.50; FL-Ratio <1.0), but the SMC for one item
was small (.21). Spearman correlations between OCI-R,
PI-R (total: .84; washing: .93; checking: .91; ordering: .66;
obsessing vs. PI-R-impulses: .52) and SOAQ (ordering
vs. SOAQ: .90) indicated good to excellent convergent
validity for all scales. The relationship between OCI-R
and Y-BOCS was moderate (.43). Spearman correlations
between OCI-R subscales and BDI (r-range = .09-.28),
BAI (r-range = .08-.38) PSWQ (r-range = .08-.40) and

MPS (r-range = -.05-.20) indicated good divergent validity


for the subscales. The good results of the Foa et al.-study
have been replicated in a German sample of patients with
OCD. The German version of the OCI-R proved to be a
reliable and valid self-report measure of obsessivecompulsive symptoms and appears to measure OCD
quite independently from depression.

The role of anxiety sensitivity in


hypochondriasis: a controlled study
Silvana Grandi, Eliana Tossani; Giovanni Andrea
Fava, Laura Sirri, University of Bologna Italy
Introduction. The belief that the anxiety-related symptoms
entail harmful somatic, psychological or social
consequences, namely anxiety sensitivity, has been
linked to depressive and anxiety disorders, where it
seems to play a predisposing and maintaining role.
According to Otto and colleagues, anxiety sensitivity
resulted one of the major predictors of hypochondriacal
fears and beliefs among depressed patients. Yet, the role
of anxiety sensitivity in hypochondriasis has not been
adequately studied. The aim of our study was twofold: we
examined whether hypochondriacal patients endorse
more anxiety sensitivity than healthy subjects and
whether this construct is sensitive to changes in
hypochondriacal symptoms after Explanatory Therapy.
Methods. 20 patients with a diagnosis of hypochondriasis
according to DSM-IV were administered both observerand self-rating instruments: Paykel's Clinical Interview for
Depression (CID), Kellner's Rating Scale of Somatic
Symptoms (RSSS), Kellner's Illness Attitude Scales (IAS)
and the Anxiety Sensitivity Index (ASI) by Peterson and
Reiss. Subjects were evaluated in three phases: at
baseline (before starting psychotherapy), at the end of
the treatment (i.e. after 8 weeks) and at a six-month posttreatment follow up. At baseline questionnaires were also
administered to a sample of 20 healthy controls, matched
for demographic variables. Explanatory Therapy was
developed by Robert Kellner for the treatment of
functional somatic symptoms and hypochondriasis. This
approach posed the bases for cognitive-behavioral
therapy and it is based on some key techniques:
providing accurate information about psychophysiological
mechanisms, teaching the principles of selective
perception, reassurance, clarification and repetition. All
these components of Explanatory Therapy support the
rationale that the way subjects think about bodily
sensations may lead to health anxiety and to a selective
attention to a part of the body. This augmented attention,
in its turn, may increase subjects' awareness of bodily
sensations and facilitate the onset of functional somatic
symptoms and hypochondriacal fears and beliefs. The
efficacy of Explanatory Therapy for the treatment of
hypochondriasis has been evidenced with a randomized
controlled study. Results. At baseline hypochondriacal
patients scored significantly higher on the ASI score than
the control subjects. At the end of the 8-week treatment
package, patients showed a significantly decrease in
hypochondriacal fears and beliefs, somatic symptoms
and anxiety sensitivity. These therapeutic gains were
maintained at the 6-month follow up. Yet, anxiety
sensitivity was still higher in patients compared with
healthy subjects. Discussion. In our study the Anxiety
Sensitivity Index score discriminated hypochondriacal
patients from healthy subjects. Among hypochondriacs
anxiety sensitivity is responsive to Explanatory Therapy,
yet it persists after treatment as a subclinical residual
symptomatology. Previous studies on mood and anxiety
disorders demonstrated how the persistence of residual
symptoms after pharmacological and/or cognitivebehavioral therapy represents a risk factor for relapse. In
fact, residual symptoms may progress and become the
prodromal phase of a new episode. Conclusion. Anxiety
sensitivity deserves particular attention in the evaluation
of hypochondriacal patients and it should be considered
as an endpoint by studies on therapeutic strategies for
hypochondriasis, because of its potential role in favoring
relapse.

Recalled Anxious Parenting Behaviors and


Anxiety Symptomatology in Young Adults
Amie Grills-Taquechel, University of Houston
USA
The impact of familial, and specifically parenting,
variables has been increasingly acknowledged in
etiological models of youth anxiety disorders (cf, Fisak &
Grills, in press; Ginsburg, Siqueland, Masia-Warner, &
Hedtke, 2004; King, Gullone, & Ollendick, 1998).
Following Rachman's seminal work, researchers have
considered the roles of direct conditioning, vicarious
learning (modeling), and information/verbal instruction.
More recently, researchers have hypothesized that
reinforcement of avoidant/anxious behavior may also play
a role in the development of anxiety (cf, Beidel & Turner,
1998; Fisak & Grills, in press; Rapee, 2002).
Nonetheless, additional research is necessary to
elucidate the specific parenting behaviors associated with
different types of anxiety-related symptoms. For example,
it may be that parent modeled behaviors have a more
influential role in the development of fearful behaviors,
while reinforcement has a more salient role in the
development of worrisome thoughts. Furthermore, other
factors (e.g., parent and/or child gender, family cohesion)

may influence the relations between recalled parenting


behaviors and current levels of anxious symptoms.
Finally, one of the key barriers in literature on parenting
behaviors concerns the combining of parent information
(i.e., asking questions regarding both parents together
versus mothers and fathers separately). The current
study seeks to address these issues, as well as extend
the extant literature on parenting behaviors through
consideration of mother and father behaviors separately.
Participants include approximately 1100 undergraduates
enrolled at a large Southeastern United States college
(~68% female; 82% Caucasian; M age=20). Recalled
maternal and paternal behaviors from youth will be
examined with the Childhood Learning of Anxiety ScaleRetrospective Version. Anxiety-related symptoms will be
measured with the following questionnaires: State/Trait
Anxiety Inventory, Social Interaction Anxiety Scale, Social
Phobia Scale, Penn-State Worry Questionnaire, and
Multidimensional Perfectionism Scale. Multiple regression
analyses will be conducted, and it is expected that
recalled maternal and paternal modeling, reinforcement,
and information transfer will predict anxiety
symptomatology. In addition, maternal parenting
behaviors are expected to have a greater influential role,
particularly on female participants. Data analyses are
currently underway. These findings will be incorporated
into the broader literature examining family factors that
increase risk for the development of youth anxiety.

Semi-Open Group Therapy for Social Phobia:


Preliminary Findings from Iceland University
Hospital
Brynjar Halldrsson, ; Sley Dav_sdttir,
Sigurbjrg Ludvigsdttir, Iceland University
Hospital Psychiatric Unit Iceland
Social phobia, also known as social anxiety disorder, is
characterized by an excessive and persistent fear of
social or performance situations during which a person
may be negatively evaluated by others. Cognitivebehavioural group therapy (CBGT) has proven to be an
effective treatment for social phobia and is the most
commonly used therapy in studies of social phobia
(Stangier, U., Heidenreich, T., Peitz, M., Lauterbach, W.
and Clark, D. M. (2003). Cognitive therapy for social
phobia: individual versus group treatment. Behaviour
Research and Therapy, 41, 991-1007). Potential benefits
of group treatment include: cost-effectiveness;
opportunities to simulate social situations in role-plays;
the exposure of being in a group setting; participants get
support from others dealing with the same problem;
vicarious learning while other group members are
performing role plays. Potential disadvantages of group
format include: the fact that some patients fail to benefit
from CBGT; increased risk of dropout from treatment;
duration of treatment can be too short for severely
impaired participants; less attention is given to individuals
problems; lack of generalization from role-plays to real life
situations.
This research was intended to compare a traditional form
of CBGT to a Semi-Open Group (SOG) treatment
designed to minimize some of the limitations of CBGT for
social phobia. The SOG format is based on traditional
CBT techniques and is different from the traditional CBGT
format in four ways. First, it makes it possible to vary
treatment length between patients based on the severity
of their disorder, and at the same time eliminate wait-lists.
Second, patients are exposed to more people. Third,
impact of dropout is not as significant as in CBGT. Fourth,
patients that have finished a few weeks in therapy
educate newcomers about social phobia. Twenty-three
patients, from Iceland University Hospital Psychiatric Unit
were randomly assigned to traditional CBGT, SOG
treatment and a Wait-List control condition. Participants
had up to eighteen weekly therapy sessions. Both groups
had two therapists and treatment sessions lasted two and
a half hours. Social phobia measures indicated significant
pre-treatment to post-treatment improvement in both
treatment groups, whereas no changes occurred for
participants on the Wait-List. Semi-Open Group treatment
was superior to Cognitive-Behavioural Group Therapy on
several measures including measures on mood. Most
importantly, results indicated that the Semi-Open Group
format works well in clinical settings. Aim of the study was
to investigate the effectiveness of a Semi-Open Group
treatment for social phobia. Results indicate that this
treatment format works well in clinical settings, but further
research is needed. The Semi-Open Group format is a
practical and innovative solution for clinical settings that
require cost-effective treatment options.

Research of Social Anxiety Disorder research;


Culture bound syndrome or Culture bound
research?
Hiroaki Harai, Miyo Okajima, ; Chisato Komatsu,
Kikuchi National Hospital Japan
The descriptions and treatments of mental disorders vary
culture to culture. It is generally believed that these
differences are explained by the differences of cultural
backgrounds. Social Anxiety Disorder (SAD) is a clear
example of this belief, and Japanese scholars named the
similar condition as Taijin-Kyofu-Sho (TKS), which is
acknowledged as a culture-bound syndrome in DSM-IV,

an American classification of mental disorders. This paper


tries to critically examine this popular belief pertaining to
SAD. Extensive literature review was performed in June
2005 with Medline, PsychINFO and Igaku-Chuo-Zasshi, a
Japanese literature database. The year of publication, the
residing country of the first author, research method,
treatment modality and the topic were tabulated. The
number of publication in each interested areas were
counted and analyzed to find the trends. Overall the
publication on SAD has increased since 1990. Some
countries like Australia, Canada, Italy, the Netherlands,
British, Japanese had actively published before 1990.
The US had increased the number ten times as much
since 1990. Germans, Swedish, Spanish, French, and
Brazilians had not published before 1990. They started
publications since 1990
The number of publications amongst, and Italians have
not changed before and after 1990. Most of the
publications written in English before 1990 were on
Pavlovian conditioning theory and cognitive behavior
therapy for social phobia. Publications written in
Japanese discussed mostly on Morita therapy on TKS.
Most of them published in English and in Japanese
combined after 1990 were about pharmacotherapy for
SAD. Research on SAD from the viewpoints of
psychoanalysts, family therapists, or social psychologists
were virtually non-existent in any of the countries. The
year of 1990 was found to be an epoch for SAD
publications. Recent systematic research efforts by
American researchers are notable. These trends of
research interests in individual countries are best
explained by who did those researches. The American
researchers examine mostly on pharmacotherapy for
SAD. Behaviorists in British common wealth countries
have been researching and treating social phobia long
before Americans renamed social phobia as SAD in
1990. Morita therapists in Japan have long been treating
TKS, believing they have found culture-bound syndrome
unique to Japan. Psychoanalysts never showed
significant interest in SAD, both in the United States and
in Japan. It is impossible to explain these changes
happened after 1990 by the cultural background of
individual patients and their society, because the
construct of culture should not change in such a short
time period. The authors speculate that the interest and
culture of researchers themselves are the main reason of
those changes.

Verification of the Effectiveness of Exposure


Therapy for Spider Phobia Using NearInfrared Spectroscopy
Makoto Hasegawa; Itaru Fukui, Tokyo Kasei
University; Tadashi Umekage The University of
Tokyo, Japan/Akasaka Clinic; Douglas Eames,
Tokyo Cyber Clinic; Eri Usami, Akasaka Clinic;
Eiji Yoshida, Akasaka Clinic; Hisanobu Kaiya,
Akasaka Clinic Japan
Lately quantitative changes in the brain's oxygenated and
deoxygenated hemoglobin levels, which reflect higherorder brain functioning, can be measured by near-infrared
spectroscopy (NIRS ). Therefore brain functioning
changes resulting from the treatment of mental disorders
(e.g. Depressive disorder, Panic disorder, Schizophrenia
and PTSD) can be measured by NIRS. The aim of this
research is to use NIRS to make clear the brain
functioning changes of spider phobia patients treated by
exposure therapy. The subjects were two female spider
phobia patients who consented to participate in the
experiments. A 32-channel NIRS instrument (OMM3000:Shimadzu Corporation, Tokyo, Japan ) was used,
but only 21-channels were active in this experiment. A
pre-treatment behavioral assessment test (BAT), was
conducted to measure how close the subjects could
come to a live spider in a transparent bottle. During the
BAT, NIRS, skin conductivity, and skin temperature
measurements were taken. The subjects then received a
total of 9 hours of treatment during three successive
days. As part of the treatment, virtual reality (VR)
exposure was conducted with the simultaneous
measurement of physiological data and the brain
functioning using NIRS. Additionally, gradual exposure
therapy using photos of spiders was done without
physiological or NIRS measurements. A post-treatment
BAT with physiological data and NIRS measurement was
also conducted. During the pre-treatment BAT, both
subjects could not come closer than 2 m to the bottled
spider. During the post-treatment BAT, both subjects were
able to take the bottled spider in their hands. As for the
pre-treatment BAT NIRS data, when both subjects had
the fearful feelings, oxygenated hemoglobin flow in the
prefrontal lobe suddenly increased, especially in the left
outside part. For the physiological measures, posttreatment data for both skin temperature and skin
conductivity indicated less anxiety was present when
compared to the pre-treatment data. During the VR
exposure therapy, after a frightening encounter with a
spider, one subject had a sudden increase in the
prefrontal lobe oxygenated hemoglobin flow. It required
18 minutes for this measure to return to the baseline
level. Through this study it was confirmed that the
oxygenated hemoglobin flow increases in the left outside
prefrontal lobe when patients experience fear (Akiyoshi et
al., 2003). In addition, the NIRS measurements also

confirmed that a minimum of about 20 minutes is required


for effective exposure therapy.

Early relationships and peer relationships in


social phobia: The roles of attachment and
rejection sensitivity
Aderka Idan, Bar-Ilan University; Ora Weisman, ;
Danny Raveh, Bar-Ilan University; Sofi Marom, ;
Haggai Hermesh, Geha Mental Health Center
Generalized Social Phobia (GSP) is an anxiety disorder
characterized by distress in interpersonal interactions.
GSP frequently begins early in life, and when untreated,
has an unremitting course. Several studies have
speculated about the etiology of this condition. For
example, it has been proposed that disrupted attachment
mechanism may affect later comfort in multiple social
interactions. Indeed, Eng, Heimberg, Hart, Schneier, &
Liebowitz (2001) found insecure attachment to be
associated with greater severity of SP symptoms, thus
demonstrating the important role of attachment in SP.
However, the authors also reported a large group of
individuals diagnosed with SP who were securely
attached. These findings suggest that attachment - albeit
an important vulnerability factor - is not sufficient in
accounting for the interpersonal disruption in SP. While
adult attachment styles focus on close relationships with
intimate partners, social anxiety typically occurs in a
broader social context, typically involving peer
relationships. In the present study, we examined the
contribution of rejection sensitivity -- individuals' tendency
to anxiously expect, readily perceive, and overreact to
rejection (Downey & Feldman, 1996) - to socially anxious
symptoms. We hypothesized that (a) consistent with
previous research, attachment would be significantly
associated to severity of SP symptoms and (b) rejection
sensitivity would be significantly associated to severity of
SP symptoms above and beyond the contribution of
attachment. One hundred and sixty six university students
participated and completed measures assessing
attachment (Experiences in close relationships
questionnaire - ECR, Brennan, Clark, & Shaver, 1998),
rejection sensitivity (Rejection sensitivity questionnaire RSQ, Downey & Feldman, 1996), state and trait anxiety
(state and trait anxiety inventory - STAI, Spielberger,
1983), depression (Beck Depression Inventory - BDI,
Beck, Rush, Shaw & Emery, 1979), and social phobia
(Liebowitz social anxiety scale - LSAS, Liebowitz, 1987).
Hierarchal regression analyses were used to test
hypotheses. The anxiety dimension of attachment
significantly predicted SP symptoms (=0.24, p=0.003)
while the avoidance dimension did not (=0.00, p=0.99).
In addition, rejection sensitivity was a significant predictor
of SP symptoms above and beyond attachment
dimensions, depression, and state and trait anxiety
(=0.38, p<0.001). The results stress the importance of
assessing multiple facets of interpersonal functioning in
the context of SP. In addition, they point at the need for
closer examination of peer relationships (e.g. of the role
of ostracism, submissiveness, and ruptures in intimacy)
for the etiology of social phobia.

'Stages-of-Change' and long term effects of


In-Patient cognitive-behavioral treatment of
Anxiety
Petra Ivert, Madlen Kraft, Edgar Geissner,
Psychosomatic Hospital 'Roseneck', University of
Munich Germany
Patients suffering from anxiety who are confronted with
expected or desired modification of this disorder are be
found in different states of (a) avoiding the problem, or (b)
awareness of and initiating efforts to change the problem
or (c) in tenacity practising newly acquired behavior.
Clinical observations within the context of in-patient
psychotherapy of anxiety disorders showed that only
getting through the treatment program in a more
mechanical way can reduce successful completion on the
long run. So, without factors like being conscious of the
problem, aiming to act against it or maintaining efforts to
cope with it, first results at the end of treatment may be
not stable when patients have to manage the problem
later on by their own. Insofar, the aim of our study was to
analyze if this observation could be supported in a more
systematic and empirical way. The study comprises 130
patients suffering from anxiety (panic disorder,
agoraphobia; standardized diagnoses by IDCL). Patients
were examined at 4 different times (at time of application
for treatment, at admission to the program, at discharge,
and 6 months after treatment). Anxiety was measured by
different standardized instruments (Beck Anxiety
Inventory, Anxiety Cognitions Questionnaire, Mobility
Index/alone, Mobility Index/accompagnied, Body
Sensations Questionnaire, and anxiety related scales of
the Symptom Check List 90-revised form). Motivational
factors were measured by a newly developed
questionnaire to examine stages of change which
consisted of six facets: precontemplation, contemplation,
preparation, action, maintenance, and termination.
Theoretical background was the Prochaska-Diclemente
Transtheoretical Model of Behavior Change, which was
adapted for purposes of examining anxiety-specific
contents with patients. Treatment consisted of single
therapy sessions, problem solving group therapy, an

intensive anxiety management training focusing on


cognitive and behavioral elements, exercises to elicit
bodily reactions related to panic, standardized and
individualized exposure to deal with avoidance behavior.
Results demonstrated that the program worked well to
reduce anxiety and avoidance behaviors in a substantial
and stable way. Bodily symptoms and reduced mobility
(alone or accompagnied) improved very strong. Anxiety
cognitions could be reduced also in an acceptable good
way. Also, as expected, motivational factors played an
important role. Highly motivated patients engaged more
and had better effects reducing their anxiety symptoms.
Facets of problem acknowledgement and intentions to
cope actively with the problem exert effects on treatment
success. Moreover, facets of perseverance and efforts
when practising alone proved to be even more important.
Successful treatment of clinical anxiety can be enhanced
by controlling motivational states of patients. Elements
strengthening self administered cognitive control, effort,
and self-efficacy should be added in the treatment of
anxiety patients.

Cognitive Behavioural Therapy of OCD: A


randomized comparative study of individual
vs. group therapy: Current status of
participant inclusion
Hjalti Jonsson, Esben Hougaard, Aarhus
University, Birgit Bennedsen, Clinic for Anxiety
Disorders & OCD, Aarhus University Hospital;
Nicole Rosenberg, Clinic for Anxiety Disorders &
OCD, Aarhus University Hospital
Purpose: To compare the effectiveness of group and
individual Cognitive Behavioural Therapy (CBT) of
Obsessive Compulsive Disorder (OCD) and to investigate
the role of OCD-related cognitions in symptomatic change
of OCD in CBT. Methods: In this ongoing study 100
participants with OCD as their main diagnosis will be
randomized to either individual or group CBT.
Pharmacological treatment is kept stabile from three
months before until the end of treatment. Symptoms of
OCD and depression as well as OCD related cognitions
are assessed with the clinician rated Y-BOCS and self
report questionnaires (OCI-R; RAS; TAF, BDI-II, BAI)
before and after the treatment period as well as at 6 and
12 months' follow-up. Results: Since March 2005, a total
of 195 patients have been referred to OCD treatment in
the clinic. Of these 88 are now included in the project.
Excluded were patients not fulfilling DSM-IV criteria of
OCD (15); patients with a primary diagnosis of another
anxiety disorders (17) psychotic disorder (9) or an organic
disorder (4); as well as patients not fulfilling language or
age requirements (6). A total of 8 patients have refused to
be included in the project (2 due to pregnancy, 1 due to
practical reasons, and 5 did not want to be randomised to
group therapy). Sixteen patients did not turn op to
assessment interviews or dropped out while in
assessment. Currently 32 patients are undergoing
assessment or on waiting list to an assessment interview.
Discussion: Even though many patients prefer individual
therapy when asked during the assessment interviews,
there are relatively few patients that refuse to be
randomised to either group or individual therapy. Inclusion
of participants and collection of data is expected to be
finished in the fall of 2008.

Cognitive behavioral target on perfectionism


in the treatment for social phobia
Vera Jovanovska Stoev, Private Professional
The present investigation is an attempt to expand the
knowledge regarding CBT in the field of social phobia
where perfectionism is the main factor of maintaining the
problem. The study explores the extent to which various
dimensions of perfectionism change as a result of 12session individual cognitive behavioural treatment. In the
study, 8 social phobic clients participated in a multiple
baseline single-case design. They completed the Frost
Multidimensional Perfectionism Scale and rated their
social standards and their social ability before and after
treatment. It was found that social phobic individuals had
higher levels on socially prescribed perfectionism. to
some extent on other oriented perfectionism and lowered
perceptions on social ability. Also, increased levels over
concern of making mistakes (CM), doubts about actions
(DA) and personal standards (PS) have been seen as
particular dimensions of perfectionism. CBT targeted
these three levels result in significant reductions on total
perfectionism scores and scores on these particular
dimensions. Changes in CM, DA and PS predicted
posttreatment reduce of the social anxiety. The results
suggested that particular dimensions of perfectionism
play an important role in social phobia. Therefore, the
treatment targeting on perfectionism may be influential in
determining the treatment outcome of social phobia.

The roles of agencies in response to clients


with obsessive compulsive hoarding
behaviours and the development of a protocol
to guide a co- ordinated, interagency
approach.
Merkel Julia, University of Adelaide; Edwards
Christopher, Centre for Treatment of Anxiety and
Depression; Helen Winefield; Shona Crabb,
University of Adelaide Australia
Current management strategies used by human service
agencies have proven ineffective in resolving issues
related to obsessive compulsive hoarding. High-risk
hoarding situations endanger the occupants and nearby
community. Client lack of insight prevents severe
hoarders from engaging with processes to reduce the
clutter, therefore the rights of the person with compulsive
hoarding behaviours to maintain their property is
juxtaposed to the rights of the community, to a safe
environment. Landlords and local governments are
affected by their duty of care to maintain safe premises.
Protocols for hoarding related issues are being developed
internationally, although little research on outcomes is
available. The aim of this research was to develop an
interagency protocol to improve outcomes for clients with
obsessive-compulsive hoarding problems. 22 participants
from mental health services, housing, local government,
guardianship or adult protective services, and community
organizations were interviewed. The results of qualitative
research revealed four main themes. Theme 1 was the
workers' negative emotional response due to nonresolution of unsafe hoarding situations. All workers at the
service delivery level expressed some degree of anger,
frustration, sadness or worry with non- resolution of
situations, and the ongoing danger that resulted from this.
However managers and policy makers were not affected
by strong emotional response to the situation. Theme 2:
Professionalism of workers: Workers attempted to build
relationships with these clients. This client group was
reluctant to engage, and the process was time
consuming, something that was not factored in to funding
and resource management. Use of legislation enabled
progress to occur in some cases, although some
differences in interpreting confidentiality was a block to
interagency communication in severe risk situations.
Specific skills training were needed. Theme 3: Extensive
time and resources directed to hoarders resulted in
unsuccessful outcomes. Strategies used were ineffective.
No relapse prevention occurred. Theme 4: No guidelines
existed for use in situations of client lack of insight and
high risk. This research supported that there was
dissatisfaction from workers with the current outcomes, a
need for further training, and for policies that support the
specific features of clients with hoarding related
problems. In addition, concern was expressed that lives
were in danger from high risk situations. The Protocol and
Flow Chart developed recommended a multidisciplinary
team approach, with legislation helpful to the resolution of
hoarding related issues incorporated. The Protocol
included pathways for situations where clients accepted
assistance and when they did not with an involuntary
assessment in situations of high risk and mental
incapacity. The Protocol was generally well received by
the agencies that participated. Sustainability of health
policy is improved by use of action research and involving
those who will implement it in the research process, as
with this project. The present situation for people with
compulsive hoarding problems is often eviction or debt. A
co-ordinated approach such as this will assist in more
compassionate management of clients with obsessive
compulsive hoarding behaviours.

The criteria for improvement in the CBT


treatment of panic disorders
Tanja Jurin, Miranda Novak, Centre for Education
and Upbringing
Introduction: CBT treatment is recognized as a successful
approach to panic disorders. According to the CBT model,
panic attacks (PA) are consequences of catastrophic
interpretations of body sensations. Maintenance of the
disorder is supported by avoidant behavior(s) and safety
maneuvers. The treatment is usually focused on cognitive
restructuring (beliefs, expectations, overestimated
appraisal of threat) and on restoring the control over
physical arousal.
Aim: The aim of this study is to determine relevant criteria
for improvement in CBT treatment. At the beginning of the
treatment several measures were included in the
assessment of improvement of treatment; structured and
semistructured interviews, behavior tests, self-reported
measures (Anxiety Sensitivity Index - ASI), selfmonitoring (frequency and intensity of panic attacks,
number and sort of avoidant and safety behaviors),
cognitive components (belief, expectations and estimation
of danger) as well as subjective evaluation of how panic
interferes with the patient's/client's social and working
functioning. Current study is in progress. Panic patients
that meet DSM-IV criteria for Panic disorder participate in
the study. The case example:
Female (35) developed panic disorder shortly after
anaphylactic shock due to antibiotic (Cefaleksin). Her
worries were as follows: What if I get sick and I have to
take the drug., What if I eat something and that could be

allergenic for me., What if I faint and the helpers don't


know that I'm allergic to Cefaleksin. Avoidant behaviors
were spreading and generalized. She didn't go anywhere
with her children alone, was refusing to take any sort of
drugs, didn't want to try new food and had a permanent
fear of new panic attacks. Safety behaviors were:
carrying an adrenalin injection, inability to stay alone with
her children. Through the course of the treatment (10
sessions + 2 follow up sessions) several behavioral
techniques (behavior experiments, exposure, selfmonitoring, relaxation, attention distraction through the
activity) and cognitive interventions (reinterpretation of
body sensations, changing metacognitive beliefs about a
threat) were applied. The changes after 10 sessions: 1.
Release of avoidant behaviors and safety behaviors; 2.
Decrease in the number, intensity and duration of panic
attacks; 3. Decrease in fear of fear; 3. Significant
changes in metacognitive beliefs about threat and her
vulnerability; 4. Significant decrease in self - report
measure results (ASI). From the 56 points at the
beginning to 21.; 5. Gradually more appropriate
functioning. Conclusion: Several criteria are included in
evaluation of treatment effects: frequency, intensity and
duration of panic attacks as well as fear of fear, number
and sort of avoidant and safety behaviors, results on selfreported measures, changes in metacognitive beliefs and
adequate working and social functioning.

The effect of computer-assisted Progressive


Muscle Relaxation with relaxation movie and
music on anxiety.
Jun-ichiro Kanazawa, University of Hokkaido;
Yoshihiro Kanai, Hiroshima University; Yuji
Sakano, University of Hokkaido Japan
Computer-assisted Cognitive Behavioral Therapy (CCBT)
for Anxiety Disorder and Mood disorder has been paid
attention. However, high dropout rate due to excessive
anxiety for the treatment is the main concern in CCBT.
Progressive Muscle Relaxation (PMR) is known for
having anxiety reduction effect, but to make full use of the
characteristics of CCBT, adding audiovisual program may
increase the effect of PMR using computer. The purpose
of this study was to compare the effect of anxiety
reduction on computer setting between PMR alone and
PMR with audiovisual program. Participants Twenty-five
undergraduate students whose STAI-T scores were
higher than moderate level were randomly assigned to
either PMR condition (five male, four female), PMR
adding audiovisual program condition (four male, four
female), or control condition (five male, three female).
Measurements I. Subjective measurements: anxiety,
tension and excitement, and refresh (excerpt from MOOD
Inventory). II. Objective measurements: skin temperature,
skin conductance level (SCL), and heart rate. Procedure
Participants were exposed to the imaging anxious
situation to heighten subjective anxiety (anxiety
provocation phase) after resting with closed eyes for five
minutes (resting phase). Then, participants were
instructed to get relaxed (relaxing phase). Subjective and
objective measures were assessed in every phase.
Relaxation programs PMR alone condition: Participants
were trained how to conduct PMR on computer screen for
thirteen minutes. PMR with audiovisual program
condition: Yu-min which effect was verified by Fujimori
et al. (2000) was used as an audiovisual program. The
audiovisual program was conducted after PMR in twenty
one minutes. Control condition: Participants were asked
to watch a screen savor of the personal computer and to
rest for thirteen minutes. Data analysis Average amount
of change from resting phase to either anxiety
provocation phase or relaxing phase was calculated, and
two way ANOVA were conducted to compare between
three conditions and two times on both subjective and
objective measurements. Subjective measurements
Significant main effects of time were observed on all
factors and no interactions were observed. These results
indicated that scores on anxiety, and tension and
excitement decreased, and also, scores on refresh
increased in relaxing phase in each condition. Objective
measurements No significant main effect of time and
interaction was observed on skin temperature and SCL.
Therefore, relaxation effects were not observed in terms
of the changes in skin temperature and SCL. Significant
main effect of time on heart rate was observed, although
there was no significance on interaction. The results
showed that scores on heart rata were decreased in each
condition. In this study, there were no significant
difference in anxiety reduction between PMR alone, PMR
with audiovisual program, and watching screen savor in
anxiety provocation situation, although anxiety were
relieved in all conditions. Therefore, these results suggest
that it is possible to relief excessive anxiety before CCBT
by PMR, PMR with audiovisual program, or resting.
Selecting relaxation method through preference increases
relaxation effect (Davis & Thaut, 1989). So further studies
are needed to examine whether selection of relaxation
method through preference increase the effect of anxiety
reduction before CCBT.

Assessment of Catastrophic Misinterpretation


of Bodily Sensations: Psychometric
Properties of the Korean Version of the Brief
Body Sensation Interpretation Questionnaire
Sujin Kim, Hallym University, Republic of Korea;
Yongrae Cho, Hallym University, Republic of
Korea
The cognitive model of panic attacks (Clark, 1986, 1988)
proposes that panic attack results from the catastrophic
misinterpretations of bodily sensations. Clark and
colleagues (1997) developed the Brief Body Sensation
Interpretation Questionnaire (BBSIQ) to directly measure
'misinterpretation of body sensations' regarded as core
driver of panic attacks and examined its reliability and
validity. The BBSIQ is a 14-item self-report measure
consisting of two 7-item subscales, panic body sensations
and external events. The two BBSIQ subscales showed
satisfactory internal consistency, acceptable test-retest
reliability, and good convergent and discriminant validity.
We translated the BBSIQ into Korean and examined the
reliability and validity of a Korean version of BBSIQ (KBBSIQ) in these two studies. 137 Korean patients (71
female, 66 male) who met DSM-? criteria for panic
disorder participated in Study 1. They completed an
assessment battery consisting of the Korean versions of
the BBSIQ, the Anxiety Sensitivity Index-Revised (ASI-R),
the Anxiety Control Questionnaire (ACQ), the Panic and
Agoraphobia Scale (PAS), and the Beck Depression
Inventory (BDI). In Study 2, of the patients in Study 1, 85
panic disorder patients (42 female, 43 male) completed
twelve sessions of group cognitive-behavioral therapy.
They filled out the battery used in Study 1 before and
after treatment. In Study 1, the results indicated that most
of the K-BBSIQ subscales except external event rankings
have acceptable internal consistency. The K-BBSIQ
subscales correlated with other measures in the expected
way, thereby providing some support for good convergent
and concurrent validity of the K-BBSIQ. In addition,
discriminant validity of the K-BBSIQ ranking part as well
as incremental validity of some subscales of the K-BBSIQ
was adequate. In Study 2, the results indicated that all
the Korean versions of the ASI-R, ACQ, PAS, and BDI
reduced significantly from pre- and post-treatment. Most
of the K-BBSIQ subscales except external event belief
ratings decreased significantly from pre- and posttreatment. Therefore, most of the K-BBSIQ subscales
demonstrated sensitivity to change following group
cognitive-behavioral therapy. In conclusion, the K-BBSIQ
appears to be a reliable, valid measure to assess
misinterpretation of body sensations in patients with panic
disorder. Furthermore, the K-BBSIQ seems to be clinically
useful because most of the K-BBSIQ subscales were
sensitive to assessing treatment effects.

Group Attendance CBT Program Decreases


Number of Relapses in Patients with Anxiety
Disorders and Improve Their Quality of Life.
Jirina Kosova, Prague Psychiatric Center; Lenka
Hoffmanov, Prague Psychiatric Center; Helena
Vrubelov, Prague Psychiatric Center Czech
Republic
Numerous clinical trials have proven efficacy of cognitive
behavioral techniques (CBT) in the treatment of virtually
all anxious disorders. Therapeutic programs adopted for
daily attendance regiments were originally used as an
alternative and possibly more efficacious treatment option
in hospitalized patients. However it has been proven with
time that these techniques significantly reduce need for
hospitalization, shorten its time; improve social
functioning and help better in return to normal life and
work. In comparison with individual CBT, group CBT
techniques, by allowing employment of intensified
therapeutic approaches, are highly efficacious. The aim of
this study was to compare group attendance CBT
program with standard ambulatory treatment of patients
with anxious diseases by means of incidence of relapses
and functional status of patients. Randomized
comparative study in 204 patients who fulfilled criteria of
ICD-10 for anxiety disorders was performed. Patients
were randomized either to specialized 7 weeks CBT
program (Group A) or a standard ambulatory treatment
(Group B). All randomized patients were followed for a
period of one year. For the assessment of symptoms the
following scales were used: Clinical global impression
(CGI), Hamilton rating scale for anxiety (HAM-A),
Hamilton rating scale for depression (HAM-D), and
Quality of life enjoyment and satisfaction questionnaire
(Q-LES-Q). Primary end points (relapse, completion of all
visits) were assessed upon trial completion at 1 year.
Analysis was performed by using Chi-square distribution
statistic and Fisher Exact Test. For statistical analysis of
changes of symptoms burden ANCOVA covariation
analysis was used. In Group A (N=84) 71 patients
completed the study (84,5%), in Group B (N=120) 64
(53.3%); p-value <0.0001. In Group A in total 8 relapses
(9.5%) were observed compared to 41 relapses (34.2%)
in Group B during one year, the difference was statistical
significant as assessed by Chi-square distribution statistic
(p-value <0.0001). Difference between groups in terms of
both seriousness of symptoms and improvement score
according to CGI was also significant (p-value <0.0001).
Based on the overall result assessed by the scale HAM-A

patients in Group A achieved superior improvement (1.45; 95% CI -1.55, -1.35) compared to Group B (-1.13;
95%CI -1.23, -1.03); p-value <0.0001. Total score = 10
was observed in statistically more patients in Group A
(70.8 %) than in Group B (23.8%), p-value <0.0001.
Assessment performed by using the scale Q-LES-Q
shows improvement in both groups, however
improvement of patients in Group A (-1.09) is more
significant, p-value 0.0275. Intensive CBT program is
effective in prevention of relapses in patients with anxious
disorders. As assessed by the HAM-A, there was
significantly less symptoms in patients randomized to
Group A than Group B after one year of monitoring. Also
quality of life of patients who completed CBT program
was better. Presented results are in agreement with
previous controlled studies, where CBT was compared
with other treatment strategies. It is also important to
underline our finding that more patients in Group A
completed the study, which means that intensive group
CBT improves compliance of patients throughout their
entire disease.

Dysfunctional relationship beliefs, shyness,


and fear of negative evaluation
Selda Koydemir, Ayhan Demir; Middle East
Technical University
In order to account for the development and maintenance
of social-evaluative concerns, a variety of cognitive
models have been utilized, which emphasize the role of
cognitions and maladaptive responses in eliciting this
experience. According to these theoretical views,
individuals with social-evaluative anxiety exhibit a
distinctive pattern of self-relevant cognition which
maintains their anxiety and inhibition (Clark & Wells,
1995; Rapee & Heimberg, 1997). These individuals are
usually characterized by concern about interpersonal
evaluation, and by distorted, perfectionist beliefs.
Although much evidence has been documented with
regard to cognitive processes of people with social
anxiety, the case of dysfunctional cognitions specific to
interpersonal relationships is yet to be known. This study
examined the role of the interpersonal cognitive
distortions on social-evaluative anxiety in a sample of
Turkish university students. It was proposed that shy
people would be highly concerned about receiving
negative evaluation, and hold dysfunctional beliefs about
other people such as rejection and relationship
expectations. A total of 415 (181 males, 234 females, with
mean age of 20.51) Turkish non-clinical undergraduate
students, voluntarily participated in this study. The
participants completed Turkish versions of Revised
Cheek and Buss Shyness Scale, Brief Fear of Negative
Evaluation Scale, and Interpersonal Cognitive Distortions
Scale (ICDS; Hamamci & Bykztrk, 2004). ICDS has
3 subscales measuring interpersonal rejection, unrealistic
relationship expectation, and interpersonal misperception.
Correlation coefficients among study variables were
computed which showed that shyness was significantly
positively associated with fear of negative evaluation (r =
.45, p < .001), and two subscales of ICDS, namely
interpersonal misperception (r = .39, p < .001), and
unrealistic relationship expectation (r = .20, p < .001).
Fear of negative evaluation also correlated significantly
positively with interpersonal misperception (r = .37, p <
.001), and unrealistic relationship expectation (r = .38, p <
.001). In addition, the multiple regression analysis
indicated that fear of negative evaluation, interpersonal
rejection, and interpersonal misperception were
significant predictors of shyness. These results indicated
that cognitive processes are important in the experience
of shyness, especially distorted beliefs about other
people, including fears of being negatively evaluated,
negative attitudes toward others, and attempting to
understand others using unrealistic methods. The results
will be discussed in terms of cultural considerations.

Cognitive Behavioral Analysis of Therapeutic


Process for Client Having Social Phobia
Park Kyung Ae, Kwang Woon University
This research study was conducted based on qualitative
research using phenomenological approach. The data
was glened from the written counseling process for a
client who showed symptoms of social phobia. The
process was composed of 25 sessions (24 main sessions
+ 1 booster session) over a period of 1year. The
research was focused on how to understand the process
of psychotherapy and the outcome of it for a client having
soical phobia according to cognitive behavioral approach.
This approach has proven to be very effective for this
type of disorder. The paper details the major information
of the client, the developmental path of the problems, the
reasons for applying CBT. The first part of paper
summerizes the major points of the counseling
documentation for 25sessions. In the second part of
paper, the researcher attempts to find meaning from the
client's experiences and to classifiy the criteria of those
experiences according to the CBT approach. The final
section offers interpretation and insights about the
cognitive behavioral approach and the social phobia. In
clsong, the paper will discuss the necessity of a
qualtitative based research regarding counsling and will
propose an elaboration and systematization of that
research method.

Cognitive perception of panic disorder in


terms of comorbid somatic illnesses
Milan Latas,; Sanja Adnadjevic, Institute of
Psychiatry
Previous studies reports high comorbidity rates of panic
disorder (with or without agoraphobia) and somatic
illnesses. This could arise the question: Is there a
difference in panic disorder perception in terms of
presence of somatic illnesses? In this study the authors
was investigated the effect of the presence of comorbid
somatic illness on the cognitive perception of panic
attacks in patients with panic disorder with agoraphobia.
The study sample was consisted of 64 patients with panic
disorder with agoraphobia presented to the Day clinic of
Institute of Psychiatry in Belgrade for the assessment and
treatment of panic disorder and agoraphobia. Presence
of comorbid medical illnesses was estimated by the
National Institute of Mental Health Panic Questionnaire
(NIMH PQ). Cognitive perception of panic attacks was
assessed by the 3 dimension questionaire: Panic
Appraisal Inventory (PAI). The results of the study show
that 75% of patients with panic disorder have at least one
comorbid somatic illness. The results show less capability
of perception for copping panic attacks in patient with
comorbid medical illness in generally. Patients with
gastrointestinal and urological illnesses have worse
perception of capability for handling panic attack, while
that was not the case with patients with cardiovascular
and endocrine illnesses. The results also shows that
there are no differences in perception of anticipation of
occurring of panic attacks and in perception of
anticipation of panic attacks somatic, social and
behavioral consequences in terms of presence of
comorbid somatic illnesses. Observed difference
indicates that treatment program for patient panic
disorder with agoraphobia and comorbid medical illness
deserves to have greater attention because of theirs
specific cognitive perception of panic attack.

Outcomes of cognitive-behavior therapy for


Japanese patients with panic disorder
Kiyoe Lee, Nagoya City University; Yumiko
NodaNagoya City University; Sei Ogawa, Nagoya
City University; Tadashi Funayama, Nagoya City
University; Norio Watanabe, Nagoya City
University; Junwen Chen, Tokai Women's
University; Toshiaki A. Furukawa, Nagoya City
University
To evaluate cognitive-behavioral therapy (CBT) for panic
disorder (PD), originally developed for Western patients,
among Japanese patients. Seventy outpatients who
participated in group CBT for PD were evaluated using
the Panic Disorder Severity Scale (PDSS), the primary
measure for assessing the severity of PD, at the
beginning and at the completion of the program. We also
examined baseline predictors of the CBT outcomes.
Fourteen patients (20%) did not complete the program.
Among completers, the average PDSS score fell from
12.8 at baseline to 7.1 post-therapy (44.7% reduction).
While controlling for the baseline severity, significant
predictors of outcome included the duration of illness
before entering the CBT program and the baseline social
dysfunction. Our data suggest that group CBT for PD is
acceptable and can bring about similar degree of
symptom reduction among Japanese patients with PD as
among Western patients.

Catastrophic Cognitions as Prognostic


Factors in Cognitive Behavioral Treatment for
Panic Disorder
Nohemi Marcos, Ester Garriga; Itxaso Figueras;
l, Miriam Morales; Nadine Riesco; Mental Health
Center, Mtua de Terrassa Hospital
There is an increasing interest in the study of the rol that
catastrophic cognitions play in Panic Disorder (PD).
Recent research points out that these thoughts are
central in the disorder maintenance,but not in its etiology
(Barlow,2002). Several factorial studies have
distinguished three categories for the catastrophic
cognitions: the physical cognitions, the mental
cognitions and the social cognitions (Khawaja, Oei and
Bagliali, 1994). Although there is not enough knowledge
about the rol that these thoughts play in the course of PD,
it seems that social cognitions are the ones that predict a
poorer therapeutic outcome (Arrindel,1993; Hicks, Barlow,
Gorman, Shear and Woods, 2005). The purpose of the
present study is to analyse (factorial analysis) the
Agoraphobic Cognitions Questionnaire (ACQ)
(Chambless,1983), to assess the group cognitive
behavioural treatment (CBT) effectiveness in modifying
each of the catastrophic categories, and to evaluate if the
pre values of these categories predict the treatment
outcome in a differential way. METHOD: Subjects. The
sample consisted of 206 out-patients who met criteria for
PD according to DSM-IV criteria. 143 Subjects were part
of the treatment group and 63 part of the control group
(patients in waiting list). Material. The Chambless Battery
composed of three self-report instruments: the ACQ, the
Body Sensations Questionnaire (BSQ) (Chambless,
1984), and the Mobility Inventory for Agoraphobia :alone
or accompanied (MI) (Chambless, 1984). Procedure:

Treatment group patients were assessed at pre and post


treatment. It was a group intervention of 10 one hourweekly sessions. Subjects from the control group are
assessed at pre and after 10 weeks, and after it they
receive psychological therapy. The treatment includes:
psicoeducation, interoceptive exposition, in vivo
exposure, cognitive restructuring and homework tasks.
Stadistical analysis: A factor analysis with a varimax
rotation of the ACQ scores at pre-treatment was made.
The cognition categories were compared to know if there
were differences between treatment group and control
group. A T Student-Fisher test for independent samples
was used. The effectiveness of the group treatment in
modifying the cognitive categories was evaluated with a
repeated measures analysis . Finally, a multiple
regression analysis was made to evaluate if each of the
pre factors can predict in a differential way the post
results. From the factorianalysis four categories were
obtained: social cognitions, physical cognitions, rare
physical cognitions and rare social cognitions. The
treatment was effective, showing an improvement in both
social and physical cognitions. There were significant
statistical differences between the treatment group and
the control group. However, none of the factors predict
the treatment results at post. Our results confirm that
cognitive behavioural intervention is effective in modifying
in an equal way the values of the different catastrophic
categories (Hicks, 2002). At the same time, it supports
previous research (Chambless and Gracely, 1988) that
considers there is not relation between the level of the
categories at pre and the treatment outcome. On the
other hand, there are the studies that show the predictive
aspect of social cognitions (Hicks, Barlow,Gorman,Shear
and Woods, 2005). Considering the controversial results
and the low number of studies related to this subject, it
would be interesting to carry on this line of research.

The Diagnostic Utility of the Thought-Action


Fusion Scale
Donald Marks, Andrew Wolanin, Jennifer BlockLerner, Michelle Manasseri, Sarah Deal, Sara
Walters-Bugbee, La Salle University
The concept of thought-action fusion (TAF) refers to a set
of beliefs or cognitive biases whereby an individual
becomes convinced that having a particular thought is
morally equivalent to acting on that thought (e.g., thinking
about lying is as reflective of a character deficit as
actually lying) or that having a thought influences the
likelihood of actual events (e.g., thinking about a plane
crash increases the likelihood of an actual crash). TAF
has been studied extensively in conjunction with
obsessive-compulsive disorder (see Berle & Starcevic,
2005), in which belief in the noxious properties of
particular cognitions often leads the individual to engage
in neutralizing rituals designed to dispel thoughts and
their effects. To measure an individual's propensity for
thought-action fusion, Shafran and colleagues (1996)
developed the Thought-Action Fusion (TAF) scale, a selfreport measure that has been demonstrated to possess
sound psychometric properties (Rassin, Merkelbach et
al., 2001). Recent research using the TAF scale reveals
that it may also afford diagnostic utility for other anxiety
disorders in addition to obsessive-compulsive disorder.
Specifically, these studies have indicated that elevated
scores on the TAF scale correlate with significant scores
on measures associated with panic disorder, social
anxiety disorder, and posttraumatic stress disorder
(Hazlett-Stevens et al., 2002; Rassin, Diepstraten et al.,
2001). To date, however, studies have been confined
either to non-clinical samples (e.g., Hazlett-Stevens et al.)
or laboratory environments (Shafran et al.), and they
have not been applied in clinical settings. Also, the
diagnostic utility of the TAF scale has not been examined
with a clinical population. The purpose of this study was
two-fold: a) To examine the diagnostic utility of the TAF
scale in a community mental health setting, considering
specifically its relationship to other clinical screening
measures and its value as an indicator of anxiety disorder
diagnosis; and b) to replicate findings of earlier studies
using non-clinical populations and to compare results
from a non-clinical sample with those obtained in a
clinical setting. The study made use of two samples. In
the first, participants (N = 50) sought outpatient treatment
for anxiety symptoms at an inner-city community mental
health facility. In the second, participants (N = 50)
included undergraduate Psychology students at a
university in the northeastern United States. Participants
in both the clinical and student group were asked to
complete the TAF scale, as well as the CognitiveAffective Mindfulness Scale-Revised (CAMS-R; Feldman,
Kumar & Greeson, 2003), a measure of dispositional
mindfulness, and the Acceptance and Action
Questionnaire-II (AAQ-II; Hayes et al., 2004), a measure
of psychological flexibility. The latter measures, which
assess constructs directly related to TAF, were included
to ascertain convergent validity of the TAF scale. In
addition, participants in the clinical sample were asked to
complete a series of self-report measures of anxiety and
psychological distress that have been previously
validated with clinical populations, including: the Anxiety
Sensitivity Index (ASI; Peterson & Reiss, 1987), a
measure designed to assess fear of anxiety symptoms
associated with panic and other anxiety disorders; the
Penn State Worry Questionnaire (PSWQ; Meyer et al.,

1990), a measure assessing tendency to worry and


difficulty controlling worry - symptoms associated with
GAD; the Beck Anxiety Inventory (BAI; Beck & Steer,
1993), a screening measure designed to assess severity
of a range of anxiety symptoms; the Outcome
Questionnaire 45 (OQ-45; Lambert et al., 1996), a
measure of symptom distress, interpersonal functioning,
and social role satisfaction; and the Quality of Life
Inventory (QOLI; Frisch, 1994), a measure of satisfaction
across multiple life domains. Finally, all participants in the
clinical sample received an in-depth (50 to 90 minutes)
semi-structured clinical interview with a Master's-level
clinician. Data collection for the both samples is in
process (current N = 42 in clinical sample). Specific
questions this study will address include: a) Do results on
the TAF scale predict results on other self-report
measures for anxiety symptoms, b) do results on the TAF
scale predict symptom distress and quality of life, c) do
TAF results or particular cut scores predict diagnosis, d)
do TAF results contribute to the predictive value of other
measures and e) do mindfulness and psychological
flexibility mediate the relationship between TAF and
psychological symptoms? In addition, the study will
consider significant differences, if any, between the
predictive value of the TAF for clinical and non-clinical
samples. Findings from the study could contribute to our
understanding of anxiety symptomatology and the role of
TAF in symptom formation. Limitations of this study
include its correlational nature and reliance on selfreports. Future research should employ behavioral
measures and experimentally examine whether TAF
contributes to development of anxiety symptomatology in
normal and clinical populations. Moreover, additional
studies are necessary to specify the nature of the
relationships between TAF and mindfulness and between
TAF and psychological flexibility. Mindfulness and
acceptance-based interventions have demonstrated
efficacy in treating these symptoms (Baer, 2005), but the
extent to which these interventions address TAF is not
well understood.

Virtual Reality Exposure Therapy for the


Treatment of Fear of Heights Using 360
Degree Panoramic Movies: A Case Report
Hideichi Miyano, University of Miyazaki Japan
Virtual reality (VR) technology is increasingly being used
in psychotherapy. Over the years, many studies have
shown that VR exposure is effective for treating specific
phobias, such as fear of heights, fear of flying,
claustrophobia, spider phobia, and driving phobia.
Although VR exposure is regarded as a promising
approach to the treatment of phobias, VR exposure with
virtual environments using three-dimensional computer
graphics (3DCGs) has certain disadvantages. First,
creating virtual environments with 3DCGs and adapting
them to the needs of the individual patients is difficult or
impractical for most clinical psychologists. In addition,
3DCGs are not exact replicas of real environments and
resemble animations. Therefore, virtual environments
created using 3DCGs can seem unreal, resulting in the
failure of the exposure therapy. In this paper, we present
VR exposure using 360 degree panoramic movies,
wherein video-recorded panoramic movies are displayed
on a head-mounted display (HMD) equipped with a
position tracking device in order to look around the virtual
environment. As an initial step in evaluating the VR
exposure using 360 degree panoramic movies, a case
study for the treatment of fear of heights was conducted.
The subject was a 13-year-old male student who
indicated fear and avoidance of heights. He reported that
he had been afraid of heights since he was a child. To
create the virtual environment, 360 degree panoramic
movies of height-related scenes (e.g., riding a Ferris
wheel, crossing a hanging bridge) were recorded using a
digital video camcorder with a hemispheric mirror. In the
exposure sessions, the panoramic movie files were
played. The images were displayed on the HMD, and
according to the need of the virtual environment, the
sounds were played on stereo speakers and a body sonic
system. After eight VR exposure sessions, the scores of
self-reported measures of fear of heights decreased and
were maintained at the seven month follow-up. This study
indicates that VR exposure using 360 degree panoramic
movies can be effective in the treatment of fear of
heights.

anxious to see emergency phone numbers, the number


of court building, and other numbers related to legal
offices. He realized his abnormal pattern of behavior but
unable to control it. He received medications and
hypnotherapy but failed to free from his sufferings.
Moschini (2005) explains that creating life line stimulates
a person to recollect memories from the past. Past
experiences influence an individual present action.
Frustration in the past may influence aggression at
present, and when everything one did does not matter he
becomes helpless (Peterson, Maier, & Seligman, 1995).
Meichenbaum (1977) explains that a person needs to
understand why and how he or she behaves. A therapist
needs to guide the client to realize whether the action
creates expected changes or creates further frustrating
situation. It is important that the client is cooperative in
doing assignment to learn to deal with the situation. The
Socratic methods was conducted during the interview to
help clients to recollect memories of his life and to realize
the reasons of his obsessive-compulsive pattern of
behavior and his phobia. Life line assignment stimulates
him to recollect his memories of life disasters and
frustration he experienced during childhood. Recollecting
memories stimulates the client to have dreams
associated with his childhood experience. The memory
recollection allows him to gain more understanding about
being irrational and getting frustrated due to his
helplessness resulting the obsessive-compulsive behavior
and phobia Bursting in anger in the counseling room he
realized that he was a victim of his own irrational belief.
The forgotten childhood experiences before the age of 14
were realized as the source of the irrational belief he had
to live with for more than 35 years. Understanding the
irrationality gradually changes the client to terminate his
obsessive compulsive pattern of behavior and his
numerophobia. Discussion includes the cooperative
attitudes of the client that supports the therapeutic
processes in rather brief period.

Belief domains of the Obsessive Beliefs


Questionnaire-44 (OBQ-44) and their specific
relationship with obsessive-compulsive
symptoms
Samuel Myers, Peter Fisher, Adrian Wells,
University of Manchester UK
Obsessive-compulsive disorder (OCD) is characterized by
recurrent obsessions or compulsions that provoke
distress and interfere significantly with everyday
functioning. Cognitive theorists have implicated several
belief domains in the etiology of OCD. These beliefs can
be conceptualized as falling into two categories metacognitive and cognitive. Metacognitive beliefs relate
to the meaning and control of thoughts whereas cognitive
beliefs are general or social beliefs. Cognitive (e.g.,
Salkovskis, 1985) and metacognitive models of OCD
(e.g., Wells & Matthews, 1994; Wells 1997) have been
developed that incorporate these different types of belief.
The debate about which beliefs are most central to OCD
is ongoing. The Obsessive Beliefs Questionnaire-44
(OBQ-44) was developed by the Obsessive Compulsive
Cognitions Working Group to measure a number of the
beliefs considered important in the development and
maintenance of OCD. In this study an exploratory factor
analysis of the questionnaire was conducted with a
student population (n = 238). Results indicated four
factors: 1) perfectionism and intolerance of uncertainty, 2)
importance and control of thoughts, 3) responsibility, and
4) overestimation of threat. All four factors were positively
associated with obsessive-compulsive symptoms and
worry. A series of regression analyses was run to test the
relative contributions of cognitive and metacognitive
factors. In doing so we controlled for worry and general
threat. The metacognitive dimension of importance and
control of thoughts emerged as a consistent unique
predictor of overall obsessive-compulsive symptoms.
Exploratory analyses of predictors of obsessivecompulsive symptom subtypes showed that
metacognition contributed to obsessing, neutralizing, and
checking, while perfectionism contributed to ordering,
washing, and doubting. The data suggests that particular
beliefs may be important in OCD.

Recollecting Memories of Childhood,


Eliminating Irrational Fear:Using Life Line in
Brief Psychotherapy on a Person who Suffers
from Obsessive Compulsive and Phobia
Satiadarma Monty, Department of Psychology Tarumanagara University

Changes of Brain Activation in Patients with


Obsessive-Compulsive Disorder After
Symptom Improvement brought by Behavior
Therapy : A Functional Magnetic Resonance
Imaging (fMRI) Study (II)
Akiko Nakagawa, Maiko Nabeyama, Kyushu
University; ; Nakatani Institute of Psychiatry,
King's College London; Hirokuni Sanematsu,
Kyushu University, Kawasaki Medical School

Obsessive-compulsive behavior is a repetitious behavior


of a person based on an irrational belief. A 43 year old
male complained that he needs to eliminate his fear and
anxiety by repeating undoing. He started to suffer from
this problem at the age of 14 after being expelled from his
uncle's house. He hangs and pulls towel several times
before using it. Recently, he takes bath by counting
numbers of bucket of water less than his age. He wipes
table several times after reading documents on the table
to eliminate the possibility of the document excess remain
attach on the table. He became numerophobia and get

JapanRecent neuroimaging studies have implicated


abnormal brain activities and cognitive dysfunctions in
obsessive-compulsive disorder(OCD), though there has
been no concrete consensus. The effectiveness of
behaviour therapy for OCD is well established, which
makes it possible and ideal for investigation on change of
these abnormal brain activities and cognitive dysfunctions
after symptom improvement without any confounding
effect of medication. At the last EABCT congress in Paris,
we reported that successful behaviour therapy, in fMRI
during Stroop test, reduced activation in frontal brain

regions and increased activation in posterior brain regions


in patients with OCD, which were accompanied by the
improvement of their Stroop performance itself.
The present study is to confirm these findings using
symptom provocation task during fMRI and investigate
further how behaviour therapy works for OCD. Subjects
were eleven patients with OCD diagnosed by SCID and
received 12 sessions of weekly 45minute of behaviour
therapy. At the recruitment, patients younger than 17 and
older than 60, with other Axis I, with Y-BOCS (Yale-Brown
Obsessive Compulsive Scale) scores of less than 17 and
with IQ of less than 80 were excluded. We compared the
fMRI data of the subjects on a symptom provocation task
before and after treatment. In the task condition, the
patients were asked to silently generate stimulating words
related with their OC-symptoms which had been tailored
for each patients beforehand. As the control condition,
names of vegetables, flowers and fruits were used. fMRI
scanning was performed with a 1.5-T MRI scanner
(Magnetom Symphony; Siemens, Erlangen, Germany)
with a standard head coil. To investigate the change in
the patients' brain activation during symptom provocation
task before and after treatment, between-group analysis
was performed with a random-effects model. For this
analysis, the task versus control condition contrast
images for all patients were obtained before and after
treatment. The pre-treatment contrast images were
compared with the post-treatment contrast images using
a paired t-test to determine the effects of treatment as
indexed by changes in brain activation. After 12 weeks of
behaviour therapy, the patients' mean ( standard
deviation) Y-BOCS score significantly decreased, from
29.7 3.0 to 12.4 4.9 (p<.001). After the symptom
improvement, the patients showed decreased activation
in the right temporal gyrus and increased activation in the
left cerebellum. Our previous report suggested that
successful behaviour therapy normalized brain activity in
OCD by reducing activation in frontal brain regions and
increasing activation in posterior brain regions involving
the cerebellum, which were critical for cognitive function.
Together with the results of the present study, cerebellum
might play a substantial role in improvement of the OCsymptom. Further studies of this kind with larger sample
sizes, with other cognitive tasks and with
pharmacotherapy as a treatment procedure will be
promising for elucidation of pathophysiology of this
disabling disorder and obtaining more clinical
implications.

An Investigation of Appraisals in Individuals


Vulnerable to Excessive Worry: The Role of
Intolerance of Uncertainty
Koerner Naomi, Concordia University; Michel J.
Dugas, Concordia University Canada
Several studies have been conducted to examine
whether the construct of intolerance of uncertainty, a
dispositional characteristic that arises from a set of
negative beliefs about uncertainty and its implications
(Dugas, Gagnon, Ladouceur, & Freeston, 1998; Dugas &
Robichaud, 2007), meets formal criteria as a cognitive
vulnerability for excessive and uncontrollable worry.
Cognitive models of anxiety suggest that vulnerability is
manifest in the manner in which individuals process
information. As such, cognitive bias is expected to be
observed in individuals characterized by high levels of a
putative cognitive vulnerability. Dugas, Hedayati, et al.
(2005) examined the relationship between intolerance of
uncertainty and interpretations of ambiguous information
and found a strong correlation between the two. The
current study is a replication and extension of the study
on appraisal bias conducted by Dugas, Hedayati, et al.
(2005). It was hypothesized (1) that relative to individuals
low on intolerance of uncertainty, those high on
intolerance of uncertainty would appraise ambiguous,
negative, and positive scenarios as more disconcerting,
and that the most robust between-group differences
would be observed for the ambiguous scenarios; (2) that
in individuals high on intolerance of uncertainty, level of
intolerance of uncertainty would be a stronger predictor of
appraisals of ambiguous scenarios than would nondispositional factors such as demographic, clinical, and
mood variables; and (3) that negative appraisals of
ambiguous situations would mediate the relationship of
intolerance of uncertainty to worry. Individuals low (n=
110) and high (n= 89) on intolerance of uncertainty were
compared on their appraisals of ambiguous, negative,
and positive scenarios using a vignette task. Participants
completed measures of: intolerance of uncertainty (Buhr
& Dugas, 2002; Freeston et al., 1994), worry domains,
generalized anxiety disorder (GAD) symptoms, as well as
anxious and depressive symptoms. Individuals high on
intolerance of uncertainty appraised all situation types as
more disconcerting relative to the comparison group.
However, when controlling for demographics, GAD
symptoms, and mood variables, the groups differed only
in their appraisals of ambiguous situations. Further, in the
high vulnerability group, degree of intolerance of
uncertainty was a stronger predictor of appraisals of
ambiguous situations than were GAD symptoms and
mood variables. Tests of mediation showed that
appraisals of ambiguous situations partly mediated the
relationship of intolerance of uncertainty to worry, the
main symptom of GAD; however, worry also emerged as
a partial mediator of the relation of intolerance of

uncertainty to appraisals of ambiguous situations. An


exploratory analysis revealed that in individuals high on
intolerance of uncertainty, appraisals were not specific to
the content of current worries, whereas they were, to
some extent, in individuals low on intolerance of
uncertainty. The results will be discussed within the
context of findings emerging from cognitive models of
generalized anxiety disorder, in particular the model
proposed by Dugas, Gagnon, et al. (1998).

Tracking and analyzing 14 obsessivecompulsive disorder(OCD) patients' overall


histories, from the first appearance of OCD
until the end of treatment.
Kohei Nishikawa, CBT center
This paper aims to track the development of OCD and its
treatment using Cognitive -Behavioral Therapy (CBT), by
analyzing three periods in patients' histories. The first :
the patients' progression from the beginning of treatment
with CBT until recovery or end of treatment. The second :
the severity of symptoms during drug treatment and CBT
treatment periods. Finally we track the patients' overall
histories, from the first appearance of OCD until the end
of treatment. 14 OCD patients (3 male, 11 female, with an
average age of 31.6, ranged 14-51) were treated using
CBT. All of exposure and response prevention
method(ERP) was ordered to do by myself at home. Of
the 14 OCD patients, 8 were washing type, 4 were
checking type, and 2 patients were of other types. They
were assessed with Y-BOCS at 3 times; at first
consultation, at the beginning of CBT, and at the end of
treatment (or now, in the case of current patients).
Patients were asked for a rough estimate of the time
between the first appearance of OCD symptoms and the
beginning of treatment.Rate of recovery, speed of
treatment, timing of first ERP, relation between incubation
period and speed of treatment, response of
pharmacological refractor, and period from first
consultation to beginning of treatment with CBT, were
expressed. Our data shows that the average patient first
received treatment about 9.3 years (range 0.3-29y) after
the appearance of OCD symptoms, usually receiving drug
treatment. If the patient was unresponsive to medication
after an average of 22.4 months (range0-69y), CBT was
used. Using CBT, severity of symptoms was reduced by
an average of -1.0 points on the Y-BOCS for every 45
minutes of counseling at our clinic in Japan. But the
patients all responded differently to treatment.
In the fast recovery group, 21% of patients' scores
dropped 2.9 points on the Y-BOCS after 45 minutes of
CBT (range 2.5-3.8). In the middle recovery group, 43%
of patients' scores dropped 0.8 points (range 0.5-1.4). In
the late or not yet recovered group, 36% of patients'
scores dropped 0.2 points (range 0.0-0.3). Looking at the
data, on average, when someone gets OCD, they go to
the hospital after 9.3 years, and the first approach to
treatment was the prescription of drugs. If they couldn't
recover due to the drugs having no or poor effect after
22.4 month, doctors would supplement with CBT.
Symptom scores dropped -1.0 (Y-BOCS) per 45min of
CBT at our clinic. The outcome of treatment was: 35.7%
patients recovered, 42.9% patients continued drug
treatment supplemented with CBT, and 21.4% patients
dropped out.

10-Minutes Cognitive Behavioral Therapy for


OCD Patients; a Case Report.
Misari Oe, Hideaki Egami, Mari Takamatsu,
Yuiko Yoshihara, Ku Takeshi Ueda, Mitomi
Tanaka, Kurume University Hospital Japan
Japan has a health-insurance system that covers all of its
citizens. Moreover, psychotherapies by clinical
psychologists are usually more expensive than
psychiatric interviews. It means that many patients crowd
to hospitals, so naturally psychiatrists shorten time for
interviews. It is necessary to establish brief and effective
therapies for Japanese psychiatrists. We introduce 10minutes cognitive behavioral therapy (TM-CBT) for
Obsessive-Compulsive Disorder (OCD), which consists of
3 parts in each session. 1) using daily columns make a
complement on her progress, 2) explain a principle, The
first fear can control easier than afterwards, 3) set
concrete goals for next two weeks. Daily columns (which
consist of date, daily events, number of obsessivecompulsive behaviors, Scales of the day, what I think)
have a purpose in which one's observing ego could be
promoted with the patient become aware of that
symptoms are not monotonous. TM-CBT is a new method
established through the ideas of changing cognitive
mastery. We will present a case , who is a early 30s
female with severe obsessive-compulsive symptoms (e.g.
she cannot go to the rest room because she feels
unclean, or she is assured that she hurt someone while
she walks around, etc.) . In addition to medication, TMCBT was carried out. After one year, obsessive idea and
behavior have decreased extensively. Checking the sheet
and regular reflection seemed to be effective. TM-CBT is
easy to carry out in psychiatric practice, and have a
possibility to extend to other anxiety-related disorders,
such as dissociative disorder, adjustment disorder, panic
disorder, etc.

Effects of safety behavior on the maintenance


of anxiety and negative belief in social
anxiety disorder in Japan
Isa Okajima, University of Hokkaido; Yoshihiro
Kanai, Hiroshima University; Junwen Chen, Tokai
Women's University; Yuji Sakano, University of
Hokkaido Japan
Exposure treatment in cognitive behavior therapy has
long been acknowledged as a central component of
effective treatment of social anxiety disorder (SAD).
However, improvements obtained by exposure are
relatively modest (e.g., Butler et al., 1984). Safety
behavior plays an important role in the maintenance of
anxiety and negative belief in SAD (Clark and Wells,
1995). SAD patients engage in various safety behaviors
in social situations in order to decrease the risk of
negative evaluations from others. However, it has not
been revealed that how much safety behavior influences
the maintenance of anxiety and negative belief in SAD.
The present study examined which each of avoidance
behavior and safety behavior affects the maintenance of
anxiety and negative belief in SAD by using Structural
Equation Modeling (SEM). Participants were 442 healthy
students (145 male, 245 female, 52 sexuality missing
person; Mean age=21.09; SD=8.01) and 43 SAD patients
(13 male, 30 female; Mean age=21.07; SD=8.36). Thirty
two undergraduate students who met the SAD criteria of
Mini-International Neuropsychiatric Interview were
included in a group of SAD patients. Safety behavior was
measured by using the Avoidance Behavior In-situation
Scale (ABIS) that the author had made (Okajima et al.,
2005). The reliability and validity of ABIS are confirmed.
Avoidance behavior measured by using the LSAS,
anxiety measured by using the SPS and SIAS, and
negative thoughts measured by using the FNE. Each
scale was compared healthy students with SAD patients
by t tests. This result showed that SAD patients
significantly (p<.001) have more high score than healthy
students in all scales expect for the ABIS. We tested the
overall structural equation model by using all participants'
data. The model was found to fit the data well. Because
validity of the hypothesized model was demonstrated,
analysis was conducted testing for difference between
clinical and non-clinical in the structural parameters of the
model, using the multiple-group procedure. Result of
multiple-group procedure indicated that the model
produces the good fit (GFI: 0.89, AGFI: 0.87, CFI: 0.92,
and RMSEA: 0.04), and all of causal path coefficients are
significant (p<.05). The results of the present study
revealed that safety behavior contributes more strongly to
anxiety (path coefficient: 0.57) and negative belief (path
coefficient: 0.51) in SAD patients than in healthy students
(anxiety: 0.23, belief: 0.29). The influence of avoidance
behavior on them in SAD patients (anxiety: 0.47, belief:
0.19) was as large as in healthy students (anxiety: 0.46,
belief: 0.24). From the results, it is speculated that SAD
patients are linked more precisely between safety
behavior and negative belief than healthy people,
whereas frequency in the use of safety behaviors is
equivalent between groups. Clark and Wells (1995)
suggests that often there are quite precise links between
specific safety behaviors and feared outcomes. The
results of this study conform with the findings that
reducing safety behavior during exposure was more
effective than traditional exposure (e.g. Kim, 2005). It is
suggested that reducing safety behavior during exposure
is effective for improvement of SAD symptoms.

Effectiveness of exposure and ritual


prevention for obsessive-compulsive disorder
in Japanese health care settings
Miyo Okajima, Chisato Komatsu, Kikuchi National
Hospital; Yuka Noguchi, Nagoya City University
Hospital; Kayo Hashimoto, Sawa Hospital;
Hiroaki Harai, Kikuchi National Hospital Japan
The efficacy of exposure and ritual prevention (ERP) and
Serotonin Reuptake Inhibitors (SRIs) for obsessivecompulsive disorder (OCD) has been demonstrated in
several randomized controlled trials (RCTs), and most of
the treatment guidelines recommend the combination
therapy as the first line treatment. However, the results in
these controlled trials employ rigorous exclusion criteria
and are not necessarily generalized in Japanese health
care settings. There are only two Japanese trials that
aimed at Japanese samples (Kamijima, 2004; Nakatani,
2005). For the service of improving health care outcome
for Japanese patients with OCD, it is important to find the
efficacy of empirically supported therapies (EST) in
treating heterogeneous patients who seek treatments for
obsessive symptoms, and factors that predict better
treatment outcomes.
In conducting the current study, a benchmarking research
strategy was employed (Wade, 1998). RCT findings were
utilized as the gold standard in evaluating the
effectiveness of CBT, which was covered under Japanese
National Health insurance system. In the present study,
we used the de-facto severity measure (Y-BOCS) as a
means of improvement criteria. The fifth author had
started and managed the behavioral treatment program
since 1999. We surveyed every patient who had been
referred to the program as well as selected patients
whose principal diagnosis was OCD, and 128 patients

were identified through the survey. Twenty-eight patients


were excluded due to early termination within a few
weeks of visiting. We included patients with comorbid
conditions as well as children and analyzed remaining
100 patients. The treatment consisted of the
administration of self-report questionnaire, employment of
daily self-monitoring, and evaluation of Y-BOCS. Patients
were encouraged either to take SRIs and/or to participate
in ERP. Most of the patients participated in ERP in
outpatient setting, however, some received in inpatient
settings or by home visits. We have organized a patient
support group including recovered patients, OCD no
Kai. Patients were encouraged to participate in its
monthly meeting. We surveyed the treatment outcome
after six month since the first visit. Recovery was defined
as theY-BOCS score being lower than 16, and the score
decreasing at least by 35% relative to the initial score.
Partial improvement was defined as the score decreasing
at least by 25%. We compared the ratio with existing
RCT results, and carried out exploratory data analysis in
order to search predicting factors for recovery. Fifty-three
% recovered and additional 25% showed partial
improvement. The current results corresponded well with
existing published data of RCTs. After completing a t-test
of significance, one factor that demonstrated a significant
difference was the presence or absence of engagement
of ERP (two tailed, t (98) = 11.46, p<.01). Participation of
OCD no Kai also predicted recovery (two tailed, t (98) =
6.78, p<.01). There was no other factor that predicted
the treatment effect. we revealed that ERP is effective in
treating OCD in Japanese health care setting.
Participation of OCD no Kai seems to facilitate the
participation of ERP. Comorbidity and younger age did
not affect treatment outcome.

Two cases successfully treated for


medication withdrawal using mindfulness and
relaxation in a team approach for anxiety
disorders.
Akiko Otsuka, Hiroaki Kumano, University of
Tokyo Japan
This study reports two cases of anxiety disorder treated
with mindfulness and relaxation. . The first case, 40-yearold female with generalized anxiety disorder and panic
disorder with agoraphobia(patientA) having once
undergone cognitive-behavioral therapy (CBT), she
wanted to have medication stopped, and thus counseling
was re-introduced. The second case, 30-year old male
with social anxiety disorder(patientB) whose goal of the
treatment was to withdraw medication, were successfully
treated by means of counseling which focused on
mindfulness and relaxation. To achieve mindfulness, they
were encouraged to concentrate on "here and now,"
perceive the present as it was, suspend thinking, and let
go of negative emotions. To induce relaxation, they did
autogenic training and breathing training. Visiting our
clinic every other week, they were counseled by a clinical
psychologist and then seen by a psychosomatic internist.
Concerning the patientA, after the third session of
psychological counseling, the attending physician talked
with her and she decided to withdraw medication. After
some two and a half months of treatment, she was able
to control anxiety, by seeing her anticipatory anxiety as "a
scene crossing her mind," avoiding worrying about what
had happened and would happen, and paying close
attention to "hear and now." She could then successfully
withdraw medication. A follow-up assessment after the
completion of counseling showed that the therapeutic
effects had been maintained. On the other hand, after 4month treatment, the patientB decided to reduce the
medication step-by-step, and another 10 months later, he
also successfully stopped medication. In our presentation,
we will review the effectiveness of inducing mindfulness
and relaxation on anxiety disorders and show the
differences and similarities between the present method
and CBT.

Cognitif and Behavioral Treatment (CBT) of


the Panic Disorder with Agoraphobia
Benelmouloud Ouafia,
The use of CBT remains the recent technique in Algeria
and its introduction in the therapeutic arsenal field;
already insufficient,finds resistances from the part of
same practitioners.
It's about the studie schowing the interest of CBT in the
panic disorder with agoraphobia. It's about the
comparative study of the two types of the population
presenting the diagnosis of a panic disorder with
agoraphobia. The first group will be treated by the
antidepressor and the other by CBT. The first population
estimated to 50 patients and receive only the
antidepressor (Anafranil) and the other of 50 patients
receive the technique of CBT, the two population will be
selected according to the randomization principle. The
study duration is of 03 months and assessment is done at
a day 0,7,14;30 and 90 according to Cottraux anxiety
scale. the results are in saver of CBT approach better
than a pharmacological treatment. In fact,
disappearances of the phobias, the panic attacks and the
improvement of the life quality are observed. The CBT
will have to know a renewan of interest concerning the
treatment of the anxious disorders and it's an integral part
of the therapeutic arsenal in our country.

Personality Profile in Anxious Disorders


Cristina Pablo, Iris Monteiro, ; Jos Pacheco,
Hospital Jlio de Matos, Lisbon Portugal
Anxiety disorders represent a broad spectrum of patiens
that look for treatment at the Cognitive Behavioral
Departement of Hospital Jlio de Matos, many of them
are reffered to consultation by their psychiatrist or clinical
physician. Objective: The aim of this paper is to evaluate
and describe the personality traits of individuals (N=200)
with the diagnosis of anxiety disorder (Panic Disorder,
Generalized Anxiety Disorder, Social Phobia and Simple
Phobias) who are in treatment at the first semester of
2007. Method: Patients were selected according to DSMIV-TR criteria for PD/PDA, GAD, Social Phobia and
Simple Phobia. Evaluation included the following
assessment tools: SCL-90, BDI and MCMI-II. Expected
Results: We expect the results show a major evidence of
avoidant personality traits and comorbility with other
peronality disorders. We also expect to observe a
moderate level of distimic symptomatology.

How should we treat patients with severe


resistant obsessive-compulsive disorder?
Anusha Pillay, SW London and St George's
Mental Health NHS Trust; Lynne M. Drummond,
St George's, University of London; Shashi Rani,
SW London and St George's Mental Health NHS
Trust; Peter Kolb, SW London and St George's
Mental Health NHS Trust; UKJ
We present a naturalistic study examining outcome in
patients suffering from severe, chronic resistant
obsessive-compulsive disorder. We compared those
patients who were admitted to a specialised inpatient unit
with patients who received intensive community
treatment.. The Inpatient Unit and the outcome with the
most severely ill patients has been studied over many
years (Drummond, 1993; Drummond et al., 2007). The
Enhanced Community Service for OCD has only recently
been reported.
(http://www.nice.org.uk/page.aspx?o=391017) All patients
were aged 18 years or older. Qualified psychiatrist
interviewed all patients and ICD 10 diagnoses made.
They were screened for evidence of severe refractory
OCD. This was defined as:- o
Yale-Brown
Obsessive Compulsive Schedule Score (YBOCS) >30 o
Previous trials of at least 2 serotonin reuptake inhibiting
(SRI) drugs at dosages recommended in the British
National Formulary for at least 3 months o
Two Previous trials of cognitive behaviour therapy (CBT)
which included graded exposure and response prevention
(ERP). Community Patients. Patients who met the
above criteria and who did not display any
contraindication for home-based or community treatment
were included. Inpatients Patients admitted to the
inpatient unit not only met severity criteria but had
complications rendering community treatment unsuitable
viz:- o
Patient danger to self of others o
Extreme lack of self-care needing intensive nursing care
e.g. incontinence of urine or faeces. o Poor self-care
that getting up in the morning took >4 hours o
Complicating diagnosis of schizophrenia or severe
psychosis in addition to OCD o
Profound OCD
with reversal of patterns of night and day Demographic
data were recorded including age; sex; duration of OCD
and previous treatments Measure of severity of OCD and
depression were recorded at commencement of therapy.
Measures used were YBOCS ; Padua ; Beck Depression
Inventory (BDI) Data were analysed using SPSS version
14.0. Community Patients Since May 2006, 18 patients
examined with average age 37 years (sd 11.06; range 19
- 57 years) ; mean duration of OCD 21 years (sd 12.07;
range 3 - 40 years); mean YBOCS 32.4/40(sd 1.6; 30-35)
at start of treatment. Mean BDI score 29.2/63 ( sd 11; 445). Patients so far showed 33% reduction of OCD
symptoms and 45% reduction in depressive symptoms.
Inpatients Over past 2.5 years, 27 patients meet the
severity criteria. Average age was 35.5 years (sd 13.4;
18 - 63 years); mean duration of OCD of 16.0 years (sd
11.0; range 4-50 years). Mean YBOCS Score 34.6/40 (sd
3.4; 30-40) at admission; mean BDI 29.2/63 (sd 12;range
). At discharge, average 28% reduction in obsessivecompulsive symptoms and 48% reduction in depressive
symptoms With current emphasis on local services, there
is a tendency to assume that they can provide optimal
treatment for patients with all conditions and a range of
severity. All the patients presented in this study were
profoundly disabled by OCD. They had all received
appropriate treatment in their local areas and had failed
to improve significantly.. Despite this they responded to
treatment from a Unit with special interest and expertise
in OCD. We suggest that each Healthcare Region could
benefit from developing similar specialist community
treatment centres for OCD. The provision of inpatient
facilities for OCD is likely to be relevant to a much smaller
group of the most profoundly ill individuals and can be
provided at a National level.

Virtual Reality Therapy for Anxiety Disorders:


A meta-analysis
Mark Powers, Paul Emmelkamp, University of
Amsterdam Netherlands

There is now a substantial literature investigating virtual


reality exposure therapy (VRET) as a viable treatment
option for anxiety disorders. In this meta-analysis we
provide effect size estimates for virtual reality treatment in
comparison to in vivo exposure and control conditions
(waitlist, attention control, etc.). A comprehensive search
of the literature identified 13 studies (n=397) that were
included in the final analyses. Consistent with prediction
the primary random effects analysis showed a large mean
effect size for VRET compared to control conditions
(Hedge's g=1.11 (SE=0.15, 95% CI: 0.82 to 1.39). This
finding was consistent across secondary outcome
categories as well (domain specific, general subjective
distress, cognition, behavior, and psychophysiology). Also
as expected in vivo treatment was not significantly more
effective than VRET. In fact, there was a small effect size
for VRET relative to in vivo conditions (Hedge's g=0.34
(SE=0.15, 95% CI: 0.05 to 0.63). There was a trend for a
dose - response relationship with more VRET sessions
showing larger effects (p=0.06). Outcome was not related
to publication year or sample size. Implications for clinical
practice and future directions are discussed.

Augmentation of exposure therapy with a


cognitive enhancer (Yohimbine).
Mark Powers, Marleen van Dijk; Maarten
Vording; , Carlijn Sanders, , Rahov Maor, Paul
Emmelkamp, University of Amsterdam
Netherlands
Anxiety disorders are the most common mental disorders
in the United States accounting for approximately 30% of
all mental health care costs. Fortunately, exposure-based
treatments of anxiety disorders offer some of the largest
effects sizes in the litterature. However, some patients do
not respond to treatment, some continue to experience
residual symptoms, and up to 50% of patients who
respond to combined CBT and pharmacotherapy relapse
if they discontinue their medication. In addition, therapists
report the difficulty of in-session exposure due to time
constraints. In efforts to improve the delivery, outcome,
and sustainability of treatment effects, researchers have
begun to explore the potential role of augmenting
exposure interventions with biological agents.
Procedurally, exposure-based CBT is very similar to
animal models of extinction of conditioned fears, and
recent advances in animal research have identified
pharmacological agents that appear to both accelerate
and consolidate extinction learning (Cain, Blouin, &
Barad, 2004; Davis, 2002). For example, administration of
Yohimbine (an a2-receptor antagonist) during extinction
trials accelerates fear reduction and also may convert
ineffective exposures to successful ones (Cain, Blouin, &
Barad, 2004). In a series of studies, Cain et al. (2004)
found that systemic administration of Yohimbine (5mg/kg)
reduced the number of trials needed to extinguish fear in
conditioned mice from 30 trials to only 5 trials. The
facilitative effects of Yohimbine on fear reduction were
also evident when the mice were later tested without the
drug. Even more interesting, Yohimbine treated mice
appeared to be protected from the negative effects of
spacing extinction trials (20-minute intertrial intervals)
compared to placebo treated mice. The effect of
Yohimbine during exposure in humans has not yet been
investigated. The aim of the current study is to examine
the effects of Yohimbine administration during exposurebased treatment of claustrophobia in humans.
Participants (N=60) with claustrophobic fears will be
randomized to receive either Yohimbine or pill-placebo
during a two sessions of exposure (single one hour
exposure) to a claustrophobic situation. Outcome data will
include standardized measures of claustrophobia,
physiological data, and behavioral assessments. We
hypothesize that the Yohimbine group will outperform
placebo. In addition, based on available safety data we
do not anticipate any serious adverse events. These data
would provide additional evidence that elevated
norepinephrine enhances emotional memory and in the
context of human fear reduction. Preliminary results will
be presented.

Exercise Intensity and Instructional Set


Manipulation with Anxiety Sensitive
Participants: A work in progress.
Mark Powers, Maarten; Vording Marleen; van
Dijk Carlijn; Sanders Rahov; Maor , Paul;
Emmelkamp University of Amsterdam,
Netherlands;
The purpose of this study is to determine the relative
efficacy of aerobic exercise when conducted with
adjunctive cognitive restructuring and guided threat
reappraisal versus aerobic exercise with no additional
component in reducing fear of fear. In addition, we will
examine the relative efficacy of elevated bodily
sensations by having participants exercise at 70% or 50%
of their heart rate maximum to control for participation
and general activity. Participants (n=100) with high
anxiety sensitivity will be randomized to one of five
conditions: (a) 70% HR + Cognitive Restructuring, (b)
70% HR without Cognitive Restructuring, (c) 50% HR +
Cognitive Restructuring, (d) 50% HR% without Cognitive
Restructuring, or (e) a waitlist control. . Based on the
available evidence, we hypothesize that aerobic exercise

with cognitive restructuring and guided threat reappraisal


and at a high intensity (70%) will facilitate the extinction
of fear of fear. In this study, outcomes will be assessed in
terms of effect-sizes representing the relative advantage
of aerobic exercise with cognitive preparation over
aerobic exercise alone, but will be complemented by
traditional significance testing. A waitlist condition will be
included to control for the effect of time and enrollment.
These data will add the the accumulating data for the
efficacy of exercise for anxiety and provide initial
evidence on potential mechanisms of fear reduction.
Preliminary analyses will be presented.

GAD: Response to Cognitive Behaviour


Group Therapy Programme
Nuria Pujol Gimenez, ; Joana Guarch Domenech,
Servei Psicologia; Olga Puig Navarro, Servei
Psicologia, ; Rafael Penades Rubio, Servei
Psicologia, Institut Clinic De Neruocincies,
Hospital Clnic
Generalized Anxiety Disorder (GAD) is a prevalent
disorder, frequently associated with co-morbid affective
and anxiety disorders and long-lasting symptomatology.
The core of GAD symptomatology is linked to cognition
such as excessive worries and difficulties on coping
under the circumstances of uncertainty. Specifically, CBT
focus mainly on these problems through different
techniques as cognitive restructuring, problem solving
and anxiety management. Although CBT has
demonstrated its efficacy and specificity over GAD, the
rates of recovery still remain under 50%. Aims: To
assess the efficacy of structured CBT oriented group
therapy in patients with GAD. Additionally, the degree of
clinical change it will be calculated. A sample of 55
outpatients with GAD diagnosis was analysed in a
Primary Mental Health Center. t-paired tests have been
performed to test the statistical significance of the
differences between baseline and measures after the
CBT treatment. Jacobson methodology was used to
evaluate reliability of change in the STAI scores (T
version). Nearly 70% of the sample showed reliable
change and close to 60% among this subsample fulfil
recovery criteria. CBT oriented group of treatment shows
efficacy in GAD patients being the improvement
statistically and also clinically meaningful.

Challenging Irrational Beliefs to Eliminate


Phobia of Darkness:A Case Study
Zahra Roswiyani, Department of Psychology Tarumanagara University;
Darkness is sometimes associated with demonic
atmosphere where evil spirit threats life. Phobia of
darkness relates to insecure feelings of being threatened
in an unknown situation. A young adult female client was
referred of having phobia of darkness and unable to turn
on lights in the dark areas in her office and at home. She
is afraid that ghost would come and threat her in such
areas. She always needs someone to come along with
her; her supervisor in the office considers this condition
disturbs her work. Beck (1995) explains that memories
are stored in a form of schemas and certain dysfunctional
schemas caused behavioral and emotional problems.
Changing the dysfunctional schemas needs to change
the automatic thoughts and conditional beliefs by
metacognition, that is the ability to think about thinking.
Meichenbaum (1977) explains that in order to help clients
being able think differently, a therapist does not tell them
how to feel, rather to help them understand how and why
they do what they have been doing. The therapist used
Socratic methods to understand the clients' concerns,
have agenda of the sessions of what they need to do
based on facts and not on assumptions, and assigns
homework for clients to do. During preliminary sessions
the client was asked to explain her concerns and to
challenge to think about what her concerns were all
about. She was asked to understand the similar situation
from different angle of perception. The therapist assigned
the client to list her daily activities and self-monitored the
moment when she feels insecure. She was taken to
understand not to assume but to deal with facts. After the
third session the client was able to go alone to dark areas
in the office and at home, although she remain rather
afraid to see TAT card with a picture of old lady. The
therapy continued associated with understanding her fear
on elderly people. After the 8th session she was able to
deal with her fears. Discussions contain the clienttherapist collaborative effort on each session which
support the therapeutic processes.

Treatment and Psychotherapy utilization in


Germany: Adolescents and young adults
affected by an anxiety disorder
Juliane Runge; Katja Beesdo, Technische
Universitt Dresden; Roselind Lieb, Max Planck
Institute of Psychiatry, Munich, Germany;
Epidemiology and Health Psychology, University
of Basel, Switzerland; Hans-Ullrich Wittchen,
Technische Universitt Dresden, Germany; Max
Planck Institute of Psychiatry, Munich, Germany

Recent studies show that in Europe about ten


respectively six percent of the adult population has been
affected by an anxiety disorder in their life or in the last
12 months, but that only about one third of those affected
received any type of treatment. Most frequently, both,
general practitioners and mental health professionals
have been contacted, followed by the consultation of a
psychiatrist or a mental health professional alone [Alonso
et al., 2004]. No information has been given about
differentiated treatment use in particular anxiety
disorders, or about treatment use in already highly
affected age groups of adolescents and young adults.
The aim of this study was to describe treatment use in
German adolescents and young adults by a sample
representative for the region of Munich, which is known
as a region of relatively high density of those treatment
offers. Treatment use will be presented differentiated for
kind of treatment, age and gender. A representative
community sample of N= 3.021 individuals (14 to 24
years at baseline) was prospectively examined up to 10
years. Lifetime diagnoses of anxiety disorders and
treatment use were assessed using the DSM-IV-M-CIDI.
Associations (Odds Ratio, OR) were calculated using
logistic regression analysis. About one third reported a
lifetime diagnosis of any anxiety disorder. 43% of those
affected received any kind of treatment (Range: 11 to
74%), with highest treatment rates in individuals affected
by panic disorder or OCD. Of all individuals affected,
psychotherapy was the most frequent kind of treatment
(28%), followed by consultation centers (12%), general
practitioners (10%) and psychiatrists (9%). Individuals
with OCD, PTSD, panic disorder, or generalized anxiety
disorder showed highest rates of psychotherapy
utilization (Range: 50 - 61%). Use of any treatment or
psychotherapy was more often reported by individuals
aged 24 years and above. Women reported slightly more
psychotherapy utilization than men (OR = 1.83, 95%-CI
1.2-2.7). Our estimations of lifetime diagnosis of anxiety
disorders exceeded current European estimations and
show, in accordance with the young age of onset of most
anxiety disorders, that already adolescents and young
adults are highly affected by anxiety disorders. Compared
to European estimations, we presented higher treatment
use, especially for psychotherapy, in all age groups,
which may be due to the high density of treatment
possibilities in the region of Munich. Anyhow, we have to
state, that most people affected by any anxiety disorder
do not receive any or specialized treatment. Presumably,
rates for adequate treatment are even lower. Especially
young or male individuals are characterized by a lack of
any or psychotherapeutic treatment. Considering the long
term effects of anxiety disorders, like the risk of
subsequent depressive disorders, this result is alarming.
Efforts should be undertaken to reach the young, not
adequately supplied individuals and to prevent proximate
harm. Alonso et al. (2004). Use of mental health services
in Europe: results form the European Study of the
Epidemiology of Mental Disorders (ESEMeD) project.
Acta Psychiatrica Scandinavica, 109, 47-54.

Revision and Assessment of the Evidence for


a Revised Cognitive-Behavioural Model For
Fear of Falling.
Hull Samantha; Ian Kneebone, Surrey NHS
Primary Care Trust and University of Surrey UK
Fear of falling is reported at a prevalence rate of 12-65%
for older people living in the community. This fear has a
reality base: 35% of community dwelling elders
experience a fall each year. However the fear of falling
can also develop without a history of falls (Maki, Holliday,
& Topper, 1991). Fear of falling can significantly impact
upon an individual's immediate and continued quality of
life. In the short-term, fear of falling is related to poor
balance and posture. Longer-term, fear of falling can lead
to the avoidance of physical activities, muscle wastage,
and lowered self-esteem and self-efficacy. This not only
puts the individual at an increased risk of falling, but also
reinforces the cycle of avoidance that maintains the fear.
The broad range of negative social, physical and mental
health consequences associated with the fear of falling,
coupled with the prevalence of falls in an increasingly
ageing society, highlights the importance of clinical
involvement. The effectiveness of interventions, however,
maybe constrained because health care professionals are
not fully alerted to the multifactorial processes that can
underlie the development and maintenance of this fear
(Tennstedt et al., 1998). To address this issue, a
hypothetical heuristic cognitive-behavioural model has
been proposed (Childs & Kneebone, 2002). The model
illustrates the connections between the short- and longterm risks of fear of falling, providing a framework to
portray possible routes in the development, maintenance
and escalation of this fear. This paper presents a revision
of the model and reviews the evidence base in its
support. The initial model was re-considered in order to
develop it from a heuristic to educate clients, to an
explanation that might inform research and the
development of intervention approaches. A
comprehensive literature review was undertaken to
assess the overall acceptability of the revised model and
its sub-components. The search was structured by the
identified components of the revised model. The
databases PsychINFO, EMBASE, MEDLINE, CINAHL
(R), the British Nursing Index, ScienceDirect, and the

Cochrane Library were systematically searched. There is


substantial evidence to support the revised cognitive
behavioural model for the fear of falling. Sub-components
of the model received differing degrees of support.
Overall however, and consistent with the revised model,
increasing self-efficacy and self-esteem, challenging
negative thoughts and engaging in structured supportive
physical therapy appear to reduce fear of falling. There is
extensive literature that supports the theoretical
components and framework of a revised version of Childs
and Kneebone's cognitive-behavioural model of fear of
falling. Future research is required to test the model with
populations presenting both with and without the fear of
falling. The model highlights the likely benefits of
cognitive behavioural therapy alongside physical therapy
in the management and treatment of fear of falling.
\

Predictors and therapeutic efficacy in the


treatment of Obsessive Compulsive Disorder
Gianni Savron, Affective Disorders Center Pavanello, Padua, Italy; Rosanna Montanaro,
Oncological Hospital , Critical Area , Bari, Italy;
Mordenti Sergio, Affective Disorders Center Pavanello, Padua, Italy; Paolo Pitti, Lahun
Center Psychotherapy and Work, Orvieto, Italy
The predictors identification of OCD is an imporant
aspect on evaluation of ethiology, prognosis and effective
treatament of the disorder. The aim of the study were: 1)
comparing the psychological differences in states and
traits in a sample of OCD patients mached with a control
group; 2) identifing the pre-treatment clinical predictors,
with assumption that anxiety and depression affect the
disorder and his treatment; 3) evaluating the relations
between illness behaviours, OC symptomathology and
clinical scales. Fifty-one patients with DSM-IV criteria for
Obsessive Compulsive Disorder were matched with
normal control group (n=51) balanced for
sociodemographic variables. All subjects were assessed
using self rating scales (Anxiety Sensibility Index,
Symptom Questionnaire, Illness Attitude Scales,
Compulsions Checklist, Tridimensional Personality
Questionnaire) and assessor rating scales (Yale-Brown
Obsessive Compulsive Scales, Brief Psychiatric Rating
Scale). To identify the clinical and demografic variables
predicting OC symptomatology was conducted the
regression analysis. The dependent variables in
regression analysis included CC and Y-BOCS, while the
indipendent variables included: ASI, SQ, IAS, TPQ, and
demographic variables (age, sex, marital status,
education, occupation, anset and duration of illness,
comorbidity, pharmacotherapy, psychotherapy). Seventytwo per cent of patiens had axis I secondary diagnosis.
Patiens with OCD present higher scores in anxiety
sensitivity, anxiety, depression, hostility, somatic
symptom, illness behaviour and harm avoidance trait.
Duration of illness,anxiety sensitivity and harm avoidance
were found to significantly predicts patients OCD clinical
symtomatology, instead comorbid anxiety-depression
wasn't. In OCD Illness behaviour was related with anxiety
sensitivity and somatic symptoms. The results of this
study suggest the specific psychological state and trait
aspects in subjects that develop OCD and lend support to
importance of Anxiety Sensitivity, duration of illness and
harm avoidance trait to make it. The anxiety sensitivity
play a primary role in OC severity symtomatology and
illness behaviour had a secondary importance.

How to become a fearful flyer: the learning


history of flying phobia
Bettina Schindler, Fit to Fly fear of flying
seminars; Noortje Vriends, University of Basel,
Switzerland; Jrgen Margraf, University of Basel,
Switzerland
Learning theory about fear conditioning provides
theoretical explanations of the different pathways of the
acquisition of flying phobia. Among subjects with flying
phobia about half reported some kind of traumatic event
indicating classical conditioning. In studies about other
specific phobias the percentage of classical conditioning
varies between 10% and 66%, depending on the kind of
phobia and the methods that are used. In the present
study we examine the role of learning processes in the
acquisition of flying phobia. 30 patients with severe flying
phobia and 30 healthy controls completed a structured
interview about flying history, aversive flight experiences,
stressful life events in the period of the aversive flight
experience, the influence of media information and the
personal and family's valence of flying. Only 43% of the
patients reported a frightening experience in a plane at
the onset of their flying phobia, while the control group
reported with 53% an even higher degree of frightening
experiences in the air. However, patients experienced
significantly more stressful life events at the time of their
frightening experience in the air than controls. Moreover,
patients were significantly more influenced by negative
media information. Also the personal and family's valence
before the onset of fear of flying differed significantly
between patients and controls, i.e. controls had more
positive appraisal of flying before the aversive events
took place than the patients. The results of this study
show that classical conditioning cannot explain the
acquisition of flying phobia alone. Also stressful life

events at the time of phobia onset, informational


conditioning through media and evaluative conditioning
seem to influence this process.
This study supports a vulnerability-stress model, i.e. flying
phobics are more susceptible to negative events that
have little impact on non-phobics. Our results will be
integrated in a contemporary model of human
conditioning of phobias with a discussion of the clinical
implications for the treatment of flying phobia.

Paying attention to the audience to reduce


speech anxiety: Comparison of acceptancecommitment and cognitive restructuring
rationales
Takanori Sei, Shinshu University; Yoshinori
Sugiura, Shinshu University
Speech anxiety, one of the subtypes of social anxiety
stems from evaluative self-focus during the speech. Clark
and Wells (1995) have suggested when social phobics
enter the social situations, they shift their attention to
internally, which called self-focused attention. This
attention makes them self-evaluative during the social
situations and makes him or her more anxious. In order
to reduce anxiety, it is recommended to pay active
attention to the audience. This strategy is a kind of
exposure, however, there are multiple rationales to
explain why outwards attention is important. Situational
attention refocusing(SAR; Wells, 2000) required social
phobics to shift their attention outwards to notice their
negative perspectives are not true. On the other hands,
Acceptance and Commitment therapy (ACT; Hayes,
1999) considers that people should watch the audience to
get a clue to improve their speech. Those methods share
the component of external attention, however, have
ratinales. This study compared ACT ratinale and SAR
(cognitive restructuring) rationale. In addition, they are
compared to no intervention method. Seventy three
college students (54.7% women) were required to give an
oral presentation as a part of regular course evaluation.
Participants were randomly assigned to either ACT (n
=34), SAR(n =32), or no treat control (n =7). Speech
anxiety was measured twice: just before the speech (pre)
and after (post) it. They also rated satisfactions after their
speech. Used measure were 'Features of Agari
Experience Questionnaire'(FAEQ; Arimitu & Imada,1999).
There was significantly decrease of the anxiety across
three conditions. However, there were no differences
between three methods. Visual inspection of the data
suggested that SAR indicated the largest decrease the
anxiety, followed by ACT and control. There was no
sugnificant differences between three methods in
satisfaction. In conclusion, there was an effect of
decreasing both SAR and ACT speech anxiety. Anxiety
was decreased effectively in SAR, and it was shown in
ACT and SAR that the satisfaction rating increased as
anxiety decreased.

Are distorted beliefs about inflated


responsibility reduced by exposure and
response prevention (ERP) in OCD patients?
Eiji Shimizu, Tomotaka Suzuki Chiba University
Graduate School of Medicine, Yasuhiro Orita
Chiba University Graduate School of Medicine,
Makoto Mitsumori Chiba University Graduate
School of Medicine, Michiko; Nakazato Chiba
University Graduate School of Medicine,
Masaomi Iyo Chiba University Graduate School
of Medicine Japan
Introduction: Based on the hypothesis that responsibility
beliefs are important in the experience of obsessional
problems, Salkovskis et al (2000) have developed two
new questionnaires specifically designed to measure the
beliefs; RAS(Responsibility attitude scale)and
RIQ(Responsibility interpretations questionnaire). The first
aim of this research is to compare between distorted
beliefs about responsibility in Japanese patients with
Obsessive Compulsive Disorder (OCD) and those in
normal controls. The second aim is to compare the
responsibility beliefs before and after exposure and
response prevention (ERP) therapy in OCD. Methods:
First, the Japanese version of RAS and RIQ were
administered to 30 patients meeting DSM-IV criteria for
OCD (mean ageSD of 34.1 13.8) and 37 healthy
normal controls (mean ageSD of 36.5 7.9). Second,
for 19 OCD patients (mean ageSD of 37.3 15.4) who
completed the 10-session ERP treatment, evaluations
including Yale-Brown Obsessive-Compulsive Scale (YBOCS), RAS and RIQ were also performed before and
after the treatment. Results: In the first study, Japanese
OCD patients (mean Y-BOCSSD of 26.0 5.7) showed
significantly higher median scores of RAS (OCD 4.42 vs.
Controls 3.42), RIQ (F, frequency) (OCD 1.81 vs.
Controls 0.06) and RIQ (B, Beliefs) (OCD 48.1 vs.
Controls 0) than normal controls, respectively
(p<0.00001). In the second study, median Y-BOCS score
was 26.6 at baseline and 16.0 after the 10-week ERP
treatment, a significant decrease (p=0.001). However,
there were no significant differences in RAS (4.42 to
4.40) and RIQ (B) (48.1 to 38.0) before and after ERP.
RIQ (F) (1.81 to 1.30) scores after ERP were significantly,
but slightly decreased than those before ERP. Discussion:

Though we confirmed that ERP as pure behavioral


therapy is an effective treatment for OCD, no significant
changes in distorted beliefs about responsibility by RAD
and RIQ (B) were observed before and after ERP. Based
on developments in cognitive theory for OCD, our data
suggested that ERP should be combined with cognitive
manipulation about inflated responsibility for its evolution
into cognitive behavioral therapy (CBT).
Conclusions: Distorted beliefs about inflated responsibility
may not be reduced by only behavioral components of
ERP in OCD patients. Manipulating responsibility should
be added into ERP for CBT.

A study on the relationship between


cognitive-behavioral therapy outcome and
neurocognitive impairment in Obsessive
Compulsive Disorder
Min-Sup Shin, Seoul National University College
of Medicine; Soon-Ho Seol, Seoul National
University Hospital Korea
Cognitive-behavioral therapy (CBT) and the
pharmacotherapy with serotonin reuptake inhibitors
(SRIs) are two most effective intervention strategies for
patients with OCD. Some effort has gone into identifying
factors associated with treatment success, and previous
studies have especially concentrated on the
neurocognitive impairment of OCD as a predictive factor
for pharmacotherapy outcome. In contrast, few studies
have investigated the predictors for non-response in CBT
and the existing data are inconclusive. In the recent study
conducted by Bolton et al. (2000) and Moritz et al. (2005)
to explore neurocognitive impairment as a possible
predictor for CBT non-responders, no significant
relationship was found between neurocognitive
impairment and treatment outcome. However, previous
investigations have limitations because visual memory
and visual organization ability known to be important
deficit in OCD were not measured. The present study
was therefore designed to employ the neuropsychological
battery, including the tests sensitive to organizational
deficit of OCD and to utilize an established CBT
procedure and research methodology. From July 2006,
data has been collected on patients who were diagnosed
with OCD and underwent 14 sessions of standardized
CBT, which was conducted at the neuropsychiatry
department of Seoul University Hospital. Self-report
questionnaires and neurocognitive assessment were
administered individually pre and post treatment. The
psychological ratings included Yale-Brown Obsessive
Compulsive Scale (Y-BOCS), Beck Depression Inventory
(BDI), Beck Anxiety Inventory (BAI), Anxiety Sensitivity
Inventory (ASI), and Negative Treatment Indicators in
MMPI? (TRT). The neurocognitive tasks included KWAIS, Rey-Osterrieth Complex Figure Test, Object
Alternation Test, Controlled Oral Word Association,
Wisconsin Card Sorting Test, and Trail Making Test A/B.
Until now, data was collected from eight patients (gender:
four males and four females; age: 31.50years,
SD=13.24). 50% of the patients (all female) showed a
reduction of more than 35% on the Y-BOCS, who were
classified as responder group. There were no differences
in severity of symptoms between two groups in pretreatment assessment. However, OC symptom (Y-BOCS
scores) of responder group significantly decreased in
post-treatment assessment, t=5.431, p=.012. Any
significant differences were not found in other
psychological symptoms assessed by self report
questionnaires and neuropsychological tests between
pre- and post-treatment assessment. The present study
failed to find any considerable neuropsychological
differences between responder and nonrepsonder group.
These results are generally consistent with results of
previous studies, indicating that the neurocognitive deficit
was not related to treatment response. However, our
findings were besed on small number of patients, it is
needed to examine the relationship between cognitivebehavioral therapy outcome and neurocognitive
impairment in large number of OCD patients.

The effects of video feedback with cognitive


intervention on the image of video in socially
anxious individuals.
Kentaro Shirotsuki, ; Satoko Sasagawa,
Graduate School of Human Sciences, Waseda
University; Shinobu Nomura, Faculty of Human
Sciences, Waseda University Japan
Previous studies reported the effectiveness of video
feedback in the treatment of Social Anxiety disorder
(SAD) (Clark & Wells, 1995). On the other hand, Smits et
al.(2006) failed to find the difference between exposure
and exposure with video feedback. Smits et al. (2006)
suggested the probability of negative outcome in the
video might interfere with the effects of video feedback,
since it is possible to interpret the image of the video
negative, neutral, or positive. In the present study, we
investigated the effects of video feedback with cognitive
intervention on the image of video in socially anxious
individuals. We composed video feedback only group
(VF; n=9) and video feedback with cognitive intervention
group (VF+; n=10). Participants were high socially
anxious Japanese college students (Mean age=20.42,
SD=1.17), selected on criteria of scores higher than the

average + 0.5SD of the Japanese Short Fear of Negative


Evaluation scale (Sasagawa et al., 2004). In the
experiments, participants were asked to choose a topic of
their own selection and to give a 3-min speech to the
experimenter and the video camera after 2-min speech
preparation. 5-min rest periods were set before speech
preparation and after speech. We assessed Speech
Perception Questionnaire (SPQ; Rapee & Lim, 1992) for
self-perception of speech just after speech task (ST),
after second rest (SR), and after video feedback (V1).
Each 5 items of negative and positive image for video
were assessed after SR and V1. Cognitive intervention
for VF+ was conducted before SR. Video feedback was
done after SR. At baseline, there was no significant
difference in SPQ (after ST) and the items of negative
and positive image for video (after SR) (p>.10). The
results of ANOVA of group _ time (2 _ 3) in SPQ showed
significant interaction (F[2, 34]=3.94, p<.05). Post hoc
tests showed no significant difference in SPQ for both
groups between ST and SR (p>.10). However, only VF+
group improved in their self-perception after video
feedback (p<.05). Further analysis showed only VF+
group changed in their negative image and enhanced
positive image of video (p<.05). The present results
suggest two main points. First, strong negative image and
absence of positive image of video may disrupt the
effects of video feedback. Second, video feedback only
may not improve self-perception of speech performance.
However, it is suggested that video feedback with
cognitive intervention enhances the improvement of
negative self-perception. In summary, present findings
suggest video feedback with cognitive intervention to the
image of video is more effective to improve the selfperception of their performance in SAD. Present study
suggests that negative image of the video interfere with
the effects of video feedback, and cognitive intervention
promote the effects of video feedback. Future research
should examine the effects of video feedback with other
cognitive approaches; for example, the feedback from
audience and interactional feedback with therapists or
strangers may prove effective.

Effect of group size on outcome, in Cognitive


Behavior Group Therapy for Social Phobia
Marom Sofi, Geha Psychiatric Mental Health
Center Israel, Tel Aviv University; Eva GilboaSchechtman,; Idan Aderka, Bar Ilan University,
The Psychology Department, Israel; Avraham
Weizman, Haggai Hermesh, Geha Psychiatric
Mental Health Center Israel, Tel Aviv University
Israel
CBGT for SP has received robust empirical support
(Heimberg & Becker, 2002), however the effect of group
size on the efficacy of the intervention and on attrition
rates has not been systematically examined. We
examined 36 consecutive groups of CBGT for SP with a
total of 509 patients. CBGT was carried out in a
community outpatient clinic located in a general mental
health center. DSM-IV diagnoses were based on a
structured psychiatric interview the Mini International
Neuropsychiatric Interview (MINI) (Lecubrier et al. 1996)
and included many patients with comorbid affective and
anxiety disorders. Groups consisted of 6 to 22
participants. An experienced CBT therapist and a cotherapist conducted the treatment. Eighteen 1.5 hour
sessions were conducted. Outcome was evaluated by
self-report ratings pre-and post CBGT. The self-report
measures included the Liebowitz Social Anxiety Scale
(LSAS) (Liebowitz, 1987) self questionnaire and the Beck
Depression Inventory (BDI-1) (Beck, 1987). Significant
improvements in self-report rating measures were
observed across all groups. Stepwise regression
analyses revealed that group size was a significant factor
influencing the outcome of CBGT regarding SP and
depression, such that smaller groups had a larger relative
and total individual reduction both in the LSAS and in the
BDI. Attrition rate was greater in small groups as
compared with large groups. Smaller groups of CBGT for
SP produced greater individual benefits both in SP and
depression, but were associated with higher attrition rate.
Results of this study are discussed from an individual
therapeutic and health-policy perspectives

Cognitive behavior group therapy for


generalized and non-generalized social
phobia: Short- and long-term effects in a
prospective naturalistic study.
Marom Sofi, Geha Mental Health Center, Sackler
Faculty of Medicine, Tel-Aviv University, Tel-Aviv,
Israel; Eva Gilboa-Schechtman, Idan, M Aderka,
Bar Ilan University Israel, Psychology
Department; Abraham Weizman, Sackler Faculty
of Medicine; Haggai Hermesh, Sackler Faculty of
Medicine, Tel-Aviv University, Tel-Aviv, Israel
CBGT for Social Phobia is an effective treatment of the
disorder, however: many controlled clinical trials exclude
co-morbid patients and are based on small samples.most
studies do not assess maintenance of treatment gains, or
do so only for short periods of time, the existing data are
limited with respect to CBGT's differential treatment
effects for the two subtypes of SP and using pre-

treatment level of depression to predict CBGT outcome


resulted in inconclusive results in the literature. The aim
of the study was to examine the efficacy of cognitive
behavioral group therapy (CBGT) for social phobia (SP)
in a naturalistic outpatients setting in generalized (GSP)
and specific SP (SSP) patients, upon completion and at
1-year follow-up. Consecutive SP outpatients (N=219),
were diagnosed using a structured interview. CBGT was
provided in 18 1.5-hour weekly sessions. At pre- and
post- treatment questionnaires and clinician ratings were
collected. Self-report measures were obtained at 1-year
follow-up. The main outcome measure was the Liebowitz
Social Anxiety Scale (LSAS). CBGT was effective in
reducing both self-reported social anxiety (effect size =
1.23) as well as depression (effect size = 0.94). GSP
patients (GSPs) and SSP patients (SSPs) differed in their
presenting psychopathology and in their response to
CBGT. Among treatment completers, 44% GSPs and
37% SSPs achieved at least 50% improvement and 40%
GSPs and 73% SSPs reported distress and functioning
within the normal range. Among SPs with current
depression or depressive history, SP symptoms
aggravated during the follow-up period, while SPs with no
current depression or history of depression experienced a
further alleviation of SP symptoms during follow-up. 1.
CBGT provided in a public clinic to non-selected, mostly
unmedicated, and comorbid patients, is an effective
treatment for the majority of SP sufferers. 2. Current
depression or depressive history predict later
exacerbation of SP symptoms. Therefore, depressed SPs
may need additional intervention to maintain CBGT gains.
3. SSPs may benefit from less intensive treatment than
GSPs.

The effects of suppressing obsessive


intrusive thoughts: a systematic review of the
experimental literature.
Andrew McLean, University of Glasgow, UK
Thought suppression has been commonly cited as a
developmental and/or maintaining factor in cognitivebehavioural conceptualisations of obsessive-compulsive
disorder (OCD). The current review synthesised findings
from experimental investigations that have examined the
suppression of thoughts characteristic of OCD.
Computerised database searches and other strategies
were used to identify relevant papers. In total, 11 studies
satisfied criteria for inclusion. Employing a structured
rating scale, two studies were found to be of high
methodological quality, eight of moderate quality, and one
of low quality. With respect to thought occurrences, no
study provided evidence for the purported rebound effect
of suppression. Only two investigations generated data
consistent with immediate enhancement. Moreover,
almost all effect sizes went in the opposite direction to
expectation. For measures beyond thought occurrence,
findings were mixed. Whilst there appears to be limited
support for the citation of thought suppression in
conceptualisations of obsessional problems, the review
highlights an extant literature lacking in many respects.
Studies over longer time periods and within participants'
everyday environment are therefore recommended, as
are studies using clinical samples.

Early therapeutic alliance, treatment


expectancy and motivation as predictors of
outcome in exposure and response
prevention treatment for obsessive
compulsive disorder
Stian Solem, Bjarne Hansen,; Leif E. O. Kennair,
Patrick A. Vogel, Norwegian University of
Science and Technology,Norway
There are few predictors of outcome documented for
obsessive-compulsive disorder (OCD). Therapeutic
alliance, treatment expectancy and motivation are
considered important predictive factors in psychotherapy,
but their role in treating OCD is poorly documented. The
aim of this study was to investigate whether early
alliance, expectancy and motivation predicts outcome in
48 outpatients (31 women, 17 men) who underwent
exposure and response prevention (EX/RP) treatment for
OCD. The study used a one-group pretest-posttest
design with the Yale-Brown Obsessive Compulsive Scale
(Y-BOCS) as the measure of outcome. Early alliance as
measured with the Working Alliance Inventory (WAI) short form, and expectancy (Borkovec & Nau, 1972) were
both correlated with outcome, while motivation as
measured with the readiness for change index from the
University of Rhode Island Change Assessment (URICA)
was not. A multiple regression analysis, controlling for YBOCS at pre-treatment, did not find the total scores of
WAI and expectancy to be significant predictors. A
correlation analysis with the three predictors' subscales
revealed that agreeing on the goals of therapy and having
a high expectancy regarding the treatment's logic were
both correlated with outcome. A multiple regression
analysis with these two subscales, controlling for Y-BOCS
at pre-treatment, revealed that agreeing on the goals of
therapy which is an important component of the
therapeutic alliance was a significant predictor. This
model accounted for 27.3% of the variance. The
importance of these findings for conducting EX/RP
treatment for OCD is discussed.

Responsibility to continue thinking and


refraining from catastrophic thinking: New
metacognitive dimensions to predict worrying
Yoshinori Sugiura, Tomoko Sugiura, The Japan
Society for the Promotion of Science; Yoshihiko
Tanno, The Univetsity of Tokyo
Excessive worrying, a cardinal feature of generalized
anxiety disorder (GAD), is a common but debilitating
problem. Among many etiological models, the
metacognitive model (Wells, 2000) considers positive and
negative beliefs about worrying central in the
development of pathological worrying. The MetaCognitions Questionnaire (MCQ; Cartwright-Hatton &
Wells, 1997) was developed to measure five
metacognitive dimensions: positive beliefs about worry,
negative beliefs about worry, lack of cognitive confidence,
negative beliefs about thoughts in general (including
themes of superstition, punishment, responsibility, and
need for control: SPR), and cognitive self-consciousness.
All five subscales were shown to be correlated with
diverse emotional disturbances, including worrying, trait
anxiety, and obsessive-compulsive symptoms. Especially,
negative beliefs about worrying has been proven to be a
strong predictor of both pathological worrying and GAD
status. This study introduced two additional dimensions
not adequately represented in the MCQ to enhance the
prediction of worrying. Two new metacognitive constructs
are responsibility to continue thinking (RESP) and
refraining from catastrophic thinking (REFRAIN). RESP is
a belief that one needs prolonged thinking about stressful
problems (Y. Sugiura, in press); while REFRAIN reflects
the ability to be detached from negative thinking (T.
Sugiura, 2007). RESP is considered a subfacet of
positive beliefs about the utility of worrying and was
shown to be a stronger predictor of worrying than the
MCQ positive beliefs. REFRAIN may represent a
metacognitive mode, wherein thoughts are evaluated as
mental events, not as realities (Wells, 2000). This study
compared these new scales with the established
metacognitive dimensions measured by the MCQ.
Specifically, their incremental validity over the MCQ
subscales in the prediction of worry and the factor
structure of metacognitive dimensions were examined.
Japanese college students (N = 460; 36% women), with a
mean age of 19.07 years (SD = 1.37), completed the
MCQ, RESP, REFRAIN, and the Penn State Worry
Questionnaire (PSWQ; Meyer, Miller, Metzger, &
Borkovec, 1990). First, a hierarchical regression analysis
revealed the unique contributions of RESP and REFRAIN
to worrying over the MCQ subscales. Five MCQ
subscales explained 48% of the variance of the PSWQ;
RESP and REFRAIN explained additional 11%. Second,
a factor analysis revealed two broad dimensions of
metacognitions. (a) Factor 1 consisted of positive beliefs,
cognitive self-consciousness and RESP. These are
considered to represent excessive and fruitless effort to
control thinking. (b) Factor 2 included negative beliefs
about worrying and lack of cognitive confidence.
REFRAIN loaded negatively on Factor 2. Therefore, this
was interpreted as negative metacognitive appraisal
about one's ability to control cognition. MCQ SPR loaded
on both factors. Confirmatory factor analysis supported
the two-factor structure (GFI = .97; RMSEA = .08). Two
new metacognitive dimensions, responsibility to continue
thinking and refraining from catastrophic thinking, not only
demonstrated incremental validity over the existing
metacognitive variables but also fit with the metacognitive
framework. RESP may clarify why effortful worrying to
solve problems becomes pathological. REFRAIN
suggests how to ameliorate pathological worrying, namely
to be detached from negative thoughts, as is emphasized
in recent mindfulness based interventions.

Using Cognitive Therapy and Anxiety


Reduction Program to Eliminate Anxiety,
Helplessness and Guilty Feeling
Zamralita Taruna, Department of Psychology Tarumanagara University
Cognitive therapy believes that thoughts mediate
between feelings and behaviors. Distorted thinking and
faulty learning experiences cause emotional distress. A
55 year old school principal has recently been suffering
from anxiety for more than 6 months. She believes she
has lack of support from the school staff although she has
been elected as the principal for the 2nd term. The
distress escalated soon after the promotion, because one
of the teachers disagreed on the promotion. She believes
that she can not accomplish the task very well, although
her promotion was a proof that she was trusted by the
entire board members to remain as the principal. Her
conflict to hold the position escalated following the fact
that her husband had suffered from a stroke thus she
must become the bread winner of the family. She needs
to retain the job, but she becomes anxious for being
helpless in conducting her duty, in taking care of her
husband, and in dealing with the entire situations. She is
afraid of getting angry or feeling sad, losing her
concentration and feeling guilty for failing to deal with
various situations. She went for medication and the
treatment did not help thus she asked for psychological
treatment. Following the assessment and setting the
agenda to work with the client, the therapist implemented
Anxiety Reduction Program (Thompson, 2003, pp.145-

146) consisting of (1) relaxing the muscles, (2) engaging


in positive self-talk, (3) visualizing the doing-well, (4)
rewarding the doing well. During the sessions, the
therapist implemented 2 approaches (a) using checklist of
negative thoughts, and (b) giving homework to write the
thoughts (Thompson, 2003, pp. 162-163). The checklist
consists of (a) negative opinions about the self, (b) selfcriticism and self-blame, (c) negative interpretations of the
events, (d) negative expectations, and (e) selfresponsibilities. The homework includes (a) writing daily
schedules, (b) labeling the events, (c) using the ABC
approach, (d) responding the automatic thoughts (the
double column technique), and (e) solving difficult
problems. After 8 sessions of therapy the client was able
to eliminate her anxiety. She retains the job as the school
principal, feels more positive for being able to do her job,
and able to reward her self for doing well on the job. The
effectiveness of the integrative approach of cognitive
therapy and anxiety reduction program to reduce anxiety,
helplessness and guilty feeling, was also influenced by
the cooperative attitude of the client. Discussions includes
cooperative attitudes of the client during therapy which
also support the sessions.

Trait of personality and interpersonal


relationship in patients with OCD : changes
with treatment
Mayumi Tomita, Kazuko Yoshioka, Faculty of
Intergrated Human Studies and Social Sciences;
Fukuoka Prefectual University; Midori Kawamoto,
Depertment of Psychiatry, Kawasaki medical
school; Eriko Nakatani, Institute of Psychiatry,
King's College London; Tomohiro Nakao,
Graduate School of Medical Sciences, Kyushu
University; Akiko Nakagawa, Depertment of
Psychiatry, Kawasaki medical school
It has been indicated that the responses to treatments in
patients with OCD might be related with their trait of
personality and interpersonal relationship (A.E.Skadol et
al 1995, Mavissakalian et al 1990), though without
consensus. The aim of this study, therefore, is to
investigate whether there is any differences 1) in trait of
personality and interpersonal relationship in patients with
OCD compared with previous studies, 2) between the
changes of these differences, if any, after improvement by
BT and by pharmacotherapy with Fluvoxamine. The
subjects were 40 outpatients (15 men and 25 women with
mean age 33.4). The assessments were undergone
before and after 12 weekly treatments. Trait of personality
was assessed using Personality Diagnostic
Questionnaire-Revised (PDQ-R) and trait of interpersonal
relationship was assessed using Relationship
Questionnaire (RQ), both were self-rating questionnaire.
OC symptoms were assessed with Yale-Brown
obsessive-compulsive scale (YBOCS), and patients who
showed at least 35% reductions of total YBOCS and
whose CGI-I (Clinical Global Impression-Improvement)?5
were defined as Responders. Regarding the change of
before and after treatment, the data of 10 BT responders
and 6 Fluvoxamine responders were analyzed. PDQ-R 1)
Before treatment, thirty-four patients (75%) met at least
one PD diagnosis: obsessive-compulsive PD (OCPD); 22
(55%), dependent PD (DPD); 16(40.0%), histrionic PD;
12(30.0%), avoidant PD(AvPD); 9(22.5%), and paranoid
PD; 9(22.5%) The relatively higher ratios of DPD in this
study were corresponding to previous studies (26%: PDQ
Mavissakalian et al.1990, 13.3%: SCID Matsunaga, et
al.1995). While AvPD was the most frequent personality
category in previous studies, the ratio of it was relatively
low in this study. In this study, the 3 optional scale scores;
mean Impairment/Distress scale score was 2.6, Too Good
scale scores was 1.4 and Suspect Questionnaire scale
score was 0.4.
2) In the BT responders, mean PD total score changed
from 40.3 to 37.1. Suspect Questionnaire score
decreased from 0.7 to 0.2 (t(9)=2.236, p<.052). In the
Fluvoxamine responders, mean PD total score changed
from 27.5 to 19.9. Impairment/Distress score decreased
from 2.5 to 1.0 (t(5)=2.236, p<.076). RQ 1) Before
treatment, the types of the patients were; Secure:29.7%,
Fearful:27.0%, Preoccupied:24.3%, Dismissing:18.9% 2)
Five out of 10 patients (50%) in the BT responders
showed increased scores in Secure, but no patients in
the Fluvoxamine responders showed this.
Additionally, more than half of the BT responders showed
change in their interpersonal type after treatment, while
there was no change in the Fluvoxamine responders. The
fact that as many as 75% of our patients had at least one
PD might be influenced by the feature of our subjects
most of whom had been treatment refractory. The lower
ratio of AvPD might be related with our treatment regimen
where patients must continue 12 weekly outpatient
sessions.
The decreased Suspect Questionnaire score in the BT
responders suggests that BT could restore patients'
confidence for their recognition. In addition, BT could
change interpersonal relationships, judging from the
increased score of Secure in RQ.
Future studies with lager sample sizes and objective
assessment scales will be warranted.

Validation of the Cognitive Model of


Panic:The specifity of sensations and
catastrophic misinterpretations
Hakan Turkcapar, Ankara Diskapi YB Training
and Research Hospital, Department of
Psychiatry; Olga Guriz, Ankara Diskapi YB
Training and Research Hospital, Department of
Psychiatry; Sibel Orsel, Ankara Diskapi YB
Training and Research Hospital, Department of
Psychiatry
Cognitive hypothesis of panic states that patients with
panic disorder have an tendency to misinterpret certain
bodily or mental sensations as a sign of imminent
disaster. For each patient, there tends to be an internally
consistent and logical link between the sensations
experienced during panic and the particular
interpretations made. For example, palpitations are
misinterpreted as a signal of a heart attack, dizziness as
evidence of impending loss of control, etc. The
association between sensations and catastrophic
outcomes is a crucial component of cognitive models of
panic disorder that needs to be empirically supported.
But, to date, research in this area has been limited. The
aim of the present study was to investigate whether
individuals with panic disorder are characterised by an
enhanced tendency to associate particular somatic
sensations with particular threatening outcomes. In order
to test this prediction, the correlation between the
symptoms or sensations and interpretations in patients
with panic disorder were examined. It was hypothesized
that significant correlations between sensations and
cognitions would be obtained. The 60 patients had been
diagnosed as DSM-IV panic disorder with SCID were
recruited in to the study. Panic Attack Sensations and
Cognitions Questionnaire, Panic and Agoraphobia Scale
and Hamilton Anxiety Scale has been applied. Panic
Attack Sensations and Cognitions Questionnaire is
consisted of 18 bodily (e.q. palpitation) and mentally (e.q.
derealisation) sensations and 5 catastrophic cognitions
(e.q. I am going to pass out). In this Questionnaire
patients were asked to rate sensations and cognitions
during their most severe panic attacks in the last 3
months. Severity of symptoms were rated between never
(0) and most severe (4). Pearson correlations were
computed between each of the sensations and
catastrophic cognitions. The significance level was set at
p< 0.01. Majority of feared bodily and mentally sensations
were significantly correlated. Most significant correlations
(p<0.01) between symptoms and cognitions for each
symptoms as follows: palpitation is correlated with
suffocation(r=.47), dying from heart attack (r=.36), and
passing out (r=.46). Shortness of breath most correlated
with suffocation (r=.81), dizziness is correlated with
suffocation (r=.44), dying with stroke (r=34),and passing
out (r=36), depersonalization is most correlated with
loosing control/going crazy and paralyzing with fear
(r=.48), numbness with passing out (r=.49), flushes and
chills with passing out (r=.49), blurred vision with passing
out (r=36), dry mouth with suffocation (.53), tinnitus with
loosing control (r=.34), concentration problems with
paralysed by fear (r=.50), anxiety with paralysed by fear
(r=.45). The results of our study are generally congruent
with the cognitive theory of panic disorder, for example
the highest correlations was found between shortness of
breath most correlated with suffocation, and
depersonalization is most correlated with loosing
control/going crazy. On the other hand each sensations
correlated more than one cognitions and some cognitions
correlated most of the symptoms. These show that
idiosyncratic connections between the symptoms and
meanings can vary between individuals. Consistent with
the previous researches the present study provides
further new evidence that feared bodily and mental
sensations are statistically significantly correlated with
specific catastrophic cognitions.

Difference of Word Recognition in High and


Low Obsessive Compulsive Symptom middle
school students in China
Jianping Wang, Bo Peng, Zhihui Yang; Ligang
Zhu,Yulong Wang, School of Psychology, Beijing
Normal University, Beijing China
To compare the word recognition performance and the
confidence of the memory in the high and low obsessive
compulsive Symptom middle school students(Ss) 32 high
obsessive compulsive Symptom (HOC) Ss and 32 low
obsessive compulsive Symptom (LOC) Ss who were
chosen from 3070 middle school students using Padua
Inventory and SDS (Self-Rating Depression
Scale)responded to a word recognition task, which totally
has 60 obsessive compulsive sensitive words (OCSW) ,
60 emotional sensitive words (ESW) and 60 neutral
words (NW) . There is no difference on the recognition
performance between HOC group and LOC group.
However, on the basis of signal detection analysis for the
OCSW, the HOC Ss has the lower d'than the LOC Ss ( t
(62) = 2.468, p = 0. 016) . On the confidence of right
responds to the words, there is significant difference
between HOC Ss and LOC Ss (F (1, 62) =
4.749,p=0.033), and also, the interaction of memory
confidence between the groups and words types was
significant ( F (1, 62) = 4. 690, p =0.013) . The results of

the present study implicate that HOC Ss will not show the
bias to the OCSW, but they have difficulty in
differentiating the threat-related information. And the
disability to differentiate threat-related information is one
of the causes for lower confidence of HOC Ss, but this
relationship merits further study.

findings. Further, these techniques should be


disseminated to clinicians, and incorporated into
academic stress management programs at universities to
specifically target excessive and uncontrollable academic
worry. Future research should investigate the efficacy of
these interventions for GAD patients.

Verbal Repetition in the Modification of Belief


in Contamination-Related Thoughts
Chris Watson, Christine Purdon, Department of
Psychology, University of Waterloo Canada

A Preliminary Study of the Efficacy of


Cognitive-Behavioural Therapy Group for
People with Social Anxiety in Hong Kong
Fu Keung Wong, The University of Hong Kong

Acceptance and Commitment Therapy (ACT) is a


therapeutic approach that emphasizes emotional
disengagement from the content of thoughts, rather than
the alteration of the thought's content, as a key to
overcoming mood and anxiety problems. ACT promotes
the disengagement from thought content through
cognitive defusion techniques, which include verbal
repetition (VR). In VR, a selected word is repeatedly said
aloud until it loses its associative meaning, which renders
the word emotionally neutral. In a single-case design,
Masuda et al. (2004) found that VR significantly reduced
the believability of and distress associated with selfrelevant negative thoughts. The purpose of the current
study was to examine the effectiveness of VR in a
randomized controlled study. In this study, VR presented
with a cognitive defusion rationale was compared to brief
imaginal exposure (IE) presented with a habituation
rationale, and to no intervention, in its ability to promote
disengagement from contamination-related thoughts in an
analogue sample of people with contamination fears
characteristic of obsessive-compulsive disorder (OCD).
Participants were undergraduate students scoring in the
clinical range on the Padua Inventory-Washington State
University Revision (Burns et al., 1996) contamination
obsessions and washing compulsions subscale.
Participants identified their three most upsetting
contamination-related thoughts and rated them on
believability, distress, and meaningfulness using 100-mm
visual analogue scales. They were then randomly
assigned to receive VR or IE with each of their three
contamination-related thoughts as the targets, or to no
intervention (sit quietly). Following this, participants rerated the thoughts on the above dimensions. Participants
returned to the laboratory one week later and again
completed ratings for each of their contamination-related
thoughts. Repeated measures multivariate analysis of
variance indicated that significant reductions in
believability, distress, and meaningfulness were observed
following VR, but not IE or no intervention. These
reductions were maintained at one-week follow-up. In the
present study, the rapid verbal repetition of
contamination-related thoughts, presented with a
cognitive defusion rationale, appears to be effective in
promoting emotional disengagement, and may be an
effective addition to treatment of OCD.

Objectives: There is no documented empirical study on


the the use of CBT for peoiple with social anxiety with
Chinese people. This study adopted a randomized waitlist control design to examine the efficacy of cognitivebehavioural therapy group (CBT group) for Chinese
people with social anxiety in Hong Kong. A total of 34
Chinese participants with social anxieties were randomly
assigned into experimental and control groups. The
participants in the experimental group received a 10session CBT group treatment while participants of the
control group did not. Outcome measures included The
Liebowitz Social Anxiety Scale, Emotions Checklist,
COPE scale and Dysfunctional Attitude Scale Preliminary
findings suggested that members of the CBT group
showed significant decrease in social anxiety,
dysfunctional rules and negative emotions and significant
increases in adaptive coping skills and positive emotions
than members of the control group. The findings provided
initial evidence of the efficacy of CBT group for Chinese
people with social anxieties. Future research should use
a larger sample and examine the longer-term effect of
CBT group treatment.

An Examination of Self-Administered
Interventions to Reduce Pathological
Academic Worry
Kate Wolitzky-Taylor, ; Michael Telch, University
of Texas at Austin USA
Despite the prevalence of academic worry at the college
and university level, there is a paucity of research in this
area. In addition, there is an even greater dearth of
research investigating treatments for excessive and
uncontrollable academic worry. Further, the research on
psychosocial treatment strategies for reducing
pathological worry (as seen in its most severe form in
generalized anxiety disorder; GAD) is limited, with several
behavioral treatments seen in treatment manuals still
untested in controlled trials. Finally, GAD is associated
with high medical utilization and significant costs to
society (see Wittchen, 2002, for reviews). Researching
cost-effective treatments may have important public
health implications. The current study investigates the
efficacy of two self-administered interventions in reducing
pathological academic worry. Participants reporting
significant levels of academic worry that is either causing
significant distress or significant interference were
randomized to one of four conditions: a) worry exposure
(WE), b) expressive writing (EW), c) a placebo control,
consisting of pulsed audio-photic stimulation (APS), and
d) wait-list control (WLC). Participants practiced their
interventions three times per week for one month at
home, and were assessed at pre, post, and a three
month follow-up. Measures include questionnaires (with
the primary outcome questionnaire being the Academic
Worry Questionnaire, AWQ), number of visits to the
student health service, and grade-point average.
Structured diagnostic interviews were also conducted at
pre-treatment and follow-up assessment to determine
GAD status. Results from the first 75 participants indicate
that those in the WE and EW conditions showed
significantly lower academic worry (as measured by the
AWQ), significantly lower levels of overall worry, and
significantly more improvement on GPA than those in the
APS placebo and WLC conditions. No differences were
found on health outcomes (i.e., number of visits to the
health center). The efficacy of worry exposure and
expressive writing with this population suggests there are
cost-effective treatments for pathological academic worry.
There are significant public health implications for these

Effects of group cognitive-behavioral


intervention on social anxiety in patients with
schizophrenia: randomized controlled trial
Hirofumi Yamaji, International University of Health
and Welfare, Japan; Hitoshi Okamura, Graduate
School of Health Sciences, Hiroshima University,
Japan
Objective: There are many patients with schizophrenia
who suffer from anxiety symptoms. The objective of this
study was to investigate the effects of a group cognitivebehavioral intervention on social anxiety and self-efficacy
in patients with schizophrenia utilizing a psychiatric daycare. Method: The subjects were 79 patients who fulfilled
the eligibility criteria and gave their written consent to
participate. They were randomly assigned to either an
intervention group (N=40) or a control group (N=39). The
intervention in the control group consisted of a usual daycare activity program, and in the intervention group it
consisted of a cognitive-behavioral intervention in addition
to a usual day-care activity program. Evaluations were
made by means of the Japanese version of Brief Social
Phobia Scale (BSPS), the Japanese version of General
Self-Efficacy Scale (GSES), and the Japanese version of
Positive and Negative Syndrome Scale (PANSS), and
they were performed 3 times: before the intervention,
immediately after completion of the intervention, and 3
months after completion of the intervention. Results: The
changes in scores on the BSPS and GSES between
before the intervention, immediately after the intervention,
and 3 months after the intervention showed significant
differences between the two groups. Conclusion: The
results suggested that the cognitive-behavioral
intervention has a role in improving self-efficacy and
reducing social anxiety in patients with schizophrenia,
and that approaching to both self-efficacy and social
anxiety may be linked to improvement of their QOL.

Psychoeducation of Panic Disorder in Early


Treatment
Chika Yokoyama, Eri Usami, Akasaka Clinic for
Psychosomatic Medicine and Psychiatry; Mina
Masaki, Nagoya Mental Clinic / Panic Disorder
Research Center; Reiko Iwasa, Akasaka Clinic
for Psychosomatic Medicine and Psychiatry;
Eriko Kagohara, Yokohama Clinic, Natsuko
Kaiya, Akasaka Clinic for Psychosomatic
Medicine and Psychiatry Japan
The aim of this study was to evaluate the effectiveness of
a group psychoeducation in decreasing anxiety about
panic symptoms and treatment in panic disorder (PD)
patients. Subjects were 50 patients with a DSM-IV-TR
diagnosis of panic attacks or panic disorder at the first
visit to Nagoya Mental Clinic and Akasaka Clinic in Japan
between April and December in 2006(male=14,
female=36, mean of age=34.5810.27, mean of years
since first panic attack=6.088.04). Patients and family
were introduced to 1 session (50 min.) face-to-face
psychoeducation plus usual treatment(medication) after
the first visit(mean of days=22.9416.81).
Psychoeducation components included (a)symptoms of
panic disorder, (b)prevalence,
(c)treatment(pharmacotherapy and cognitive behavioral
therapy), (d) understanding of medication(period of taking
medication, effectiveness, side effects, and dependence)
, (e)coping with panic attacks, (f)risk factors of provoking
panic attacks and lifestyle. Patients were assessed before

and after intervention by knowledge of panic disorder


symptoms and treatment, State-Trait Anxiety Index(STAI),
the Anxiety Sensitivity Index(ASI), self-efficacy in control
of panic disorder symptoms, worried about medication
and motivation for treatment(Visual Analog Scale:VAS).
Also, patients were inquired to the degree of satisfaction
with psychoeducation. 21 patients(42%) were
accompanied by their family. The proportions of having
the knowledge of panic disorder symptoms before
psychoeducation are as follows: panic disorder, 72%;
panic attacks, 82%; anticipatory anxiety, 68%;
agoraphobia, 60%; depressive symptoms, 40%;
residual symptoms, 12%; treatment, 34%. Patients
had poorer knowledge of residual symptoms and
treatment. In comparison with pre-psychoeducation,
patients showed significantly greater improvement and
lower scores on the knowledge of panic disorder
symptoms, STAI, ASI, self-efficacy in control of panic
disorder symptoms, worried about medication and
motivation for treatment(p<.01). About the degree of
satisfaction with psychoeducation, 23 patients (46%)
reported much and 27 patients (54%) reported very
much. Psychoeducation increased the self-efficacy of
control panic disorder symptoms, and motivation for
treatment and decreased anxiety sensitivity and anxiety
about medication. Although, our study data was lack of
comparison with controls, it suggested that
psychoeducation would be effective for introducing
treatment.

Impulsivity in non-clinical persons with


obsessive-compulsive symptoms
Ariane Zermatten, Martial Van der Linden,
University of Geneva, Switzerland/ University of
Lige, Belgium
In recent years, there has been a growing interest in the
relationship between Obsessive-Compulsive Disorders
(OCD) and impulsivity. However, there is no consensus
concerning this relationship, partly due to the multidimensional nature of impulsivity. The present study
aimed to explore the relations between obsessivecompulsive symptoms and four facets of impulsivity
recently proposed by Whiteside and Lynam (2001):
Urgency (the tendency to experience strong impulses
often under conditions of negative affect), Lack of
Premeditation (the tendency not to think of the
consequences of an action before engaging in it), Lack of
Perseverance (the inability to remain focused on a boring
or difficult task) and Sensation Seeking (the tendency to
pursue exciting activities as well as an openness to trying
new experiences that could be dangerous). The UPPS
Impulsive Behaviour Scale developed by Whiteside and
Lynam (2001) as well as the Obsessive-Compulsive
Inventory-Revised (Foa et al., 2001) were administered to
220 non-clinical individuals. Main results revealed a
significant correlation between Urgency and the different
obsessive-compulsive symptoms (r range from .21 to
.40). In addition, when entered in a regression controlling
for depression, Urgency was a significant predictor of all
of the OCI-R subscales except Washing and Hoarding.
Moreover, lack of Premeditation was negatively correlated
with the Checking (r = .20; p <. 01) and Ordering (r = .26; p <.01) subscales and negatively predicted these
symptoms in a regression analysis. As for lack of
Perseverance, it was positively linked with Obsessions (r
= .13; p <.05) and negatively with Ordering (r = -.17; p
<.05), although it did not significantly predict these
symptoms when entered in a regression controlling for
depression. Finally, no relation was found between
obsessive-compulsive symptoms and Sensation Seeking.
The present study globally suggests that obsessions,
compulsions and impulsivity are somehow linked but that
it is necessary to differentiate between different facets of
impulsivity and different obsessive-compulsive symptoms
in order to study the complex relationship between these
two constructs.
This Research was supported by the Swiss National
Science Foundation, 1114-067135.01/01

Adult Anxiety
Spanish Programme
Intervencin grupal para trastornos de
ansiedad en un Centro de Salud Mental.
Datos preliminares
Silvia Acosta, C B Mulet, ; M Checa, ; S Cholvi, ;
E Basabe; J Pujol, P Casaus, Centro de Salud
Mental de Tarragona Spain
Los trastornos de ansiedad (TA) consumen un gran
nmero de los recursos asistenciales disponibles en los
Centros de Salud Mental. El abordaje cognitivoconductual ha demostrado ser eficaz y las intervenciones
grupales permiten economizar recursos manteniendo la
calidad de la intervencin. El objetivo del presente trabajo
es comprobar si una terapia de estas caractersticas
ejerce mejora sobre la sintomatologa ansioso-depresiva
en pacientes con TA y si sta se mantiene una vez
finalizada la intervencin.Nuestro tratamiento grupal se

distribua en 12sesiones semanales y 90minutos de


duracin, con una media de 12participantes. stas se
estructuraron en 3mdulos focalizados en los
componentes de la ansiedad.Criterios inclusin:
presentar un TA (CIE-9) y motivacin para el
cambio.Criterios exclusin: padecer otro trastorno mental
que pudiera interferir en la dinmica grupal, presencia de
limitaciones intelectuales y/o no cumplimiento del
contrato teraputico.Se incluyeron 40pacientes,
principalmente mujeres (18-60aos). La mayora de los
participantes convivan en pareja, se encontraban
laboralmente activos y acudieron a terapia derivados por
otro especialista. Para la evaluacin se utilizaron los
cuestionarios STAI y BDI. stos fueron administrados
antes de iniciar el tratamiento, una vez finalizado y a los
tres meses de seguimiento.Se obtuvieron puntuaciones
significativamente inferiores tanto en el STAI-rasgo como
en el BDI a lo largo de los diferentes momentos de
evaluacin. No se obtuvieron cambios estadsticamente
significativos en STAI-estado.Ms all de los diseos
experimentales, nuestros resultados confirman la utilidad
de los abordajes cognitivo-conductuales para el
tratamiento grupal de la ansiedad, aportando una mejora
en la validez externa.

Neuroimagen y neuropsicologa en Trastorno


Obsesivo Compulsivo: Implicaciones
terapeticas
Josep Andreu Pena, M Angeles Ruiperez, C
Avila, F Martinez, Universidad Jaime de Castello,
Spain
Introduccin: Desde hace ms de 25 aos, las tcnicas
de neuroimagen han entrado a formar parte del arsenal
diagnstico en Medicina clnica y en investigacin
biomdica, siendo una herramienta de gran valor en el
conocimiento de la etiologa, pronstico y teraputica de
los trastornos mentales.Mtodo: Se revisan los estudios
ms importantes en Neuropsicologa y en Neuroimagen,
con especial atencin a aquellos que relacionan ambos
campos de investigacin con el pronstico y el
tratamiento del Trastorno Obsesivo Compulsivo
(TOC).Resultados:Tanto en los hallazgos con imagen
estructural como con tcnicas de imagen funcional se
observa una hiperactividad del circuito cortico-estriadotalmico, que incluira el crtex orbitofrontal y el ncleo
caudado. Los estudios sobre dficits cognitivos
(Fontenelle et al., 2006) incluyen reas como memoria,
planificacin, toma de decisiones, inhibicin de
respuesta y atencin, ms selectivos para tareas de
inhibicin de respuesta, que podran representar el
sustrato neurocognitivo de los sntomas TOC
(Chamberlain et al., (2004).Por otro lado, hay estudios
que demuestran que los frmacos serotoninrgicos y la
terapia de conducta reducen la hiperactividad del sistema
fronto-estriado-talmico normalizando sta y que esta
reduccin es proporcional a los cambios
clnicos.Conclusiones: Parece razonable concluir que
subyace en el TOC una alteracin funcional en los
circuitos que conectan el rea prefrontal y el cortex
medial con el tlamo a travs del estriado y que sta se
relaciona con la disfuncin en tareas ejecutivas, ms
concretamente con la inhibicin de respuesta. Estas
alteraciones tienden a normalizarse tras la aplicacin de
un tratamiento clnicamente eficaz.

Correlatos clnicos y psicofisiolgicos de la


preocupacin desadaptativa (Worry)
Luis Carlos Delgado; P. Perakakis, ; M Viedma
del Jesus, P Guerra, H Robles, ; A Farida-Jr,; J
Vila, Universidad de Granada Spain
l rasgo de preocupacin ha sido reconocido como una
caracterstica fundamental en distintas condiciones
psicopatolgicas, tales como la ansiedad generalizada, el
estrs postraumtico y la depresin (Borkovec et al.,
1983). Tambin ha sido asociado a una menor flexibilidad
autonmica (Thayer et al., 1996), y a quejas de salud
(Brosschot et al., 2005).METODOLOGADe una muestra
de 483 estudiantes se seleccionaron a 55 mujeres de un
nivel alto de preocupacin y a 23 mujeres de un nivel
bajo, a travs del Penn State Worry Questionaire
(PSQW), (Meyer et al, 1990) descartando a las que
presentaban desorden de ansiedad generalizada.
Se realizaron medidas subjetivas de afecto (PANAS),
ansiedad (STAI-R), Quejas de Salud (SHC), Conciencia
Emocional (TMMS24), Depresin (BDI) y se registraron
medidas psicofisiolgicas perifricas en un experimento
que constaba de una lnea de base, un ensayo de
defensa, una serie de ensayos de sobresalto y un
periodo de preocupacin. RESULTADOSLos ndices de
las medidas subjetivas reflejan diferencias significativas
entre ambos grupos que se acompaan de resultados
anlogos obtenidos en las medidas fisiolgicas,
mostrndose, entre otros, diferencias en los patrones
respiratorios y la respuesta cardiaca de defensa entre
ambos grupos. CONCLUSIONES Los resultados
indican un patrn respiratorio con tendencia a la
hiperventilacin y un menor control vagal para el grupo
de alta preocupacin, existiendo unas caractersticas
similares a las encontradas en pacientes con trastornos
de ansiedad generalizada que pueden denotar la
presencia de un estado sostenido de preactivacin
emocional negativo.

Calidad de vida en pacientes con trastorno de


ansiedad generalizada
Sandra Diaz; Arturo Bados, Universidad de
Barcelona Spain
Se estudia a) si la calidad de vida (CV) de personas con
trastorno de ansiedad generalizada (TAG) o TAG
subclnico es peor que la de personas sin trastornos; y b)
qu variables predicen la CV. Se compararon 7 personas
con TAG, 12 con TAG subclnico y 62 controles. Estos
grupos difirieron significativamente en tres de las cuatro
dimensiones de CV y en CV total. El grupo con TAG
puntu peor que el grupo control en satisfaccin general,
bienestar fsico/psicolgico y CV total. El grupo con TAG
subclnico (y sin comorbilidad) puntu peor que el grupo
control en estas variables y en ausencia de sobrecarga
laboral/tiempo libre. Los grupos de TAG y TAG subclnico
no difirieron en CV. En cuanto a los predictores, se
realizaron cinco anlisis de regresin mltiple, uno para
cada medida de CV. La depresin fue un predictor
significativo de todas las medidas, excepto de la
ausencia de sobrecarga laboral/tiempo libre, mientras
que la tendencia a preocuparse fue un predictor
significativo de esta ltima medida y del bienestar
fsico/psicolgico y la CV total.En resumen, en
comparacin a personas sin trastornos, la CV es menor
en el TAG y en el TAG subclnico incluso en ausencia de
comorbilidad. El humor deprimido y la tendencia a
preocuparse -pero no la ansiedad, el estrs y la
intensidad de las preocupaciones en distintas reascontribuyen negativamente a esta peor CV. La
consideracin de estos dos aspectos en el tratamiento
del TAG puede mejorar los resultados y la CV de los
pacientes.

Evaluacin integral y modificacin del estrs


como factor de riesgo piscosocial
relacionado con trastorno cardiovascular en
estudiantes universitarios clnicamente sanos
Carlos Figueroa; B Dominguez, Fes Zaragoza
Unam; B Ramos del Rio, ; R Rojas Contreras, R
Velasquez Diaz, R Zepeda Martinez, Facultad de
Psicologia UNAM
Introduccin: La mayora de los factores de riesgo
psicosociales se relacionan claramente con mecanismos
plausibles psicofisiolgicos que cumplen un rol
mediacional en el proceso psicosomtico, por lo que los
estudios actuales estn incorporando medidas de los
factores de riesgo, como el estrs, de los mecanismos
psicofisiolgicos, y su desenlace en los trastornos
cardiovasculares.Objetivo: Identificar y modificar el estrs
como indicador psicosocial de riesgo cardiovascular en
estudiantes universitarios mediante un programa
psicoeducativo sobre riesgo cardiovascular y manejo de
estrs.Mtodo: Participaron 26 estudiantes universitarios
clnicamente sanos, de la carrera de psicologa de la FES
Zaragoza, UNAM. Se realiz una valoracin integral
(mdica, psicolgica y psicofisiolgica) del estrs,
midindose: Sntomas de estrs agudo y crnico,
Fuentes de estrs, y la actividad autonmica (reactividad
cardiovascular) ante el estrs. La intervencin consto de
6 sesiones psicoeducativas sobre promocin de salud
cardiovascular y manejo del estrs. La postevaluacin
fue una replica de la preevaluacin. Resultados: La post
evaluacin revel las siguientes reducciones en sntomas
de estrs agudo: trastornos digestivos (p.04),
preocupacin (p.001), trastornos de sueo (p.001) y
depresin (p.001). En estrs crnico: trastornos de
sueo (p.001), timidez (p.001) y falta de motivacin
(p.001). Se modificaron las fuentes de estrs
relacionadas con la escuela (p.005), as como la
reactividad cardiovascular de la presin sangunea
diastlica (p.005).Discusin: Se confirma la presencia del
estrs como factor psicosocial de riesgo cardiovascular
en esta poblacin. La evaluacin integral de este
indicador de riesgo permite tener acceso a una
informacin que usualmente no es considerada en los
protocolos de evaluacin.

Tratamiento cognitivo-conductual grupal del


trastorno de pnico: percepcin de control
versus aceptacin de los sntomas de pnico
Maria Cruz Garcia, Romina Cortizo Vidal, lona;
Monica Astals Vizcaino, Belen Diaz Mugica,
Hospital del Mar Barcelona Spain
Est demostrada la eficacia y efectividad de la Terapia
Cognitivo Conductual (TCC) grupal en el tratamiento del
trastorno de pnico (TP). Los hallazgos describen
intervenciones teraputicas basadas en elementos
molares ms que en aspectos moleculares. Entre estos
ltimos, se encuentran intervenciones orientadas hacia
un esquema de control vs las dirigidas a la aceptacin de
los sntomas. El objetivo del presente estudio es
comparar los resultados de dos tratamientos que se
diferencian en el componente de la intervencin
cognitiva.Se estudia una muestra de 20 sujetos con
diagnstico de TP con/sin Agorafobia (criterios DSM-IV)
usuarios del Centro de Salud Mental Adultos de Sant
Mart Sud asignados a dos grupos de 12 sesiones de
TCC. Ambas intervenciones incluyen: psicoeducacin
sobre el TP, intervencin cognitiva, tcnicas de reduccin
de la activacin, exposicin interoceptiva e instrucciones

para la autoexposicin in vivo. Para valorar el


componente teraputico diferencial (control de los
sntomas vs la aceptacin de los mismos) en ambos
grupos se evaluan: ndices de ansiedad (STAI-E/R),
ndices de depresin (BDI), frecuencia de cogniciones
agorafbicas y grado de temor a sensaciones corporales
(Cuestionarios de Chambless) antes y despus de la
TCC grupal.Al finalizar el anlisis estadstico se discutirn
los resultados intragrupo e intergrupo en funcin del
efecto sobre los sntomas y las cogniciones del pnico. Si
las diferencias entre ambos grupos resultan significativas
el estudio aportar apoyo emprico y sealar la
relevancia de estudiar en posteriores investigaciones las
variables ms moleculares.

Evaluacin de un programa de afrontamiento


del estrs en un Hospital de Da de Agudos
Eva Garcia Bayona, M. Jimenez, B Gias, s; L
Yugero, ; C Sarri, Hospital de dia de Granollers
Spain
Introduccin: existen pocos estudios sobre la efectividad
de las intervenciones teraputicas en hospitales de da
de corta estancia para adultos. El programa pretende que
la persona maneje las situaciones de estrs con un
repertorio adaptativo de habilidades, y as pueda prevenir
recadas. Mtodo: el estudio evala la operatividad y la
efectividad del programa. 20 pacientes, 15 mujeres y 4
hombres, participan en 16 sesiones, dos semanales, de
60 minutos cada una. Predomina el diagnstico de
trastorno de personalidad (35%) y de trastorno psictico
(30%). Al ingreso y al alta se administra una escala de
evaluacin psicopatolgica (SCL-90-R) y dos
cuestionarios, uno de estrategias de afrontamiento
(WOC-R) y otro de valoracin cualitativa del programa.
Resultados: Ningn paciente concluye todo el programa,
y un nmero considerable de ellos lo comienza una vez
ste ya se ha iniciado. nicamente se obtienen
resultados de 9 pacientes, lo que no posibilita un anlisis
estadstico de los datos. La gravedad psicopatolgica
disminuye y el nmero de habilidades aumenta en 8 de
los 9 pacientes. La mayora (18) considera que el
programa les ha ayudado a aprender y a comenzar a
utilizar estrategias adaptativas de afrontamiento.
Discusin: Los resultados indican la inoperatividad de
este tipo de programas en hospitales de da de corta
estancia. A pesar de las limitaciones metodolgicas, los
resultados indicaran una mejora anmica (atribuble
tambin al programa integral de hospital de da), y un
aumento en el nmero de estrategias utilizadas. A partir
de esta evaluacin, el abordaje grupal en nuestro centro
se focaliza, no tanto en el aprendizaje de estrategias de
forma sistematizada, como en la movilizacin de los
propios recursos de la persona, as como en el uso de
otros factores teraputicos grupales.

Fobia sangre-inyecciones-dao: Validacin de


una batera de imgenes como herramienta
teraputica
Eva Maria Grasa, ; J Mitjans, ; G Saladich, ; P
Mateo,; Antonijoan Arbos, Perez Sola, Barbanoj
Rodriguez, Hospital Sta. Creu i St. Pau
INTRODUCCIN: La fobia a la sangre/inyecciones/dao
(FSID) es un miedo inducido por la visin de
sangre/heridas, o por recibir inyecciones u otras
intervenciones mdicas invasoras. Adems del miedo, la
emocin de asco tambin desarrolla un papel principal en
la etiologa y mantenimiento del trastorno. El estudio de
la relacin entre miedo-asco y FSID requiere de
instrumentos vlidos para su valoracin. Se presentan
resultados preliminares descriptivos de las caractersticas
psicomtricas de un conjunto de imgenes asociadas
especficamente a la FSID. MTODO: Se preclasificaron
125 fotos, distribuidas en 5 categoras: Neutra,
Agradable, Miedo, Asco y FSID. Se administr la batera
a 60 voluntarios sanos (30 mujeres). Se valoraron las
dimensiones de valencia afectiva, arousal, dominancia y
las emociones miedo y asco. Se compararon las
puntuaciones medias (n=25 imgenes) de las 5
dimensiones utilizando modelos lineales generales
(ANOVA's). RESULTADOS: la ANOVA de un factor
(categoras) indic un efecto principal para valencia (F
(2,6) = 446.09, p < 0.001), arousal (F (2,2) = 109.35, p <
0.001), dominancia (F (2,1) = 48.47, p < 0.001), miedo (F
(2,15) = 79.09, p < 0.001) y asco (F (1,9) = 157.60, p <
0.001). Las puntuaciones en valencia fueron ms
elevadas en las imgenes de la categora Agradable. En
arousal fueron mayores en las categoras Asco, Miedo y
FSID, y en miedo lo fueron en la categora Miedo,
seguida de Asco y FSID. Para la emocin asco, las
imgenes de la categora Asco obtuvieron puntuaciones
ms altas que las de FSID y Miedo. CONCLUSIONES:
La clasificacin a priori de las imgenes se ha visto
globalmente confirmada por las puntuaciones obtenidas
en las dimensiones evaluadas. Esta batera permitira
evaluar de manera adecuada las emociones de asco y
miedo asociadas a la FSID.Estudio financiado por beca
FIS del Ministerio de Sanidad y Consumo.

Traduccin al espaol, adaptacin cultural y


propiedades psicomtricas del inventario
para miedos FSSC.II
Milagros Ascencio Guirado, ; Vila Ruiz, Robles
Garcia, Paez Agraz, Instituto Jalisciense de
Salud Mental Spain
Introduccin: La evaluacin de los miedos constituye la
clave para la deteccin y prevencin temprana de los
problemas de ansiedad. Entre las medidas de auto
aplicacin que permiten una rpida evaluacin destaca,
en tanto que abarca un basta cantidad de miedos y ha
demostrado adecuadas propiedades psicomtricas, el
Inventario de miedos para nios (FSSC-II, de las siglas
de su nombre en ingls: Fear Survey Schedule for
Children II) (Gullone y King, 1992). El objetivo del
presente trabajo fue traducir al espaol, adaptar
culturalmente y determinar la confiabilidad y validez de
sta importante medida.Mtodo: La muestra del estudio
estuvo integrada por ms de 5,000 adolescentes y
adultos jvenes de preparatorias pblicas de la Zona
Metropolitana de Jalisco, Mxico; que aceptaron
participar de forma annima y voluntaria. Se llev a cabo
la traduccin al espaol y adaptacin cultural del FSSC-II
tras la autorizacin de la autora de su ltima versin en
ingls, y se aplic al total de la muestra. Se calcularon
los coeficientes alpha de Cronbach del total y subtotales
de la escala; y se llev a cabo un anlisis factorial de
componentes principales con rotacin
varimax.Resultados: La muestra de este estudio consisti
de 2992 mujeres y 2038 hombres, con una media de
edad de 16.43. Para la adaptacin mexicana se llevaron
a cabo cambios en el 11.53% de reactivos: algunos
reactivos de la versin original fueron adaptados para
Estados Unidos (Ollendick, 1983) y no para Mxico, y
viceversa. La consistencia interna de la escala fue de
.96, y los coeficientes alphas de Cronbach para las sub
escalas van de 0.70 a 0.94. En el anlisis factorial se
distinguieron 5 factores generales con valores eigen
superiores a 1. La totalidad de los reactivos se agruparon
de acuerdo a lo tericamente esperado, en: 1) Miedo a la
muerte o peligro, con 29 reactivos; 2) Miedos a animales
o a lesiones, con 14 reactivos; 3) Medo al fracaso escolar
o a la crtica, con 16 reactivos; 4) Miedo a lo
desconocido, con 13 reactivos; y 5) Miedos mdicos, con
6 reactivos.Discusin: Fue necesario hacer menos
modificaciones respecto a la versin australiana en
comparacin a las que se llevaron a cabo para conseguir
la versin estadounidense. En ambos casos, no es el
constructo a evaluar lo que se modifica, sino la forma de
explorarlo en la cultura particular. Tambin hubo reactivos
para Mxico que no se modificaron respecto a los
generados para la versin estadounidense. En relacin a
los datos psicomtricos de la versin mexicana del
FSSC-II es posible concluir que se trata de un
instrumento vlido y confiable para evaluar la frecuencia
e intensidad de miedos en adolescentes y adultos
jvenes de habla hispana, por lo que se sugiere su uso
con fines clnicos y/o de investigacin. Se trata de una
medida con alta consistencia interna, y una estructura
factorial y varianza explicada congruentes con la
australiana y la estadounidense (Gullone King, 1992;
Ollendick, 1983). Las incongruencias entre las diferencias
versiones se explican en trminos de la diferencia de
edad de las muestras sujetas a estudio.

Raduccin al espaol, adaptacin cultural y


propiedades psicomtricas del inventario
para miedos FSSC.II
Milagros Ascencio Guirado; Vila Ruiz Robles, ;
Paez Agraz, Universidad de Gualalajara
Introduccin: La evaluacin de los miedos constituye la
clave para la deteccin y prevencin temprana de los
problemas de ansiedad. Entre las medidas de auto
aplicacin que permiten una rpida evaluacin destaca,
en tanto que abarca un basta cantidad de miedos y ha
demostrado adecuadas propiedades psicomtricas, el
Inventario de miedos para nios (FSSC-II, de las siglas
de su nombre en ingls: Fear Survey Schedule for
Children II) (Gullone y King, 1992). El objetivo del
presente trabajo fue traducir al espaol, adaptar
culturalmente y determinar la confiabilidad y validez de
sta importante medida.Mtodo: La muestra del estudio
estuvo integrada por ms de 5,000 adolescentes y
adultos jvenes de preparatorias pblicas de la Zona
Metropolitana de Jalisco, Mxico; que aceptaron
participar de forma annima y voluntaria. Se llev a cabo
la traduccin al espaol y adaptacin cultural del FSSC-II
tras la autorizacin de la autora de su ltima versin en
ingls, y se aplic al total de la muestra. Se calcularon
los coeficientes alpha de Cronbach del total y subtotales
de la escala; y se llev a cabo un anlisis factorial de
componentes principales con rotacin
varimax.Resultados: La muestra de este estudio consisti
de 2992 mujeres y 2038 hombres, con una media de
edad de 16.43. Para la adaptacin mexicana se llevaron
a cabo cambios en el 11.53% de reactivos: algunos
reactivos de la versin original fueron adaptados para
Estados Unidos (Ollendick, 1983) y no para Mxico, y
viceversa. La consistencia interna de la escala fue de
.96, y los coeficientes alphas de Cronbach para las sub
escalas van de 0.70 a 0.94. En el anlisis factorial se
distinguieron 5 factores generales con valores eigen
superiores a 1. La totalidad de los reactivos se agruparon

de acuerdo a lo tericamente esperado, en: 1) Miedo a la


muerte o peligro, con 29 reactivos; 2) Miedos a animales
o a lesiones, con 14 reactivos; 3) Medo al fracaso escolar
o a la crtica, con 16 reactivos; 4) Miedo a lo
desconocido, con 13 reactivos; y 5) Miedos mdicos, con
6 reactivos.Discusin: Fue necesario hacer menos
modificaciones respecto a la versin australiana en
comparacin a las que se llevaron a cabo para conseguir
la versin estadounidense. En ambos casos, no es el
constructo a evaluar lo que se modifica, sino la forma de
explorarlo en la cultura particular. Tambin hubo reactivos
para Mxico que no se modificaron respecto a los
generados para la versin estadounidense. En relacin a
los datos psicomtricos de la versin mexicana del
FSSC-II es posible concluir que se trata de un
instrumento vlido y confiable para evaluar la frecuencia
e intensidad de miedos en adolescentes y adultos
jvenes de habla hispana, por lo que se sugiere su uso
con fines clnicos y/o de investigacin. Se trata de una
medida con alta consistencia interna, y una estructura
factorial y varianza explicada congruentes con la
australiana y la estadounidense (Gullone King, 1992;
Ollendick, 1983). Las incongruencias entre las diferencias
versiones se explican en trminos de la diferencia de
edad de las muestras sujetas a estudio.

Efectos de 2 intervenciones cognitivo


conductual en el trastorno por estrs
postraumtico, depresin, ansiedad y
autoestima que presentan mujeres violadas
Laura Hernandez, Facultad de Psicologia UNAM;
I G Gonzalez Hernandez, Facultad de Psicologia
UNAM
Introduccin: En Mxico el abuso sexual afecta a familias
de todos los niveles socioeconmicos y culturales y se
presenta tanto en el mbito urbano como en el rural.
Desde 1996 se han dado avances considerables en esta
rea en trminos de atencin poltica, conciencia pblica
y reformas legislativas. Sin embargo, es mucho lo que
an queda por hacer para explicar el anlisis psicolgico
del abuso sexual dentro de un contexto social patriarcal
en el cual el poder no est distribuido equitativamente y
las pautas de relacin entre las mujeres y los hombres se
mantienen social y culturalmente (Bograd, 1988) Los
diversos informes sobre abuso sexual con que se cuenta
en Mxico miden diferentes indicadores. Sin embargo,
cuando se coincide en la medicin del mismo dato las
diferencias porcentuales que podemos observar son
mnimas, lo que nos permite hablar de coincidencias que
van del 23.2% al 28 % con respecto a la edad en que las
vctimas manifiestan haber sufrido el abuso sexual y que
se ubica antes de los 10 aos. Asimismo, el parentesco
del agresor con la vctima tambin es coincidente en
diversos estudios al igual que el hecho de que la mayora
de las violaciones se cometen dentro del hogar. Otro
aspecto que es importante considerar es que la mayora
de las personas violentadas sexualmente son vctimas de
alguien a quien conocen o en quien confiaban, ya que la
mayora de las agresiones ocurren dentro del entorno
habitual del menor. El abuso sexual provoca traumas que
a veces duran muchos aos, hasta llegar incluso a la
muerte, homicidios o suicidio, impactndose toda la
familia. Muchas mujeres viven aos intimidadas por el
perpetrador, sometidas a niveles de estrs y terror, que
las deterioran, hasta llegar a presentar estrs
postraumtico. Otra repercusin grave son los efectos
que a largo plazo se producen, ya que los nios
abusados sexualmente pueden generar una tendencia a
repetir esta conducta y cometer delitos violentos. La
relacin existente entre vctima y victimario, tambin
dificulta mucho la intervencin e investigacin. Mtodo:
En el presente estudio se examinan los efectos de dos
intervenciones cognitivo conductual de 3 y 4
componentes en los sntomas de estrs postraumtico,
depresin, ansiedad y autoestima que presentan mujeres
violadas. La muestra consisti de 10 mujeres violadas
que cumplan los criterios por estrs postraumtico, 5 se
sometieron a la intervencin de 3 componentes:
relajacin, exposicin imaginaria y en vivo,
reestructuracin cognitiva y 5 a la de 4 componentes:
relajacin, exposicin imaginaria y en vivo,
reestructuracin cognitiva y habilidades sociales. Se
utilizaron los criterios para el trastorno por estrs
postraumtico del DSM IV-TR, (APA, 1995), BAI, BDI, la
escala de autoestima de Reidl, (1981) y el Inventario de
salud, estilo de vida y comportamiento (SEVIC), Snchez
Sosa & Hernndez Guzmn (1992). Resultados: En
ambos grupos se observa una correlacin positiva entre
los criterios por estrs postraumtico, y los niveles de
depresin, ansiedad y autoestima antes, despus y
durante el seguimiento. No observndose diferencias
significativas entre grupos. Discusin: Los criterios por
estrs postraumtico tienen correlaciones positivas con
los puntajes obtenidos en los niveles de depresin,
ansiedad y autoestima, observndose un decremento en
la sintomatologa despus de la intervencin tanto de 3
como de 4 componentes. Resalta el decremento de los
niveles de depresin postratamiento y seguimiento en
ambos grupos. La investigacin contina en proceso con
objeto de analizar ms detalladamente los efectos de la
intervencin.

Anlisis de las propiedades descriptivas del


Obsessive Compulsive Invetory revised (OCIR) en poblacin adolescente comunitaria
espaola
Agustin Ernesto Martinez Gonzalez, Clinica
Psicologica Mayor; Jose Piqueras Rodriguez,
Ana Isabel Rosa Alcazar, Jose Olivares
Rodriguez, Luis Joaquin Garcia- Lopez;
Universidad de Alicante; Universidad de Murcia;
Universidad de Granada Spain
El Inventario de Obsesiones y Compulsiones Revisado
(Fullana et al., 2005) ha sido traducido y validado tanto
para su uso en muestras clnicas y no clnicas de adultos
de habla inglesa (Foa et al., 2002; Hajcak et al., 2004),
as como en poblacin no clnica espaola (Fullana et al.,
2005).El objetivo principal de este trabajo es estudiar las
diferencias en el OCI-R Total y las subescalas segn las
siguientes variables sociodemogrficas: edad, condicin
de ser o haber sido repetidor de curso, estudios de los
padres, existencia de enfermedad mental o mdica del
sujeto e historia previa de enfermedad mental o mdica
de los padres. La muestra consisti en 269 estudiantes
de 1 y 2 de Bachillerato de 3 institutos de la Regin de
Murcia. La edad media fue 17.04 aos (D.T.=0.74), 119
(42.2 %) fueron varones y 150 (55.8 %) mujeres. Los
resultados mostraron que la media del OCI-R total era
20.88 (DT = 10.15). En cuanto a la variable sexo, se hall
que las mujeres obtuvieron puntuaciones ms altas en
todas las escalas, excepto en comprobar. Respecto a la
variable edad tan solo se aprecia una diferencia
marginalmente significativa en la subescala Lavarse, en
el sentido de puntuaciones superiores en los
adolescentes de 16 aos frente a los de 18 aos.
Encontramos puntuaciones superiores para aquellos
adolescentes que informaban de enfermedad fsica frente
al grupo sin enfermedad fsica ni psicolgica, hallndose
diferencias estadsticamente significativas en todas las
subescalas, excepto en las subescalas Lavarse y
Ordenar.

Propiedades psicomtricas de la adaptacin


espaola del Vancouver Obsessional
Compulsive Inventory
Raquel Nogeira, Universidad de Malaga; A
Godoy, Universidad de Malaga; A Gavino,
Universidad de Malaga; P Romero, Universidad
de Malaga
En este estudio se han examinado las propiedades
psicomtricas de la adaptacin espaola del Vancouver
Obsessional Compulsive Inventory (VOCI; Thordarson,
Radomsky, Rachman, Shafran, Sawchuk y Hakstian,
2004) en una muestra de poblacin adulta. El objetivo de
esta investigacin ha sido comprobar si las propiedades
psicomtricas de la adaptacin espaola del VOCI,
realizada con una muestra de estudiantes (Nogueira,
Godoy, Gavino y Romero, 2007), se replicaban en una
muestra de poblacin adulta, de caractersticas
sociodemogrficas ms heterogneas.Los factores
obtenidos mediante anlisis factorial exploratorio tuvieron
una correspondencia alta con los seis factores del VOCI
original. Los anlisis mostraron que la consistencia
interna de la prueba es muy alta, tanto para la
puntuacin total como para cada una de las subescalas.
En cuanto a la validez, los resultados mostraron que
tanto la validez convergente como la discriminante son
adecuadas. Por un lado, la puntuacin total del VOCI
present una correlacin alta con las puntuaciones
totales de otros instrumentos de sntomas obsesivoscompulsivos y con instrumentos de creencias e
interpretaciones relacionadas con el TOC y moderada
con las medidas de otros tipos de psicopatologas. Por
otro lado, las subescalas tambin presentaron
correlaciones superiores con medidas de sntomas
obsesivo-compulsivos que con medidas de otros tipos de
psicopatologas. En este estudio se han replicado con
poblacin adulta los resultados obtenidos anteriormente
con una muestra de estudiantes, lo cual parece confirmar
que la adaptacin espaola del VOCI es un buen
instrumento de evaluacin de sntomas obsesivo
compulsivos en muestras variadas de poblacin
espaola.

Adaptacin espaola del Not Just Right


Experiences Questionnaire - Revised (NJREQR)
Raquel Nogueira, ; A Godoy; A Gavino,
Universidad de Malaga; P Romero, Universidad
de Malaga Spain
Es frecuente que los pacientes con trastorno obsesivocompulsivo (TOC) hagan referencia a experiencias
desagradables en las que tienen la sensacin subjetiva
de que hay algo que no est como debera (sensacin
Not Just Right). Los intentos por medir estas
experiencias son escasos y nunca se han realizado en
poblacin espaola. Con el objetivo de disponer de un
instrumento en castellano que evale estas situaciones,
se ha realizado la adaptacin espaola del Not Just Right
Experiences Questionnaire-Revised (NJRE-Q-R). Para
ello se han llevado a cabo dos estudios con poblacin no
clnica, el primero en una muestra de estudiantes y el

segundo en una muestra de adultos de la comunidad.


Los resultados muestran que la adaptacin espaola del
NJRE-Q-R es una medida fiable y vlida. La primera
mitad del cuestionario presenta una consistencia interna
moderada, tanto entre los estudiantes como entre las
personas de la comunidad. La consistencia interna de la
segunda parte tambin es alta en ambas muestras. Con
respecto a la validez predictiva, en ambos estudios se
han obtenido correlaciones moderadas con diversas
medidas de comportamientos obsesivo-compulsivos. En
lo referente a la validez discriminante, las correlaciones
fueron de moderadas a bajas con otras medidas de
psicopatologas, como ansiedad, depresin y
preocupaciones, y bajas con una medida de
inteligencia.En resumen, la adaptacin al castellano del
NJRE-QR se ha mostrado equivalente a la versin
original de Coles, Frost, Heimber y Rhaume (2003), lo
que permite comparar los resultados publicados en
medios anglosajones y las puntuaciones obtenidas con la
versin castellana.

Efectos en los niveles de ansiedad percibida


y la Variabilidad de la Frecuencia Cardiaca
(VFC) del Entrenamiento en Relajacin
Muscular Progresiva (ERMP)
Marta Ocana Marine, ; E Parrado Romero, a; M
Valero Herreros, J Ramos Castro, ; M Garcia
Gonzalez, a; L Cpdevila Ortis, Universitat
Autonoma de Barcelona Spain
El Entrenamiento en Relajacin Muscular Progresiva
(ERMP) es ampliamente utilizado para el control del
estrs i en la evocacin de relajacin. El anlisis de la
Variabilidad de la Frecuencia Cardiaca (VFC) se
considera un marcador de la influencia del SNA en el
ritmo cardiaco, usado como indicador de estrs y
relajacin. El objetivo del presente trabajo es explorar los
efectos del ERMP en los niveles de ansiedad percibida y
en los parmetros de anlisis de la VFC. Se realiz un
estudio con 15 mujeres (edad = 21,87 aos, DT=3,044)
que llevaron a cabo un ERMP de 2 semanas de duracin
y asistieron al laboratorio en 2 ocasiones coincidiendo
con la primera y ltima sesiones del ERMP, en las cuales
se registraron la VFC y la ansiedad percibida mediante el
inventario STAI-S y una escala de 0-10 antes i despus
de la prctica de relajacin. Se observaron cambios en la
ansiedad percibida y en la VFC posteriores al ERMP. Se
dio una variacin interindividual notable en la respuesta
de la VFC al entrenamiento en relajacin. No se encontr
correlacin entre los parmetros fisiolgicos y
cognitivos.El anlisis de la VFC es una tcnica
prometedora para identificar los cambios debidos a la
regulacin del SNA en el funcionamiento cardiovascular
despus de un entrenamiento en relajacin. Se
recomienda el uso combinado de tcnicas cognitivas y
fisiolgicas para valorar el efecto de las tcnicas de RMP.
Realizado con el apoyo del MEC (DEP2006-56125C03/PREV; SEJ2005-05113) y de la Generalitat de
Catalunya (SGR2005-00318; DEU).

Agorafobia: Comorbilidad entre ansiedad y


depresin
Wenceslao Penate, Universidad de La Laguna; P
Garcia Perez, C Pitti, R Garcia; Universidad de
La Laguna; Universitario de Canarias
Muchos han sido los estudios que demuestran que existe
una alta comorbilidad entre los trastornos de ansiedad y
depresin [ESEMeD/MHEDEA, (2004); Patel y Kleinman,
(2003); WHO-ICPE, (2000)]. Hablamos que de cada tres
casos, dos aparecen con esta comorbilidad. Pero la
cuestin es, qu ocurre primero? Es la ansiedad la
que a la larga favorece un trastorno de depresin o por el
contrario es la depresin la que, con el paso de los
aos, da lugar a un trastorno de ansiedad?La
comorbilidad entre agorafobia y depresin, diferentes
estudios muestran que existe una alta comorbilidad
entre el trastorno de pnico, la agorafobia y la
depresin, entre un 6,6% y un 17,1% (Sanderson y cols,
1997; Fava y cols, 2000; Zimmerman y cols, 2002,
2005).Si nos centramos slo en el Trastorno de Pnico
con agorafobia el porcentaje es an mayor, tratndose de
un 24,5% (Zimmerman y cols, 2005). En estos estudios
se ha comprobado que cuanto ms tarde se debuta en
el Trastorno, ms dura el episodio y ms crnico es el
problema, mayor ser la comorbilidad con depresin.
Los objetivos de este trabajo son determinar la
comorbilidad con depresin en una muestra de pacientes
con agorafobia, determinar las tasas en funcin de dos
medidas de depresin: CBD y BDI, ver el peso relativo
de las medidas de depresin en la prediccin de las
puntuaciones en ansiedad y el peso de las variables de
ansiedad en la prediccin de los niveles de depresin.

Investigacin sobre la eficacia diferencial de


los formatos individual y grupal en un
Programa de Psicoterapia Cognitivo Conductual de manejo de ansiedad
Beatriz Perez Basallo, ; David Brugos Miranda,
Centro de Salud Mental de Vallecas Villa, Spain
Introduccin: El abordaje cognitivo-conductual constituye
el mtodo psicoteraputico ms rpido, eficaz y con

resultados ms permanentes para los trastornos de


ansiedad. En esta investigacin se compar en el mbito
pblico la eficacia de un programa protocolizado
cognitivo-conductual de manejo de ansiedad en funcin
del formato elegido para su aplicacin, individual o
grupal. Mtodo: Se seleccionaron sujetos mayores de
edad, diagnosticados de acuerdo a la CIE-10 de
Trastorno de Pnico, Agorafobia con o sin Trastorno de
Angustia, o Trastorno de Ansiedad Generalizada, con
Historia Clnica abierta en el centro, y todos ellos con
tratamiento farmacolgico en el momento de la
intervencin. Se parearon ambos grupos en las variables
de edad, gnero, diagnstico CIE-10 e historia clnica. Se
realizaron mediciones PRE-POST tratamiento con
diferentes escalas de psicopatologa general, factor
cognitivo, conductual y fisiolgico de ansiedad, ansiedad
estado-rasgo y una escala visual-analgica (0-10). El
programa de tratamiento incluye 9 sesiones
estructuradas ms una de seguimiento, realizadas tanto
en formato individual como en grupal. Los objetivos de la
terapia son aportar informacin sobre el trastorno,
aprender recursos para manejar la ansiedad y desarrollar
habilidades de afrontamiento ms adaptativas.
Resultados: Los resultados obtenidos de la intervencin
grupal son los siguientes: se obtuvieron disminuciones
significativas (p<0,05) de la respuesta fisiolgica a la
ansiedad (BAI), la respuesta conductual agorafbica
(MA), la respuesta cognitiva (ASI), el nivel de ansiedad
subjetiva, la limitacin funcional y el grado de depresin
debido a la ansiedad. Adems aument de forma
significativa la sensacin de autocontrol sobre la
ansiedad. As mismo disminuyeron significativamente 3
subescalas del cuestionario de psicopatologa general
SCL-90R: obsesivo-compulsivo, ansiedad y ansiedad
fbica. Los resultados de la intervencin individual se
estn analizando para su comparacin con lo grupal.
Discusin: La terapia de manejo de la ansiedad resulta
efectiva en su aplicacin en grupo, ya que el triple
sistema de respuesta de la ansiedad (cognitivo,
fisiolgico y conductual) disminuye significativamente tras
la intervencin. Se observa tambin que dicha terapia
cognitivo-conductual permite la modificacin de los
rasgos de personalidad relacionados con la tendencia a
la ansiedad, lo cual creemos puede ayudar al
mantenimiento a largo plazo de los cambios
conseguidos.

Ansiedad en la diferentes etapas del


desarrollo de la mujer
Rosa Pinto, Rosito Eliana Sandra, Universidade
Nove de Julho
Introduccin: La literatura presenta una concordancia en
lo que respecta la mayor prevalencia de trastornos
ansiosos en mujeres. Vale recordar que la ansiedad
puede manifestarse de forma episdica, asi como estar
asociada a eventos o situaciones. El objetivo de esta
investigacin fue hacer un levantamiento de snto9mas
de ansiedad en mujeres en fiferentes perodos de
desarrollo y observar si hay una alternancia de
puntuacin de la ansiedad en las diferentes etapas
cronolgicas. Mtodo: Participaron 69 funcionarias de
una empresa de servicios generales, con edad entre 21 y
59 aos y escolaridad variada. Se utiliz el inventario
IDATE-Trazo y Estado que investiga fenmenos de
ansiedad en adultos y un cuestionario elaborado por las
autoras versando sobre los sentimientos generados en
funcin de las expectativas en atender a las demandas
de la rutina profesional. La aplicacin fue colectiva y, las
respuestas, individuales. El sigilo de la empresa y de los
participantes fue asegurado. Resultados: En lo que se
refiere a los resultados, para aneisdad-trazo (como la
persona se siente generalmente) 100%; de 31 a 40 aos,
96,77% y de 41 a 59 aos, 88,46%. Discusin: En la
muestra investigada fue posible observar una inversin
en las variables puntuacin de la ansiedad y edad
cronolgica, es decir, en la medida que aument la edad,
disminuy la ansiedad. Outras investigaciones son
necesarias para corroborar tales hallazgos. Sin embargo,
en el sentido de apertura de discusiones, se puede
sugerir que tal reduccin pueda justificarse por el hecho
de la mujer adquirir, con la madurez, la condicin de
manejar su ansiedad de forma ms funcional.

Nuevos datos sobre la fiabilidad y validez de


la escala para la deteccin de la ansiedad
social en poblacin adolescente espaola
Jose Antonio Piqueras Rodriguez, Universidad
de Alicante; M D Hidalgo Montesinos, Jose
Olivares Rodriguez, ; V Garcia Rodriguez,
Universidad de Murcia; L J Garcia Lopez,
Universdiad de Granada; A Rosa Alcazar,
Universidad de Murcia Spain
En la actualidad existen pocos cuestionarios
especficamente desarrollados para evaluar la fobia
social en la adolescencia. nicamente dos (SPAI y SASA) han sido adaptados a la poblacin adolescente de
habla espaola y ninguno ha sido desarrollado de forma
especfica para medir la Fobia Social en y para nuestra
poblacin. El objetivo principal de este trabajo es aportar
nuevos datos sobre el proceso de validacin psicomtrica
de un nuevo instrumento basado conceptualmente en los
criterios del DSM-IV (APA, 1994): La Escala para la

Deteccin de la Ansiedad social (Olivares y GarcaLpez, 1998). En estudios anteriores, la EDAS ha


demostrado ser una medida cuya estructura es bifactorial
(factor Ansiedad, que refleja la evitacin y malestar
social, y factor Interferencia), con una excelente
consistencia interna y alta homogeneidad (Olivares,
Piqueras y Snchez-Garca, 2004). En este estudio, se
trata de aportar nuevos y diferentes datos de la
validacin de esta prueba. Para ello se presentan los
resultados de estabilidad temporal del EDAS Total y sus
subescalas (fiabilidad test-retest), de utilidad diagnstica
(validez predictiva) y de relacin con otros instrumentos
de evaluacin similares (validez convergente).

Conductas de afrontamiento inadaptativas en


la agorafbia (con o sin pnico): Relacin con
otros cuadros clnicos y con poblacin no
clnica
Carmen Pitti P Garcia Perez, J. M Bethencourt,
W Penate, Universidad de la Laguna, Spain
El propsito de este trabajo es analizar las estrategias de
afrontamiento utilizadas por los pacientes con agorafobia
(PA) con o sin pnico. Tradicionalmente se conocen 2
estrategias: conductas de huida y de evitacin, tambin
se suelen incluir las conductas de evitacin interoceptiva,
y el cuarto tipo de conductas y las menos estudiadas son
las de afrontamiento parcial. stas ltimas conductas
permiten a los PA afrontar, as sea parcialmente, los
estmulos fbicos. A estos cuatro tipos de estrategias las
hemos denominados Conductas de afrontamiento
inadaptativas (CAI). El objetivo especfico es determinar
en qu medida utilizan las CAI los PA, en comparacin
con pacientes de otros trastornos; conocer el uso
diferencial de las distintas estrategias de afrontamiento
por parte de los PA y establecer el papel de las
conductas de afrontamiento parcial en la evaluacin que
hacen los clnicos del progreso teraputico. La anomala
de estas estrategias de afrontamiento parcial es que
proporcionan cierta validez aparente, ya que la persona
es capaz de resistir la presencia de los estmulos
temidos, sin embargo la informacin que proporcionan
acta como un mecanismo reforzante que adquiere el
valor de estmulo discriminativo sobre las condiciones en
que puede ser afrontado un contexto fbico. Proponemos
entonces una nueva clasificacin de las conductas de
afrontamiento, que tenga en cuenta 3 parmetros:
atender a la funcin que regulan las conductas y
pensamientos, considerar la naturaleza de las estrategias
e incluir los comportamientos de carcter inadaptativo.

Estudio de efectividad de un entrenamiento


en terapia cognitivo conductual para el
tratamiento de trastornos de ansiedad en una
institucin pblica de salud mental: variables
actitudinales relacionadas con la adquisicin
de competencias
Rebecca Robles Garcia, Universidad de
Guadalajara
Resumen: INTRODUCCIN: Los trastornos de ansiedad
(TA) constituyen problemas de salud pblica a nivel
mundial. Afortunadamente se cuenta con estrategias
psicolgicas altamente efectivas para su tratamiento,
entre las que destaca la terapia cognitivo conductual
(TCC). Empero, no es el tratamiento pblico institucional
de primera eleccin en pases en vas de desarrollo.
OBJETIVO: Determinar la efectividad de un programa de
capacitacin para implementar TCC para TA en una
institucin pblica de Mxico. MTODO: El programa de
capacitacin se imparti a 27 psiclogos que
completaron las siguientes medidas antes y despus del
curso: escala anloga visual de actitud hacia de TCC en
general y de TCC para TA en lo particular, y examen de
conocimientos de TCC para TA. Se registr el nmero de
grupos de TCC para TA que se implementaron al finalizar
el curso en la clnica de ansiedad de la institucin.
RESULTADOS: Se document una relacin positiva y
estadsticamente significativa entre actitudes positivas
hacia la TCC y los conocimientos de TCC al finalizar el
curso. Las participantes adscritas a la clnica de ansiedad
implementaron cuatro grupos de TCC para TA. La
desercin del 20% de los participantes se relacion con
la resistencia al modelo teraputico basado en evidencia
cientfica. CONCLUSIONES: Es posible implementar la
TCC para TA en instituciones pblicas a travs de
concienciar de la obligacin de impartir tratamientos
basados en evidencia y de la importancia de contar con
formas de intervencin breves y grupales, as como
capacitando en competencias especficas con el
modelamiento como tcnica primordial de enseanza.

Evaluacin de las dinmicas traumticas en


casos de abusos sexuales
Ana Isabel Sani, Silvia Paiva, Ana Sacau, ;
Gloria Jolluskin, Universidad Fernando Pessoa
Introduccin: El abuso sexual de nios y adolescentes ha
sido objeto de mucha discusin e investigacin en
Portugal. Es fundamental profundizar el conocimiento
sobre a vivencia e impacto del trauma en los menores
vctimas de abuso sexual, para poder realizar una
intervencin y una prevencin ms eficaz. As, en este

trabajo se sugiere un anlisis de las dinmicas


traumticas presentes en las situaciones de abuso sexual
a travs del anlisis de los discursos elaborados por las
victimas y allegados. Mtodo: Evaluamos el trauma en
las vctimas de abuso sexual, a travs del anlisis del
discurso de los menores y sus acompaantes a consulta.
El estudio cont con la participacin de 6 menores, 3 del
sexo femenino y 3 del masculino, con edades
comprendidas entre los 12 e los 16 anos. Recogimos las
narrativas de los menores a travs de un guin de
entrevista de evaluacin a vctimas de abuso sexual, que
incidi sobre cuatro reas traumticas: sexualizacin
traumtica, sentimiento de impotencia, sentimiento de
traicin y estigmatizacin. Para la obtencin de las
percepciones de los acompaantes usamos el guin de
entrevista parental, estructurndolo en tres fases:
funcionamiento familiar prerevelacin, respuestas al
abuso y la revelacin y funcionamiento familiar actual.
Las narrativas fueron analizadas segn la estructura de
categoras previas de la entrevista y el registro de las
dinmicas traumticas de Browne e Finkelhor (1988),
recurriendo al programa informtico NUD*IST para
tratamiento e anlisis de las mismas. Resultados:
Nuestros resultados no nos permitieron identificar en la
muestra todas las dinmicas traumticas referidas en la
literatura. Por otro lado, se identificaron nuevas
categoras influyentes en el grado del trauma.
Relativamente al impacto del abuso sexual, se
encontraron diferentes niveles de intensidad entre los
menores. Tambin se verificaron puntos divergentes y
convergentes entre la visin del menor y de los
acompaantes. Discusin: Podemos concluir que resulta
ventajoso introducir figuras parentales en la evaluacin,
si bien no debe sustituirse por el autorrelato del menor.
Nuestras conclusiones apuntan la necesidad de definir
propuestas de intervencin basadas en perspectivas
cognitivoconductuales, centradas en el menor y en sus
principales figuras de vinculacin.

Experiencias Traumticas En Universitarios Y


Su Relacin Con Medidas De Psicopatologa
E Inmovilidad Tnica
Lidia Toribio, ; Arturo Bados, Universidad de
Barcelona Spain
Se estudi la ocurrencia de eventos traumticos y su
relacin con sntomas psicopatolgicos actuales e
inmovilidad tnica. Cien universitarios contestaron el
Cuestionario de Eventos Traumticos, la Escala TEPT de
Purdue - Revisada, las Escalas de Depresin, Ansiedad y
Estrs y la Escala de Inmovilidad Tnica.El 70% haban
experimentado algn evento traumtico (el 90% si el
trauma se defini laxamente). El riesgo condicional del
TEPT fue del 12,5%, mientras que la prevalencia actual
del TEPT en la muestra total fue 8,8%. Cuarenta y cuatro
personas experimentaron ms de un trauma.Las
personas traumatizadas difirieron de las no
traumatizadas en depresin, ansiedad y sntomas
postraumticos de reexperimentacin, evitacin y
activacin; tambin en inmovilidad tnica durante el
trauma (o durante su peor experiencia estresante en el
caso de personas no traumatizadas). Aquellos con uno y
mltiples traumas difirieron tambin en estas variables,
excepto depresin e inmovilidad tnica. A partir del peor
trauma informado, se crearon cinco grupos: Accidente
grave de trasporte, Atraco/agresin fsica, Maltrato
fsico/abuso sexual, Noticias de heridas/muerte y Otros
traumas. Estos grupos no difirieron en las medidas
psicopatolgicas, pero s en inmovilidad tnica. El grupo
de Maltrato fsico/abuso sexual inform de mayor
inmovilidad durante el trauma que el de Noticias de
heridas/muerte.Experimentar traumas es muy frecuente,
aunque el riesgo y frecuencia del TEPT son mucho ms
bajos. Las personas traumatizadas experimentan mayor
psicopatologa actual y haber sufrido ms de un trauma
agrava esto. La inmovilidad tnica no parece diferir entre
la mayora de diferentes tipos de traumas.

Caractersticas psicomtricas de una


adaptacin espaola del Inventario de
Pensamientos Ansiosos (AnTI)
Antonio Vazquez Morejon, Rosa Jimenez
Garcia- Boveda, ; Raquel Vazquez Morejon,
Universidad de Sevilla, Spain
Introduccin Desde los aos 80 se ha concedido una
particular relevancia a las Preocupaciones como rea de
inters para el estudio de diversos trastornos de
ansiedad, generndose la necesidad de desarrollar
nuevos instrumentos para la exploracin fiable y vlida
de estas Preocupaciones.El AnTI (Wells, 1994), es un
instrumento de evaluacin que consta de 22 items y
evala tres dimensiones relacionadas con el contenido y
los procesos de las preocupaciones: preocupacin social,
preocupacin por la salud y meta-preocupaciones. Los
estudios psicomtricos de la versin original inglesa
muestran propiedades muy satisfactorias en cuanto a
fiabilidad y validez. El presente estudio trata de explorar
algunas caractersticas psicomtricas de una traduccin
espaola de este instrumento.MtodoTras la traduccin
de la escala por el mtodo de doble traduccin y tras un
pilotaje de la misma en 25 pacientes, se procedi a
aplicar el AnTI a 686 pacientes atendidas/os en Centros
de Salud Mental (433 mujeres -63,1%- y 253 hombres -

36,9%-, con una edad media de 37,2 aos, D.T.=12,78,


rango 15-75). Simultneamente y con vistas a la
exploracin de la validez concurrente se aplic el
Inventario de Ansiedad de Beck (Beck y cols, 1988) y, en
168 sujetos, el SCL 90R (Derogatis, 1977). En 71
pacientes se volvi a aplicar el AnTI en un periodo de 3
meses en orden a explorar la fiabilidad
temporal.ResultadosLa puntuacin media global de AnTI
es de 55,23 (D.T.= 12,16, rango 27-86) mientras que las
correspondientes a las subescalas a) Social: 23,10
(D.T.= 5,81, rango 9-36), b) Salud: 12, 65 (D.T. = 4,84,
rango= 6-24), c) Metacognicin : 19,48, (D.T. 5,12 , rango
=7-41).Los datos correspondientes a fiabilidad muestran
una consistencia interna (alpha de Cronbach) de .875, y
una fiabilidad temporal para un intervalo de 3 meses que
oscila entre una correlacin de Pearson de .625 (signif.
Bilateral=.000) para la subescala Meta-preocupacin y de
.886 para la subescala de Salud, siendo la fiabilidad para
el AnTI global de .735 (signif. bilateral =.000).En cuanto a
la validez concurrente se observan correlaciones
sustanciales y significativas (r= .589, sig. bilateral=.000)
con la puntuacin en BAI y con la puntuacin total en
SCL 90R (r=.667, signf. bilat.=000); la subescala Social
de AnTi muestra particularmente correlaciones
sustanciales y significativas con la Subescala de
Sensibilidad Interpersonal de SCL90R (r=. 688, sgnif. bil.
=000).DiscusinLos resultados obtenidos tanto en
consistencia interna como en fiabilidad temporal
muestran datos muy similares a los referidos en la
versin original inglesa (Wells, 1994). Por otra parte, la
validez concurrente muestra resultados consistentes y
prometedores que sustentan el inters de este
instrumento para el estudio de trastornos
ansiosos.ConclusionesLos resultados confirman una
satisfactoria fiabilidad y validez de esta adaptacin
espaola del AnTI. No obstante, se hace preciso
continuar explorando otras caractersticas psicomtricas
de este instrumento (estructura factorial, sensibilidad al
cambio, validez concurrente con otros instrumentos
especficos para Preocupaciones) as como, entre otros
aspectos, su utilidad para discriminar entre diversos
grupos diagnsticos.

Nivel de patologa comrbida asociada a


fobias especficas y trastornos de la ansiedad
Maria Isabel Viedma el Jesus, P Guerra; M
Blasa Sanchez, L Delgado, A Rodriguez, J
Pegalajar, J Vila, Universidad de Granada,
Spaain
Introduccin: Los trastornos de ansiedad provocan un
gran malestar subjetivo, interfiriendo y perturbando la
vida de quien los padece. Dentro de ellos, la fobia
especfica es un trastorno muy comn dentro de la
poblacin. Sin embargo, muy pocas personas con fobia
especfica solicitan tratamiento psicolgico. El objetivo de
este trabajo es aportar un valor cuantitativo del nivel de
patologa de diversos trastornos de ansiedad que ayude
a comprender el bajo porcentaje de personas que
solicitan ayuda psicolgica por este problema. Mtodo:
Han participado 88 personas; 68 han sido asignadas a un
grupo clnico con un diagnstico primario de ansiedad
(17 ansiedad social; 22 pnico con/sin agorafobia y
agorafobia; 16 ansiedad generalizada y 13 fobias
especficas) y 20 a un grupo control sin sntomas clnicos
ni subclnicos de ansiedad. A los participantes se les ha
pedido que completen el Cuestionario de ansiedad
estado-rasgo (STAI-R/ STAI-E), el Inventario de
Depresin de Beck (BDI), y el Inventario de
Preocupacin (PSWQ). Resultados: Los participantes
con un diagnstico de ansiedad muestran puntuaciones
superiores a los controles en las diversas medidas de
autoinforme. Dentro del grupo clnico, los fbicos
especficos obtienen las puntuaciones ms bajas, y ms
similares al grupo control, en ansiedad general,
preocupacin y sintomatologa depresiva comrbida.
Conclusiones: Las personas con fobias especficas
muestran menor patologa comrbida que las personas
con un diagnstico de ansiedad social, ansiedad
generalizada o pnico. Esto explicara que, a pesar de
ser un problema muy comn en la poblacin general, se
busque ayuda de manera menos frecuente.

Abordaje teraputico desde una perspectiva


cognitivo conductual de un caso de fobia
especfica al humo en un bombero.
Begona Villoria Sistach, Leal Leturia, ; Martin
Lopez, Arcega Felipe, J.I Paso, ; Bulbena
Vilarassa, Hospital del Mar Spain
Introduccin: El PRE-B es un programa especfico de
intervencin psiquitrica y psicolgica para el colectivo de
Bomberos.La fobia al humo es un subtipo de fobia
especfica caracterizada por respuestas de miedo intenso
y por conductas de evitacin ante las situaciones de
exposicin a ese factor ambiental (1).La exposicin en
vivo es considerado el tratamiento ms potente para las
fobias especficas. Objetivo: Presentar la intervencin
teraputica de un caso de fobia al humo en un bombero
y evaluar la eficacia del tratamiento.Mtodo: Se
realizaron dos entrevistas clnicas y cuatro sesiones de
exposicin. En las dos entrevistas se aplic una
intervencin cognitiva para que el paciente accediera a la
exposicin con la menor ansiedad anticipatoria posible y

con atribuciones adaptativas de sus reacciones motoras


y fisiolgicas ante la situacin fbica. La intervencin
conductual durante las sesiones de exposicin en vivo
con prcticas en situaciones reales simuladas se dise
con exposicin gradual, teniendo en cuenta el grado de
activacin, el nivel atencional, el intervalo y la duracin
de las tareas.Resultados: El paciente present buena
evolucin superando su fobia al humo, lo que le permite
desarrollar su profesin con absoluta normalidad
pudiendo afrontar todas las intervenciones sin presentar
ansiedad desadaptativa y sin realizar ningn tipo de
conducta evitativa.Conclusin: Los resultados de la
intervencin confirman la eficacia del tratamiento
aplicado y el beneficio del programa PRE-B.Referencias:
Marks, I. M. (1987): Fears, phobias and rituals. New York:
Oxford University Press.

Cross Cultural &


Global Issues
English Programme
The offensive subtype of social phobia: The
phenomenology and treatment responses.
Jung-kwang Ahn, Jung-hye Kwon; Bora Nam,;
Hyun-ki Kim, Dal-nim Cho, Department of
Psychology, Korea University Korea
The offensive type of social phobia is reported frequently
in Japan and other East Asian countries. Individuals with
this type of social phobia believe that they show
inadequate features in social interactions - their gaze,
emitting odor, facial expressions, blushing, etc. - that
make others feel unpleasant and offended. The offensive
type can be one of the qualitatively different subtypes of
social phobia. However, there have been little empirical
research about the offensive type. In this study, we tried
to examine differences between the offensive type and
the non-offensive type social phobia in clinical symptoms
and responses to cognitive behavior therapy (CBT).
Thirty-seven participants (20 men and 17 women) were
recruited from a waiting list of people who had wanted to
participate in the group CBT at Korea University Social
Phobia Counseling Center. The individuals were selected
through an individual face-to-face clinical interview using
the Korean version of the Anxiety Disorders Interview
Schedule for DSM-? (ADIS-?; Brown, Di Nardo, & Barlow,
1994). The following measures were administered before
and after the group CBT: the Korean version of Social
Avoidance and Distress Scale (SADS; Watson & Friend,
1969); the Brief-Fear of Negative Evaluation (B-FNE;
Watson & Friend, 1969); the Social Interaction Anxiety
Scale (SIAS; Mattick & Clarke, 1998); the Social Phobia
Scale (SPS; Mattick & Clarke, 1998); the Blushing,
Trembling, and Sweating Questionnaire (BTS-Q; Bgles
& Reith, 1999); the Beck Depression Inventory (BDI;
Beck & Steer, 1993); the Beck Anxiety Inventory (BAI;
Beck & Steer, 1993); the Social Interaction Self
Statement Test (SISST; Glass et al., 1982); the Taijin
Kyofusho Scale-17 (TKS-17; Kleinknecht et al., 1997,
Cho, 2005). All participants were subdivided into two
groups - the offensive type and non-offensive type - by
TKS-17 scores. Individuals with scores in the top 25%
were put into the offensive type group, and individuals
whose scores were in the bottom 25% were classified as
the non-offensive type. The offensive group and the nonoffensive group differed on nearly all pre-treatment
measures (SADS, B-FNE, SIAS, SPS, SISST, SFA).
However, there were no significant differences on BTSQ.
Individuals with the offensive subtype demonstrated
higher scores on these measures, suggesting that they
had more severe symptoms in general. A preliminary
analysis using repeated ANOVA showed that there was
no differential treatment effects between the two groups.
The results demonstrated that there were clinical
differences between the two subtypes. The offensive type
reported higher levels of social avoidance, fear of
negative evaluation, social interaction and performance
anxiety, negative automatic thinking, and self focused
attention. However, they did not differ on their physical
symptoms such as blushing, trembling, and sweating,
suggesting that there were qualitative as well as
quantitative differences between the two types. Further
research is needed to replicate these findings and
examine treatment responses to CBT and
pharmacological treatment. In addition, the question
needs to be addressed in future studies whether the
offensive type can be defined as categorical or
dimensional entity.

Relationship between Spiritual Well-Being


and meditation
Rui Bizarro, Rute Meneses, FCHS-Universidade
Fernando Pessoa, Porto, Portugal
In health settings, well-being is currently regarded as an
important endpoint of intervention. Additionally, the
acceptance of meditation as an effective intervention tool
is rapidly growing. For instances, Chang et al. (2004)
results suggested that meditation carries an improvement
in coping mechanisms, attention levels, and positive

states of mind. Being so, the aim of the present study is


to investigate the relationship between the duration of
meditation practise (DMP) and a type of Well-being:
Spiritual Well-Being (SWB). All the participants (n=90),
adults attending meditation courses, between January
and July 2006, in several Indian towns (e.g., Mysore,
Bombaim, Udaipur, Mont Abu, Jaisalmer, Varanasi,
Rishikesh, and Dharamshala) (convenience sample),
were assessed with a socio-demographic questionnaire
developed for this study and the Spiritual Well-Being
Questionnaire (SWBQ). Statistically significant
correlations were found between the DMP and: (a) the
SWBQ total score (r(90)=.29, p<.006); and (b) the SWBQ
Transcendental domain (r(90)=.37, p<.000). Statistically
significant correlations were also found between the DMP
and several items of the Personal, Community and
Environment domains. Those who practised meditation
for a longer time referred, concerning the Transcendental
domain, more personal relationship with the Divine/God
(r(90)=.39, p<.000), more worship of the Creator
(r(90)=.33, p<.001), more oneness with God (r(90)=.28,
p<.009), more peace with God (r(90)=.30, p<.004), and
more prayer life (r(90)=.29, p<.006). They also reported
more connection with nature (r(90)=.23, p<.03)
(Environment domain), more joy in life (r(90)=.22, p<.03),
and more inner peace (r(90)=.23, p<.03) (Personal
domain). As far as the item awe at a breathtaking view
(Environment domain) is concerned, the correlation was
negative (r(90)=-.21, p<.05), maybe due to of a lack of
clarity of the item. These results support the
use/recomendation of meditation from all clinicians
wanting to improve the SWB of their patients.
Nevertheless, this recommendation has to be supported
with more studies focusing patient samples. The present
results also support the importance of maintaining the
practice of meditation in order to achieve a better SWB.

A Study of Prevalence of Obsessive Compulsive Disorders and Its Comorbidity


with Psychiatry Problems in Iranian
Nonclinical Adolescents
Amini Homayoun and Ali Nasseri, Tehran
University of Medical Sciences; Hossein
Ardekani, Tehran University of Medical Sciences
Publication of Iranian adolescences epidemiology of
Obsessive-Compulsive Disorders (OCD) in nonclinical
adolescent's population has been scarce. This study was
undertaken to assess prevalence of OCD and its
comorbidity in samples of adolescent's nonclinical
population. Present study went through two stages. In
first stage ,we assess epidemiology of OCD in 920
students,472male(%51.3) and 448 females (%48.7),aged
between 14-19 years who completed Obsessive Compulsive Inventory-Revised(OCI-R)(Foa, Kozak and
Salkovskis,1998)and Maudsley Obsess ional-Compulsive
Inventory(MOCI)(Hodgson & Rachman 1977).In second
stage,106 samples who diagnosed as OCD were
interviewed and completed Symptoms Checklist-90-R
(SCL-90-R) (Derogatis , Lipman & Covi 1973). The
Prevalence of OCD were %11.5.The Prevalence of
Psychiatric comorbidity for anxiety and depression were
%81.1and %68 respectively. There were no significant
relationship between OCD and other psychiatric
problems. ). On the basis of this epidemiological and
comorbidity data, it is concluded that OCD is far more
common than was previously believed. However, good
epidemiological study in other part of world than US or
European Countries is still needed.

Chinese Masculinities and their Psychological


Effects on Men
Lau K. L., Johnny, Cheung K. L., Louis; Mak W.
S., Winnie, The Chinese University of Hong Kong
Among the studies on gender norm, a great proportion
has targeted the female population. The psychology of
men has gained social scientists' increasing attention and
the meaning of conceptual masculinities has been
modified over the past three decades. Developed by
Mahalik (2003), the Conformity to Masculine Norms
Inventory (CMNI) measured one's endorsement of 11
masculine norms in the American societies. However,
there is still a lack of comprehensive, empirical research
on masculinities and their association with men's health
among Chinese. The present study aimed at identifying a
set of masculine norms that is conformed by Chinese
men in Hong Kong. Also, it attempted to explain Chinese
men's positive and negative psychological functioning in
terms of their individual conformity to the masculine
norms. An online questionnaire was constructed for
Chinese men in Hong Kong. A sample of 744 participants
was surveyed on their profiles of endorsement of
masculine norms and their well-being, including
psychological well-being, life satisfaction, and gender role
related stress. Confirmatory factor analysis for the 94item CMNI failed to yield the 11-factor model of American
masculine norms among this Chinese sample.
Exploratory factor analysis was then performed to the
original 144-item version of CMNI and a 10-factor solution
(41.4% of total variance being accounted for) with 99
items was finally generated. Among the 10 factors, eight
were similar to the original CMNI masculine norms while
two factors that were unique to this Chinese sample were

named 'Humility' and 'Superiority'. Findings supported the


hypothesis that conformity to masculinity norms was
negatively correlated with psychological well-being (r = 0.28, p<.01) and life satisfaction (r = -0.22, p<.01) and
positively related to gender role related stress (r=0.25,
p<.01). Based on the hierarchical regression analyses,
masculine norm conformity significantly accounted for an
additional 31.4% of the variance in psychological wellbeing, 11.1% of the variance in life satisfaction, and
20.6% of the variance in gender role related stress,
ps<.001. The 10 factors generated by the revised CMNI
confirmed that conformity to masculine norms is culturally
specific. The new factor 'Humility' coincides with the Asian
value of being non-confrontive, humble, and modest (Lee
& Saul, 1997). The norm of 'Superiority' aligns with the
traditional Chinese belief that men are always the gender
with authority (Bond & Hwang, 1986). Moreover, the
present findings revealed significant and moderate
correlations between norm conformity and psychological
functioning. Implications of the revised inventory to CBT
and clinical purposes in the Chinese community are
discussed. / Deviation of Chinese masculine norms from
the American ones may reveal that using a culturally
sensitive inventory in understanding men's conformity to
masculine norms is important for building effective
therapeutic alliance with men.

Cross-cultural study of the offensive subtype


of social anxiety disorder: proposal and
reliability of Nagoya-Osaka diagnostic criteria
Yoshihiro Kinoshita, University of Southampton;
Susan Bgels, Department of Medical, Clinical
and Experimental Psychology, Maastricht
University; Ron M. Rapee, Department of
Psychology, Macquarie University; Franklin R.
Schneier, Columbia University College of
Physicians and Surgeons; Junwen Chen,
Department of Psychology, Faculty of Human
Relations, Tokai Women's University; Toshihiko
Nagata, Department of Neuropsychiatry, Osaka
City University Medical School; Toshi A.
Furukawa, Department of Psychiatry and
Cognitive-Behavioral Medicine, Nagoya City
University Graduate School of Medical Sciences
Japan
Conviction subtype Taijin Kyofu (TK) is a subgroup of
mental disorder characterized by conviction and strong
fear of offending others in social situations and had often
been considered culture-bound. Although the concept of
social anxiety disorder (SAD) could overlap with that of
conviction subtype TK, patients with this disorder would
often not be so diagnosed with the current DSM-IV. We
propose the Nagoya-Osaka Criteria, an expanded version
of diagnostic criteria for SAD which can also diagnose
conviction subtype TK, and the diagnostic criteria for the
offensive subtype. This study aims to examine the crosscultural inter-rater reliability of the proposed criteria. 18
case vignettes of patients with SAD and related disorders
were collected from 6 different countries, and 13
independent raters from 7 different nationalities gave
diagnoses for them according to the original DSM-IV and
the expanded criteria. Case vignettes of offensive SAD
were submitted from non-East Asian countries as well.
The average agreement ratio for the most frequent
diagnostic category in each case was 61.5% (SD=19.0)
with DSM-IV and 87.6% (SD=13.0) with the modified
DSM-IV with Nagoya-Osaka Criteria for SAD (Wilcoxon
signed rank test, p<0.001). In terms of diagnoses for
subtypes of SAD with the proposed criteria, the average
agreement ratio for the most frequent diagnoses in each
case was 61.5% (SD=17.1). The modified DSM-IV criteria
with the Nagoya-Osaka Criteria can improve inter-rater
reliability. The inter-rater reliability for subtypes within
SAD according to the proposed criteria was satisfactory
but warranted further refinement.

interviewed on their profiles of depression and anxiety


using the DASS-21, PANAS, and CCL. Using the median
split method, 545 participants with a mean depression
score of 9.58 (SD = 4.27) and anxiety score of 9.96 (SD
= 3.86) were selected for further analyses. Findings
indicated that both models were partially and moderately
supported. Among the depressed group (n = 457),
consistent with the tripartite model, depression is
positively correlated with negative affect (r = 0.37) and
negatively with positive affect (r = -0.35), ps < .001.
However, depression is also positively related to arousal
(r=.55, p < .001). The pattern is clearer among the
anxious group (n = 506). Whereas anxiety is positively
correlated with negative affect (r = 0.38) and arousal (r =
0.61), its relationship with positive affect is small though
significant (r = -.11, p < .01). As to their cognitive content,
the pattern is less obvious. Among the depressed group,
the correlations with depression-related cognitions and
anxiety-related cognitions are .57and .40, ps < .001,
respectively. Among the anxious group, the correlations
with anxiety-related cognitions and depression-related
cognitions are .40 and .33, ps < .001, respectively. The
present study is one of the first attempts in understanding
the specificity of depression and anxiety among Chinese
and in testing the validity of the two prevailing models.
Findings showed that the tripartite model is generally
robust in differentiating the two disorders, whereas the
cognitive patterns between the two disorders are less
clearly differentiated. Implications to the use of CBT in the
treatment of depression and anxiety among Chinese are
discussed. Validity of explanatory models of depression
and anxiety must be tested before they are applied and
used in a different cultural context. Given China is the
most populous country in the world and mental illness is
increasingly recognized as the leading burden of disease
(Murray & Lopez, 1996), attention must be put in
understanding the structure of these mental disorders in
order to design culturally relevant and effective
treatments for individuals suffering from these disorders.

Behavioral and cognitive therapy of anxiety


disorder: interest and limitation in Algeria
Benabbas Malik, Service De Psychiatry, Centre
Hospitalier Universitaire De Constantine, Algeria
The behavioral and cognitive approch to anxiety disorder
is still at its infancy in Algeria.
this is due to the ignorance of related techniques by the
majority of the practitioners and the rivaly of
pharmacological treatments. The aim of this paper is to
show the advantages of theses techniques for the
anxious patients compared to other types of treatments.
this is a prospective study concerning 30 patients affected
by anxiety disorders according to the American
classification DSM IV ( generalised anxiety disorder,
panic disorder and compulsive obsessionnel disorder and
PTSD) and who receive behavioral and cognitives
techniques in accordance to their state.
this group of patients is compared to another group
representing the same diagnostics but receiving
pharmacological treatment only ( Antidepressors and
anxiolytiques ) and the treatment lost 08 weeks. Disorder
evaluation is made according to the anxiety scale, phobia
in its french version, the list of compulsive obsessions of
Marks and the scale of Horowitz for the PTSD ) we notice
a great deal of improvement in disorders among the
group of patients receiving psychotherapeutics
techniques compared to the group following
chimiotherapeutics treatment at the symptomatic,
relationnel and emotionnel level. the contribution of
behavioral and cognitives techniques remains very crucial
and indispensable for the treatment of anxiety disorderrs
because they are beneficiant at the level of financial cost
( less expansive compared to pharmacological treatment
) as well as less and limited duration without substitution
symptoms ( compared for the other group ).

Differentiating Depression and Anxiety among


Chinese: Applicability of the Tripartite Model
and the Cognitive Content-Specificity Model
Winnie Mak and; Elaine Lam, The Chinese
University of Hong Kong

The Relationship between Taijin Kyofu (Social


Anxiety) Tendency and Assertiveness in
Japanese Students
Takashi Mitamura, Katsunori Taleshima, Junko
Tanaka-Matsumi, Kwansei Gakuin University
Department of Psychology; Masao Yokota, Nihon
University Department of Psychology Japan

Past studies have attempted to differentiate depression


and anxiety based on the tripartite model (Clark &
Watson, 1991) and cognitive content of the respective
disorders (Beck et al., 1987). According to the tripartite
model, while depression and anxiety share a general
distress factor (high negative affect), depression is unique
with anhedonia (low positive affect) and anxiety is unique
with physiological arousal. Researchers also argued that
depression and anxiety differ in their cognitive content,
with depression being characterized by cognitions related
to self-degradation, rejection, and abandonment, while
anxiety is being characterized by cognitions related to
danger, threat, and impending doom. Despite empirical
support for both models in the West, little attention has
been paid in examining the applicability of these two
models among Chinese. The present study attempted to
test the validity of these models among Chinese in Hong
Kong. Using a randomized household survey design, 941
Chinese across all 18 districts in Hong Kong were

Taijin kyofusho (TKS) is a common form of social phobia


in Japan and is featured as a Japanese culture-bound
disorder (Kirmayer, 1991). Japanese people have a
tendency to harbor anxiety in social situations due to the
cultural emphasis on complex interpersonal codes
specific to social roles people are expected to play
(Nakayama, 1989). Thus, Japanese people may easily
experience fear of interpersonal relations and social
situations. One of the differences between Japanese TKS
and social phobia is that TKS concerns a distinct fear of
offending others (Dinnel, Kleinknecht, & Tanaka-Matsumi,
2002). Wolpe (1982) observed that a fear of displeasing
and offending others is related to suffocating assertion.
Empirical studies have shown a negative correlation
between the measures of assertion and social anxiety
(e.g., Orenstein, & Carr, 1975; Mitamura & Yokota, in
press), and, consequently, assertiveness training has
proven successful in alleviating social anxieties. The
purpose of our study was to demonstrate a similar

relationship between assertion and TKS tendency in


Japanese students. A total of 366 Japanese
undergraduate students (166 males and 200 females) in
Tokyo participated in the questionnaire study consisting of
two scales. Their mean age was 19.6 (age range: 18-39
yrs). We measured assertiveness by a Japanese
language version of Rathus Assertiveness Schedule
consisting of 19 items (RAS; Shimizu, et al., 2003). We
assessed the TKS tendency by the Anthrophobic
Tendency Scale (ATS) developed in Japan to assess
one's tendency to experience anxieties in interpersonal
situations (Horii & Ogawa, 1996, 1997). The ATS
consisting of 30 items is based on a six-factor mode
consisting of Factor 1 feeling apprehensive for self and
others, Factor 2 difficulty of melting into group, Factor 3
feeling embarrassed in social setting, Factor 4 feeling
apprehensive of eye gaze, Factor 5 fear of losing
control, and Factor 6 fatigue of living. The six-factor
measurement model of the ATS provided modest fit to the
present Japanese student data, X2(390, N = 366) =
837.97; GFI = .82, AGFI = .79, and RMSEA = .067. As
expected, results revealed that RAS (M = 62.30, SD=
10.50, Cronbach's Alpha = .79 ) correlated negatively with
ATS (M = 85.58; SD = 10.50, Cronbach's Alpha = .93), r
= -.73, p < .001. More specifically, RAS correlated
negatively with each of the six factors of the ATS: Factor
1 (M = 16.08, r = -.53), Factor 2 (M = 15.14, r = -.56),
Factor 3 (M = 16.17, r = -.69), Factor 4 (M = 12.63, r =.52), Factor 5 (M = 14.19, r = -.45), Factor 6 (M = 12.36, r
= -.47), respectively, with 354 degrees of freedom for
each correlation. Cronbach's alphas of these six subscales ranged from .79 to 93. Assertion was strongly and
negatively associated with Taijin-Kyohu tendency in
Japanese students. Correlations among RAS and the six
factors of ATS indicated that non-assertive individuals
tend to fear eye contact and gaze, be embarrassed and
be afraid of losing control in social situations. These
results suggest the usefulness of developing culturallysalient assertion training for Japanese people who report
inappropriate levels of social anxieties in the form of TK
tendency.

Stigmatization of Obese Children in the


Region of Thessaly, Greece
Piperakis Stelios, ; Anastasia Triga; Maria
Zafiropoulou, Department of Pre-School
Education, University of Thessaly, Volos, Greece
Social and psychological difficulties associated with
obesity may be related to the stigma and prejudice that
obese children experience, which hinder their social
development during childhood and adolescence. Goffman
(1963) defined stigma as any personal attribute that is
deeply discrediting to its possessors; these attributes
include tribal stigmata, abominations of the body, and
blemishes of individual character. Indeed, despite its
high prevalence in the population, obesity may be one of
the most discriminated against of all physical conditions,
associated with numerous societal disadvantages. Issues
of stigma and stereotype among peers are particularly
relevant during childhood and adolescence because the
formation of adaptive social relationships is important
during these developmental periods. Unflattering
portrayals of obese persons pervade popular culture,
while multiple studies document that children, adults, and
even health care professionals who work with obese
patients hold negative attitudes toward overweight and
obese persons (Crandall and Schiffhauer 1998;
Greenberg et al. 2003). Staffieri (1967), found that boys
as young as age 6 to 7 said that they prefer to look like a
muscular silhouette and consistently assigned
unfavorable adjectives (e.g. sneaky) to overweight
silhouettes. Youth who are stigmatized for their weight or
body shape may fail to achieve normal social
development competencies and difficulties with peer
relationships may be predictive of short - and - long term
psychological outcomes. Three hundred children of upper,
middle and lower income attending 5th grade took part in
the study. The original six drawings by Latner and
colleagues 2005 were presented to participants in a
questionnaire. The drawings depicted one child with no
visible disabilities (Healthy), one holding crutches with a
brace on the left leg (crutches), one sitting in a
wheelchair with a blanket covering both legs (wheelchair),
one with no left hand (hand), one with facial disfigurement
on the left side of the mouth (face) and one child who
was obese. Their task was to put in rank order six
drawings depicting children (of the same sex with the
participant) depending on how much they liked each
child. In addition, participants' height and weight was
recorded in order to calculate Body Mass Index (BMI).
Gender calculations revealed that 52.3% were female
while the remaining percent belonged to males. BMI
scores revealed that 59.7% of the participants had
average weight, 30.7% were overweight and 8.7% were
obese, while 1% of the participants underweight. The
Healthy child was given the highest percentage among
the drawings while the obese child received the lowest.
?he healthy drawing received 60.3% as a first choice
preference, crutches received 6.3%, wheelchair
received 6,7%, hand received 6.0%, face received
15.3% and the obese child 5.3% as a first choice of
preference. The most important finding of this study was
that children were most strongly biased against the obese
child. The bias against obesity supported by this study is

reflected in recent publications that mirror several other


studies worldwide. Our results are in the process of
further analysis.

Comparison of functional & dysfunctional


cognitions from Islam & cognitive therapy
viewpoints in development & treatment of
depression
Siyamak Tahmasebi, Maryam Momen Vaghefi,
University of Welfare and Rehabilitation
MDD is a frequent psychological disorder that explained
& treated well basis on dysfunctional
cognitions(dysfunctional automatic thoughts,assumptions
& schemata).In the existential school ,there is a type of
depression named existential or meaning depression that
resulted from meaningless or having small physical
meaning.Islam attributed this depression to distancing
from God & approaching to Satan.Objective of this article
is understanding of functional & dysfunctional cognitions
from Islam & CT viewpoints in MDD & meaning
depression. This article is a review article that uses
original books and major theories to meet that goal.the
impications highlighted in the passage. The important
difference between MDD & meaning depression
cognitions is in the content. Content of functional
cognitions(Divine Cognitions) in Islam is spiritual &
transpersonal whereas in CT they are physical &
personal.Also treatment of both depression are not
different in process and structure but in the content are
some differences. Functional cognitions in Islam leads to
approaching to God & self-actualization, whereas in CT
leads to well-being.Meaning depression could
predispose MDD & treatment of it can supplement the
treatment of MDD.

Cross Cultural & Global Issues


Spanish Programme
Factores de riesgo de TCA en una muestra de
adolescentes espaoles y chilenos: Un
estudio transcultural
Paola Espinoza, ; Rosa M. Raich Escursell,
Universitat Autnoma de Barcelona Spain
Introduccin: Objetivo: comparacin transcultural de los
factores de riesgo de las alteraciones del comportamiento
alimentario, y de las actitudes y conductas alimentarias
de una muestra de adolescentes urbanos espaoles y
chilenos. Mtodo: Mtodo: Estudio realizado en una
muestra de 278 adolescentes (en Terrassa (Espaa) 172
(61,9%): 97 chicas y 75 chicos y y Via del Mar (Chile):
106 chicos (38,1%): 64 chicas y 42 chicos. De edad
media 12,96 (d.e.0,44) aos en un diseo descriptivo.
Anlisis comparativo segn pas y sexo en IMC, Dieta
personal y Dieta sociofamiliar, Influencia del modelo
esttico corporal, Actitudes y conductas alimentarias
Satisfaccin y preocupacin corporal Resultados:
Resultados: El IMC es similar en la muestra de
adolescentes segn pas las chicas de la muestra
espaola realizaban menos dieta que las chicas de la
muestra chilena y segn sexo chicas y chicos de ambas
muestras realizaban dieta en igual proporcin. La
influencia del Modelo esttico Corporal es segn pas
similar pero segn sexo las chicas de ambas muestras
informan mayor influencia del modelo esttico corporal
que los chicos. Las actitudes y conductas alimentarias
son similares en ambos pases. En satisfaccin corporal
los adolescentes chicos y chicas de la muestra chilena
presentan mayor satisfaccin corporal. En ambos
contextos los chicos informan mayores niveles de
satisfaccin, ms chicas desean perder peso y ms
chicos preferiran ser ms altos. Discusin: Discusin:
Este estudio est en la lnea de resultados de estudios
transculturales que hallan cada vez ms preocupacin
corporal e ndices de comportamientos, actitudes
alimentarias y preocupacin corporal en pases de
Amrica Latina en comparacin con muestras europeas.

Deterioro emocional y neuropsicolgico en


mujeres inmigrantes
Natalia Hidalgo, a; Isabel Lpez-Chicheri, ; M.
Prez-Garca, Peralta Ramrez, H. Robles
Ortega, Universidad de Granada Spain
Introduccin: Si bien el inters por constatar el estado de
salud mental de las personas emigradas es importante
(Mortensen, Canton-Graae y Mc Neil, 1997; Garca y
Alda, 2005), no encontramos referencias especficas
sobre su repercusin en variables neuropsicolgicas.
Nuestro objetivo es delimitar las variables emocionales y
neuropsicolgicas en mujeres inmigrantes con propsito
de adecuar nuestra intervencin. Mtodo:Participaron
voluntariamente 15 mujeres inmigrantes (Edad
Media:37,267; DT:8.956; Aos de escolaridad
media:11.267, DT:4.479) a las que se le administr el
SCL-90 (Derogatis, L. R.), la Escala de Apreciacin del
Estrs (EAE, Fernndez Seara, J.L. y Mielgo Robles, M.),
el TAVEC (Benedit, M.J.) y el STROOP (Stroop, J.R.).
Resultados: Los resultados muestran deterioro
clnicamente significativo en recuerdo inmediato y
reconocimiento del TAVEC, y deterioro moderado en el

SCL-90 (somatizacin, obsesin, susceptibilidad


interpersonal, depresin, ansiedad, hostilidad, ansiedad
fbica, ideacin paranoide y psicoticismo) y en recuerdo
a largo plazo del TAVEC. Tambin encontramos un
empeoramiento estadsticamente significativo (p <0,01)
en ansiedad, hostilidad y psicoticismo cuanto menor es el
tiempo de permanencia en Espaa. Discusin: Si bien la
mayora de los resultados encontrados no son
clnicamente significativos, se hallan puntuaciones por
encima de la media. Esto puede deberse al estrs vital
unido al estrs psicosocial al que se enfrentan para
adaptarse a las nuevas demandas del medio
desencadena respuestas fsicas, psicolgicas y
conductuales negativas. Conclusiones: El tiempo de
permanencia en el pas de acogida resulta clave en el
tratamiento. Una intervencin temprana con las personas
inmigrantes al llegar a Espaa podra evitar futuras
alteraciones psicolgicas.

Sucesos vitales estresantes en Nicaragua, El


Salvador, Chile y Espaa. Estudio
transcultural
Paulina Paz Rincn Gonzlez, Universidad Santo
Toms; Jos Juan Vzquez, Universidad de
Alcal de Henares; Sonia Panadero, Universidad
Complutense de Madrid Spain
Introduccin: El nivel de desarrollo econmico y social de
una sociedad parece influir sobre el nmero de sucesos
vitales estresantes (SVE) padecidos a lo largo de la vida
y sobre las caractersticas de los mismos. En este trabajo
se presentan los resultados de un estudio que analiza las
diferencias existentes en nmero y caractersticas de los
SVE padecidos por estudiantes universitarios de cuatro
pases con diferentes niveles de desarrollo:
nicaragenses, salvadoreos, chilenos y
espaoles.Mtodo: Participaron en este estudio
transcultural 651 estudiantes universitarios:
nicaragenses (209), salvadoreos (228), chilenos (98) y
espaoles (116). La informacin se recogi mediante un
cuestionario de carcter autoaplicado que inclua, junto a
cuestiones de carcter sociodemogrfico, una adaptacin
del LTE-Q, (Brugha y cols., 1992) para evaluar
SVE.Resultados: Los resultados muestran una relacin
entre el nmero y tipo de SVE padecidos por los
estudiantes universitarios y el nivel de desarrollo del pas,
acumulndose de una forma especial estos sucesos
entre los estudiantes universitarios de los pases menos
desarrollados: El Salvador y Nicaragua. Entre estos
estudiantes aparecen en mayor medida problemas muy
diversos como problemas en la infancia,
desestructuracin familiar, problemas de salud o
problemas econmicos.Discusin: De los resultados de
este trabajo se desprende un mayor padecimiento de
SVE por los estudiantes de los pases con menores
niveles de desarrollo. Los bajos niveles de desarrollo
socioeconmico de un pas pueden incidir en una mayor
exposicin de su poblacin a SVE por la existencia, entre
otros aspectos, de unos deficientes o inexistentes
servicios pblicos y sistemas de proteccin social junto a
mayores tasas de pobreza.

Frecuencia e intensidad y tipos de miedos en


adolescentes y adultos jvenes mexicanos:
Comparacin por gnero, edad y con
muestras australianas y estadounidenses
Mara Guadalupe Vila Ruiz, Unidad de
Investigacin en Enfermedades CrnicoDegenerativas; Milagros Ascencio Guirado,
Instituto Jalisciense de Salud Mental; Instituto
para el Fortalecimiento de la Capacidades en
Salud S.C. FOCUS Salud; Rebeca Robles
Garca, Universidad de Guadalajara; Francisco
Pez Agraz, Universidad Iberoamericana
Introduccin: De acuerdo a diversos estudios, entre el 30
y 50% de nios expresan uno o varios miedos intensos, y
stos son ms frecuentes en mujeres y en tanto menor
edad se tenga (Ollendick, 1983). Los tipos de miedos
tambin cambian de acuerdo a la etapa de desarrollo del
individuo: los miedos fsicos (a los animales, tormentas,
dao) disminuyen en la medida que pasa el tiempo, y se
acentan los miedos sociales (Graciano, DeGeovanni y
Garca, 1979). Los factores culturales impactan de
manera importante en los patrones de psicopatologa
infantil y del adolescente (Elbedour, Shulman y Kedem,
1997), con lo que resulta importante su evaluacin local
para lograr una prevencin y tratamiento sensibles al
contexto. Mtodo: Ms de 5000 estudiantes mexicanos
de preparotria completaron la versin en espaol del
Fear Survey Schedule for Children II (FSSC-II). Se
estim la frecuencia de miedos excesivos y la intensidad
de miedos en general, y se compararon por gnero
(hombres y mujeres) y por grupo etreo (14-17 aos y
18-24 aos).Resultados: La muestra consisti de 2992
mujeres y 2038 hombres con una media de edad de
16.43. La prevalencia de miedos excesivos fue de 86.5%.
los once miedos ms frecuentes fueron: que alguien de
mi familia est muriendo, ser secuestrado, tener una
enfermedad seria, sida, que alguien de mi familia tenga
un accidente, tomar drogas peligrosas, no poder respirar,
mi propia muerte, ser amenazado con un arma, la guerra
nuclear y que me atropelle un carro o camin. Hubo

semejanzas y diferencias culturales con respecto a los


reportados para australianos (Gullone y King, 1992) y
estadounidenses (Ollendick, Matson y Hesel, 1985). El
puntaje total de intensidad de miedo fue: 47.08 + 25.49.
El anlisis multivariado para la intensidad total de miedos
demostr un efecto significativo y por gnero (F=511.78,
P<.0001), pero no por grupo etreo (14 a 17 aos vs. 18
a 24 aos). La interaccin de gnero y edad fue
significativa para el total (F=4.49, p=.034), y para las
dimensiones de: miedo a la muerte o peligro (F=3.94,
p=.047), miedos al fracaso escolar o crtica (F= 3.849,
p=.050), y miedo a lo desconocido (F= 5.325,
p=.021).Discusin: La frecuencia e intensidad de miedos
en nuestra muestra se considera alta. En todos los
casos, son las mujeres adolescentes (entre 14 y 17 aos)
las que presentan mayor intensidad de miedo, en
comparacin con mujeres adultas y hombres en cualquier
rango de edad. Existen diferencias y semejanzas con
otras culturas. Una diferencia marcada es que la muestra
estadounidense punta mas alto en general, y en miedos
propios en particular (mi propia muerte, por ejemplo) en
comparacin con las muestras australianas y mexicanas,
con mi9edos principalmente externos (a que alguien de
la familia muera). Otras diferencias son ms bien
territoriales (en Australia temen a los tiburones, por
ejemplo). La muestra mexicana fue ms similar a la
australiana (vs. Estadounidense). Las similitudes ms
marcadas entre las tres culturas fueron: SIDA, que
alguien de mi familia muera y no poder respira.

Eating Disorders
English Programme
Anger regulation, autonomy-connectedness,
and eating disorders
Marrie Bekker, Tilburg University
Recent evidence suggests that autonomy-connectedness,
particularly its components self-awareness (SA) and
sensitivity to others (SO), contribute importantly to sex
differences in prevalence of mental disorders. Two
experiments were targeted on emotion-regulatory
mechanisms between these developmental personality
characteristics and disturbed behavior such as emotional
(binge) eating and restricted eating. Study 1 Methods:
High school students were randomly assigned to either
an anger-inducing condition, or a neutral condition using
the Ultimatum Game. Self-reported and behavioral anger
were assessed after the manipulation, and trait anxiety,
autonomy-connectedness, and attachment styles were
examined as dispositional factors.
Study 2 replicates Study 1 but also emotional eating and
restricted eating (cognitive and behavioral) were added
as dependent variables. Study 1
Subjects in the experimental condition were angrier than
controls, with women being less angry than men. An
interesting interaction effects appeared. Women in the
experimental condition compared to controls felt more
angry but were less willing to show their angry feelings
dependent on their level of SO; in men, the moderating
effect of SO was absent.
Study 2 Results will be presented during the conference.
Attachment-based, high sensitivity to others seems to
lead particularly women to experience stronger anger
feelings on the one hand, but more anger inhibition on
the other. If this factor also shows to play an important
role in anger regulation associated with eating disorders
(Study 2), more attention for this factor is needed in order
to improve treatment.

Cognitive Behavior Therapy (CBT): Response


Variables In Anorexia Nervosa Sybtypes.
M Teresa Bel, Ana Falces, Isabel Frigola,
Carlos Conesa, Vicente Fabregat, Raquel
Borrego, ; Antonio Corominas, Department Of
Psychiatry, Fundaci Hospital De Mollet, Spain
Several studies suggest that patients with diagnoses of
anorexia nervosa with high rates of purgative behavior
are at a higher risk of suffering from medical
complications and usually show a poorer response to
treatment. OBJECTIVE:To study the response differences
to a Cognitive Behavior Therapy Program as measured
by clinical and biological variables in purgative and
restricitve subtypes of anorexia nervosa. Sample: 21
women with diagnoses of anorexia nervosa fulfilling DSMIV criteria (11 restrictive subtype and 10 purgative
subtype). Mean age: 22.35 years (SD: 3.5). Patients
followed Cognitive Behavior Therapy in a six-month
outpatient treatment program. Weight, amenorrhea, and
clinical variables (Eating disorders Inventory -EDI-, and
Eating Attitudes Test -EAT-40) were assessed at baseline,
after the treatment period, and one year after program
finalitzation. The dependent variables (weight, EAT-40,
and EDI scores) were correlated with the variable
subtype of anorexia nervosa by using a Variance
Analyses ANOVA in a mixt design 2 X 3 with each
independent variable in every evaluation time. 'Bulimia'
EDI subscale showed significant correlation with subtypes

of anorexia (p<0.05). Furthermore, the correlations


between purgative subtype of anorexia and weight tend
to reach estatistical signification (p=0.059), as well as the
correlation between purgative subtype and EAT-40 score
(p=0.064). With regard to amenorrhea, McNemar test
was used to evaluate the differences among the
assessments at baseline and at follow-up. 16 patients (8
restrictive subtype and 8 purgative subtype) who present
amenorrhea when they are were included in the program
didn't have this symptom at the end of follow-up (p<0.01).
Patiens who met criteria for purgative subtype of anorexia
nervosa had significantly lower weight and showed more
symptoms in all of the three monitorization periods when
compared with restrictive sybtype patients. Bulimic
symptoms, use of laxatives and self-induced vomiting
were considered poor prognosis predictors. This study
confirms that purgative subtype of anorexia nervosa has
a worse course and leads to a poorer recovery from this
disorder.

MMPI-2 profiles of women with eating


disorders in a Dutch day treatment sample
Exterkate Cecilke, GGNET AMARUM Specialistic
centre for eating disorders Netherlands
This study examined the MMPI-2 profiles of 324 Dutch
patients with eating disorders at an eating disorder day
treatment program. The MMPI-2 profiles were studied in
five diagnostic eating disorder groups. The eating
disorders Anorexia and Bulimia Nervosa are distinguished
in subtypes according to diagnostic criteria in the
Diagnostic and Statistical Manual of Mental disorders
(DSM-IV) (American Psychiatric Association, 1994).
Anorexia Nervosa consists of both a restricting type (ANR), with an absence of binge eating or purging, and a
binge eating/purging type (AN-P). Bulimia Nervosa
consists of both a non purging type (BN-NP) and a
purging type (BN-P). The non purging type does not
purge frequently but exercises excessively or restricts
eating. Eating Disorder Not Otherwise Specified
(EDNOS) is a category of eating disorders where patients
have significant features and associated impairment but
fail to meet diagnostic threshold for either the category of
Anorexia or Bulimia Nervosa. All patients referred to the
day treatment program of a specialized centre called
Amarum in Zutphen, in the period 1994-2001, were
eligible for this study, 324 participants met the DSM-IV
criteria for an eating disorder. We used the Dutch
(computer-based) MMPI-2 (Derksen et al., 1993) with
national norms for the Dutch population. This Dutch
version of the MMPI-2 is a widely used assessment
instrument in Holland (Butcher, 2004). All diagnostic
subgroups showed high mean elevations of the T scores
on the same six or seven scales. Remarkable similarities
exist between the mean profile configurations. The MMPI2 distinguishes especially in that patients with restricting
Anorexia Nervosa score lower on one validity scale (F),
two clinical scales (1 and 2) and several supplementary
and content scales of the MMPI-2 compared to the other
groups. Only on the validity scale L did they score higher.
The MMPI-2 also distinguishes patients with the Bulimia
Nervosa purging type who score higher on Scale 9 and
different on several content and supplementary scales.
Results are discussed with regard to other studies of
MMPI and MMPI-2 profiles of women with Anorexia
Nervosa, Bulimia Nervosa and EDNOS in inpatient and
outpatient settings. In summary, all the diagnostic
subgroups of eating disorders showed high mean
elevations on the same six to seven clinical scales,
indicating a wide range of psychological problems, severe
psychopathology and distress. Furthermore, the MMPI-2
profile configurations of the different subgroups looked
alike, suggesting that the subgroups are more similar
than different. The highest mean elevations were in most
groups remarkably the same. Finally, the results of our
study suggest that the MMPI-2 distinguishes the five
diagnostic subtypes with the AN-R subgroup reporting the
lowest relative symptomatology on the validity, clinical,
content and supplementary scales. The BN-P subgroup
scores higher on Scale 9 (Hypomania) and has higher
scores on twelve and lower mean scores on three of the
content and supplementary scales.

Clinical and psychometric validation of a


measure of testable assumptions in the
eating disorders
Reena Dhokia, Vincent Square Eating Disorders
Service, Central and North West London
Foundation Trust; Hendrik Hinrichsen, South
West London & St. George's Mental Health NHS
Trust and Institute of Psychiatry; Caroline Meyer,
Loughborough University Centre for Research
into Eating Disorders;Glenn Waller, Vincent
Square Eating Disorders Service, Central and
North West London Foundation Trust and
Institute of Psychiatry UK
CBT for the eating disorders is most likely to be effective
when it is possible to test cognitions about the role and
function of the pathological eating behaviours. In order to
facilitate this, a measure of testable assumptions in the
eating disorders has recently been developed. This paper
reports on the clinical and psychometric validity of an

extended, 20-item version of that measure - the Testable


Assumptions Questionnaire for the Eating Disorders
(TAQ-ED-20). The measure was administered to both
clinical (N = 72) and non-clinical samples (N = 128),
along with the Eating Disorders Examination
Questionnaire (EDE-Q). The TAQ-ED-20 had acceptable
psychometric properties among both groups. It
differentiated clinical and non-clinical groups, but did not
distinguish anorexic and bulimic patients. In the clinical
group, there were specific associations between
assumptions about one's body and eating attitudes.
Among the non-clinical women, unhealthy eating attitudes
were associated with assumptions about both one's body
and one's emotions. These findings are compatible with
the transdiagnostic model, where common eating
attitudes across clinical cases are more important than
diagnostic status. They suggest that it is important to
address specific conditional beliefs when treating patients
with anorexic and bulimic disorders, through the use of
surveys and behavioural experiments.

Comparative Analysis of CT of Anorexia and


Combined CT of Anorexic Child with his
Mother
Dusanka Djurovic; Jasmina Biro, Institute for
Health Care of Children and Adolescents
Most common therapeutic treatment of Anorexia Nervosa
are Cognitive Therapy (CT) and Family Therapy. However
there were small efforts to use what's the best from both
theoretical approaches. In our clinical practice, we use
CT in the treatment of Anorexia, but we apply CT also to
the mothers of Anorexic child. That includes therapeutic
changes of ideas of perfection and high goals, as well as
stressing the importance of rational limits in education of
children. Two different approaches in CT of Anorexia was
compared. In the first approach, a usual CT was applied
on 10 patients with Anorexia, while in the second
approach, CT was applied on Anorexic child and on his
mother (also 10 patients). The effects were measured
using BMI after one month and after six month. The
results show that the combined CT of Anorexic child and
his mother has significantly better effects in the treatment
of Anorexia.

The effects of early adverse experiences on


emotional experience in the eating disorders
John Fox, Division of Clinical Psychology,
University of Manchester UK
Current thinking about aetiological processes in eating
disorders, has pointed to the importance of emotionally
abusive familial and contextual factors (Kent and Waller,
2000). Although family environments are important in the
development of personality, this is only a limited part of a
child's sociocultural experience. School and peer
relationships are also very important during development.
Bullying can also be particularly important in the
development of attitudes about weight and shape,
however little research has been undertaken examining
its specific role in development of eating disorders or
emotional experience. As well as influencing a child's
development of his/her core beliefs and schemata,
emotionally aversive experiences can prevent the child
from developing functional coping strategies thereby
forcing them to seek some form of avoidance or
dissociation. Heatherton & Baumeister (1991) postulated
that binge-eating offers individuals an escape from selfawareness, in that it narrows experience of sensations,
removing concerns about expectations, norms and longlasting implications of actions. More recent models of
bulimia have begun to incorporate these positive beliefs
about binge-eating. Research has begun to suggest that
anger and disgust are of particular importance in eating
disorders, and bingeing and self-starvation may serve to
avoid the experience of painful emotions. Therefore the
aims of the present study are to examine which basic
emotions underlie eating disorder symptomatology, and
how particular early experiences may influence an
individual's experience of particular emotions. The
present study compares 3 all female groups - an eating
disorder group (n=61), a general psychiatric group (n=30)
and a 'normal' student group (n=100). Participants
completed a number of measures, looking at early life
experiences, particularly home environments and
childhood bullying, levels of state and trait emotions and
levels of eating disordered, depressive and anxious
symptomatology. People who reported that they were
bullied several times a week had significantly higher EAT26 scores than those who were never bullied, when
abuse and neglect were controlled for. Individuals were
more likely to inform an adult if they came from a less
punitive home environment, and those who did not tell
anyone reported higher levels of eating disorder
symptomatology in later life. However, those who told an
adult who did not contact the school to try and counteract
the bullying, subsequently had higher levels of bulimic
symptomatology. The eating disordered group scored
significantly higher than the general psychiatric control
group on both state and trait levels of disgust, . Those
who told an adult who did not contact the school to try
and counteract the bullying, had higher state levels of
disgust. It appears that bullying may be an important
factor in the development of eating disorders, when it
occurs combined with a punitive home environment. The

likely mechanisms of this are discussed, along with the


impact of the combination of a more global punitive
environment on emotional development. It seems that
high levels of disgust are associated with eating disorder
symptomatology and bullying, however no such
association with anger was observed, and possible
reasons for this are also addressed.

Eating disorders in men: clinical features


Ignasi Garrido, Eating Disorders Unit. Hospital
Mtua de Terrassa. Barcelona. Spain; Maria
Luque, Antonia Amaro
Men with anorexia and bulimia nervosa account for 10%
of people with these disorders. However, for binge-eating
disorder (BED), this percentage rises to 25%. The aim of
this study is to describe the clinical features of male
patients attended at our Eating Disorders Unit. The initial
sample consisted of 38 men who were referred to our unit
between 1994 and 2006. These patients represent the
4,5% of the patients attended. We present demographic
and clinical variables. In a second analysis, we excluded
patients with another axis-I disorder who was primary to
the eating disorder. Patients with some missing data
were also excluded, but this did not affect the distribution
of diagnosis. The final sample consisted of 22 patients.
We used the EDI-2, EAT-40, BSQ and BDI to measure
eating behaviour and mood. Due to the small size of our
sample, we grouped anorexia and EDNOS-subtype
anorexia (AN) in one group, and bulimia and EDNOSsubtype bulimia (including BED) (BN) in another group.
Several studies show that major eating disorders and its
EDNOS subtypes share the main features. We compared
both groups with non-parametric tests. There is an
increase of male patients attended at our unit. Of the
whole male patients, the 8,1% met criteria of anorexia
nervosa, 18,5% bulimia nervosa, and 65,8% EDNOS,
according to DSM-IV criteria. Within the EDNOS group,
the 32% met criteria of BED. The mean age was 26,9
years. With the final sample (n=22), 45,5% met criteria of
anorexia or EDNOS-anorexia (n=10), and 54,5% met
criteria of bulimia or EDNOS-bulimia (n=12). BMI was
statistically different between both groups. Within the BN
group, patients with BED had a higher BMI than the other
BN patients. Results of psychometric measures show
some differences between AN and BN groups, unless
they do not reach statistical significance, due to the small
size of groups. Even though there may be an increase in
eating disorders in men, it is still difficult to have big
samples. Future studies should address the comparison
between male and female patients in clinical features and
in prognosis.

The interaction between perfectionism, selfesteem, worry, and meta-worry in eating


disorders
Ruggiero Giovanni Maria, Studi Cognitivi, Postgraduate Cognitive Psychotherapy School,
Milano, Italy; Sara Bertelli, Eating disorders unit,
Ospedale san Paolo, Milano, Italy; Luca
Boccalari, Eating disorders unit, Silvio Scarone,
Eating disorders unit, Ospedale san Paolo,
Milano, Italy; Patrizia Todisco, Eating disorders
unit, 'Spedali Civili di Brescia, Italy
In scientific literature, perfectionism and self-esteem are
generally considered as the most important non-adaptive
cognitive beliefs in eating disorders. More recently,
research has shown that worry is another maladaptive
cognitive process present in eating disordered subjects.
In turn, maladaptive cognitive beliefs and processes are
maintained by metacognitive beliefs, called meta-worry.
The study aims to explore the interaction between all the
above mentioned cognitive and metacognitive beliefs. 48
bulimic patients and 36 anorexic patients, as well as 38
nonclinical volunteers, completed 4 measures of cognitive
and metacognitive dimensions: the Multidimensional
Perfectionism Scale, the Rosenberg Self-Esteem Scale,
the Penn State Worry Questionnaire, and the
Metacognition Questionnaire The study shows that
perfectionism, worry, and meta-worry are present in
higher degree in eating disordered subjects than in
control and that eating disordered subjects show lower
levels of self esteem scores than control. In addition,
multiple linear regression suggests that worry moderates
the psychopathological role played by perfectionism and
self-esteem in eating disorders. On the other hand, metaworry seems not to play a role as an underlying factor for
eating disorders. Meta-worry in eating disorders may be a
side effect of worry.

Emotion Dysregulation and Impulsivity in


Clinical and Non-Clinical Samples
Michelle Hanisch, Natalie Loxton, University of
Queensland; Analise O'Donovan, Griffith
University Mt Gravatt QLD, Australia
Many disorders in the DSM-IV contain criteria that reflect
both impulsivity (IMP) and emotion dysregulation (EmD)
(e.g. Bulimia Nervosa, Binge Eating Disorder). However,
while these dimensions are theoretically related few
studies have examined the contribution of both these
concepts in combination. Indeed, recent

conceptualisations of IMP have included an EmD facet


(e.g. 'urgency' the tendency towards impulsive behaviours
in the face of negative affect; Whiteside & Lynam, 2001)
and recent additions to models of bulimia have included
an EmD factor (mood intolerance; Fairburn et al. 2003).
Further, mindfulness-based interventions have shown
promising results for disorders characterised by EmD and
IMP (Linehan, 1993; Marlatt & Kristeller, 1999) as well as
for bulimia and binge eating disorder (Kristeller et al.
2006; Safer et al. 2001). To examine the relationship
between EmD and IMP in eating disorders, two studies
were conducted. The initial study explored the
relationship between IMP and EmD and disordered eating
in a non-clinical university sample. The second study
examined the same relationships in a clinical population
both pre- and post- an 8-week Mindfulness intervention. A
range of measures were used for both studies.
Participants in both studies completed measures of IMP
(BIS-11, Patton, et al. 1995; SPSRQ, Torrubia et al.,
1995; UPPS, Whiteside & Lynam, 2001) and EmD
(DERS, Gratz & Roemer, 2004; TMMS, Salovey et al.
1995), as well as the EDI-3 (Garner, 2004); a measure of
disordered eating. Forty-three students completed the
self-report measures in exchange for course credit.
Women meeting criteria for BN or BED attended an 8week Mindfulness program specifically for eating
disorders, completing measures at pre-treatment, mid-,
and post-treatment. Preliminary results indicate that EmD
and IMP are separate constructs. Early data indicate that
only the IMP facet of urgency is related significantly to
measures of ER and to eating disorder symptoms both in
clinical and non-clinical populations. Initial data suggest
that Sensitivity to Reward is not significantly related to BN
or BED symptoms, as has been found in previous
research (Dawe & Loxton, 2004). Measures of ER were
significantly related to BN and BED. There were
significant decreases pre- to post-treatment on measures
of EmD, IMP and Mindfulness. Additionally, there were
significant decreases in both BN and BED symptoms as
measured by the EDI-3. Although results are preliminary
and need to be explored further, this study may be able to
elucidate whether IMP and EmD are central aspects of
BN and BED as indicated by the DSM-IV. In order to
improve treatment for women suffering from these
disorders, it is essential to understand the nature of the
influence each factor has upon the other and whether
they are amenable to change.

Cognitive behavioral marital psychotherapy:


does the overlap with marital counseling
help?
Helen Heinz, Greek Association of Behavioral
Research-Branch of Macedonia
The proposed poster represents an attempt to examine
the relationship between marital counseling and marital
cognitive behavioral psychotherapy.
As working definitions, I consider counseling as an
intervention which focuses on the here and now reality
situations and helps one become better equipped to deal
with various life situations. On the other hand,
psychotherapy aims at assisting one's awareness by
mastering inner conflicts and patterns that have
previously determined one's thoughts, feelings, actions
and decision making skills. Marital counseling focuses
mainly on the marital problems attending the couple's
relationship as client. On the other hand, marital
psychotherapy focuses on the marital problems through
the understanding of the inner personal and probably
unresolved conflicts each spouse has and projects on the
relationship. Should these two approaches be combined
or should they by applied separately as if the one
impedes the results of the other?
It is a common phenomenon in marital intervention the
spouses to demand from the specialist a quick
improvement in order to resolve the emerged crisis in
their marriage. Recognizing the pressure the relationship
faces, it is also very common to the specialist to proceed
to suggestions based on the information spouses give
concerning their interaction at the present time. This
pressure can be proved helpful, but it is not a stable
solution.
Taking into account the fact that the demand for an
immediate resolution of the marital conflict cannot be
satisfied without an understanding of the personal frame
of each spouse [an accept adopted by both counseling
and psychotherapy], it seems that the marital specialist
acrobates between counseling and psychotherapy. A
marital case study is presented in order to show the
overlap between marital psychotherapy and counseling.
The applied model was a combination of cognitive
behavioral therapy and communication training based on
a systemic formulation. Through examples based on the
sessions of the applied treatment, it is demonstrated the
need for an understanding of the spouses' history and of
their interaction system in order to apply either a
psychotherapeutic technique or counseling. The given
suggestions aimed at an immediate relief of the crisis, but
they presupposed the understanding of the marital
system and the projections the spouses made based on
their personal family history. The presented case study is
a common case in clinical praxis. In order to be treated, it
demanded the combination of counseling and the
detection of the spouses' personal histories. The question
which arises is whether the application of counseling

should be independent from the spouses' personal history


and should focus only at the marital symptom or
whether psychotherapeutic intervention should be the first
preference at marital crisis. In other words, where are the
boundaries - if any- between marital counseling and
marital therapy? Should they be distinct or is it a
necessary and effective coexistence, both helpful to the
specialist and to the resolution of the marital problems
too? It seems that they should coexist!

The Relation Among Eating Behavior, Body


Image And Personality Factors: A Brazillian
Overview
Denise Heller, Talita Marques, Maria da Graa
Padilha, Universidade Tuiuti do Paran Brazil
Eating disorders are psychopathologies characterized for
a sick relation between food and thoughts related to
weight, body image and social acceptance. The present
study intends to identify and to correlate eating behavior,
body image and personality factors to evaluate which of
them would be more connected to the development of
such psychopathologies. 50 students, male and female
(18 to 25 years old) from a private Brazilian university
participated. For the data collection were used following
instruments: Eating Attitude Test (EAT-26), Body Shape
Questionnaire (BSQ) and the Inventory of Personality
(IFP). Results were obtained with the Stepwise method
and it points to the body image indicating an eating
behavior disturbance (p = 0,73 e R2 = 0,53). That
shows the distortion in the body image as the most
responsible factor for a prediction to an inadequate eating
behavior. Such distortion is related to the current Brazilian
beauty pattern: leanness and muscle definition. This
study shows the importance of identifying what variables
predict eating disorders to enable efficient preventive
actions avoiding these disorders to become a public
healthy problem as the obesity nowadays.

Eating Disorder Behaviors in univeristy


female athletes and nonathletes
Suet Hon, The Chinese University of Hong Kong
The number of university students participate in athletics
has been increasing in the past years. Female athletes
concern with their body weight and appearance a lot
more than the male athletes. In some cases, female
athletes were suffered from the eating disorder problems
and that affect their performance and school life. This
study aims at comparing disordered-eating symptoms
between university female athletes and nonathletes.
Participants include 60 university female athletes and 60
female nonathletes. All participants filled in the Eating
Disorder Inventory-2, a self report measure of 91 items,
and self reported weight and menstrual funtion. No
significant difference was found in body dissatisfaciton
between female athletes and nonathletes. No difference
in mean body weight was noted between the two groups.
Nonathletes were classified as having a high risk for
disordered eating. In the study, female athletes did not
exhibit more disordered-eating symptoms than woman
who did not participate in sports.

Increasing implicit self esteem in children


using evaluative conditioning
Jorg Huijding, Erasmus University Rotterdam;
Arjan Bos, Erasmus University Rotterdam
Self-esteem, the overall evaluation of one's worth or
value as a person, is a construct that has been found to
play an important role in the mental and social
development of children and adolescents. It has been
proposed that low self-esteem may compromise healthy
development in children, and may for instance be related
to aggression. Therefore it seems important to investigate
possibilities to increase self-esteem. Until recently,
virtually all research on changing self-esteem focussed
on explicit, self-reported self-esteem. More recently,
however, researchers have made a distinction between
(self-reported) explicit and implicit self-esteem. Implicit
self-esteem refers to automatic and possibly unconscious
evaluations of the self. There is some recent evidence to
suggest that implicit self-esteem can also be successfully
changed using evaluative conditioning (e.g., Baccus et
al., 2004). Meanwhile, no studies have explored whether
implicit self-esteem can also be changed in children in
this way. Given the alleged role of self-esteem in the
healthy development of children and adolescents the
present studies aimed to test whether the computerized
evaluative conditioning procedure that was successfully
used in adults by Baccus and colleagues (2004) can also
be used to increase self-esteem in children, and whether
this manipulation also influences aggression. A group of
133 primary school children between the ages of 10 and
13 years old were randomly assigned to the experimental
or the control condition. All children first completed the
Rosenberg Self-Esteem Scale, followed by the evaluative
conditioning task. During this task children in the
experimental condition always received positive feedback,
in the form of a smiling face, in response to self-relevant
stimuli, whereas children in the control condition received
positive, neutral or negative feedback. Following this task
all the children completed a reaction time measure of
implicit self-esteem (IAT) and another self-report measure

of explicit self-esteem (a Dutch version of the Self


Perception Profile for Children). Finally, we assessed
aggression using the 'hot sauce' paradigm, in which
children were asked to indicate how much of a very spicy
(hot) sauce they would have another individual eat, after
this individual purportedly had given them a big portion of
the sauce to eat. In line with Baccus (2004) we found that
children in the experimental group showed a significantly
higher implicit self-esteem on the IAT than did children in
the control group. In addition, the children in the
experimental group showed less aggression than did
children in the control group. Meanwhile, no significant
relation between implicit self-esteem and aggression
emerged. In line with earlier findings implicit and explicit
self-esteem were unrelated. These findings suggest that
implicit self-esteem in children may relatively easily be
increased using a computerized evaluative conditioning
task. In addition the task seemed to have an effect on
aggression. Although both effects were rather small and
need replication, these findings are promising and
warrant further research.

Unwanted Intrusive Thoughts And Eating


Disorder Symptomatology: AN exploratory
study in children.
Lucia Igualada, Universidad San Vicente,
Valencia, Spain; Conxa Perpia, ; Amparo
Belloch, Faculty of Psychology, University of
Valencia, Spain
Since the earliest descriptions of anorexia nervosa (AN),
the presence of obsessive symptoms have been
underlined. (Serpell et al., 2002). Retrospective studies
have shown that a significant percentage of patients with
AN do display premorbid obsessive-compulsive
symptoms; that is, the relationships between both clinical
presentations seems to have early manifestations. The
aim of the present study was to study the relationship
between intrusive thoughts analogous to obsessions and
dysfunctional attitudes and behaviours related to body
and eating in early ages. The participants were 120
children from public schools in Valencia, Spain, (64 boys,
56 girls; age range:12-16; Mean: 13; SD: 0.82).
Measures: The Obsessional Intrusive Thoughts Inventory
for children (INPIOs-C; Igualada et al, 2006), is a 43-item
self-report questionnaire concerning
thoughts/images/impulses (27 items) and overt and
covert behaviours (16 items) of aggression, doubts, sex,
dirt/contamination, hoarding, checking and counting.
Respondents rate each statement on a 7-point scale from
0 (never) to 6 (everyday).The internal consistency was
high (a= 0.92). The Children's Eating Attitudes Test
(ChEAT; Maloney et al., 1988), is the children's version of
the EAT, designed to measure attitudes and behaviors
related to food, body and eating in children under 15. The
internal consistency obtained in the present study was
high (a= 0.87). The mean sample in INPIOs-C was 42.33
(SD: 27.4), and in ChEAT 6.85 (SD: 8.23), indicating that
the participants obtained low scores although with an
important variability. No differences in sex were found.
The correlations (Pearson) were different in boys and
girls. In the boys group, the Fear of Getting Fat was
significantly correlated with the four factors of INPIOS-C
(r range: 0.37-0.51; p<0.01); Food Preoccupation
correlated with 3 INPIOs factor (but Checking and
Repetition subscale) (r range: 0.27-0.43; p<0.05-0.01),
and Social Pressure to Eat correlated with two
subscales: Doubts and Contamination (r: 0.27, p<0.01),
and Magical Thinking/Superstition (r: 0.49, p<0.05). In
the girls group, the Fear of Getting Fat factor was
significantly correlated with the four factors of INPIOS-C
(r range: 0.31-0.53; p<0.01); Food Preoccupation
correlated with 3 INPIOs factor (but Aggression and NoConvenient Behavior subscale (r range: 0.29-0.51;
p<0.05-0.01), and Social Pressure to Eat correlated only
with Magical Thinking/Superstition (r: 0.27, p<0.01).
When the subjects were divided in two groups on the
basis of the cut-off point of the ChEAT >= 15 (18 subjects
above this point, 12 girls), the t-test in each INPIOs-C
subscales were significant (p<0.02-0.0001). Whereas
'Fear of getting fat' was related to the same pattern of
unwanted instrusive thoughts in boys and girls, 'Food
preoccupation' and 'Social pressure to Eat' factors were
different in function of sex: notice that 'Checking and
repetition' was present not only in 'Fear of getting Fat' but
also in 'Food Preoccupation' only in girls. When
subclinical eating disordered subjects were selected, they
presented the highest scores in intrusive thoughts with
obsessive content. These results are in consonance with
those studies indicating the importance of the interplay
between eating disorder symptoms and the experience of
intrusive thoughts analogous to obsessions.

The Effects of Multidimensional Perfectionism


and Emotion Regulation Style on Eating
Disorder Behaviors
Hyun Gang Jung, Gyeongja Oh, Yonsei
University of Korea
The purpose of this study was to investigate the effects of
multidimensional perfectionism and emotion regulation
style on abnormal eating behaviors. Previous research
has shown that binge eating behavior and anorexic
behavior are different in temperament and personality

trait characteristics (Diaz-Marsa et al. 2000; Vervaet et al.


2004). Perfectionism and emotion regulation style are two
personality characteristics which have been reported to
be associated with eating disorder behaviors (Tyrka et al.
2002; Fairburn et al. 1999; Murphy et al. 2000; Johnson
et al. 1987), but there has been little research on how the
two personality characteristics differently contribute to
binge eating and anorexic behavior. The Korean version
of multidimensional perfectionism scale (MPS; Hewitt &
Flett, 1991a ; Lee et al. 1998), Emotion Regulation Style
Check List (yoon, 1999) and Eating Attitude Test26(KEAT-26; Lee et al. 1998) were administered to 241
college women (mean age SD of 22.8 4.85). MPS
consists of 45 items assessing three dimensions of
perfectionism (self oriented perfectionism, other oriented
perfectionism, socially prescribed perfectionism). Emotion
Regulation Style Check List has three subscales of
emotion regulation style (avoidance/distraction style,
support-seeking style, active style). KEAT-26 consists of
three factor scores: dieting-the degree of avoidance of
fattening foods and preoccupation with being thinner;
bulimia and preoccupation with food; and oral control-the
degree of self-control around eating and the perception of
pressure from others to gain weight. Hierarchical
regression analyses revealed that multidimensional
perfectionism and emotion regulation style significantly
influenced binge-eating behavior. Other-oriented
perfectionism( = .210, p < .05) and socially-prescribed
perfectionism ( = .210, p < .05) among 3 subtypes of
perfectionism were significantly predictive of binge eating
behavior. Avoidance/distraction style( = .222, p < .001)
and support-seeking style( = .177, p < .05) among 3
subtypes of emotion regulation style predicted binge
eating behavior above and beyond perfectionism.
Furthermore, interaction between self-oriented
perfectionism and avoidance/distraction style( = -.177, p
< .05) also influenced binge eating behavior.
Perfectionism significantly influenced anorexic behavior
as well, but unlike binge eating behavior, it was selforiented perfectionism( = .225, p < .05) and socially
prescribed perfectionism( = .137, p < .05) that were
predictive of anorexic behavior. The main effect of
emotion regulation styles on anorexic behavior(= .229, p
< .05) was not significant. The present study showed that
personality characteristics contributing to binge eating
behavior and anorexic behavior might be different. While
both perfectionism and emotion regulation style
significantly contribute to binge eating behavior,
contribution of emotion regulation style was not significant
for anorexic behavior. Further, specific aspects of
perfectionism involved were different for the two types of
eating disorder behaviors. The findings suggest a need to
consider different intervention strategies for binge eating
and anorexic behaviors.

Eating Disorders: Relationship between


Depressive Symptomathology and disordered
Behaviours and Cognitions
Maria Luque, Eating Disorders Unit. Hospital
Mtua de Terrassa. Barcelona. Spain; Ignasi
Garrido, oi Amaro
Eating Disorders (ED) are a complex multifactorial
phenomena. These disorders show cognitive distortions
and behavioural alterations associated to diet, weight and
shape. They are often associated to psychopathology,
predominating afective-like disorders. The aim of this
study is to establish the relationship beween depressive
symptomathology and disordered behaviours and
cognitions in patiens suffering from ED, as well as to
assess the differences between patients with Anorexia
Nervosa (AN) and patients with Bulimia Nervosa (BN).
Subjetcs: The sample consisted of 70 patients
accomplishing DSM-IV criteria for ED (36 patients with
AN and 34 patients with BN). These patients had been
attended at the Eating Disorders Unit of the Hospital
Mtua de Terrassa Material and Procedure: An initial
interview was conducted at the beginning of each
assessment. Information on demographic variables,
including age, family situation and level of education, as
well as the history of the disorder was obtained from all
subjects. The Beck Depression Inventory - BDI (Beck,
1961) and the Eating Disorder Inventory 2 - EDI2
(Garner, 1991) were used to assess depressive and
eating symptomathology, respectively. Results show
significant correlations between EDI2 scales and BDI.
This relationship is specially significant with the 'Drive for
Thinness' scale, which shows the role of cognitions in
both depressive and eating disorders. Even though we
have found a relationship between depression and eating
disorders, we cannot conclude whether depression is
primary or secondary to eating disorders. However, the
high prevalence of depression in eating disorder patients
suggests the importance of taking into account the
depressive symptomathology in the treatment of these
patients.

Alexithymia in patients with Eating Disorders


Paula Matos, Ana Bessa,Faculty of
Psychology/Unversity of Psychology; Jos
Gouveia, Faculty of Psychology/University of
Coimbra Portugal

Alexithymia is characterized by difficulties in identifying


and communicating feelings, an impoverished imaginative
life, and an externally orientated cognitive style.
Investigations have been conducted to examine the
relationships between eating disorders and alexithymia.
Several studies found high rates of alexithymia among
patients with anorexia nervosa or bulimia nervosa. In
clinical practice, patients with eating disorders present
difficulties in identifying their feelings accurately and
communicating them to other people. They seem to have
problems in self-regulation of distressing emotional states
(Taylor, Parker, Bagby & Bourke, 1996). In this study we
will examine the relationships between alexithymia and
psychological characteristics and behaviors associated
with eating disorders (assessed by EDI - drive for
thinness, bulimia, body dissatisfaction, ineffectiveness,
perfectionism, interpersonal distrust, interoceptive
awareness and maturity fears). Moreover we will analyze
relationships between alexithymia, depression and
anxiety. Additionally, we want to study these variables
comparing anorexia nervosa and bulimia nervosa and
comparing eating-disordered patients with normal
population and with psychiatric population. In this study
we will include two clinical samples (patients with eating
disorders and psychiatric patients with other diagnosis)
and a group of normal population.
The following instruments will be used: the 20-item
Toronto Alexithymia Scale (TAS-20; R.M. Bagby, J.D.A.
Parker, & G.J. Taylor, 1994); the Beck Depression
Inventory (BDI; Beck, Ward, Mendelson, Mock &
Erbaugh, 1961); the Beck Anxiety Inventory (BAI; Beck,
Epstein, Brown & Sterr, 1988); and the Eating Disorders
Inventory 2 (EDI-2, Garner & Olmstead, 1984; Garner,
Olmstead, & Polivy, 1983). We hypothesize that
alexithymia is high in eating disorders and that it is
associated with anxiety and depression. Moreover we
think that alexithymia correlates more significantly with
some specific dimensions of EDI. Results of our study
will help to identify specific relationships between
alexithymia and eating disorders and to better understand
the association between alexithymia, depression and
anxiety. These data can be used to improve the treatment
of eating disorders.

Interpersonal competence and quality of


relationships in eating disorders
Paula Matos, Ana Silva, Jos Gouveia, Faculty
of Psychology/ University of Coimbra Portugal
The complex etiology of eating disorders necessitates
complex interventions. As a result, treatment of eating
disorders has included a wide range of approaches
ranging from interpersonal models to family-based
therapy and to cognitive-behavioural therapy (Wilson &
Fairburn, 1993).
To best treat eating disorders it is necessary to know
which specific aspects of the social arena are generally
found to be problematic among these patients.
Interpersonal problem-solving skills, relationships quality,
perceived social support and interpersonal competence
have therefore been evaluated frequently in this
population (Worobey, 2002). Research findings indicate
that subjects with eating disorders tend to demonstrate
social impairment. In addiction, limited interpersonal
problem-solving skills have been associated with
heightened social anxiety and decreased social
interactions (Striegel-Moore, Silberstein, & Rodin, 1993).
The current investigation explores associations between
interpersonal competence, quality of relationships and
social anxiety. We want to study if these interpersonal
factors are related specifically to eating disorders. We will
use the Interpersonal Competence Questionnaire (ICQ,
Buhrmester, Furman, Wittenberg & Reis, 1988). This 40item questionnaire was designed to assess five domains
of interpersonal competence: initiating relationships,
disclosing personal information, asserting displeasure
with others, providing emotional support and advice, and
managing interpersonal conflict. The quality of current
relationships will be assessed by the Quality of
Relationship Inventory (QRI, Pierce, Sarason, & Sarason,
1991). The QRI was developed to assess the perceived
availability of social support from specific relationships.
The dimensions evaluated by the QRI are social support,
conflict and depth. The Social Avoidance and Distress
Scale (SAD, Watson & Friend, 1969) and the Fear of
Negative Evaluation Scale (FNE, Watson & Friend, 1969)
are also used and they assess social anxiety. The Brief
Symptom Inventory (BSI, Derogatis, 1982) is also
included and it evaluates psychological problems,
including nine dimensions (somatization, obsessivecompulsive, interpersonal sensitivity, depression, anxiety,
hostility, phobic anxiety, paranoid ideation and
psychoticism). The Eating Disorders Inventory 2 (EDI-2,
Garner & Olmstead, 1984; Garner, Olmstead, & Polivy,
1983) evaluates the following dimensions: drive for
thinness, bulimia, body dissatisfaction, ineffectiveness,
perfectionism, interpersonal distrust, interoceptive
awareness and maturity fears. This research involves a
clinical sample of patients treated for eating disorders.
We will compare eating-disordered patients with patients
that suffer from others psychopathological disorders and
with normal population. We will also compare subgroups
of eating disorders (Anorexia Nervosa vs Bulimia). We
will evaluate the comorbidity in the patients groups. The
sample of eating disordered patients is collected in an

eating disorder treatment unit in a hospital setting. It is


hypothesized that patients with eating disorders would
exhibit lower interpersonal competence and quality of
relationship, and higher social anxiety. Improving our
knowledge about interpersonal competence, quality of
relationships and social anxiety in eating-disordered
patients will allow to a better understanding of the
relational life of these patients and may provide additional
information for their treatment.

Attachment and eating disorders: can the


past influence the present?
Paula Matos, Elisa Guerra, Jos Gouveia;
Faculty of Psychology/University of Coimbra
Portugal
Eating disorders are seen as a current problem. They are
more and more common in industrialized societies, and
affect predominantly young women. A variety of
sociocultural, emotional, physical, individual and family
factors have been suggested as contributing to or
causing the development of eating disorders.
Disturbances in attachment have been linked with eating
disorder symptomatology. Attention has mostly focused
on the early relationships between children and their
parents. The attachment, a specific kind of affective bond
that begins at birth and goes to adulthood, is
conceptualized as the propensity of human beings to
make strong affectional bonds to particular others
(Bowlby, 1977). A significant number of studies of
adolescents and adults with eating disorders have
reported retrospective accounts of parenting experiences
(Brown, L.S. & Wright, J., 2001). Difficulties in
development of a secure attachment have been
considered as risk factors to the development of eating
disorders. The quality of attachment is thought to
influence psychological functioning. In our study,
attachment is conceptualized as a variable that can
predispose to eating disorders. We try to examine the
relationships between attachment styles and the
development and maintenance of eating disorders.
Additionally, we want to relate attachment status to
specific problems present in eating-disordered patients:
drive for thinness, bulimia, body dissatisfaction,
ineffectiveness, perfectionism, interpersonal distrust,
interoceptive awareness, maturity fears. We will use the
Adult Attachment Scale - R (AAS-R, Collins & Read,
1999) and The Eating Disorders Inventory 2 (EDI-2,
Garner & Olmstead, 1984; Garner, Olmstead, & Polivy,
1983), which are self-reports instruments. This study
involves a clinical sample of patients treated for eating
disorders. As we want to study the specificity of the
findings for eating disorders, we will compare the
subgroups of eating disorders (Anorexia nervosa vs
Bulimia), and the eating-disordered patients with a
general psychiatric population (patients with axis I an II
psychopathological disorders) and with a group of normal
population. We will screen out the comorbidity in patients
groups. We expect that insecure attachment is common
in eating-disordered patients, reflecting
anxious/ambivalent and/or avoidant patterns. Theoretical
explanations for these relationships are considered
alongside implications for clinical practice and research.

Does disgust enhance eating disorder


symptoms?
Birgit Mayer, Arjan E.R. Bos, ; Peter Muris, ;
Jorg Huijding, ; Martha Vlielander, Erasmus
University Rotterdam Netherlands
During the last decade, various studies have explored the
relationship between disgust and eating disorders. As
disgust is strongly related to food choice and food
rejection, which both seem to play a role in eating
disorders, it seems plausible to hypothesize that these
concepts are intimately related. Some studies indeed
suggest a relationship between disgust (sensitivity) and
eating disorders. However, so far, none of the studies
tried to clarify the causality of the relationship between
disgust and eating disorders. The present study describes
an experiment in which the hypothesized causal
relationship between disgust and eating pathology was
investigated. Fifty female undergraduate students were
either assigned to an experimental condition in which
feelings of disgust were induced by means of a bad
smelling odorant, or to a control condition in which no
such disgust manipulation was carried out. Both
experimental and control subjects were asked to
complete questionnaires for measuring various eating
disorder-related concepts (i.e., self-esteem, body esteem,
restraint eating, body change strategies, and food
craving). In addition, participants were tested explicitly
and implicitly with regard to their preference for highcaloric food. Participants in the disgust condition were
expected to display higher levels of eating disorderrelated characteristics and a decreased preference for
high-caloric food than control women. Results
demonstrated that subjects in the disgust condition did
not report lower self-esteem or body esteem, and did not
show higher levels of restraint eating behavior or other
body change strategies. Furthermore, women in the
disgust condition did not display a decreased explicit or
implicit preference for high-caloric food. As far as we
know, this is the first study that investigated the
hypothesized causal link between disgust and eating

disorder symptoms. The results of the present study


seem to indicate that there is no causal relationship
between feelings of disgust and eating disorder
symptomatology in young females.

Clarifying the role of impulsivity in dietary


restraint: a structural equation modelling
approach.
Olivia Mobbs, Paolo; GHISLETTA Methodology
and Data Analysis Unit, University of Geneva,
Switzerland, Martial; Van Der Linden Cognitive
Psychopathology and Neuropsychology Unit,
University of Geneva Switzerland
Impulsivity plays an important role in eating disorders.
However, impulsivity is still poorly defined. Recently,
Whiteside and Lynam (2001) identified four components
of impulsivity based on a factorial analysis conducted on
several measures of impulsivity. The four components
are: (1) Urgency, defined as the tendency to experience
strong impulses, frequently under conditions of negative
affect; (2) Premeditation, defined as the tendency to
think and reflect on the consequences of an act before
engaging in the act; (3) Perseverance, defined as the
ability to remain focused on a task that may be boring or
difficult; (4) Sensation Seeking, defined as the tendency
to enjoy and pursue activities that are exciting, and
openness for new experiences. These components could
be related to specific psychological mechanisms
(Bechara & Van der Linden, 2005). The current study
attempted to clarify the relationship between the four
dimensions of impulsivity of Whiteside and Lynam's
model and both aspects of dietary restraint (Concern for
Dieting and Weight Fluctuation) in a nonclinical sample.
The continuum model suggests that restrained eaters
have an intermediate position between healthy normal
eaters and persons with bulimia regarding bulimic
symptoms (loss of control over eating, weight concern
and weight control practices). Data were collected from a
volunteer community sample (N = 216) of females who
answered the UPPS Impulsive Behavior Scale (Whiteside
& Lynam, 2001) and the Restraint Scale. A structural
equation model was tested. The model provided a good
fit to the data (?2/df=1.64, RMSEA=0.054) and revealed
that Concern for Dieting was positively related to Urgency
(bta = 0.25). Weight Fluctuation was related to lack of
Perseverance (bta = 0.25) and tended to relate to
Sensation Seeking (bta = 0.17, p = 0.056). The
association between Urgency and Concern for Dieting
suggests that eating could be a way of satisfying certain
strong impulses with the aim of relieving negative affect in
the short term. Lack of Perseverance and Sensation
Seeking were associated with Weight Fluctuation,
suggesting that restrained eaters display difficulty in
controlling their thoughts of food or thoughts concerning
shape and are more prone to seek reward (food). This
phenomenon may lead to overeating because thoughts of
food increase the desire to eat. However, the absence of
a relationship between dietary restraint and lack of
Premeditation suggests that restrained eaters are able to
balance immediate rewards against potential long-term
negative consequences related to excessive eating. They
are aware that excessive and maladaptive eating could
result in negative psychological (e.g., self-depreciation)
and physical consequences, and this may explain why
they don't engage in bulimic deleterious behaviours (e.g.,
binge eating, vomiting). Further clarification of the
psychological mechanisms underlying the four facets of
impulsivity with specific psychological tasks is necessary.
Child sexual abuse and eating disorders in a

small sample of women in a south Brazilian


city
Maria da Graa Padilha, Universidade Tuiuti do
Parana Brazil
Child sexual abuse is forced or manipulated forced
touching or sexual activity between an adult and a child
or even an older child and a younger child. Sexual abuse
includes sexual activities such as: peeping, flashing, and
child pornography, as well as sexual intercourse, sodomy,
mouth-to-genital contact. It is estimated that one in three
girls and one in seven boys are sexually abused before
they reach the age of eighteen (Tobin & Kessner, 2002).
Eating disorders are psychopathologies characterized by
a pathological relation with food (overeating or starving)
and a dimorphic body image. There are few studies that
indicated the relation between eating disorders and
sexual abuse. According to Connors (2001) Child sexual
abuse is a risk factor for the development of the following
psychological disturbances in adult women: depression,
anxiety, anger, substance abuse, self-mutilation and
eating disorders. The variations in the victim's pre-morbid
conditions and the social support after disclosure may
affect the development of eating disorders. Participants
were 19 women aged 15 to 32, diagnosed with eating
disorders from South Brazilian medical clinics. The
Bulimic Investigatory Test Edinburgh (BITE), and a
questionnaire of sexual abuse (developed by the authors)
have been utilized. 58% of the participants feel fat; 40%
take anorexigens; 12% diuretics and 13% use laxatives
daily; 33% consider that their eating behavior is a
negative influence in their lives; 18% provoke daily vomit;
42% of the participants reported sexual abuse before the

age of 18, like touching genitals, being exposed to


pornography and penetration attempts. 50% of the sexual
abused participants reported abuse more than once; 44%
of them were abused by some relative; 23% feel guilty
about the abuse and 23% feel disgusted. 13% consider
that their eating disorder is a consequence of the abuse
they suffered during childhood. Child sexual abuse is
associated with family factors just like eating disorders.
These factors appear to be: the mother's negligence,
weak family communication, high expectations about
success and body, poor autonomy, alcoholism, chaotic
family environment. Implications for therapy are
discussed. Further research is necessary to confirm the
relation between child sexual abuse and eating disorders.

Alexithymia and body weight in obese


patients
Laura Pecori, Clinical Psychology Unit Dimel,
University of Genoa, Italy; Gianfranco Adami,
Surgery Unit, Dicmi, University of Genoa, Italy
The current clinical practice shows that alexithymic
personality traits are fairly common in obese patients1.
Most obese persons are used to ascribe any
psychological distress to their overweight, and feelings
and emotions become only split and marginal aspects of
the whole personality. This attitude might be accounted
for by the widespread contempt and stigmatization
towards obesity existing in the developed western world.
However, the presence of personality traits similar to
those observed in patients with psychosomatic and
somatoform disorders cannot be excluded. This study
evaluates in severely obese patients whether having a
body shape far different from the standard accepted one
may cause the development or the maintenance of
alexitymic personality traits. The presence and the degree
of alexithymia were assessed by the Toronto Alexithmia
Scale questionnaire (TAS-20) in 65 severe obese patients
undergoing biliopancreatic diversion (BPD) for the
surgical treatment of obesity, with a mean body weight
(BW) of 124.5. The results are compared with those of 75
individual at three years following BPD, when body
weight and body morphology are within normality since
more than two years (mean BW: 78.1 kg since 28
months). Furthermore, all subjects filled the Restraint
Scale (RS) and the Eating Disorder Evaluation (EDI), self
report questionnaires broadly employed to assess eating
behavior and body weight attitudes of obese and eating
disordered patients. In the obese patients and the
postobese subjects, the prevalence of alexithymia (TAS20 score higher than 74) was substantially similar (30%
vs. 37%, respectively), and very similar TAS-20 score
mean values were found (mean values 55.5 vs. 52.6). In
the postobese subjects the food- and weight-related
attitudes as assessed by RS and EDI were more
satisfactory than in the obese patients, as it was
demonstrated in longitudinal studies2. In a stepwise
regression model, in both groups the TAS-20 score was
independently predicted by the EDI interoceptive
awareness and by the EDI interpersonal distrust score.
Finally, no relationship was found between the presence
of alexithymia or the TAS-20 score and the EDI bulimia
subscale results. In conclusion, about one fourth of obese
patients requiring bariatric surgery had personality traits
with overt alexithymic features. The presence of
alexityhmic conditions appears to be substantially
independent of the overweight condition, and most likely
reflects psychological characteristics which are not
influenced by the external appearance of the body and/or
by the poor social acceptance of the obese status. In
postobese subjects an improved eating behavior does not
correspond to a low grade of alexithymia. Though in
previous studies a close relationship between binge
eating disorder has been reported3, the results of this
study suggest that the tendency to binge eating is not a
substantial element of the alexithimia construct. 1)
Legorreta, G, et al: Psychother Psychosom 1988; 50,8894. 2)Adami GF, et al. Int J Eat Disord. 1994; 15: 265-74.
3)Pinaquy S,et al Obes Res 2003; 11:195-201.

Experiencing body image in eating disorders


by means virtual reality: assessing the sense
of presence and reality judgment of the
virtual experience.
Conxa Perpi, Dpto Personalidad; Facultad de
Psicologa, Universidad de Valencia, Spain; Jos
Heliodoro Marco, Eating Disorders Unit Previ
Clinical Center, Spain; Victor Liao, Eating
Disorders Unit Previ Clinical Center, Spain;
Vernica Guilln, Eating Disorders Unit Previ
Clinical Center, Spain; Cristina Botella, Dpto.
Psicologa Bsica, Clnica. Facultad Ciencias
Humanas, Universidad Jaume I, Castelln, Spain
The efficacy of Virtual Reality (VR) as a therapeutic tool
has been demonstrated in the fields of health and
rehabilitation. The management of pain, or the treatment
of diverse mental disorders, such as anxiety disorders
has been helped by VR techniques with success. In
Eating Disorders (ED), VR has been developed in the
treatment of Body Image (BI) in anorexic and bulimic
patients (Perpi, Marco, Botella, Baos, 2004), or in
binge eating disordered patients (Riva, Bacchetta, Cesa,

et al., 2004) obtaining good and promising results. Now is


the time to analyze its efficiency, feasibility and usability.
The aim of the present study is to compare the virtual
experience of a BI application in VR (Virtual&Body)
using three different displays: Head Mounted Display
(HMD), without HMD, that is, using the screen, and the
CAVE system. For this purpose, 30 ED patients were
randomized assigned to one of the three virtual
experience of Virtual&Body (Perpi et al., 2000) with/
without HMD/ and CAVE. Measures The RJPQ (The
Reality Judgment and Presence Questionnaire) (Baos et
al., 2005) and The ITC-SOPI (The revised version of the
ITC-Sense of Presence Inventory) (Lesiter et al., 2001)
were administered in order to assses the level of
immersion, presence, and reality judgment in the virtual
experience; besides seven questions in a Lickert format
(0:not at all- 10:absolutely) were designed in order to ask
them DURING the virtual experience and to assess the
clinical relevance and the degree of reality of the
experience in the user. The measures were Fear and
avoidance of eating; Fear of weighing after eating; Fear
of and avoidance of looking at the mirror; and degree of
Reality of these experiences. The data collection is now
in process, but our hypothesis is : although HMD and
CAVE conditions will produce high levels of sense of
presence and reality judgment, there will be no
differences regarding without HMD condition, because
the meaning of the virtual environment is clinically
significant and very relevant for the clinical population. In
case VR could abstain of expensive devices and displays
being able of producing an experience in the user with
the same sense of presence than with HMD, VR systems
would be more efficient and usable in its applications to
the diary clinical practice.

Obese patients (class i & ii) who accept vs.


Dont accept to engage in a weight reduction
program (cognitive behavioral treatment).
Whats the difference?
Conxa Perpi, ; Christina Larsson, ; Patricia
Roca, Rosana Bolea, Dpto. Personalidad;
Facultad de Psicologa, Universidad de Valencia,
Spain; Carlos Morillas, SAntonio HernndezMijares, Servicio Endocrinologa, Hospital Peset,
Valencia, Spain
There are some evidence that the continued
consumptions of a low-calories, low fat diet, high levels of
physical activity, and overall vigilance regarding their
weight are more related with the successful at long term
weight loss and maintenance (Wing & Klem, 2002). The
adherence to changes in diet and activity is central in a
weight reduction program. Studies on the characteristics
of the type of patient who take advantage of this kind of
therapeutic programs, and on variables contributing to the
success of weight reduction and the adherence to the
therapeutic prescriptions are needed. The purpose of the
present study is to analyze the differences in diverse
areas between those obese who accept vs. those who
don' t accept to get involved in a cognitive behavioural
treatment for weight reduction based on LEARN program
(Brownell, 2000) and the Cognitive Behavioral treatment
of obesity (Cooper, Fairburn & Hawker, 2003). Measures:
The Weight and Lifestyle Inventory, WALI, (Wadden &
Foster, 2001), a paper-and-pencil questionnaire that
inquires about the following areas: biological factors;
environmental influences, social and psychological status,
and timing of the present weight loss effort. Moreover we
have included, questions about readiness, motivation and
quality of life. Participants: Foreseeably about 40-50
women obese patients coming to the Endocrinology
Service of Hospital Peset (Valencia), seeking for weight
reduction treatment will fulfil the WALI. Although this
study is now in progress, and the purpose is to explore
these differentiations, some of these differences
hypothesized are expectations, goals of weight reduction
and goals of the treatment and emotional distress. The
knowledge of the characteristic of this kind of patient
more difficult to treat and resistant to initiate a
therapeutic change process, could contribute to optimizer
multidisciplinary weight reduction programs.

Modes of Mind in Anorexia Nervosa: Clinical


and research implications of a novel process
account
Park Rebecca, University of Oxford, UK; Philip
Barnard, MRC Cognition and Brain Sciences
Unit, Cambridge UK
There is _a pressing need to develop new treatments for
Anorexia Nervosa (AN), because the outcome is so poor
(Fairburn 2005). For treatment development, a better
understanding of processes underpinning AN is urgently
required. This paper introduces a novel process account
of AN (Park & Barnard 2005) and preliminary supporting
data. This account is developed from a cognitive science
based framework (Barnard and Teasdale 1995) which
applied to depression has underpinned development of
novel interventions such as mindfulness (Teasdale 1999;
Segal, Williams & Teasdale 2002). It describes how
modes of processing self -related meaning may
contribute to maintenance of the psychopathology. In AN,
we suggest attention is predominantly focussed on
verbal, intellectual meanings, manifest in a compulsively

busy 'Doing' mode of mind, with little attention to


experience of 'being' in the present moment. This 'Doing'
mode of mind is adaptive and reinforcing, serving as a
means of avoiding intense affect and bodily demands,
and resists change. Applied to AN, the framework
augments existing understanding by providing a detailed
account of processes by which therapeutic strategies
exert effects, and concise predictions for research and
clinical practice. Novel strategies for intervention are
predicted. Specifically, the account predicts that an
experiential,' being' mode of mind as compared to an
analytical 'doing'; mode of mind will reduce eating
disorder psychopathology independent of effect on
mood. Clinical interventions adapting mindfulness are
predicted to have differential effects on a ED specific
stressors, such as eating foods which challenge selfcontrol. Experimental methods and clinical pilots with high
risk and clinical populations are used to evaluate these
specific predictions. An initial evaluation of key predictions
are presented (also see linked open paper submission by
Rawal, Park and Williams). In an analog study, inducing
an experiential, as compared to an analytic mode of
processing self-experience reduces Eating disorder
behaviors following a stressor, only in subjects with high
ED concerns. This effect is independent of mood change.
Preliminary results of a pilot study training mindful
awareness of body states in patients with AN are also
described. The framework suggests guiding principles
indicating what will help and what will hinder recovery,
and novel treatment strategies: Cultivating an
experiential mode of 'being' in the present moment may
help reduce symptoms in AN. Key to recovery is a
change in the relationship between bodily experience,
thoughts and feelings. The mode of mind an individual is
in at the time of a therapeutic interventions may be
central to it's impact. Altering the modes in which selfrelated meanings are experienced, in particular cultivating
'Mindful awareness' of body states may assist recovery
The implications of this account for future clinical practice
and research are discussed.

Personality dimensions and attrition in eating


disorder cognitive behavior inpatient therapy
Calugi Simona, Riccardo Dalle Grave,
Department of Eating and Weight Disorder Villa
Garda Hospital; Francesca Brambilla, Mental
Health Department, Center for Study and
Treatment of Eating Disorders, L. Sacco Hospital,
Milan; Giulio Marchesini, Unit of Metabolic
Diseases, Alma Mater University of Bologna,
Policlinico S. Orsola, Bologna, Italy

A transdiagnostic inpatient cognitive


behaviour therapy for eating disorder
Dalle Grave Riccardo, Department of Eating and
Weight Disorder Villa Garda Hospital. Garda (.
Italy

Recent research in the development of eating disorders


suggest that early parental relationships and unhealthy
family functioning may play a significant role in disordered
eating attitudes and behaviours (Calam et al, 1990).
Cognitive behaviour theory of eating disorders has
acknowledged that multiple and complex aetiological and
maintaining factors should be seriously considered both
in the understanding and management of eating disorders
(Cooper et al., 2004). Aim of the present study was to
examine the relationship between rearing patterns and
eating disorders psychopathology. Participants were 94
female university students of a mean age of 20 years.
Participants were asked to complete the following three
questionnaires: the Parental Bonding Instrument (PBI),
the Eating Attitudes Test-26 (EAT-26), and the Eating
Disorders Inventory (EDI). Correlational analyses
between the PBI subscales and EAT-26/ EDI showed that
paternal protection and maternal care did not relate to
EAT-26 and EDI total scores and subscales. Maternal
care correlated to EAT-26 total score and the EDIInteroceptive Awareness subscale. Paternal care was
found to correlate with a variety of variables. In order of
significance paternal care correlated negatively with EDIInteroceptive Awareness (P=0.001), EDI-Ineffectiveness
(P=0.002), EDI-Body Dissatisfaction (P=0.008), EDIBulimia (P=0.018) and EDI total score (P=0.025). Present
results support previous findings on the importance of low
parental care and high maternal overprotection in eating
disorders and behaviours (Turner et al, 2005). As has
already been suggested in the literature low levels of
parental care may lead to the development of beliefs that
one is flawed and unlovable to significant others, while
high levels of maternal overprotection may result in a
child developing a belief that it is are unable to handle
everyday responsibilities independently and in a
competent manner. Present findings, as well as the
possible mediating role of resulting beliefs, have an
impact of both understanding and managing eating
disorders.

Cognitive behaviour therapy (CBT) for eating disorders


has been developed and evaluated only in outpatient
setting. Aim of the presentation is to describes a novel
model of inpatient CBT (CBT-I) indicated for patients with
an eating disorder of clinical severity not manageable in
an outpatient setting or that failed outpatient treatment.
CBT-I is a manual based treatment derived by the new
CBT-E (Fairburn et al., 2003), with some adaptations to
rend the treatments suitable for an inpatient setting. The
principal adaptations include: 1) multidisciplinary and
noneclectic team composed of physicians, psychologists,
dietitians and nurses all trained in CBT; 2) assisted
meals; and 3) CBT family therapy for patients under 18
years of age. The treatment lasts 20 weeks (13 for
inpatients followed by seven weeks of residential dayhospital) and, as CBT-E, is divided in four stages and can
be administered in a focused form (CBT-IF) or in a broad
form (CBT-IB). A randomized control trial started on
November 2005 is evaluating the effectiveness of the
treatment comparing CBT-IF and CBT-IB.

Evaluation of Treatment Efficacy of a shortterm CBT for in Patients with Binge Eating
Disorder using Ecological Momentary
Assessment
Mller Roland, ; Andrea Hartmann, Andrea
Meyer, Simone Munsch, Institute of Psychology,
University of Basel Switzerland
It has been shown that Ecological Momentary
Assessment (EMA) with palm top computers has several
advantages in assessing target behaviour: It enhances
compliance with self-monitoring and minimizes the risk of
retrospective memory bias (Gorin & Stone, 2000). It
further allows assessing behaviour change in the natural
environment of the patient. We used EMA to assess the
outcome of a randomized CBT short-term program in
terms of number of daily binges according to DSM-IV and
daily mood course. 41 female patients attending a short
intervention programm for BED were assigned to either a
group with two EMA measurements (before and after
treatment) or with three measurements (eight weeks
before treatment, before and after treatment). The
compliance of BED patients in self-monitoring their eating
behaviour in our study was high (74.2 of the alarms were
answered by the patients) and underlines the feasibility of
the EMA method (le Grange et al., 2002). We found that
daily mood course estimates were enhanced during
treatment and that the number of daily binges was
significantly reduced until post treatment (p<.05). EMA is
a valuable method to assess behaviour change and
treatment efficacy in naturalistic daily live of patients with
BED. Assessing antecedents of binges as mood course
in natural environment of the patients might help to
further identify risk situations and enhance efficacy of
CBT treatments.

Aim of the study was to evaluate the role of role of


personality dimensions (temperament and character) in
predicting dropout in a cognitive behaviour eating
disorder (ED) inpatient setting. 130 ED patients (119
females and 11 males) consecutively hospitalized were
included in the study. Baseline assessment included
weight and height measurement, the Eating Disorder
Examination, the Beck Depression Inventory, the StateTrait Anxiety Inventory, and the Temperament and
Character Inventory (TCI). 29 patients (22.3%)
discontinued the treatment. Compared with continuers,
dropouts had a lower education level, a higher
prevalence of separation or divorce in the family, and a
lower scores on TCI Persistence scale. In a Cox
regression model, after correction for age, gender and
BMI, Persistence maintained a significant effect on dropout (HR, 0.78; 95% CI, 0.62 - 0.99; P = 0.040). Eating
disorder patients with low Persistence are significantly
less likely to complete inpatient treatment.

Parental bonding and disordered eating


attitudes and behaviours in a female
university student sample
Gregoris Simos, Krystalia Asmatoglou, ;
Evangelos Ntouros, Nikolas Nikolaidis, CMHC/
2nd Department of Psychiatry, Aristotelian
University of Thessaloniki, Greece

Core beliefs and narcissistic traits in the


eating disorders
Jennie Sines, Loughborough University; Glenn
Waller, Institue of Psychiatry, King's College
London; Caroline Meyer, Loughborough
University UK
Narcissism is a personality trait that can interfere with the
application of evidence-based therapies for the eating
disorders, influencing collaboration and the patient's
willingness to take responsibility for participating in
change. It can be conceptualized in terms of both its core
element (entitlement, grandiosity) and defences that
support self-esteem ('bad you' and 'poor me' attitudes). In
order to understand and work with this personality
characteristic, it is important to understand the
personality-level cognitions that underpin the traits
concerned. Objectives This study examined the
associations between schema-level core beliefs and
narcissism in the eating disorders. Eighty eatingdisordered patients and 70 non-clinical comparison
women completed validated measures of the different
elements of narcissism and of core beliefs. Multiple
regression analyses were used to identify the core beliefs

that are associated with each aspect of narcissism.


Patterns of association differed across the groups. Among
the eating-disordered women, different core beliefs were
associated with core narcissism and with each of the two
defences. Unconditional, schema-level beliefs are
associated with narcissistic personality traits in the eating
disorders. These therapy-interfering personality
characteristics might be addressed by modifying the
relevant core beliefs. This target might need to be worked
on before it is possible to work more directly with the
eating disorder itself.

The weight of a thought: thought suppression


in obese and normal-weight restrained eaters
Barbara Soetens, Caroline Braet, Ghent
University, Department of Developmental,
Personality and Social Psychology Belgium
Dieting does not always lead to the desired outcome:
weight loss. Moreover, when on a diet, an inability seems
to emerge to stop thinking about food. The obese in
particular are a vulnerable group, given their heightened
dieting intentions. Although commonly observed, it
remains unclear where these paradoxical effects originate
from. One possible underlying mechanism is provided by
the ironic processing theory by D.M. Wegner. This theory
states that suppressing unwanted thoughts can be
counterproductive because it leads to a rebound of these
thoughts, eventually causing increased preoccupations. In
line with this view, the present study examines the effects
of suppressing food- and eating- related thoughts on
thought frequency, in obese and normal-weight
youngsters. Ninety-seven clinically obese and non-obese
boys and girls, with different levels of dietary restraint,
were asked to monitor their thoughts about food for five
minutes, during three subsequent trial periods.
Participants were randomly allocated to either the
suppression condition (n = 50) or the control condition (n
= 47). Participants in the suppression condition were
instructed to suppress thoughts about food, while
participants in the control condition were asked to merely
monitor them. The number of food-related thoughts was
recorded across trials. No indication was found for an
overall post-suppression rebound effect, using ANOVAs
with repeated measures. However, when examining
subgroups of high and low restrained eaters, results
clearly showed that the obese high restrained eaters
displayed a pattern that was indicative of a rebound effect
for food-related thoughts. None of the other groups
shared these effects. The results corroborate the
hypothesis that trying not to think about food and eating
may be counterproductive, at least for a subgroup of
clinically obese high restrained eaters. Hence, thought
suppression may be one of the factors contributing to the
acceleration and perpetuation of burdensome foodrelated thinking in clinically obese high restrained eaters.
Clinical implications include that recommending thought
suppression may not be an adequate approach to cope
with food- and eating-related intrusive thinking because it
can actually sustain and strengthen these oppressive
thoughts. Therefore clinical practice should address
patients' thought suppression tendencies as a part of
diagnosis and treatment of eating- and weight-related
problems.

Anorexia Nervosa - a Hemispheric disorder?


Darker-Smith Susan M., University of Derby UK
Anorexia Nervosa is a destructive disorder with a high
mortality rate amongst young people and limited
understanding of the nature of it's causation amongst the
clinicians. Little research has been carried out from the
perspective of the patient's understanding of what
happens during the Anorexic Development Cycle and in
clinical work, the presenter had met many young people
stating that their families / the media (and the desire to be
thin) were not the main causation nor contributors to their
disorder. Qualitative, semi-structured interviews were
utilised with the use of multiple choice questionnaires with
239 members of eating disordered support groups, all of
whom had been treated previously for Anorexia Nervosa.
All 239 participants stated that they had experienced a
critical voice. with a different tone / pitch to their own
voice and recognisable as distinct from themselves - yet
also recognisable as an aspect of themselves (not
otherwise diagnosed under DSM 4-tr / ICD-10). In no
cases did this alleged 'voice' meet the criteria for any
other psychological disorder. In 214 cases, the voice
was male-dominant. In 81 cases, an image of some kind
accompanied the 'voice'. In all cases, the participants
spoke about the 'voice' imposing 'it's' wishes over that of
the participant. 233 of the interviewees perceived
themselves to have been particularly bad at mathematics
prior to anorexic onset, becoming good at mathematics
once they became anorexic. 6 of the interviewees
perceived no notable change. 237 interviewees referred
to themselves pre-anorexic as artistic, right-brain
orientated and during anorexia as logical, left-brain
orientated. It would seem that although these results are
subjective reports based on participant's own perceptions
- there does seem to be a generality between subjects
relating to hearing a 'critical voice', distinct from their own
self. Furthermore, it seems that the majority of
participants viewed themselves as being right-brain
dominant prior to anorexic onset and left-brain dominant

post anorexic onset. This may indicate a hemispheric


dominance for eating disorders and may further explain
the extreme rule-setting prevalent in anorexia nervosa as
being a left-hemisphere function (Schiffer, 1998)
Following on from Gilbert's work on Compassionate Mind
Training - in which the negative 'critical voice' is viewed
as a self-critical aspect of the self - the development of a
compassionate mind-set may help to reduce self-critical
voice-hearing in Anorexia Nervosa (Darker-Smith, 2005).

Using Compassionate Mind Training in the


treatment of Anorexia Nervosa.
Darker-Smith Susan M., University of Derby UK
Anorexia Nervosa is a destructive disorder with a high
mortality rate amongst young people and limited
understanding of the nature of it's causation amongst the
clinicians. In a previous study, the presenter found that
239 participants cited hearing a 'critical voice' which often
prompted their eating disordered behaviours. Gilbert's
work into compassionate mind training addresses the
critical voice by training individuals to develop a
compassionate mind set. 15 participants were selected,
all of whom had a history of Anorexia Nervosa with at
least two prior hospital admissions for Anorexia Nervosa.
All were currently exhibiting psychological symptoms of
Anorexia Nervosa, within the lower-end of a 'healthy'
weight. All had an awareness of an internatised 'critical
voice' distinct from the subject's own voice (not otherwise
diagnosed under DSM 4-tr / ICD 10) and all reported
experiencing rigid rules, imposed by 'critical voice' over
the subject's own wishes. Treatment consisted of the
following: (i) Separation of the critical mind (left-brain
dominant) from client's (right-brain dominant) mind via
cognitive restructuring (ii) Introduction of 'compassionate
self' (Gilbert) & Perfect nurturer (Lee) (iii) Learning to
differentiate 'heart' from 'mind' (Feldman) (iiii)
Identification of critical rules & integration of new rules
(v) Self-identity Formation After 2 months of treatment,
Anorexic perceptions of appearance and the critical
voice had weakened in all 15 subjects. One subject
stated: It's like being allowed to breathe again for the first
time in years... At a 7 month follow-up, in 14 subjects,
the critical voice had disappeared completely. In the
remaining subject, the voice had weakened
substantially. It would seem that although these results
are subjective reports based on participant's own
perceptions - there does seem to be a generality between
subjects relating to hearing a 'critical voice', distinct from
their own self. Furthermore, it would appear that by
using methods (such as Gilbert's Compassionate Mind
Training), it seems possible to reduce the critical voice
which the Anorexic participants in this study stated
'controlled the anorexia' and encourage the development
of a compassionate self, able to self-soothe and
reassure. Noticibly, eating behaviour and weight
increased during therapy & throughout follow-up in all
partipants - without direct focus on either. One participant
stating 'For the first time in my life - I can't hear that voice
telling me not to eat'. All participants made a steady
weight-gain throughout the 7 months of follow-up.
Previously, all participants had struggled to make any
significant weight gain, citing fear, shame and guilt as
preventors to weight-gain. All 15 subjects had been
hospitalised for Anorexia on two or more occasions
previously and were classified as chronic anorexics. It
is possible that acute anorexia may be treated in less
time, using this method. However, further research will
be required.

Excessive exercise and eating


psychopathology: A novel cognitive
exploration using a newly developed measure
Lorin Taranis, Caroline Meyer, Loughborough
University; UK Stephen Touyz, ; Eva Nauman,
Sydney University Australia
Excessive exercise is characterised by an inability or
unwillingness to cut down or stop exercising even though
it is detrimental to health. Excessive exercise is present in
up to 80% of eating disorder patients, often precedes the
onset of an eating disorder, is one of the last symptoms
to subside and is associated with poor outcome. A
cognitive-behavioural conceptualisation of excessive
exercise assumes that its maintenance is due to more
that just the control of weight and shape. Specifically, for
most patients exercise involves cognitive, behavioural,
and emotional components (including anxiety & guilt,
extreme concerns about the perceived negative
consequences of stopping or reducing exercise, and
rigid/inflexible exercise behaviour). However, existing
measures of excessive exercise tend to be
unidimensional, and have not been specifically designed
to measure cognitive, emotional and behavioural facets in
the context of eating disorders. This paper introduces a
new reliable, valid self-report measure comprising 30
items measuring the obsessive, compulsive, pathological,
and emotional aspects of exercise in the eating disorders.
While the psychometric properties of the measure are
presented elsewhere, this paper presents findings from
our initial research highlighting links between excessive
exercise and eating-related attitudes among non-clinic
young women, as measured by the Eating Disorders
Inventory (Garner, 1992). The new exercise measure
demonstrates strong positive associations with EDI

scores. Specifically, there are positive associations of


drive for thinness scores with compulsive exercise and
weight and shape motivation, while bulimic attitudes and
body dissatisfaction subscales are positively associated
with compulsive exercise, weight and shape motivation
and lack of enjoyment. This paper presents the first
measure of excessive exercise that has been based on a
cognitive-behavioural model, and has been developed
specifically for use in eating disorders research and
assessment. Although requiring replication with a clinical
group, these initial findings suggest that for those women
with eating pathology, cognitive interventions should be
targeted at the compulsive elements of exercise in
addition to weight and shape motivation. In addition, for
those with bulimic-type disorders and/or high levels of
body dissatisfaction, interventions should also work to
enhance enjoyment of the positive aspects of exercise.

The efficacy of a multidisciplinary Cognitivebehavioral treatment for Binge Eating


Disorder
Federica Tarantino, Romana Schuman, Centro
Gruber, Private Centre, Bologna, Donatella
Ballardini Centro Gruber, Private Centre,
Bologna, Elena Tomba Bologna, Alessandra
Bravi Silvana Grandi Department of Psychology,
University of Bologna, Bologna Italy
In the current psychiatric nosography Binge Eating
Disorder (BED) is classified as an eating disorder not
otherwise specified (EDNOS). A large number studies
however, suggest that BED could be considered as an
official diagnostic category. The most important criterium
in the diagnosis is the presence of recurrent episodes of
binge eating, without compensatory behaviors (like
vomiting or use of laxatives). BED is often associated
with either overweight or obesity. The aim of this study is
to determine the efficacy of a Cognitive-behavioral
treatment programme, based on a multidisciplinary
approach. 48 female outpatients suffering from BED were
included in this study. The DSM-V criteria for BED and
the conclusion of the therapeutic programme had to be
attained as inclusion criteria in the sample. The therapy
consisted of 20 treatment sessions, of which 10 of them
were based on a nutritional rehabilitation treatment and
the other 10, were based on a Cognitive-behavioral
psychotherapy (CBT). The sessions were carried out in
parallel and required a collaboration of a multidisciplinary
equipe (a nutritional specialized physician, a
psychotherapist, a psychiatrist). The efficacy of the
therapy was assessed by several variables, such as:
interruption of binge eating episodes (number weekly
binge eating episodes); the subjects were also assessed
by self- administered questionnaires (Eating Disorder
Inventory-EDI-; Eating Attitude Test-EAT-; Three Factor
Eating Questionnaire- TFEQ). Were also evaluated the
values of the Body Mass Index (BMI). All the variables
were valuated in the pre (T0) and post (T1) treatment.
Descriptive and frequencies analysis and paired t-Test
were carried out. At the post- treatment (T1): 65% of the
sample presented a weight loss; 80% of the patients
presented a cessation of the binge eating episodes. The
BMI was lower (p>0,05); and the number of weekly binge
eating episodes was reduced (p>0,05). At the posttreatment the EDI subscales (Bulimia: p>0,05,
Enteroceptive awarness: p>0,05; Maturity fear:
p>0,05) differencieted significantly from the pre-treatment
measurements. Also the EAT and the TFEQ subscales
presented these significant statistical values (Bulimia and
food preoccupation: p>0,05 p=,001; Dieting behavior:
p>0,05; Restraint: p>0,05). The results showed the
efficacy of a CBT multidisciplinary program in patients
with Binge Eating Disorder. After 20 sessions we
observed either a decrease or a cessation of weekly
binge eating episodes, an improvement in eating attitudes
as supported by many subscales instruments. These
results showed also, that this kind of treatment is effective
to induce a weight loss. The cross-sectional/naturalist
design represents the major limitation of this study.

The Co-morbidity between Eating Disorders


and Anxiety Disorders
Stephen Touyz, Caroline Hunt, Sydney; Maree
Abbott, The University of Sydney; Janice Russell,
Northside Clinic; Tamsen St Clare, Westmead
Anxiety Treatment and Research Unit Auistral;ia
Studies have consistently shown that eating disorders
(ED) and anxiety disorders (AD) frequently co-occur
(Kaye et al 2004). Lifetime prevalence rates of at least
one AD varies from 25% to 75% in Bulimia Nervosa (BN)
and from 23% to 75% in Anorexia Nervosa (AN). Studies
have also shown that the onset of AD often precedes the
onset of an ED and this has lead some researchers to
speculate that early onset AD may predispose individuals
to the development of an ED (Kaye et al, 2004). Whilst
most studies have focused on the prevalence of AD in ED
populations, significantly less research has examined the
prevalence of ED's among anxiety patients. As a result,
there is a general lack of information as to frequency of
ED pathology among patients presenting to anxiety
clinics, and it is unclear whether ED's are more
commonly associated with some AD as compared to
others (Black Becker, 2004). Research has also

suggested that comorbid anxiety may be a prognostic


indicator for poor outcome in ED populations (Fichter and
Quadfleig, 2004). The current study endeavours to
examine the comorbidity between ED's and anxiety
disorders and implications for treatment. A total of 140
participants will be recruited across 4 sites for this study,
which will include: - 70 adult female ED participants will
be recruited through referrals to two Sydney based
private hospitals and the University of Sydney psychology
clinic. Participants presenting for ED treatment will be
screened for anxiety disorders on admission and then
again at 6 months post treatment completion. The
treatment received will also be investigated (e.g individual
and group therapy, Cognitive Behavioural treatments,
medications) and the response to treatment of comorbid
and non comorbid groups will be compared. - 70 adult
female anxiety disorder participants will be recruited
through referrals to a Sydney based hospital and the
University of Sydney psychology clinic. Participants
presenting for anxiety treatment will be screened for
eating disorders on admission. Depending on numbers,
individuals presenting with eating disorders will be reassessed at 6 months post treatment completion of a
CBT based program for anxiety disorders. The response
to treatment of comorbid and non comorbid groups will
also be compared. Preliminary results based on our
eating disorder sample of 32 women, indicate that anxiety
disorders are present in 78% of the sample and 76%
report the onset of anxiety to have preceded the
development of the ED. The results we have obtained so
far support much of the current literature finding that ED
and anxiety disorders frequently co-occur. So far only 1
of 23 anxiety participants assessed has met criteria for an
eating disorder not otherwise specified (EDNOS). Our
findings to date, appear to support much of the literature
suggesting that anxiety disorders are prevalent amongst
individuals with ED's. Unfortunately the research findings
of eating disorder and anxiety disorder co morbidity
studies are inconsistent, and inherent methodological
limitations are common. Furthermore there are few
studies investigating the response to treatment and
treatment outcome of individuals with co morbid eating
and anxiety disorders. It is hoped that this research will
identify and draw attention to the possible difficulties
associated with treating individuals with co morbid eating
and anxiety disorders, and subsequently improve their
treatment in the future, leading to more favourable
outcomes.

Self-esteem in 480 patients suffering from


eating disorders
Luis Vera, Alexandra Laszcz, Sophie CriquillonDoublet, Centre Hospitalier Sainte-Anne,Cmme,
Paris, France
We supposed that assertiveness is a measure of selfesteem (social skills, internal feelings of efficacy). This
assessment associated to others evaluations is proposed
before the beginning of any treatment in the Centre
Hospitalier Sainte-Anne, Clinique des Maladies Mentales
et de l'Encphale, Paris. Since 2004 till 2006 inpatients
and outpatients suffering from eating disorders: anorexia
(group 1), anorexia/bulimia (group 2) and bulimia (group
3), (DSM-IV diagnosis) answered to the Rathus Schedule
of Assertiveness. We compared the three groups
according to the results in the Rathus Schedule. The
statistical treatment of scores shows significant
differences in assertiveness between the three groups. In
this communication we describe the nature of self-esteem
in each group. We found that bulimia presents a lower
self-esteem than anorexia. Our results are discussed in
the light of emotional impairments in eating disorders
population.

Survey results of female college students


regarding the relationship of abuse and other
stressful life events to eating disorders and
other psychopathological symptomatology
Ana Mara Villarroel Lastra, Rosa Mara Raich
Escursell, Universidad Autnoma de Barcelona
Spain
There is strong evidence to support the relationship
between stressful life events, such as sexual abuse, and
eating disorders. In fact, sexual abuse has been deemed
a nonspecific risk factor for eating disorders, specially for
bulimic symptomatology (Deep, Lilenfeld, Plotnicov,
Pollice, & Kaye, 1999; Favaro & Santonastaso, 1997;
Schmidt, Humfress, & Treasure, 1997; Smolak & Murnen,
2002; Steiger & Zanko, 1990; Tobin & Griffing, 1996;
Waller & Ruddock, 1995; Webster & Palmer, 2000;
Wonderlich, Brewerton, Jocic, Dansky, & Abbott, 1997).
Current studies have indicated that other types of abuse,
like emotional and physical, can also play an important
role in their etiology (Deep et al., 1999; Folsom et al.,
1993; Kent, Waller, & Dagnan, 1999; Rorty, Yager, &
Rossotto, 1994). The aim of this investigation is to study
the prevalence of stressful life events, especially ones
related to abuse experiences, in a sample of college
students and to review their association with eating
disorders, anxiety and depression. A survey was taken of
386 caucasian women living in Catalonia, between the
ages of 18 and 30. Abuse and other stressful life events
were documented by using the Traumatic Life Events

Questionnaire (TLEQ; Kubany & Haynes, 2004); eating


disorders were measured through the Eating Disorders
Examination Questionnaire (EDE-Q; Fairburn & Beglin,
1994); depressive symptomatology with the Beck
Depression Inventory (BDI; Beck, Ward, Mendelsohn,
Mock & Erbaugh, 1961); anxiety with the State-Trait
Anxiety Inventory (STAI; Spielberger, Gorsuch &
Lushene, 1970) and self-esteem with the Rosenberg SelfEsteem Scale (RSE; Rosenberg, 1965). Results indicate
that stressful life events with the greatest prevalence in
the group were: sudden death of someone close (58.5%),
events that threaten the life of someone close (42.2%),
emotional abuse (37%), physical abuse (28.2%) and
sexual abuse (24.9%).
Correlational analysis indicates a positive and significant
correlation between eating disorders and emotional,
physical and sexual abuse, as well as with the number of
life events suffered. Also, these three types of abuse
correlate positively and significantly with the presence of
symptoms of depression and anxiety, and indirectly with
self-esteem.
Comparison of means between EDE-Q' scales and the
measures of abuse, indicated that the group of women
with a history of emotional abuse display significantly
higher scores than those without such history in all the
scales, except in Restrain. The group of women with
sexual abuse history reported significantly higher scores
than the women without sexual abuse in "Weight
Concern and Shape Concern. Also, the three abused
groups showed significantly higher means in bulimic
symptomatology, but not in restrain symptoms, and they
appeared to be significantly more depressed that the
women without abuse. In addition, the emotionally
abused group showed significantly higher levels of
anxiety and lower levels of self-esteem when compared
to those without emotional abuse. These findings agree
with previous studies that suggest emotional, physical
and sexual abuse are important risk factors in the
development of eating disorders and depressive
symptomatology.

Comparing eating attitudes and behaviors


between Chinese and Japanese female
university students
Jianping Wang, Dandan Fu, Xiaoyan Wang,
School of Psychology, Beijing Normal University;
Fujiu Hideyuki, Graduate School of Education,
Jeoetsu University of Education, Japan; Wei
Chen, School of Psychology, Beijing Normal
University China
Rates of eating disorders (EDs) have been observed to
be rising in Asia generally, and documented in Japan in
particular. Almost no studies have directly compared
Chinese and Japanese samples to one another. This
study examined relative rates of ED symptoms and EDrelated attitudes in a Chinese and a Japanese university
sample. Subjects were N = 1197 Chinese and N = 269
Japanese female university students between the ages of
16 and 25. All subjects completed the Eating Disorder
Inventory (EDI) and the EAT-21 checklist. The results
suggested that the Japanese sample showed significantly
higher scores than the Chinese sample on the Drive for
Thinness, Bulimia, Body Dissatisfaction, Interpersonal
Distrust, Interceptive Awareness, and Ineffectiveness
subscales of the EDI. The Chinese sample, however,
showed significantly higher scores than the Japanese
sample on the Perfectionism and Maturity Fears
subscales of the same questionnaire. The Japanese
sample showed significantly higher overall rates of EDs
(8.2%) than the Chinese sample (2.6%), however, rates
of EDs, ED symptoms, and ED-related attitudes were
higher in the Chinese sample than expected. This study
examined possible explanations for the observed cultural
differences, including economic and educational factors.
The study also examined culturally-specific relationships
between eating attitudes and personality factors as
measured by the eating symptom questionnaire and the
EDI.

Development of the Perfectionistic Selfstatement Inventory about Dieting and


Investigation of its Reliability and Validity.
Mikako Yazawa, Masaru Kanetsuki, Kaneo
Nedate, Faculty of Human Sciences, Waseda
University Japan
Although perfectionism is well known to be related to
anorexia nervosa, nowadays it is also acknowledged as
being associated with bulimia nervosa. The number of
people going on an excessive diet has been increasing
and perfectionistic features are thus also recognized
among them. Moreover, although various measures have
been used to examine the association between
perfectionism and eating disorders, the existing
perfectionism scales cannot clearly assess domain
specific characteristics in the content of cognition related
to an excessive dieting behavior. The purpose of this
study is to investigate the characteristics of perfectionistic
thoughts or self-statements which could lead to a
problematic dieting behavior and eating disorder
tendency, and to develop a new measure called the
Perfectionistic Self-statement Inventory about Dieting

(PSI-D). Items for the questionnaire were generated from


two sources: (1) semi-structured interviews with 7
excessive female undergraduate dieters and (2) openended questionnaire with 41 female students. Five
Certified Clinical Psychologists evaluated these 42 items
concerning the validity of the contents and formed 40
potential items. Two-hundred eighteen female
undergraduates (M age = 19.8 years, SD = 1.16) rated
these items. Then, to examine the criterion-related
validity, 148 female students (M age = 19.9 years, SD =
1.24) completed the PSI-D, Multidimensional
Perfectionism Cognition Inventory (MPCI; Kobori, &
Tanno, 2004) and Dieting Behavior Scale (DBS;
Matsumoto et al., 1997), Drive for Thinness Scale (DTS;
Baba & Sugawara, 2000), and the Eating Attitude Test
(EAT; Mukai et al., 1994). An exploratory factor analysis
was performed on their responses. As a result, it yielded
four factors that comprised all 5 items. The first factor
reflects the Persistence of High Standards (PHS), with
factor loadings ranging between .61 and .91. The second
factor reflects the Self-Criticism about Failure (SCF), with
factor loadings ranging between .58 and .93. The third
factor reflects the Respect for Striving and Self-Worth
(RSW), with factor loadings ranging between .48 and .86.
Finally, the fourth factor reflects the Strict Self-Restraint
(SSR), with factor loadings ranging between .42 and .95.
The alpha coefficients were .89 for PHS, .85 for SCF, .87
for RSW, and .83 for SSR. We also examined the
relationships between the four factors of PSI-D and the
four scales. The PHS and SSR were weakly correlated
with the MPCI, ranging from .21 to .22. All the subscales
of PSI-D were weakly and moderately correlated with the
DBS, DTS, and EAT, ranging from .30 to 79. This finding
suggests that the PSI-D consisting of four factors is
useful to assess the characteristics of perfectionistic
thoughts or self-statements related to dieting and the
eating disorder tendency. It is likely that this scale will
assess problematic thoughts in excessive dieters. This
scale may also be used to assess the effects of
intervention to prevent excessive dieting and promote
healthy dieting. Further studies should attempt to provide
increased validity and evidence pertaining to the
measurement of PSI-D in different populations and
experimental settings.

Eating Disorders - Spanish


Programme
Signos de alarma en las conductas
alimentarias en nios de 9 y 10 aos
Rafael Ballester, Maria Carmen Guirado,
Universidad Jaime I de Castellon Spain
Presentamos los datos obtenidos en una muestra de 237
nios de 9-10 aos de la Comunidad Valenciana. Se les
administr el Cuestionario de Informacin, Actitudes y
Comportamientos relacionados con la Salud (CIACS-II)
de Ballester y Gil (2000). Los resultados muestran que
slo un 25% de los nios hace desayunos completos; un
40% manifiesta que evita entre algunas veces y
habitualmente alimentos que engordan; un 68% se
controla el peso entre algunas veces y habitualmente y
un 22% dice tener problemas de exceso de apetito.
Respecto a las razones por las que hacen deporte, un
29% dice hacerlo para tener un cuerpo ms bonito y un
25% para adelgazar, a pesar de que slo un 12% se
consideran gruesos. Un 16% dice haber intentado en
alguna ocasin vomitar despus de haber comido mucho.
Aunque los nios no manifiestan dar gran importancia a
su peso y su apariencia (media de 5,6 en una escala de
0 a 10), un 13% ha llorado en alguna ocasin como
consecuencia de su insatisfaccin por la propia figura
corporal. Finalmente, un 41% manifiesta que sus padres
han hecho dieta para adelgazar en alguna ocasin. Las
diferencias sexuales comienzan a aparecer a esta edad
de manera tmida en slo tres de los 16 items
explorados.Se concluye la importancia de mantener una
vigilancia estrecha desde la ms temprana edad respecto
a comportamientos y actitudes que puedan evidenciar
una preocupacin excesiva por el peso y la imagen
corporal.

Comorbilidad de los Trastornos de la


Conducta Alimentaria (TCA) en una muestra
de mujeres estudiantes de Barcelona: Fase
Screening
Sandra Farrera Sabioncello,S Ros Abarca, R
Toquero Colmena, ; S Cano Diaz, ; N Evangelista
Robleda, A Simon Estrada, ; R M Raich
Escursell, Universidad Autonoma de Barcelona
Spain
Introduccin: Estudio en dos fases: screening y
diagnstica. Objetivos: prevalencia de riesgo de TCA en
mujeres estudiantes de primer curso de carreras
profesionales y la relacin con indicadores de malestar
psicolgico (IMP). Mtodo: Estudio transversal muestral.
Fase screening: muestra de 515 alumnas de primer
curso de centros universitarios de Barcelona, de edad
entre 16 y 24 aos. Material: Prevalencia de TCA: Eating
Attitudes Test (EAT-40), Body Shape Questionnaire
(BSQ), Three-Factor Eating Questionnaire (TFEQ),
Eating Disorder Inventory (EDI-Bulimia y EDI-Motivacin

por adelgazar).IMP: Beck Depression Inventory (BDI),


State-Trait Anxiety Inventory (STAI), College Self-Esteem
Scale (CSES) y Rosenberg Self-Esteem Scale (RSS).
Variables sociodemogrficas y antropomtricas.
Resultados: La medias fueron: edad de 19,41 e IMC:
21,57. Prevalencia de TCA del 14,2% con presencia de
diferencias estadstcamente significativas en relacin al
IMC (p=0,036).Existen diferencias entre el grupo que
sigue dieta y no dieta en el BSQ, EDI-BU y EDI-MA
siendo superior en el grupo dieta (p<0.001). Prevalencia
de sintomatologa depresiva del 27,2%, ansiedad estado
del 17,96% y ansiedad rasgo del 25,77%. Las
asociaciones entre IMP y EAT, BSQ y riesgo de TCA son
altamente significativas. Discusin: Las edades con
mayor puntuacin en el EAT estn entre 16-18 aos,
disminuyendo la preocupacin por silueta y peso a partir
de los 22. Riesgo de TCA aumenta al incrementar el IMC
y seguir dieta. La insatisfaccin corporal y las conductas
patolgicas hacia la comida estn estrechamente
vinculadas con sintomatologa depresiva, elevada
ansiedad, bajas autoestima y asertividad y con mayor
riesgo de padecer TCA.

Estructura factorial del Eating Disorders


Inventory en adolescentes de ambos sexos
Adela Fuste, E Garcia-Grau, ; N Mas, J Gomez,
C Saldana, Universidad de Barcelona Spain
El objetivo del presente estudio es analizar la
dimensionalidad del EDI-2 y del EDI 3 en una muestra de
adolescentes, haciendo anlisis con toda la muestra y
separadamente para cada sexo. Para ello se administr
a una muestra de 1.363 adolescentes (738 chicas y 625
varones) de 14 a 19 aos el EDI 2 y el EDI 3 el cual
consta de los mismos tems, aunque organizados en
diferentes escalas. Para analizar los datos, se realiz un
anlisis factorial confirmatorio. Los resultados no
confirmaron la dimensionalidad propuesta por Garner
para las dos versiones del EDI en ninguno de los dos
sexos ni en la muestra total. As pues, decidimos realizar
anlisis factoriales exploratorios de los 91 tems para
cada sexo; los anlisis se hicieron slo para cada sexo
puesto que el grado de ajuste fue peor en la muestra
total. En la muestra de chicas, se obtuvo 7 factores en
los que cargaron 52 tems, mientras que en la de chicos,
se obtuvo 5 factores en los que cargaron slo 32 tems.
Por lo tanto, la estructura dimensional del EDI propuesta
por Garner no se confirma en la poblacin adolescente,
probablemente porque el cuestionario fue diseado para
personas con trastornos de alimentacin. Es difcil que la
validez de constructo de un instrumento que se ha
diseado con unos objetivos concretos se replique
adecuadamente cuando se utiliza con fines distintos
(identificar grupos de riesgo, evaluar programas de
prevencin, etc.) por lo que es necesario hacer
adaptaciones especficas del EDI en funcin del fin
perseguido y del tipo de poblacin.

Personalidad y familia en los TCA: Un estudio


descriptivo
Francisco Martin, A J Cangas, E M Pozo Perez,
; M Martinez Sanchez, Instituto de Ciencias del
Comportamiento
Introduccin: Los Trastornos de personalidad se han
erigido como unos de los principales tpicos actuales en
la investigacin psicolgica. Los objetivos del presente
estudio fueron reportar la prevalencia de trastornos de
personalidad en una muestra clnica de pacientes con
TCA, analizando las diferencias respecto a un grupo
control, as como describir la prevalencia de
psicopatologa familiar y los estilos interactivos familiares.
Mtodo: Se reclutaron 67 pacientes con TCA siguiendo
los criterios diagnsticos del DSM IV-TR y 46 controles,
siendo evaluados con el MCMI-II y con un cuestionario
clnico de confirmacin de trastorno de personalidad en
la admisin al tratamiento psicolgico. Se registraron las
conductas interactivas familiares a lo largo de un ao
durante las sesiones de terapia familiar y grupal.
Resultados: Entre los resultados obtenidos, se encontr
una prevalencia de TP del 90,2% de la muestra clnica,
destacando diferencias significativas en todas escalas
excepto la dependiente, histrinica, compulsiva y
narcisista. La escala esquizoide fue significativa en ANR
respecto los otros grupos y el perfil de personalidad de
las topografas compulsivas fue similar. Se obtuvo una
alta prevalencia de AF: 57% en BN (Ansiedad 21,4%,
Humor 17,9%, TP 14,3%, TCA 3,6%) y AN 81%
(Psicoticos 2,6%, Ansiedad 26,3%, Humor 13,2%, TP
18,4%, TCA 18,4% ). Los estilos familiares mas
prevalentes fueron disfuncionales (invasivos y fros, 24%
y 28%). El estilo invalidante se asoci al TP lmite. Los
estilos fros e invasivos se asociaron a TP del espectro
esquizofrnico. Discusion: Se discute sobre la gran
prevalencia de los TP en la muestra clnica y sobre el
contexto familiar y la influencia de los estilos
comportamentales encontrados en el msmo.

Terapia grupal en Bulimia Nerviosa


Amparo Martinez- Moya, ; J Abellan, J
Hernandez, Hospital Universiario Virgen Arrixaca
de Murcia Spain
La Bulimia Nerviosa y el Trastorno por Atracn son dos
de los cuadros de TCA ms frecuentes en nuestra zona
de salud mental. Por esto nos planteamos un abordaje
grupal para esta patologa.El modelo de intervencin es
psicoeducativo y desde un enfoque cognitivo-conductual
segn el modelo de Fairburn. El contenido de las
sesiones se estructura en bloques: psicoeducativos, que
se trabajan en las primeras sesiones, tcnicas de manejo
de la ansiedad y tcnicas cognitivas.Se realiza una
evaluacin pretest y postest con los cuestionarios: BDI,
BITE y STAI con la finalidad de evaluar la evolucin de la
sintomatologa afectiva y en las conductas alimentaras
patolgicas. La intervencin grupal es de 10 sesiones,
con una frecuencia semanal, de 90 minutos de
duracin.Los niveles de ansiedad y depresin mejoran
comparando las medidas pre y postest y mejora el
funcionamiento en conductas alimentaras aunque no se
produce una desaparicin completa de atracones y
conductas de purga.El planteamiento grupal mejora el
funcionamiento adaptado emocional y alimentario de los
pacientes. El abordaje grupal de esta patologa es
efectivo y mejora el balance coste-beneficio en
comparacin con la intervencin individual aunque habr
que ampliar la muestra estudiada y realizar un estudio
ms exhaustivo para confirmar este aspecto.

Exposicin a seales y reduccin de la


ansiedad ante la comida en la bulimia
nerviosa nerviosa resistente al tratamiento en
adolescentes
Elena Moreno, E Martinez, J Castro, L Lazaro,
; M Vila, J Toro, E Font, Hospital Clinic
Barcelona Spain
Los trabajos de Jansen proponen un mtodo para
descondicionar la ansiedad asociada a la comida
mediante la exposicin como frmula de prevenir la
respuesta de descontrol alimentario. Se presentan los
datos de 14 pacientes en tratamiento de
descondicionamiento en nuestro Servicio de 12 sesiones
de exposicin durante seis semanas. La media de edad
era de 16.2 y se evalu el nivel de sintomatologa al
inicio, al final de tratamiento y a los seis meses de
seguimiento. Los instrumentos de evaluacin fueron:
STAI, BDI, EAT 26, BULIT-R, EDI-2. La sintomatologa
bulmica y purgativa se haba reducido de manera muy
significativa de acuerdo con los siguientes resultados:
STAI: 81.50 (pre); 59.28 (post); 52.00 (seguimiento);
Significacin p<0.033 post y p<0.019 a los seis meses.
EAT 26: 39.07 (pre); 20.35 (post); 19.69 (seis meses);
Significacin p<0.005 y p< 0.003 respectivamente.
SEED: 38.57 (pre); 22.21 (post); 22.69 (seis meses);
p<0.002 y p<0.007. BDI: 30.21 (pre); 16.57 (post); 14.15
(seis meses); p<0.004 y p<0.003. BULIT-R: 119.57 (pre);
72.42 (post); 66.38 (seis meses). p<0.001 y p<0.002. En
los factores del EDI: Bulimia, Insatisfaccin corporal e
Impulso por adelgazar hubo mejoras significativas.
Cabra considerar la oportunidad de aadir el
descondicionamiento al tratamiento clsico.

Evolucin psicopatolgica de pacientes con


obesidad mrbidad intervenidas
quirrgicamente. Anlisis retrospectivo a un
ao
Silvia Pasqual, V Moreno, ; Sellares Canals, ;
Sanchez Gil. ; Fernandez- Sallent, ; De Flores
Formenti, Hospital de Igualada
Introduccin: La obesidad es uno de los mayores
problemas de salud pblica en los pases occidentales,
siendo frecuente la presencia de sintomatologa
psiquitrica en estos pacientes. Varias modalidades de
intervencin han sido aplicadas para la reduccin y
mantenimiento del peso en sujetos con obesidad mrbida
(OM), siendo la ciruga baritrica la que obtiene mejores
resultados tanto en la prdida de peso como en la
reduccin de la comorbilidad asociada. El objetivo de
este trabajo es valorar la evolucin del estado psicolgico
en una muestra de pacientes con OM sometidos a
ciruga baritrica. Metologa: La muestra const de 16
mujeres con una edad media de 45,7 aos ( 8.91) que
fueron sometidas a intervencin quirrgica (IQ). Se
evaluaron en cuatro momentos distintos: antes de la
intervencin y a los 3, 6 y 12 meses posteriores. Se
analiz el ndice de masa corporal (IMC), nivel de
depresin (Beck Depression Inventory, BDI), ansiedad
rasgo-estado (State-Trait Anxiety Inventory, STAI),
autoestima (Escala de Autoestima de Rosenberg, EAR) y
comportamiento alimentario (Bulimic Investigatory Test
Edinburgh, BITE). Resultados: La muestra estudiada
present una reduccin estadsticamente significativa en
el IMC (z=-2.6, p<0,01), en la sintomatologa depresiva
(z=-2.36, p<0,01) y en ansiedad rasgo (z=-2.17, p<0,05).
Conclusiones: Tras la ciruga baritrica, y la consecuente
reduccin del IMC, se observan resultados de mejora en
algunas variables psicolgicas, concretamente en
medidas de ansiedad y depresin.

Presentacin de caso nico de patologa dual


en un hospital de da de trastornos de la
conducta alimentaria (hd tca) en un hospital
general
Teresa Rangil, C Mateu Vendrell, , M Loran
Meler, ; G Penlas, ; C Diez Quevedo, ; L
Sanchez Planell, Hospital Universitari
Germanans
Introduccin: Cada vez ms se aprecia una complejidad
creciente en la comorbilidad de los TCA. El abordaje de
la patologa dual, en concreto del Trastorno por uso de
alcohol en Bulimia, representa un reto en la consecucin
de objetivos de mejora. Mtodo: Presentamos el
abordaje psicoteraputico (que incluye terapia grupal,
terapia indiividual y trabajo familiar) y la evalucacin
psicolgica (psicometra inicial, psicometra al alta y
seguimiento a los tres meses), realizado a una paciente
con diagnstico DSM-IV-TR con Bulimia nerviosa
purgativa y Trastorno por uso de alcohol en un programa
de tratamiento de HD TCA. La intervencin teraputica
ha consistido en una estancia de dos meses y medio en
HD completo y el mismo periodo de tiempo en HD
parcial. Tras el alta participa en el Programa de Grupo de
Seguimiento mensual en el propio HD. Resultados: Los
resultados obtenidos tanto en la impresin clnica como
en la evaluacin psicomtrica respecto al rea
alimentaria, corporal y personalidad, realizada al alta de
HD se observa una clara mejora de los sntomas clnicos
de ambas patologas. Estamos a la espera de poder
obtener los resultados a los tres meses de seguimiento.
Discusin: Los resultados psicomtricos obtenidos son
congruentes con la exploracin clnica al alta. Esperamos
confirmar la buena evolucin conseguida a los tres
meses de seguimiento.

Modulacin emocional de la atencin hacia


imgenes de comida y cuerpos en personas
con trastornos de la conducta alimentaria
Sonia Rodriguez, Unversidad de Granada; S
Moreno, Universidad de Jaen; Belen RodriguezBorlado, M Munoz, Unversidad de Granada; W
Machado- Pinheiro, Universidad Federal
Fluminense; M Fernadez, J Vila, Unversidad de
Granada Spain
La atencin hacia un estmulo depende de si dicho
estmulo es o no emocionalmente relevante. El objetivo
de este estudio fue examinar los sesgos atencionales
hacia estmulos significativos en mujeres con TCA en
funcin del: (a) contenido afectivo de las imgenes, y (b)
la asincrona entre la presentacin de la imagen y el
target (Stimulus Onset Asynchrony [SOA]). Participaron
48 mujeres, 24 controles y 24 con TCA (9 ANR, 6 ANP, 4
BNP y 5 BNNP) que realizaron una tarea de orientacin
espacial. Se utilizaron 3 categoras de imgenes
afectivas (24 de comida, 24 de cuerpos y 24 neutrales).
Durante la sesin las participantes pasaron por 5 bloques
de 72 ensayos. En cada ensayo se presentaba una
imagen: a) en el mismo campo visual que el target
(ensayo ipsilateral) o, b) en el campo visual contrario
(ensayo contralateral) seguido por el target con un SOA
variable (100 y 800 ms). En las instrucciones se les
indicaba que deban responder sin cometer errores y lo
ms rpido posible. Los resultados indican: (a) mayor
nmero de errores cometidos por las participantes con
TCA en la deteccin del target cuando ste va precedido
por imgenes de cuerpos con SOA corto y, (b) mayores
tiempos de reaccin para las participantes con TCA tras
la presentacin de las imgenes de comida con SOA
corto. Estos resultados muestran que los estmulos de
comida y cuerpos provocan sesgos atencionales (mayor
nmero de errores y tiempos de reaccin ms largos),
especialmente, cuando su presentacin es preatencional
o automtica.

Perfil psicopatolgico en una muestra de


adolescentes con obesidad en el Hospital
Sant Joan de Du de Barcelona
Vicente Varea, C, Caldern, ; R Daz, ; L
Gomez, ; A Gutirrez, ; J Martn, ; S Pinillos, ; R
Badosa, Hospital Sant Joan de Deu de
Barcelona Spain
La obesidad es la enfermedad nutricional mas frecuente
en nios y adolescentes en los pases desarrollados.
Nuestro objetivo es evaluar el tipo y la frecuencia de
trastornos psiquitricos en adolescentes obesos. La
muestra consta de 145 sujetos de entre 12 y 18 aos; la
edad media chicos fue 13,8 aos ("1,4) y en chicas 13,5
aos (" 1,3). En la evaluacin psicolgica se utiliz una
entrevista psiquitrica no estructurada, el cuestionario de
cribado psicopatolgico YSR (Achenbach, 1982), el
cuestionario de depresin CDI (Kovacs, 2004) y el
cuestionario de ansiedad estado-rasgo STAI (Spielberg,
1982). Los resultados indican que las chicas se
perciben como ms aisladas (p=0.022), ms agresivas
(p=0.015) y con mayores problemas en la esfera de
conducta externalizante (p=0.004) que los chicos. En
cuanto a la sintomatologa depresiva (CDI), las chicas
obtienen menor autoestima que los chicos (p=0.002) y
mayor ndice de depresin (p=0.008). La prevalencia de
depresin en chicas fue de 10-15% y en chicos fue de 5-

10%. Respecto a la sintomatologa ansiosa (STAI), las


chicas informan ms de ansiedad-estado (p=0.002) y
ms ansiedad-rasgo (p=0.015), las chicas presentan ms
ansiedad que los chicos 4:1. Tanto en chicas como en
chicos, a medida que incrementa el IMC aumenta la
depresin (p=0.02) y disminuye la autoestima
(p=0.02).CONCLUSIONES: las repercusiones de la
obesidad transcienden el mbito puramente mdico. A
media que incrementa el IMC incrementa el riesgo de
presentar ansiedad-depresin y problemas de conducta
tanto en chicos como en chicas. En general, las chicas
suelen informar de mayor psicopatologa, concretamente
suelen evitar el contacto interpersonal, se muestran ms
irritables y hostiles en comparacin a los chico.

Sex, Marital & Family


Relationships
English Programme
Body Dissatisfaction and Cognitive
Distraction in People With and Without Sexual
Difficulties: Comparative Study
Beato Ana,; Patrcia Pascoal, Faculdade de
Psicologia C.E. Universidade de Lisboa/ Hospital
Jlio de Matos Porugal
A growing literature points to the role of body-image
attitudes in understanding human sexual functioning.
Specifically, body dissatisfaction and excessive
psychological investment in one's physical appearance
may lead to physical self-consciousness, negative self
appraisal, body self-focus and body exposure avoidance
during sexual relations, which in turn may impair sexual
desire, enjoyment, and performance. In the present
research, we studied a sample of people both with and
without sexual difficulties. Our study aimed to: compare
both groups in terms of sociodemographical variables,
socio-emotional adjustment, body satisfaction and
cognitive distraction (centred on physical appearance)
during sexual activity. The study is exploratory,
descriptive, transversal and comparative. There were a
total of 115 respondents, 46 male and 69 female from a
convenience sample. The instruments used were:
General Questionnaire (sociodemographical data); The
Rosenberg Self- Esteem Scale (RSES- Rosenberg,
1965); the Percepo da Imagem Corporal (Perception of
Body Image- PIC- Pascoal, Narciso, Pereira) and the
subscale of Body Satisfaction of the Body Attittude Test
(Probst, Vandereycken, Van Coppenolle & Vanderlinden,
1995) and the Sub-Scale of Bodily Appearance of the
Cognitive Distraction Scale (Dove & Wiederman, 2000).
Our results reveal that people who have sexual problems
are older (p = 0,05). We found no differences concerning
other sociodemographical data, self esteem and
perception of socio-emotional adjustment. Our results
also found that the group with sexual problems is more
unsatisfied with their body image (p < 0,05) and more
often desire to be thinner (p<0,01). We found no
evidence that the sample with sexual problems present
more cognitive distraction during sex (p= 0,069). However
due to the level of significance found we hope to clarify
this date with a larger sample which includes clinical
sample too. The current findings suggest that body
dissatisfaction exists in people who suffer from sexual
difficulties, it may represent a risk factor to sexual
dysfunction and that the interventional programs should
integrate techniques and procedures to improve people's
body image and body esteem. Also, classical procedures
should be implemented taking into account the emotional
and cognitive implications of body exposure. Future
research should contemplate the role of dissatisfaction
with specific body parts and cognitive distraction and not
only dissatisfaction with the whole body. Also it would be
interesting to study the association between body image
concerns and the type and duration of relation.

Therapy Groups for Women Victims of


Gender Violence
Mireia Ayats Plana, Roser Cirici Amell, Mtua de
Joan Miquel Soldevilla Alberti, Mtua de Terrassa
Hospital
The objective of this study is evaluating the effectivity of a
group cognitive-behavioural intervention for women who
are or have been victims of gender violence. This
effectivity has been understood as the improvement of
the psychopathological state of these women. It is applied
a 20 session programme of 90 minutes each one, with a
frequency of one session per week. Groups are
composed of between 6 and 8 participants. Techniques to
reconstruct self-esteem are applied as well as others to
increase the consciousness of the violence situation.
There have been also used techniques of emotional selfcontrol to treat anxiety, depression and stress symptoms.
Besides, assertivity techniques are applied. Evaluations
are realized before and after intervention. The conducted
tests are: standardized interview of data collecting, MMPIbrief version, STAI, BDI and assessment questionnaire of
violence. 39 women took part in therapy groups. Mean
age was 47 years old. They had suffered psychological

violence (100%), control violence (98,7%), economic


violence (82,1%), physical violence (74,4%) and sexual
violence (66,7%). The statistic programme SPSS was
applied and a T-test analyse was done for related
samples. Significative improvements were found in STAIT, STAI-S and BDI. In MMPI it was observed significative
improvements in D and Hy subscales. There were no
significative changes in the other subscales; all of them
tended to decrease in the punctuations, except for the
Pa, which tended to increase. The mean personal
satisfaction about participating in the group was 9,06 (110). The results show that therapeutic groups are an
effective intervention for the treatment of women victims
of gender violence. As for the clinic profile, they improve
in Depression, Anxiety (state and trait) and Hysteria.
Women who participate in the groups show a high
satisfaction, in a subjective way, with this therapy.

Sexuality in Elderly Subjects


Teresa Cardoso, Sandra; Vilarinho Faculty of
Psychology and Educatinal Sciences of
University of Coimbra, Pedro; Nobre Department
of Education and Psychology, University of Trsos-Montes e Alto Douro of Portugal
With this study we intend to explore the relation between
sexual functioning and depressive/anxiety
symptomatology, cognitive variables related with sexual
beliefs and sexual information, relational variable
(intimacy) and alcohol consumption. Furthermore we
intend to clarify the importance of social and clinical
demographics variables in sexual functioning of
institutionalized and non-institutionalized aged sample.
Participants Were 201 elderly institutionalized and noninstitutionalized, with over 65 years old participated at the
present investigation, which the principal inclusion
criterion was the fact of maintaining a relationship and
sexual activity. Social demographic and clinical
questionnaire, Brief Symptoms Inventory (BSI, Derogatis
& Spencer, 1982), Sexual Beliefs and Information
Questionnaire (SBIQ, Adams et al., 1996), Female Sexual
Function Index (FSFI, Rosen et al., 1996), International
Index of Erectile Function (IIEF, Rosen et al.,1996),
Inventory Personal Assessment of Intimacy in
Relationships (PAIR, Schaefer & Olson, 1981), Cutting
down, Annoyance by criticism, Guilty feeling and Eyeopeners (CAGE, Ewing, 1984), were used. The principal
results suggested that, concerning women, there is a
negative correlation between FSFI(total) and SBIQ(total)
(r= -0,317, p< 0,001) and a positive correlation with
CAGE (r= 0,221, p<0,028). We also found a positive
correlation between FSFI(total) and Anxiety (r=0,210, p<
0.037), though no correlations were found with
depression. Concerning men, we found negative
correlations between IIEF(total) and SBIQ(total) (r= 0,233, p< 0,019) and with PAIR (r= -0,531, p< 0,000). A
negative correlation between IIEF(total) and Anxiety (r= 0,372, p< 0,000) and a positive one with Depression (r=
0,434, p< 0,000) were found. The t student test showed
that the institutionalized elderly sample had better sexual
functioning [t(201)=2,05; p=0,04] M=62,8; DP=6,13; more
orgasm [t(201)=3,21; p=0,00] M=10,6; DP=1,63 and
absence of sexual pain [t(201)=5,48; p=0,00] M=13,4;
DP=1,79 and vaginismus [t(201)=5,47; p=0,00] M=4,66;
DP=0,65. The present results suggested that there are
differences at the sexual functioning within elderly men
and women, institutionalized and non-institutionalized.
More investigations about sexuality in the elderly should
be conducted and highlighted since sexuality is still an
important factor in understanding the human aging
process.

Coming Out among Sexual Minorities in Hong


Kong: Application of the Theory of Planned
Behavior and the Moderating Role of
Attitudinal Ambivalence
Eliza Y. L. Cheung, Ah Chit Ng, Winnie W. S.
Mak, The Chinese University of Hong Kong
The phenomenon of coming out is uniquely relevant to
people with invisible stigma, which refers to traits that are
not readily observable but nevertheless cause others to
label an individual as deviant once discovered (Bohan,
1996). Lesbians, gay men and bisexual individuals (LGB)
are examples of minority group in our society that bear
such invisible stigma and they have to make conscious
and continuous decisions about the degree to which they
should reveal their sexual orientation and to whom they
should come out (Mohr & Fassinger, 200). The present
study applied the Theory of Planned Behavior (TPB) in
understanding coming out among sexual minorities. In
additional to applying the TPB to examine this
phenomenon, the moderating role of attitudinal
ambivalence, which refers to the simultaneous existence
of positive and negative evaluations in coming out to
specific person, was tested in the attitude-intention
linkage. A total of 621 LGB participants (62.8% female)
with a mean age of 20.69, (SD = 5.90, range = 12-50
years) participated in the present study. Of these, 183
were gay men, 236 were lesbians, 202 were bisexual
participants. For each of the sexual minority group, a 4step hierarchical regression was used to test the role of
the TPB and the moderating effect of ambivalence on
intention to disclose one's sexual orientation in the near

future after demographic variables were controlled. The


overall model accounted for 48.4% (p<.0001), 40.5%
(p<.0001) and 42.8% (p<.0001) of the variance in
intention to disclose in the near future for gay men,
lesbians and bisexual participants, respectively. Attitudinal
ambivalence significantly moderated the effect of attitudeintention linkage among lesbians and bisexual individuals,
ps < .001. Discussion: The present study extended the
utility of the Theory of Planned Behavior on disclosure
intention of sexual minorities in Hong Kong. All three
components of the TPB, especially perceived behavioral
control, played a significant role in determining disclosure
intentions. Lesbians and bisexual individuals who
harbored simultaneously positive and negative thoughts
and feelings concerning coming out to the target were
less likely to come out than those who did not possess
such conflicting evaluations. Conclusion: Fostering LGB's
perceived behavioral control as well as enhancing the
insights of lesbians and bisexuals about their
ambivalence attitude towards coming out could result in a
stronger intention of disclosure. This study used an
empirically validated cognitive approach in understanding
coming out among sexual minorities. It also captured the
attitudinal ambivalence that may be commonly
experienced among invisible minorities as they negotiate
across varied social contexts regarding their coming out
decisions. References: Bohan, J.S. (1996). Psychology
and sexual orientation: Coming to terms. New York:
Routledge. Mohr, J., & Fassinger, R. (2000). Measuring
dimensions of lesbian and gay male experience.
Measurement and Evaluation in Counseling and
Development, 33, 66-90.

Self-construction and self-esteem in abused


women
Roser Cirici, ; Joan Miquel Soldevilla, Mireia
Ayats, Hospital Mtua de Terrassa; Guillem
Feixas, University of Barcelona Spain
Some women suffer from physical, sexual, and
psychological violence from their partner, as well as
threats, coercion or arbitrary deprivation of freedom in
public and private life. Often, these women are not aware
of being in a dangerous situation that needs to be
changed or escaped. Kelly's Personal Construct Theory
can provide a frame for an explanation of this fact. The
experience of suffering abuse must be detected,
constructed, and integrated within the personal world of
meanings (the constructs) to be identified. Therefore, it is
necessary to understand and analyze their network of
constructs, especially those related to abuse and
mistreatment. The aim of this study is to assess the
network of constructs, focusing on the personal
construction of abuse, in a group of 29 women with an
average age of 45 who are suffering or had suffered
gender violence. Instruments: The Repertory Grid
technique is a procedure for the assessment of the
subject's personal constructs. It is aimed to grasp how
people perceive and understand the way a particular
person gives sense to his/her own experience, making
use of his/her own words. This instrument has been
adapted to evaluate more specifically the construction of
abuse by incorporating the constructs victim - abuser,
self-sacrificed - selfish, quiet - violent and dependent independent. The results indicate a general profile of a
woman who considers herself as a victim (100%), selfsacrificed (100%), quiet (90%) and dependent (55%).
The husband's or ex-husband's profile is pictured in these
grids as an abuser (100%), selfish (93%), violent
(97%) and independent (62%). A remarkable 66% of the
women would like to give up classifying themselves
neither as victims or abusers, while 34% would keep
using the construct victim - abuser to define their ideal
self. In the same way, the ideal position for all these
women would be in the poles independent (100%),
quiet (97%), and only a 48% see as ideal to take care of
themselves and their wellbeing. Self-esteem was positive
for 75% of the women. All the women of this sample
constructed themselves as victims and self-sacrificed,
which in turn are associated in their network of
constructs. As we have observed most women have
difficulties in breaking their abuse relationship. Further
studies should explore whether the relative good selfimage and self-esteem of these women is sustained in
the current abusive relationship, this preventing them
from leaving their violent partner. References: Walker,
B. & Winter, D. (2007). The Elaboration of Personal
Construct Psychology. Annual Review of Psychology. 58,
453-477. Winter, D. & Viney L. (eds.) (2005). Advances in
Personal Construct Psychotherapy. London: Wiley.
Feixas, G., Bach, L., & Laso, E. (2004). Factors affecting
interpersonal construct differentiation when measured
using the Repertory Grid. Journal of Constructivist
Psychology, 17, 297-311.

Psychopathology and Interpersonal


Relationship in Male and Female Sexual
Dysfunctions
Pedro Costa, Pedro Nobre, Departamento de
Educao e Psicologia, Universidade de Trs-osMontes e Alto Douro, Portugal

Sexual dysfunctions (SD) can either be the cause or the


consequence of the development of certain
psychopathologies (APA, 2000; Correti, Pierucci, De
Scisciolo, & Nisita, 2006; Nobre, Pinto-Gouveia, &
Gomes, 2006). Moreover, inadequate interpersonal
relationships may also influence and be influenced by SD
(Metz & Epstein, 2002; Orathinkal & Vansteenwegen,
2007; Rosen & Leiblum, 1992). Some studies indicate
that there are specific relationship patterns between some
SD's and psychopathological dimensions (Angst, 1998;
Correti et al., 2006; Figueira, Possidente, Marques, &
Hayes, 2001; Schreiner-Engel & Schiavi, 1986).
Research on the impact of interpersonal relationship in
the development of SD has also shown the strong interrelation between these two dimensions (Hawton, Catalan,
& Fagg, 1992; Heiman, LoPiccolo, & LoPiccolo, 1981;
Metz & Dwyer, 1993). The aim of the present study is to
investigate the differences between individuals (men and
women) with and without SD in terms of psychopathology
and interpersonal relationship. A clinical sample of 50
men and 50 women and a matched control sample of 50
men and 50 women answered to the International Index
of Erectile Function (IIEF; Rosen, Riley, Wagner,
Osterloh, Kirkpatrick, & Mishra, 1997), the Female Sexual
Function Index (FSFI; Rosen, Brown, Heiman, Leiblum,
Meston, Shabsigh, Fergunson, & D`Agostino, 2000), the
Brief Symptom Inventory (BSI; Derogatis & Spencer,
1982), the Beck Depression Inventory (BDI; Beck, Ward,
Mendelson, Mock, & Erbaugh, 1961), the Dyadic
Adjustment Scale (DAS; Spanier, 1976), and the Sexual
Dysfunction Interview (SDI - male version and female
version; Sbrocco, Weisberg, & Barlow, 1992). Preliminary
findings regarding differences between the clinical and
the control groups on psychopathology and interpersonal
relationship will be presented and discussed.

An examination of romantic partner qualities,


self qualities, psychological need fulfillment
and well-being in emerging adulthood.
Wendy Ducat, Melanie Zimmer-Gembeck, Griffith
University Australia
It is well established that romantic relationship quality
(RRQ) in adulthood is associated with psychological wellbeing. As specific pathways between RRQ and well-being
remain unclear (e.g. Lucus & Dyrenforth, 2006), this pilot
research used robust measures and an integrated
framework to investigate this relationship. This research
also aimed to expand findings from adulthood to the
period of early 'emerging' adulthood (17-24 years), which
is characterised by heightened exploration and
engagement in romantic relationships. Many seminal
writers in psychology have proposed need fulfillment in
relational experiences as important for psychological
growth and well-being (e.g. Maslow, 1943). Selfdetermination theory (SDT) integrates these approaches,
proposing that personal growth and well-being occurs
through fulfillment of psychological needs for autonomy,
competence and relatedness. SDT stipulates that need
fulfillment is facilitated through individual differences
variables and social contexts (Deci & Ryan, 2000) and
guided this research. Romantic relationships were
expected to be central social contexts for need fulfillment
in emerging adults who are in a romantic relationship.
Three dimensions of relational self, or aspects of the self
in the context of a significant relationship, were also
investigated. These were authenticity, attachment anxiety
and avoidance, and self-other differentiation with romantic
partners. Limited previous research has investigated selfdetermination in the context of intimate relationships, and
these studies have lacked a multi-dimensional framework.
Specifically, a multi-dimensional model of romantic
relationship quality and well-being was proposed. It is
hypothesised that romantic relationship qualities and
relational self dimensions would be uniquely associated
with perceptions of need fulfillment in romantic
relationship, and that need fulfillment would mediate the
associations between these variables and well-being.
Participants (N=218) were recruited according to preallocated criteria (i.e. 17-23 years, equal gender, in a
romantic relationship). Self-report measures included a
new measure of RRQ that included aspects of SDT;
perceptions of romantic relationship need fulfillment; adult
avoidance and anxiety attachment scales; authenticity in
romantic relationships; self-other differentiation; and
general psychological well-being. All measures had high
internal consistency. Pearson's correlations indicated that
RRQ, relational self and need fulfillment were all
associated with well-being in expected directions.
Preliminary regression analyses showed that RRQ,
authenticity, attachment anxiety and avoidance were
uniquely associated with need fulfillment, with beta's
ranging from -0.14 to 0.39, all p< 0.05 (R_ = 0.77). When
all variables were considered, the associations between
these variables and well-being were mediated by need
fulfillment (b = 0.33, p< 0.05), except for selfdifferentiation which also uniquely co-varied with wellbeing (b = 0.57, p< 0.05). Associations were supported
with structural equation modelling and the fit of this model
was good. Results largely supported Self-Determination
Theory, that need fulfillment in romantic relationships is
important for psychological well-being, and need
fulfillment uniquely covaries with the quality of the
relationship and attributes of the self. Replication and
expansion of the model of individual differences (i.e.

relational self) and social context (i.e. RRQ) for need


fulfillment and well-being, is a fruitful area for continued
research.

The effectiveness of brief solution- focused


couples therapy on decreasing cuples
conflicts in khomanini shhr of Isfahan
Bahrami Fatemeh, Isfahan University; Lila Saidi,
Isfahan University; Ozra Etemadi, Isfahan
University
Equipments instead of , weakness and deficiency and
pathology, and The conflicted couples are unsatisfacted
of characteristics and habits of their partners. They also
have many problems in their communication such as:
spend leisure, sexual relationship and diversity with
partner's original family and friends. The solution-focused
therapy is a brief approach to treatment of couples'
conflicts that was developed by shazer and his wife,
kimberg in 1970 and 1980 decades. This approach
focuses on couples power points, , attending to solution
instead of history and reasons of problems The statistical
community was the couples who had abilities also
conflicts and referred to family counseling centers from
Jan(2006) to May (2006). The samples was randomly
selected and included 20 couples ( 10 experimental, 10
control) Who had conflict problems. Solution-focused
couple therapy carried out for 6 sessions every week. the
result showed that solution-focused couple therapy
reduced total and the subscales scores of marital
conflicts(P < 0. 01). the solution-focused couple therapy
is a effectiveness approach for working with couples
;conflicts.that focus on solution instead of problem and
can lead to hope for couples.that divert couples attention
to good situations when they have had instead bad
feelings that they have now.

Relationship between attachment styles, selfesteem, depression, parental caregiving, and


romantic partner selection
Andrzej Kuczmierczyk,Sandra Couto, City
University London,. UK
Previous research has identified individual differences
across diverse sexual orientations in factors determining
romantic partner selection(Lacey et al.,2004).
Consensually desired attributes between males and
females reveal that some characteristics including
physical attractiveness, shared attitudes, values, and
beliefs, and pleasant personality tend to be unanimously
desired (Simpson & Gangestad, 1992). A proportion of
individuals however repeatedly enter abusive
relationships selecting partners who do not conform to
such desired attributes. The present study attempted to
investigate the role of attachment style in adult romantic
partner selection. Eighty three women were recruited for
participation in this study via posters displayed in local
supermarkets, counselling agencies, and at City
University. After being given information about the
purpose of the study by the second author and signing an
informed consent form, participants were asked to
complete the Parental Bonding Instrument(Parker, 1979),
Adult Attachment Questionnaire(Hazan & Schaver, 1987),
Rosenberg Self Esteem Scale (Rosenberg, 1965), Beck
Depression Inventory (Beck et al 1961), and Romantic
Partner Attributes Index(Simpson & Gangestad, 1992).
Consistent with findings from previous research, positive
memories of parental caregiving were positively related to
secure attachment. Insecure attachment was related to
higher levels of depression and lower self esteem.
Women reporting secure attachment styles appeared to
rate partner security, parenting qualities, and social
qualities as more desirable attributes in selecting their
partners. Women with insecure attachment styles tended
to rate financial security as more highly desirable in their
partner selection. Results further indicated that women
with secure attachment styles reported more positive self
esteem, lower levels of depressed mood, and more
caring parental rearing than women with insecure
attachmant styles. The results of the present study
suggest that romantic partner selection in women may to
some extent be a function of type of attachment style.
Women with secure attachment styles tend to value
social attributes more in their partners than women with
insecure attachment style, favouring financial security.
Potential implications may be that women with insecure
attachments may be more prone to selecting less
caring/loving partners. Further research needs to confirm
the role of attachment style as a possible risk factor for
women repeatedly entering abusive relationships.

The Effect of Witnessing Marital Violence in


Childhood on Dating Violence among Korean
College Students
Jee Yeon Lee; Kyung Ja Oh, Yonsei University
Korea
Recent studies have reported that observing marital
violence between parents is associated with relationship
problems such as dating violence. However, very little is
known about the processes underlying the relationship
between witnessing parental violence and dating
violence. This study was designed to examine the role of
attitudes toward dating violence and anger regulation in

the relationship between parental violence and dating


violence in college students. Specifically, it was
hypothesized that the effects of witnessing parental
violence on the child's dating violence is mediated by
attitudes toward dating violence and anger regulation.
377 Korean college students(178 male and 199 female)
enrolled in introductory psychology courses completed
questionnaires on witnessing parental violence, attitude
toward dating violence, anger regulation, and dating
violence. The Conflict Tactics Scale-version 2 (CTS 2;
Straus et al., 1996) was used to assess participant's
experience of acting violence toward a dating partner and
their reports of the level of violence exhibited by each of
their parents toward the other. Participants' beliefs about
the justifiability of dating violence were assessed with the
Attitudes about Dating Index (ADI; Foo & Margolin, 1995)
and 4 items added by Suh(2001). Participant's tendency
to experience and express anger was assessed with the
State-Trait Anger Expression Inventory (STAXI;
Spielberger et al, 1988). It includes trait anger, angercontrol, anger-out, and anger-in. The data were analyzed
using Structural Equation Modeling. Correlation
coefficients among witnessing parental violence, attitudes
toward dating violence, anger regulation, and dating
violence were examined. Students exposed to greater
parental violence were more likely to view violence as
justifiable in a dating relationship and had more difficulty
with anger management, which was associated with
higher levels of physical and psychological violence
toward their own dating partners. The full mediation
model hypothesizing that attitudes toward dating violence
and anger regulation fully mediated the relationship
between witnessing marital violence and dating violence
was tested. Goodness-of-fit measures indicate that the
model fit the data well (TLI = .99, CFI = .99, RMSEA =
.059, x2/df = 2.32). Next, we refit the model after adding
the direct path from parental violence to dating violence.
This improved the fit of model slightly but not significantly
(TLI = .99, CFI = .99, RMSEA = .060, x2/df = 2.33) with
the direct path non-significant. It provides further support
that the relation between parental violence and dating
violence is wholly accounted for by the mediators. This
study offers insight into the processes that may explain
how witnessing parental violence leads to acting violence
toward dating partner in young adulthood. These results
support the value of targeting attitudes toward dating
violence and anger regulation in prevention programs
designed to reduce dating violence.

Factorial Invariance of the Multidimensional


Measure of Emotional Abuse in Clinic and
Nonclinic Samples
Christopher Murphy, Stephen Pitts, University of
Maryland, Baltimore County USA
The Multidimensional Measure of Emotional Abuse
(MMEA) assesses four distinct but overlapping patterns of
abuse in intimate adult relationships. Its factor structure
was originally validated with college dating samples. The
current investigation generalizes the multifactorial
structure of this measure to a clinical sample of partner
violent men presenting for treatment at a community
domestic violence agency. Data from approximately 400
undergraduate students in dating relationships, and
approximately 400 clinical sample partner violent men will
be analyzed. Confirmatory factor analysis will be used to
examine different aspects of factorial invariance across
samples. Correlational patterns with physical assault and
interpersonal problems will also be explored across
samples. The preliminary analyses revealed a high level
of factorial invariance across samples and reporter
(reports on self versus partner behavior). For the
conference, more extensive analyses will be conducted
on a larger sample that is currently being gathered.
Discussion will center on the patterns of emotional abuse
observed in college dating versus clinically violent
samples, measure invariance across these populations
and reporters, and validity associations with partner
assaultive behavior and interpersonal problems.

Effects Of Sexual Stimulus Conditions In


Women With Different Levels Of Sexual
Satisfaction And Functioning
Pedro Nobre, Department of Education and
Psychology, Universidade de Trs-os-Montes e
Alto Douro, Portugal; Sandra Vilarinho, Faculty of
Psychology and Educational Sciences,
Universidade de Coimbra, Portugal
The major limitation of most laboratory-based sex
research today has been the exclusion of the dyadic
aspect of sexuality (Rowland, 1999). Erotic stimulation
used in psycho-physiological research is most often
audio-visual (segments drawn from videotapes produced
commercially for entertainment or educational purposes)
(Both et al., 2004; Palace & Gorzalka, 1992; Polan et al.,
2003; Rellini et al., 2005). Although some studies indicate
that exposure to sexually explicit material (SEM) in the
laboratory is an adequate method to evoke genital
responses and subjective sexual arousal in men and
women (Geer & Jansen, 2000; Laan & Everaerd, 1995), it
could be questioned if this is the only or the best way to
study women's sexual responses in laboratory. Some
studies suggest that women find scenes involving mutual

attraction between sexual partners and prolonged


foreplay more subjectively arousing than scenes involving
anonymous sex with strong emphasis on intercourse
(Laan et al., 1994). A significant number of studies
support also the idea that there are some gender
differences in attitudes toward and experience with SEM.
For example, Lawrence and Herold (1988), replicating
previous studies, found that women responded
unfavourably to SEM. Research has also indicated that
men have, in average, more positive behavioural and
affective responses to SEM than do women (Clark, &
Wiederman, 2000; Kelley et al., 1997; Padgett et al.,
1989). Although current psycho-physiological research is
far from early lab studies on sexual response using
sexual surrogates or couples (e.g., Masters & Johnson,
1966), few efforts have been done to investigate the role
of relational or intimate variables, by integrating them into
the stimulus conditions, for example. Following this, the
main goal of our research project is investigate the
importance of using different sexual stimulus conditions
(erotic and relationship stimulus versus sexually explicit
material) and to test some hypotheses on the role of
cognitive, affective and relationship variables as
mediators of female sexual response. The experimental
design will be a 2 (context: erotic and relational/sexually
explicit material) X 2 (sexual functioning:
functional/dysfunctional) X 2 (relationship satisfaction:
more satisfied/dissatisfied). Participants will be women
with ages between 18 and 75 years, married or living with
a partner, recruited from the general population and from
public clinics (diagnosed with sexual dysfunction). There
will be 4 groups: 2 clinical groups (each of them with 15
women), one with low scores and the other with high
scores in relationship satisfaction; 2 non-clinical groups
(each with 15 women), one with low scores and the other
with high scores in relationship satisfaction. All groups will
participate in two experimental conditions. In condition A,
participants will be exposed to sexually explicit material
for 15 minutes. In condition B, participants will be
exposed to erotic and intimate scenes (visual and audio
stimulation, accompanied by erotic audio-tape and initial
instructions asking to imagine themselves and their
partners in the video) for 15 minutes. Participants will be
assessed with both physiological measures (vaginal pulse
amplitude, vaginal blood volume, labial temperature,
heart rate, respiration and galvanic skin response) and
subjective measures (self-rating scales of desire,
subjective arousal, sexual pleasure and satisfaction);
there will be also a measure of affect and thought listing.
Since this is still a project, research data will not be
presented here. If we have some preliminary results by
the time of the Congress, we will present them. As soon
as we have results, we will be able to discuss the
importance of including the relationship component in
experimental designs, for a better understanding of
women's sexual response. By using two different sexual
contexts (erotic/ relationship versus sexually explicit) we
will have the possibility of comparing their importance in
terms of women's sexual functioning (desire,
physiological and subjective arousal) and satisfaction.
Additionally, it will be possible to discuss the ways in
which the stimulus context used in most previous
laboratorial studies might have conditioned the findings
reported so far. Finally, with this laboratorial study we will
be able to deepen and discuss the possible role of the
cognitive, affective and relationship variables as
mediators of women's sexual response to different sexual
contexts.

How does the divorce affect children? The


effects of marital separation on children
according to parents perception
Mireia Orgils, Jos Pedro; Espada University of
Miguel Hernndez de Elche, Jessica Piero
University of Miguel Hernndez de Elche
The divorce implies several changes that affect
considerably the children and can generate them
psychological problems. The aim of this study is to
examine the repercussions of the divorce in children
according to parents perception. It is examined the
understanding of the children of the separation, as well as
the effect of the divorce in the physical and psychological
health, the academic achievement and the social
relations. Finally, the information provided by each parent
is compared to know if there is agreement in the
perception of both. Participants are 151 subjects, 78
women and 73 men who have recently divorced. The
average time of living together was 7 years, and the
subjects had 1 or 2 children with their ex- spouse. The
mother had the safekeeping of the children in 93% of the
cases, the father in 5% and both parents in 2% of cases.
The information was successfully obtained through an
semistructured interview, divided in two parts: information
about the understanding of the children of the divorce and
information about the adaptation of children to the new
situation, according to parents perception. 67% of the
participants affirm that they explained clearly to their
children the reasons for the separation, but only 15% say
that their children understood perfectly their divorce. With
respect to the perception of effects in children, 27% of the
sample have noticed changes in the physical or
psychological health of their children, 26% affirm that their
children have gotten worse in their studies and 14%
declare that their children lost friends after the separation.

The correlation found between the information provided


by each member of the couple was low in the analyzed
questions. The results show that most of the parents
explained the causes of their divorce to their children,
although only a small percentage of subjects consider
that children understood perfectly the reasons of the
rupture. With respect to the repercussions of the divorce
in their children, most of the parents have not perceived
changes in the physical or psychological health,
academic yield or social relations of their children. The
study shows the lack of agreement between both parents
with respect to the understanding of the children of the
divorce and their adjustment to the new situation.

A study on the effectiveness of Imago


relationship therapy and cognitive behavior
therapy on couple's intimacy in Esfahan.
Etemadi Ozra, Isfahan University
Imago relationship therapy is relational parading
approach that is desined to increase cou0ple
communication heal wonds from childhood and promote
differentiation and correct developmental arrests.
cognitive behavior therapy help to couple in
communication skills, Promoting , Cognitive mistakes ,
conflict solution skills and behavioral skills. The Purpose
of this study was to study effectiveness of Imago
relationship therapy and cognitive behavior therapy on
marital Intimacy. The research method was quasi
experimental with pretest and posttest design with control
Group. The sample were couples who were refered to
counseling centers in esfahan. Statistical samples
consist of 48 subjects (24 couples) that were randomly
selected and distributed in experimental and control
Groups. Measurement toll was Intimacy needs survey.
The experimental group participated in 10 sessions of
Imago relationship therapy and cognitive behavior
therapy the results were analyzed with covariate and
LSD using spss software The results showed that the
imago relationship increased emotional, psychological,
intellectual, sexual, Spiritual and social -recreational
intimacy. The cognitive -behavior therapy therapy
increased emotional and sexual intimacy. The
effectiveness of two groups was significantly different on
Psychological, intellectual and spiritual intimacy. imago
relationship therapy was more effectiveness more than
CBT .that could be due of work on uncouncious stimuli
that are affect on couples behaviors and feelings.

Marital satisfaction and spouses perceived


social skills
Aline Sardinha, Eliane Falcone, Universidade do
Estado do Rio de Janeiro, Maria Cristina;
Ferreira Universidade Salgado de Oliveira, Brazil
Marital satisfaction is a relevant issue in the psychological
field, once it affects quality of life. Research data points
that social skills play an important role on marriage's
longevity. Although, most of the studies consider only the
individual level of social skills and the impact of the
mate's level of social skills in one's marital satisfaction
remain unclear. This study aimed to investigate the
relations between the perception of spouses levels of
social skills and ones marital satisfaction. Fifty couples
(100 participants) were asked to fill in the Marital
Satisfaction Scale, the Marital Social Skills Inventory and
the Marital Empathy Questionnaire. Statistical analysis
showed that spouses level of empathy was the strongest
factor related with marital satisfaction, followed by the
expression of feelings and defense of the ones rights. It
was also observed that the number of children is
inversely related with marital satisfaction and that women
had been perceived by their partners as being more
empathic than men. Hence, studying the impact of one
spouses social skills on partners marital satisfaction
may permit developing cognitive behavioral interventions
to increase marital satisfaction.

The Effect Of Acute And Chronic


Psychological Stress On Sexual Arousal In
Sexually Functional Women
Moniek ter Kuile, Daan Vigeveno,; Ellen Laan,
Department of Sexology, Amsterdam Medical
Center, University of Amsterdam, The
Netherlands
Kaplan (1983) suggested: People who are trying to cope
with severe stress, would be absurd to expect good sex.
Even the person whose sexuality is fundamentally sound
may experience difficulty making love on the battlefield,
during a divorce..., during financial crisis..., or in the midst
of severe marital fights. Although the idea that
psychological stress negatively affects sexual responding
is generally accepted, research on the influence of (acute
or chronic) stressors on genital and subjective sexual
arousal is scare. To clarify the effects of acute
psychological stress on sexual arousal in sexually healthy
women a between subjects design was used in which
subjects were randomly assigned to an acute stress
condition or control condition. We expected that women in
the acute stress condition would respond to an erotic
stimulus with overall less genital arousal and subjective
sexual arousal than women in the no-stress condition. In
addition, we explored whether women with high levels of

chronic daily stress responded to the erotic stimulus with


overall less genital arousal and subjective sexual arousal
than women with low levels of chronic daily stress. Fiftynine women were randomly assigned to an experimental
or a control condition. In the experimental condition
psychological stress was induced by a dual computer
intelligence and skill task combined with a social
(evaluation) stressor. Errors, or lack of progress, in the
computer task were acknowledged by an 'unfriendly'
assistant. In the control condition the woman got a neutral
computer task, without any time pressure or social
evaluation stressor (no assistant was in the room). After
the stress or control induction, women were exposed to a
sexual stimulus (erotic film clip). To measure genital
arousal, vaginal pulse amplitude (VPA) was assessed by
a vaginal photoplethysmograph. Self-report ratings of
subjective sexual arousal were collected after sexual
stimulus presentation. Furthermore, for the explorative
question with respect to chronic daily stress, women were
post-hoc divided into a 'low 'and a 'high' chronic daily
stress group, based on their pre-assessment scores on a
chronic daily stress questionnaire. A 2 by 2 analysis of
co-variance, indicated that acute and chronic stress
impeded genital arousal (VPA) in women. For subjective
arousal, it was found that women in the acute stress
condition reported significantly less subjective sexual
arousal than in the control condition. No differences were
observed between women with low or high chronic daily
stress on subjective sexual arousal. The results of the
present study indicate that psychological stress plays a
role in sexual arousal responses, and suggest that an
acute stressor lowers subjective as well as genital
arousal in sexually functional female volunteers, and that
high levels of chronic daily stress reduce genital sexual
arousal. The present study points to the relevance of
measuring stress-related constructs in both clinical and
laboratory research of sexual functioning.

Incest and clinical symptoms in adulthood: a


therapeutic integrative approach.
Villagra Ventosa, Lopez Navarro, Diputacion De
Barcelona, Spain
We analyzed the clinical symptoms profile of an identified
group of 20 adult female sexualy abused in their families
(during childhood and adolescence), belonging to an
area of 20.000 inhabitants, who attended to a community
outpatient service of mental health searching help for a
mental health problem, during a 2-year period. Then, we
rehearsed an integrative therapeutic approach with a
small group of six of these women, who were more
seriously damaged and who compromised to participate
and attend the different therapy sessions for a 2-year
period. The other 20 women received cognitivebehavioral therapy or counseling help. We used clinical
structured interviews, recording biographical and
evolutive life events, following the standard criteria of
DSM-IV. We took repeated measures of anxiety and
depression and social adjusment for all the women
undergoing integrative therapy (BDRS, STAI, SASS) We
consecutively selected for the intervention a small group
of 6 women who represented different evolutive stages.:
(a) dating before marriage, (b) marriage and creation of
the family, (c) growing up of the children, (d)
independence of the children and re-structuration of the
couple, and who compromised with the program.
Therapeutic process started combining in the first phase
cognitive-emotional individual therapy with the use of
antidepressive , antipychotic and ansiolytic drugs, that we
maintained along the treatment process. In a second
phase, we extend the theraphy to the coupple and/or
family, if possible, and we started group therapy with the
six patients. We found a clinical profile characterized by
symtoms that can be classified in 4 categories: (a)
anxiety disorders such as panic attacks agoraphobia; (b)
psychogenic vomit and eating compulsive behaviours; (c)
depressive disorders running from changes in mood,
dysforic or aggressive behaviours to oneself or others,
feelings of guilt to chronic depressive disorder or major
depression with suicide attemps; (d) dissociative
symptoms, such as psychogenic amnesia, black-outs,
flashbacks or intrusive thoughts related to the traumatic
events, and (e) sexual dysfuntions. The spectrum of
symptoms is broader than those typical of the PTSS
disorder, although an important part of them can be
found in the chronic type of this one.
Two of the six
women group following integrative therapy dropped in the
first phase. Four significatively reduced clinical symtoms
of anxiety and depresion. Three of them improve to
recovery and got much better personal ans social
adjusment. We have obseved that the combination of
pharmacological therapy with psychological cognitive
individual, couple/family and group therapies enhanced
the use of clients own general skills, as much as the
learning of new skills to cope with the problem and the
development of personal projects. We also observed a
relationship between clinical symptoms, evolutive stage
and live events leading to searching help and the
evolution of the therapeutical process.

Enhancing Marital Intimacy Therapy: (E.M.I.T.)


Rationale, Practice and Efficacy
Edward Waring, Surrey Memorial Hospital, UK
A close, confiding relationship between husband and wife
is the single thread which explains successful marriages
and strong families. Marital intimacy can be facilitated by
the self-disclosure of personal constructs. Enhancing
Marital Intimacy Therapy, (EMIT), is a structured,
standardized ten session therapy involving self-disclosure
of constructs derived from a programmed marital
enhancement text. A summary of how EMIT is
implemented and practiced in the clinical setting is
presented. Outcome and process research aimed at
determining the effectiveness of the EMIT approach is
described. Enhancing Marital Intimacy Therapy is
presented as a humane, efficient and effective technique.
Process research in marital therapy can be viewed as the
study of interactions between the couple and the therapist
while treatment is still in progress (35). Process research
is concerned with how couples change. Process
research seeks answers to questions about the inner
workings of martial therapy (35). This section will focus
on research aimed at elucidating those aspects of selfdisclosure of personal constructs that are associated with
therapeutic change and discuss implications for the
practice of marital and family therapy in general. A recent
study by Waring, Schaeffer and Fry demonstrated a
positive association between changes in the depth of
disclosures and increases in perceived marital intimacy
as a result of couples' participation in EMIT. Waring et al
found that for couples who are reciprocally disclosing to
one another a positive cognitive self-disclosure pattern as
opposed to a negative feeling disclosure pattern is
associated with increased intimacy. The self-disclosure of
personal constructs is effective in enhancing marital
intimacy in some but not all couples with martial discord.
EMIT also reduces symptoms of depression and nonpsychotic emotional illness and is helpful in some cases
of conflict-habituated marriages. Couples who increase
the depth of self-disclosure in a positive fashion
demonstrate significant improvement. Whether or not
personal constructs must change for therapy to be
effective remains to be determined

Sex, Marital & Family


Relationships
Spanish Programme
Orientacin sexual y evolucin del uso del
preservativo en jvenes universitarios: aos
1999-2006
Rafael Ballester, Universidad Jaume de
Castellon; M Gil; Universida de Valencia; C
Gimenez, M Edo, Universidad Jaume de
Castellon; B Gil, Universida de Valencia Spain
El objetivo es presentar los resultados de un estudio
longitudinal en que se analiza la tendencia al uso del
preservativo desde 1999 hasta 2006 en universitarios con
distinta orientacin sexual.Se evalu a 6623 estudiantes
de la Universitat Jaime I de Castell (Media edad=21,27,
DT=4,05). Por sexos, 2550 eran chicos (38,5%) y 4073
eran chicas (61,5%). El 93.3% se defini como
heterosexual, el 3.6% como bisexual y el 2.5% como
homosexual. Se utiliz la Encuesta sobre el Sida de
Ballester y Gil (2000). Los resultados muestran que entre
los jvenes heterosexuales se han producido cambios
significativos en los ltimos aos tanto en las relaciones
con parejas estables (F=6.260, p<0.000) como
espordicas (F=2.577, p<0.012). La tendencia va en la
direccin de un menor uso del preservativo con los aos
en las relaciones estables y un mayor uso en las
relaciones espordicas. En los jvenes bisexuales, no
aparece ninguna diferencia significativa entre los aos.
Finalmente, entre los jvenes homosexuales se producen
diferencias estadsticamente significativas slo en el uso
del preservativo en el sexo oral (F=3.027, p<0.007) con
una disminucin progresiva entre los aos 2000 y 2003 y
un incremento significativo a partir de ese ao hasta la
actualidad.Nuestro estudio confirma que es necesario
seguir incidiendo a travs de campaas en la poblacin
joven para la promocin del uso del preservativo. No
obstante, se aprecian diferentes evoluciones en el uso
del preservativo en grupos con distintas orientaciones
sexuales, por lo que las campaas deberan tener en
cuenta estas particularidades.

Prevalencia del bajo deseo sexual en una


ussr de la comunidad valenciana: anlisis de
los principales marcadores de riesgo sociales
y demogrficos
Rafael Ballester Arnal, M Gil Llario, Universidad
Jaume de Castello;Navarro Pardo, Universidad
de Valencia Spain
El deseo sexual hipoactivo (F52.0 del DSM-IV-TR) es
uno de los trastornos sexuales que peor incidencia tiene
para la calidad de vida del paciente, tanto en la vertiente
personal como de pareja. En este estudio se analiza la

prevalencia de este trastorno en una muestra de 350


sujetos que demandaron atencin en la Unidad de Salud
Sexual y Reproductiva de Benetser, que atiende seis
localidades del rea metropolitana de Valencia
(aproximadamente 75.000 habitantes). En la Comunidad
Valenciana las USSR desarrollan funciones de atencin
integral a la salud sexual, incluyendo tanto diagnstico,
como tratamientos mdicos y farmacolgicos y
psicoterapia individual y de pareja. Las edades atendidas
abarcan prcticamente todo el ciclo vital, desde la
adolescencia hasta la tercera edad. Los datos
(biogrficos, familiares, sociales, laborales y clnicos) se
obtuvieron mediante una entrevista estructurada, y se
codificaron mediante el DSM-IV y el programa AbucasysII.Los resultados indican que se trata de un trastorno
importante puesto que origina el 17% de las demandas,
que afecta fundamentalmente a mujeres (80.3%),
casadas (85,2%), en su mayora empleadas (45,9%). Se
distribuye homogneamente a lo largo del ciclo vital
(rango 19-75 aos), siendo ms frecuente entre los 36 y
los 50 aos (32,8%), en personas casadas con dos hijos
(42%), seguidas de los casados con un hijo (32%). Se
derivan conclusiones e implicaciones para el diseo de
programas preventivos, ya que el grado de ajuste a las
caractersticas del colectivo diana es una de las
variables ms eficaces para la aplicacin con xito de
dichos programas.

Desde el punto de vista de la prevencin de


las ETS, es abstinencia el sexo oral?
Silvia Font Mayolas, M Planes Pedra, ; A Gomez
Lima, M Gras Perez, ; A Salamo Avellanada,
Universidad de Girona, Spain
Introduccin: Si el primer paso para la prevencin de un
problema de salud es tener unos conocimientos
adecuados sobre qu se debe hacer para evitarlo,
entonces conviene asegurar que la informacin que se
transmite a las personas que podran verse afectadas es
claramente comprendida. Investigaciones realizadas con
estudiantes de diferentes pases (Sanders y Reinisch,
1999; Randall y Byers, 2003) han puesto de manifiesto
que muchos de estos jvenes no han interpretado
correctamente los trminos abstinencia y monogamia,
que juntamente con el uso del preservativo, son los
comportamientos recomendados para evitar la
transmisin sexual del virus del sida y de otras ETS. Por
ejemplo, ms de la tercera parte de los jvenes que
participaron en un estudio de Horan, Phillips y Hagan
(1998) crean que el sexo oral poda considerarse un
ejemplo de conducta abstinente. En nuestro trabajo nos
proponemos conocer qu significados atribuyen los
jvenes universitarios espaoles a los trminos sexo oral,
para detectar posibles interpretaciones incorrectas y
peligrosas.Mtodo: Participan en la investigacin 750
universitarios de primero y segundo curso, seleccionados
mediante un muestreo proporcional y polietpico. Las
mujeres representan el 67,7% de la muestra. El 65,5%
de los jvenes tienen entre 18 y 21 aos. Los estudiantes
contestaron, entre otras, la siguiente pregunta: Te
agradeceramos que nos dieras uno o ms ejemplos o
definiciones de lo que para ti significan los trminos sexo
oral. Puedes utilizar el vocabulario que prefieras y que te
resulte ms cmodo. A continuacin, se sealaban tres
espacios para dar la contestacin. Resultados:
Mayoritariamente los jvenes dan respuestas correctas
(felacin: 25,2%, contacto oro-genital: 37,2%,
cunnilingus: 10,7%, 69: 6,4%) pero igualmente son
importantes los porcentajes de los que las dan
equivocadas: el 7,7% sexo sin penetracin, el 3,1% sexo
hablado, el 0,8% contacto oro-anal y el 0,7% besos en la
boca. Otros porcentajes de inters son los
correspondientes a las respuestas divagatorias (14,9%),
que bsicamente consisten en dar su opinin sobre lo
que les parece la prctica del sexo oral y a las
respuestas eufemsticas (9,3%) del tipo besos ntimos
otra forma de juego, etc., que no permiten conocer con
claridad a qu se refieren los jvenes. Finalmente
mencionar que se han encontrado diferencias
significativas entre hombres y mujeres en las definiciones
de sexo oral como cunnilingus (p=0,041) y como sexo sin
penetracin (p=0,004): de manera que lo varones daban
en mayor proporcin que las mujeres la primera
definicin, mientras que la segunda era mencionada por
un mayor porcentaje de mujeres que de hombres.
Discusin: En consecuencia, nuestros resultados vienen
a completar y corroborar mediante una metodologa de
respuesta abierta, los obtenidos por los autores
anteriormente citados a travs de listados de ejemplos de
conductas. Es conveniente, por tanto, que si en algn
momento se pone como ejemplo de abstinencia para
prevenir la transmisin del VIH o el contagio con otras
ETS, el sexo sin penetracin, se indique claramente que
en su prctica no debe de existir ningn tipo de contacto
oro-genital, ni oro-anal.

Anlisis de los factores implicados en el


desarrollo de una percepcin saludable
propia de la imagen corporal en futuros
maestros
Maria Dolores Gil Llario, Universidad de
Valencia; R Ballester, Esperanza Navarro,
Universidad Jaime de Castello, Spain

Los estudiantes de Magisterio sern los transmisores de


informacin, actitudes y valores a numerosas
generaciones por lo que constituyen una poblacin diana
en el mbito de la salud, concretamente en la reduccin
de trastornos alimentarios que se relacionan con las
distorsiones en la percepcin de la imagen corporal. Para
optimizar los programas dirigidos a este colectivo hemos
desarrollado una batera que recoge informacin de tipo
fsico, cognitivo, emocional y conductual. Esta batera se
aplic a 90 estudiantes seleccionados aleatoriamente
(76% mujeres y 24% hombres). El 45% de mujeres tena
bajo peso, 27% normopeso y 3% sobrepeso. En cuanto a
los hombres 7,1% tenan bajo peso, 12,9% normopeso y
4,3% sobrepeso. Esta distribucin se corresponde con la
proporcin real de estudiantes as como de profesionales
en activo.Los resultados muestran diferencias
significativas entre gneros en la satisfaccin con su
imagen (t=-1.92, p=.05) a favor de los chicos. Tambin se
analizaron las variables dependientes imagen corporal
saludable: aspectos positivos(ICAP) y aspectos
negativos (ICAN). Las variables que forman parte de la
ecuacin de regresin explicativa de ICAP son la
Autoestima y la Necesidad de Aceptacin (30% de
varianza explicada). En la ecuacin de regresin de
ICAN estn la Ansiedad y las Habilidades sociales (41%
de la varianza). La ecuacin de regresin de la
satisfaccin con la imagen corporal queda conformada
por la Autoestima y las Habilidades sociales (35% de la
varianza). Se concluye que los programas de formacin
dirigidos a este colectivo deben incluir mdulos de
desarrollo de la autoestima y las habilidades sociales.

Datos preliminares sobre las caractersticas


psicomtricas de una adaptacin espaola de
la Escala de Actitudes Familiares FAS
Rosa Jimenez Garcia Boveda, A Vazquez
Morejon; R Vazquez Morejon Jimenez,
Universidad de Sevilla, Spain
Introduccin: La importancia de las caractersticas del
entorno familiar ha sido especialmente destacada a partir
de los estudios de Emocin Expresada, considerndose
un importante factor pronstico en diversas patologas.
Aunque estas dimensiones emocionales han sido
evaluadas tradicionalmente a partir de la Entrevista
Familiar de Camberwell (Vaughn y Leff, 1976), diversas
razones han limitado notablemente su utilizacin en la
prctica clnica, motivo por el cual se han empezado a
desarrollar diversos instrumentos alternativos. La Escala
de Actitudes Familiares -FAS- es una interesante
alternativa, cuyas caractersticas psicomtricas han sido
exploradas en la versin original inglesa y cuya
traduccin y adaptacin a lengua espaola puede
contribuir a una ms gil y viable evaluacin del clima
emocional. La FAS consta de 30 tems que se contestan
en una escala que va de 4 Todos los das a 0 Nunca.
Previa inversin de la puntuacin de 10 de los tems, se
obtiene una puntuacin total a partir de la suma de todos
los tems, oscilando entre 1-120, indicando una
puntuacin ms alta un mayor nivel de criticismo.
Mtodo: Tras una doble traduccin y un primer pilotaje en
10 familiares de pacientes con esquizofrenia, se procedi
a aplicar la FAS a 140 familiares de pacientes (92
hombres y 48 mujeres) con diagnstico de esquizofrenia
tratados/as en Centros de Salud Mental. En 82 casos la
escala la cumpliment la madre (58,6%), en 42 el padre
(30%) y otros familiares en 16 (11,4%). En 32 casos,
simultneamente, se aplic a cada paciente el
Cuestionario de Vinculacin Parental -CVP- (Parker y
cols, 1979). En 17 casos se volvi a solicitar, en un
intervalo de 10-12 semanas, la colaboracin de los
familiares para una segunda aplicacin de la FAS.
Resultados: La consistencia interna para los 30 tems
muestra un coeficiente alpha de Cronbach de .954,
mientras que la fiabilidad temporal para un intervalo de
10-12 semanas muestra una correlacin sustancial y
significativa (r= .637, signif. bilat =.006). En lo relativo a
validez concurrente se observan correlaciones
moderadas y significativas entre la puntuacin en FAS y
las subescalas de Criticismo (r=.366, signif. bilateral =
.039), Sobreimplicacin (r= .356, signif. bilat =.046) y
Cuidados (r= - .412, signif. bilateral = .019) del CVP.
Discusin: Los resultados obtenidos muestran una alta
consistencia interna, similar a la referida por Kavanagh y
cols, 1997) y una satisfactoria fiabilidad temporal. Por
otra parte se observa que las puntuaciones en la FAS
estn asociadas a las puntuaciones en las subescalas
del Cuestionario de Vinculacin Parental, observndose
que una mayor puntuacin en FAS se asocia con
puntuaciones ms altas en Criticismo y Sobreimplicacin
y con puntuaciones ms bajas en Cuidados, lo que
constituye un apoyo a la validez de la escala.
Conclusiones: Los resultados confirman una satisfactoria
fiabilidad y aceptable validez de esta adaptacin
espaola de la FAS. No obstante, es preciso confirmar
estos datos en una poblacin ms amplia y continuar
explorando otras caractersticas psicomtricas de esta
escala (datos normativos, estructura factorial, validez
concurrente con otros instrumentos especficos,
sensibilidad al cambio, etc.).

Primeros datos psicomtricos del Inventario


de Asertividad Sexual de Hurlbert en una
muestra espaola
Pablo Santos, J Sierra, A Castro, Universidad de
Granada Spain

Aggressive Sexual Behavior Inventory:

La asertividad sexual se ha relacionado con la salud


sexual; as, la capacidad para comunicar de forma
efectiva creencias y deseos sexuales es necesaria para
desarrollar una sexualidad saludable (Morokoff et al.,
1997), y la incapacidad para expresarlos se relaciona con
la anorgasmia femenina (Cotten-Houston y Wheeler,
1983). Adems la falta de asertividad sexual se vincula a
una mayor implicacin en conductas sexuales de riesgo
(Morokoff et al., 1997). Por tanto un instrumento para
evaluar este constructo puede ser muy til en la prctica
clnica. Se presentan los primeros datos psicomtricos
del Inventario de Asertividad Sexual de Hurlbert (IASH;
Hurlbert, 1991), en una muestra de universitarios
espaoles. Concretamente 142 sujetos con experiencia
en relaciones heterosexuales (69 varones y 73 mujeres)
y con una media de edad de 21,87 (DT = 3,00)
respondieron al IASH junto con la Encuesta de Opinin
Sexual (Fisher, Byrne, White y Kelley, 1988). Cuatro
tems fueron eliminados por su baja contribucin a la
consistencia interna, y el anlisis factorial arroj cinco
factores que fueron abandonados por su falta de
coherencia terica y su baja fiabilidad. Teniendo en
cuenta los planteamientos del autor de la escala se opta
por una estructura unidimensional, la cual alcanza unos
valores de consistencia interna adecuados (alfa de
Cronbach = 0,88). Adems, las correlaciones de la
puntuacin total de la escala con erotofilia (r = 0,33; p <
0,01), erotofobia (r = -0,37; p < 0,01) y homofobia (r = 0,24; p < 0,01) apoyan nuestras hiptesis acerca de su
validez.

Entre los instrumentos diseados para evaluar la


violencia sexual de los hombres hacia las mujeres
destaca el Aggressive Sexual Behavior Inventory (ASBI)
de Mosher y Anderson (1986). Sierra et al. (2007)
realizan una adaptacin del instrumento a poblacin
salvadorea, sin alcanzarse una adecuada fiabilidad para
la mayora de las dimensiones propuestas por los
autores originales; este hecho, unido a la elevada
consistencia interna de la escala total, alienta a utilizar
una sola puntuacin. En este estudio se informa de los
primeros datos psicomtricos del ASBI en una muestra
espaola de 224 estudiantes universitarios (M = 27,83;
DT = 7,80), seleccionados mediante muestreo incidental,
con orientacin heterosexual. Adems del ASBI, los
participantes contestaron al SCL-90-R, al Cuestionario de
Agresin de Buss y Perry (AQ), al STAXI-2, a una versin
reducida de la Rape Supportive Attitude Scale (RSAS) y
a la Double Standard Scale (DSS). Se encontr un mejor
ajuste de los datos al modelo unidimensional que al
modelo de seis factores oblicuos. Los resultados
indicaron una baja fiabilidad en tres de los seis factores
propuestos por Mosher y Anderson, presentando sin
embargo la escala total un alfa de Cronbach de 0,90. Las
correlaciones entre la puntuacin total del ASBI y las
dimensiones del SCL-90-R, AQ y STAXI-2, la puntuacin
en actitudes favorables hacia la violacin y en doble
moral, resultaron todas ellas significativas. Estos
primeros datos psicomtricos revelan que las mediciones
obtenidas con el ASBI en una muestra espaola parecen
fiables y vlidas.

Programa de atencin psicolgica para


padres "El juego del optimismo modalidad
taller"
Andromeda Valencia, ; O Rodriguez Mendoza, ;
F Balderas Molina, ; A Avaraz Vergas, ; A Flores
Leon, Universidad de Mexico

Validacin de la Rape Supportive Attitude


Scale en muestras espaolas
Ihab Zubeidat, ; V Ortega, ; Juan Sierra,
Universidad de Granada, Spain, UK

Introduccin: La literatura reporta que gran parte del xito


de las intervenciones de modificacin de conducta en la
infancia se debe a la participacin activa de los padres
como agentes de cambio y mantenimiento. Actualmente
en el Centro de Servicios Psicolgicos "Dr. Guillermo
Dvila" de la Facultad de Psicologa de la UNAM
presenta un alto ndice de demanda de servicio para
nios. Durante el proceso de evaluacin se encontr un
elevado porcentaje de estrs en la crianza como
resultado de los problemas de conducta de los nios y de
la falta de habilidades en seguimiento instruccional en los
padres. En cuanto al cuidado de la salud, el papel de los
padres tiene gran repercusin sobretodo en nios de
edad escolar, ya que son ellos los promotores (Rey,
2006). Por lo anterior el objetivo de capacitar a los
padres, as como a encargadoss de cuidar nios tiene
como caractersticas: 1) Conocer principios que
determinan el comportamiento y el aprendizaje para
comprender mejor la conducta de sus hijos. 2) Emplear
estrategias psicoeducativas que permitan, comprender el
origen de los problemas de conducta y dotar de los
conocimientos y habilidades necesarias para afrontar
estos problemas. 3) Poner nfasis en que las tcnicas y
estrategias aprendidas puedan actuar directamente en el
entorno donde ocurren los problemas. 4) Prevencin; el
fortalecimiento y mejora de las prcticas de crianza de
los padres favorece la relacin con sus hijos, as como
disminuir el riesgo de maltrato. (Loeber & Hay, 1997;
Moffitt, 1993). Por tal motivo se realiz una adaptacin
del Programa de Atencin Psicolgica Individual "El
Juego del Optimismo" a Modalidad Taller. Mtodo: Los
participantes fueron 50 padres con una media de 32 aos
de edad con motivo de consulta: dficit en el
establecimiento de lmites; los participantes cumplieron
tres etapas. Primera etapa (Pre Evaluacin): Firma del
consentimiento informado, EC (Parental Stress Index:
PSI., Abidin, R. 1979. Adaptado por Ayala) Cuestionario
de Conocimientos y Habilidades en manejo de
emociones y control del comportamiento CCyH (Valencia
& cols. En prensa). Segunda Etapa (Intervencin): Un
total de 10 horas en 5 sesiones de 2 horas. Sesin 13.Entrenamiento en manejo de conducta; Sesin 4.
Habilidades en solucin de problemas; Sesin 5.
Habilidades Sociales y Tercera Etapa (Post Evaluacin).
Resultados: La subescala adaptabilidad (ADAP=26.67):
agrado de los padres hacia su hijo aumenta; la
distractibilidad disminuye (DIS=26.1), y por tanto la
demanda (DEM=21) de atencin del nio es menor
permitindole ajustarse al entorno (escuela y hogar). La
relacin marital (ESP=16.6) y el aislamiento social
(AIS=15.5) se mantienen. El CCyH revel aumento de
conocimientos en el manejo de conducta; no obstante,
los conocimientos en solucin de problemas y autocontrol
emocional no mostraron cambios relevantes. Discusin:
Estos resultados nos permiten afirmar que el taller a
padres El Juego del Optimismo tuvo un efecto positivo
ya que el nivel de estrs en las tareas de crianza
disminuyo, mientras que la percepcin de autoficacia de
los padres se fortaleci.

primeros datos psicomtricos en una muestra


espaola
Ihab Zubeidat, ; J Sierra, ; V Ortega, Universidad
de Granada, Saoin, UK

Con objeto de evaluar las creencias y actitudes que


permiten justificar el abuso sexual contra las mujeres,
Lottes (1991) desarroll la Rape Supportive Attitude
Scale (RSAS). En consonancia con Lottes (1991), los
resultados de Sierra, Rojas, Ortega y Martn-Ortiz (2007)
en una muestra de 400 universitarios espaoles
reproducen la estructura unifactorial de la medida, as
como su elevada consistencia interna. El presente
estudio persigui extender estos primeros hallazgos
obtenidos con la versin en castellano de la RSAS en
poblacin espaola. Para ello, 344 universitarios de
ambos sexos (entre 18 y 43 aos) y 178 reclusos
varones (entre 20 y 67 aos) completaron la RSAS junto
con el Cuestionario de Agresin de Buss y Perry (AQ) y
el STAXI-2. Solo, tras eliminar siete tems de la RSAS, se
obtuvo un ajuste aceptable de los datos al modelo de
factor nico. Las mediciones aportadas por esta versin
reducida de 13 tems mostraron una elevada consistencia
interna, con valores para el coeficiente alfa entre 0,89 y
0,93. Las correlaciones entre las mediciones aportadas
por la RSAS y por los otros instrumentos fueron: a)
directas en el caso de las cuatro subescalas -ira,
hostilidad, agresin verbal y agresin fsica- del AQ; b)
directas en el caso de las subescalas ira-estado, irarasgo y expresin de ira del STAXI-2, e inversas con la
subescala control de ira. En definitiva, se presentan
evidencias satisfactorias sobre la fiabilidad y la validez de
las mediciones de la versin reducida de la RSAS en
castellano para ambas muestras.

Conducta sexual agresiva masculina: factores


determinantes
Ihab Zubeidat, UNED; J Sierra, Universidad de
Granada; Jose Gutierrez, Universidad de El
Salvador
Las agresiones sexuales del hombre a la mujer
constituyen un fenmeno complejo que est determinado
por mltiples factores. Fernndez-Montalvo y Echebura
(1998) plantean un modelo explicativo de la violencia
conyugal que integra factores como las actitudes
machistas, la actitud de hostilidad hacia las mujeres y el
estado emocional de ira, junto a otros estmulos
desencadenantes como el consumo de alcohol. En este
trabajo se pretende determinar la importancia que
factores como la ira, la agresividad, las actitudes hostiles
hacia las mujeres, las actitudes sexuales o la doble moral
sexual tienen a la hora de explicar la conducta sexual
agresiva masculina. Para ello, estas variables fueron
evaluadas en una muestra de 699 varones universitarios
salvadoreos con una media de edad de 22,39 aos (DT
= 4,63). Una vez eliminados aquellos sujetos con
puntuaciones elevadas en la Escala de Deseabilidad
Social de Marlowe y Crowne, el anlisis de regresin
realizado proporcion un modelo significativo (F (5, 370)
= 17,63, p < 0,001) incluyendo cinco variables (ira,
agresin verbal, erotofilia, actitudes favorables hacia la
violacin y doble moral sexual) que explican un 18% de
la varianza total. Es decir, el estado emocional de ira, la
agresividad verbal, las actitudes negativas hacia la
sexualidad en general, las actitudes que justifican la
violacin y la presencia de una doble moral sexual son
factores de riesgo que incrementan la posibilidad de

llevar a cabo por parte del hombre conductas sexuales


agresivas.

Adult Psychosis
English Programme
Clinical determinants of quality of life in
outpatients with schizophrenia
Hirofumi Aki, Masahito Tomotake; l; Ken
Yamauchi,l, Yasuhiro Kaneda; c, Shu-ichi Ueno,
Tetsuro Ohmori, Department of Psychiatry, The
University of Tokushima Graduate School , Japan
Although there seems to be no unanimous definition of
quality of life (QOL), QOL has been measured from two
different viewpoints. One is subjective QOL rated by
patients themselves and another is objective QOL rated
by observers. Although patients with schizophrenia were
thought to be unable to assess their QOL by themselves
because of their cognitive deficit function, it would be
reasonable to assume that symptomatically stabilized
patients are able to evaluate their QOL by themselves.
However, the relationship between these two QOL
measures is not clear. Further research is needed to
clarify clinical factors influencing subjective and objective
QOL by using appropriate measures. Moreover, previous
studies reported that insight into illness did not correlate
with subjective QOL. So we think that the relation
between insight and subjective QOL should be
investigated. The purpose of the present study is to
investigate the relationship between subjective and
objective QOL and their clinical determinants in
outpatients with schizophrenia by using schizophrenia
disease-specific QOL measures. Data collected from
eighty outpatients with schizophrenia (mean age = 40.6
years) was analyzed. Informed consent was obtained
from all subjects for the research involved in the study.
Subjective QOL was measured with the Schizophrenia
Quality of Life Scale (SQLS) and objective one was
measured with the Quality of Life Scale (QLS). Clinical
symptoms were also assessed with the Positive and
Negative Syndrome Scale (PANSS), the Calgary
Depression Scale for Schizophrenia (CDSS), the DrugInduced Extrapyramidal Symptoms Scale (DIEPSS), and
the Global Assessment of Functioning (GAF).
Psychosocial scale of the SQLS was correlated with the
QLS total, instrumental role subscale, and intrapsychic
foundation subscale. However, other two scales of the
SQLS, motivation/energy and symptoms/side effects,
were not correlated with the QLS. The PANSS positive
symptoms subscale score, the PANSS general
psychopathology subscale score, and the CDSS score
were correlated with the SQLS psychosocial scale and
symptoms/side effects scale. The luck of judgment and
insight item score in the PANSS was correlated with the
SQLS motivation/energy scale. The dosage of
antipsychotics, the PANSS negative symptoms subscale
score, the PANSS general psychopathology subscale
score, the luck of judgment and insight item score, and
the GAF score were correlated with the QLS total score.
Stepwise regression analyses were done to assess the
independent contribution of other clinical variables to
each subjective and objective QOL. The CDSS score
predicted psychosocial scale and symptoms/side effects
scale of the SQLS. The luck of judgment and insight item
score predicted motivation/energy scale of the SQLS.
The PANSS negative symptom subscale score and the
GAF score predicted the QLS total independently. These
results suggest that subjective and objective QOL have
different determinants and the active treatment for
depressive symptoms may improve subjective QOL.

How Time Flies: The Perception, Perspective


and Experience of Time in Bipolar Disorder
Swift Anna, Norfolk and Waveney Mental Health
Partnership; Malcolm Adams, University of East
Anglia; Vincent Walsh, University College
London, UK
Bipolar disorder is a devastating and debilitating illness.
Our understanding of the disorder has advanced
considerably since the connection between melancholia
and mania was first made. However, despite our
knowledge, almost one out of every five individuals with
the disorder will commit suicide (Isomets, 1993) and
research suggests high rates of relapse and chronicity in
over 10% of patients (Solomon et al, 1995). Therefore, it
is not surprising that bipolar disorder is ranked as one of
the ten most burdening diseases in the world today
(Murray & Lopez, 1996). Consequently, in order to
develop effective psychotherapies for bipolar disorder, we
need to understand the psychological processes involved
in relapse into mood episodes. Despite a growing
interest in investigating cognitive processes in bipolar
disorder, much of the research has focused on deficits in
memory, attention, perception, representation, problemsolving and reasoning. Interestingly, the experience of
time is often seen as a more specialist area pertaining to
the biological sciences despite it being a cognitive
construct. Given the biological theories that link internal

clocks and circadian rhythms, the phenomenology of time


in bipolar disorder appears a logical and important area
for investigation. This study aims to address a gap in the
literature and systematically investigate judgments of
objective time; subjective experience of time passing or
temporal perspective in bipolar mood states. In a cross
sectional, quasi-experimental design, 58 participants with
a diagnosis of Bipolar Disorder completed a clinical
interview and were assigned to one of three mood state
groups; euthymic, depressed or hypomanic/manic.
Furthermore, 20 health professionals without a diagnosis
of bipolar disorder were recruited as a control group. 78
participants completed a temporal generalization task
(Wearden, 1992); a visual analogue scale of time
experience (Blewitt, 1992) and the Zimbardo Time
Perspective Inventory (Zimbardo and Boyd, 1999).
Results indicated that the manic participants were
significantly less accurate on the temporal generalization
task indicating a deficit in time perception. However, no
significant differences were found between the control,
euthymic and depressed groups. Furthermore, in an
unfilled duration, depressed participants rated the
subjective passing of time a significantly slower than the
other groups. Additionally, the manic group rated time as
passing significantly faster than the other groups in an
unfilled duration. However, when focused upon a task
(filled duration) this effect was eliminated. Finally,
significant differences were found between the mood
groups on the ZTPI profiles indicating that different
temporal perspectives characterize bipolar mood states.
Results are discussed in relation to further hypotheses
regarding the impact these differences in temporal
phenomenology may have on relapse into mood states.
Specifically, the relevance to psychotherapy is
emphasized and areas for future research are presented.

JTC reasoning bias disappears in the


restricted situation among college students
with delusional ideation.
Hiromi Arakawa, Yoshihiko Tanno, University of
Tokyo, Japan
Delusion is one of the core symptoms in patients with
schizophrenia. Recently, it is found that the thoughts like
delusions are commonly observed in normal population,
especially in adolescent period. These thoughts named
delusional ideations (Peters et al., 1999). A number of
studies have been conducted on reasoning bias in people
with delusional ideations. Especially, studies have
focused on Jumping-To-Conclusion (JTC) reasoning
bias in people with delusions. Garety and Freeman
(1999) insisted that the JTC reasoning bias was
specifically related to the formations of delusional
ideations. However, it is not clear yet that JTC reasoning
bias always affect judgements in people with delusional
ideations. The purpose of the present study is to
investigate that data-gathering bias will be showed
among college students with delusional ideations
regardless of task conditions about degree of freedom.
Forty-two college students in Japan were participated.
Participants rated Peters et al. Delusions Inventory
(Peters et al., 1999; PDI). PDI is designed to measure
both delusion in patients with schizophrenia and
delusional ideation in the normal population. Then,
participants required performing one of the two conditions
of probabilistic judgement task called beads task.
Probabilistic judgement task consists of two trials. The
condition A started free-trial, then limit-trial followed. The
condition B was conducted in revere order. Free-trial had
no limitation of amount of gatherable information. In limittrail, available information for judgement was limited
within 10 beads. Participants were divided into two
groups by the average of PDI in each condition. One
was the high-score group (PDI > 10, M = 16.68), the
other was the low-score group (PDI < 6, M = 2.73). A twoway ANOVA (groups * conditions) revealed significant
effects for conditions significant (F (1,39) = 16.57, p <
.001), but not for groups. There was a significant
interaction between groups and condition significant (F
(1,39) = 4.48, p < .05). Only the condition A, the highscore group gathered less information than the low-score
group. Only in the condition that started from free-trial,
the students with many delusional ideations showed JTC
reasoning bias. They gathered as much information as
students with not much delusional ideations in the
condition stared limit-trial. These results imply that datagathering bias among students with delusional ideation
may appear only in the situation which given high degree
of freedom.

Highly schizotypal students have weaker


sense of self-agency
Tomohisa Asai, Yoshihiko Tanno, The University
of Tokyo/ Graduate School of Arts and Sciences
People with schizotypal traits may possess abnormal selfawareness, particularly with regard to their sense of selfagency. A sense of self-agency is the sense that it is
oneself who is causing or generating an action. The
students of the university of Tokyo were rated with the
Schizotypal Traits Questionnaire (STA). Participants were
required to move a mouse device and viewed resultant
feedback, which was biased spatially. They then judged
whether a bias existed or whether they felt they had
moved the cursor on their own. No difference was

observed between the high and the low schizotypal


groups in the perception of the bias, although the high
schizotypal group may have possessed a weaker sense
of self-agency. We determined that highly schizotypal
people have an weaker sense of self-agency. This finding
is consistent with the idea that schizophrenic
experiences, including auditory hallucination, thought
insertion, and delusions of control, could occur because
of the feeling that one is not at the origin of one's own
acts.

Improving self-esteem in patients suffering


from chronic psychosis: a randomized study
Laurence Borras, University Hospitals of Geneva,
Department of Psychiatry, Division of Adult
Psychiatry; Maria Boucherie, University Hospitals
of Geneva, Department of Psychiatry, Division of
Adult Psychiatry; Tania Lecomte, University of
Montreal, Department of Psychology; Sylvia
Mohr, University Hospitals of Geneva,
Department of Psychiatry, Division of Adult
Psychiatry; Philippe Huguelet, University
Hospitals of Geneva, Department of Psychiatry,
Division of Adult Psychiatry
Self-esteem refers essentially to the self-estimation of the
person (Reasoner, 1992). Persons suffering from
psychosis have a lower self-esteem than the normal
population because of their chronic and invalidating
illness (Silverstone, 1991). However, self-esteem is
known to be an influential variable in the actuation of
protective factors as per Liberman's model (Lecomte,
1999) and a predictive element of good psychosocial
rehabilitation in patients suffering from chronic psychosis.
The aim of the study was to examine whether a selfesteem/empowerment module could induce treatmentspecific changes in individuals with chronic psychosis. To
improve self-esteem among patients suffering from
chronic psychosis, a 12-week module (a self-contained
program of activities), created by Tania Lecomte in
Quebec and adapted to the socio-cultural context of
Switzerland was tested in a randomized clinical trial
(cross-over) containing 50 patients. Diagnosis using the
Mini-International Neuropsychiatric Interview (MINI),
symptomatology (The Positive and Negative Syndrome
Scale PANSS, the Global Assessment of Functioning
GAF) and psychosocial measures (Rathus Assertiveness
Schedule - RAS, Self Esteem Rating Scale - SERS,
Automatic Thoughts Questionnaire - ATQ, Cybernetic
Coping Scale - CCS), adherence to treatment
(Medication Adherence Rating Scale - MARS), level of
quality of life, and satisfaction of the therapy were taken
for all 50 subjects before treatment (T0), after treatment
(T1) and at 3 month follow-up (T2). Preliminary results
(on 15 patients) indicate significant effects of the module
on psychotic symptoms (positive (Z=-3.420 ; p= 0.01),
negative (Z=-2.909 ; p=0.04) and general (Z=-3.413 ;
p=0.01) symptoms significantly decreased), on coping
skills (active coping skills significantly increased (df=14 ;
p= 0.01) a significant improvement of self-assertiveness
(Z=-2.554 ; p=0.01) and self-esteem(Z=-3.296 ; p=0.00).
Satisfaction with the module was high (92% of patients
declared themselves highly or completely satisfied with
the treatment). A large part of them highlighted the
rediscovery of their personal qualities (30%), a time for
meeting and exchanging with others presenting similar
difficulties (30%), the opportunity for intellectual activities
or incentive to undertake new activities and meet new
people. The results suggest that the module had a
significant positive impact on various levels of selfesteem, but the benefits seemed to decrease over time
(T3). Thus, an ongoing support system seems indicated.
This module aims to improve self-esteem and psychosocial rehabilitation and should be integrated in existing
rehabilitation programs. Considering that the positive
effects are temporary, it seems necessary to combine
different modules adapted to the patients' capacities at a
given moment.

Psychoeducational Group Therapy For


Schizophrenia Inpatient: Improvements Of
Insight Assessed By The Insight Scale
Spanish Validiation
Natalia Camprubi, Albert Almela,, Cristina
Gisbert, Fulgencio Coron, , Montserrat Sitjas, ,
Eduard Fernandez, Institut Assistencia Sanitaria
Lack of insight and poor compliance is a common
problem in patients with psychotic disoders and
particularly schizophrenia. Is also one of the main
difficulties that can affect medication and treatment plan
adherence in this population. A treatment to increase
knowledge of illness and it's treatment will enable people
with schizophrenia to have more insight and to be more
compliant with treatment plan and have less
rehospitalitzations and relapses. The aim of our study is
to show the insight improvements after a brief intensive
pychoeduatinal group. Insight is assessed by Insight
Scale. The Insight Scale (IS) (Birchwood et al) is a selfadministered scale that assess awarness of illness to
psychosis and is based on a multidimensional model. It
has 8 items and assess 3 dimensions of insight:
awarness of symptoms, awarness of mental illess and

need for treatment. The study included a sample of


patients with a DSM-IV diagnosis of psychosis in a
inpatient rehabilitation unit and ages between 18 and 65
years old. Patients recived psychoeducational group
therapy. This treatment included 6 sessions in 2 weeks.
Sessions followed a structure group format and lasted 1
hour. Sessions covered information about mental illness
(difficulties to cope with mental illness and how to deal
with social stigma), information about schizophrenia
(symptoms and model of cause), treatment (drugs, side
effects of medications, the importance to be compliant
with medications) early symptoms of relapse and
relapse prevention (specially by stopping alchol and other
drugs abuse). The group therapy was didactic and
included formulation, guided discovery and motivational
interviewing. Patients were assessed using the Insight
Scale spanish validation before and after the group
therapy to determine whether participation in the group
therapy improve insight of illness. The effects of treatment
on insight were checked by wilcoxon signed ranks test.
Other sociodemografic variables were collected. Fifteen
patients (10 males and 5 female) with diagnosis of
psychotic spectrum disorder were included in the study.
The mean age was 42,07 (s.d.=10,93). The mean
pretreatment IS score was 7,13 (s.d.= 2,92) and
postreatment IS score was 8,13 (s.d.=2,13). Willcoxon
signed ranks test showed that the differences between
the pre and postreatment IS score were almost
significative (Z=-1,81; significance level = 0,071).
DISCUSSION Results show that psychoeducational
group therapy improves insight assessed by IS spanish
validation, although the difference between pretreatment
IS scores and postreatment scores didn't reach levels of
significance. Our study could be limited by the fact that
we didn't control other variables, for instance
antipsychotic medication. CONCLUSION Accoding to our
study, a brief psychoeducational group therapy appears
to be useful improving awareness of illness in psychotic
inpatients. The Insight Scale seems to be able to assess
changes in insight after treatment, so this short selfreported instrument is appropiate for clinical judgements
of insight and research.

Metacognitive dysfunctions and


schizophrenia: correlations with
neurocognitive deficits, symptoms, insight
and quality of life.
Antonino Carcione, Iii Centro Psicoterapia
Cognitiva Roma; Paul Lysaker, Roudebush Va
Medical Center and The Psychiatry Department,
Indiana University School of Medicine,
Indianapolis, , Usa.; Giuseppe Nicolo', Iii Centro
Psicoterapia Cognitiva Roma; Michele Procacci,
Iii Centro Psicoterapia Cognitiva Roma; J.K.
Johannesen, Roudebush Va Medical Center And
Psychiatry Department, Indiana University School
of Medicine, Indianapolis, , USA., ; Antonio
Semerari, Iii Centro Psicoterapia Cognitiva Roma
Italy
In this study we have measured the metacognitive
functioning within the narrations about oneself and one's
own disease by a group of patients suffering from
schizophrenic psychosis (Lysaker et al., 2005). The
purpose is to evaluate the presence of metacognitive
dysfunctions and their correlation with symptoms and the
general and neurocognitive functioning We have
analysed the narrations of 61 patients, among whom 40
suffer from schizophrenia and 21 from schizoaffective
disorder, by using the Metacognition Assessment Scale
(MAS) (Carcione et. Al, 1997; Semerari et al. 2003),
divided into its three general subscales Self-reflectivity
(SR), Understanding Others' Mind (UOM) and Mastery
(M) and we have evaluated the correlation with
symptoms, quality of life, neurocognition and insight.
Patients with less ability to understand their mind (SR
scale) show a worse neurocognitive functioning. A good
level in understanding one's own states of mind (SR
scale) is associated in a significant way with depressive
symptoms. The regulation and coping abilities (M scale)
are significantly linked to the disease awareness and to a
good quality of life and are inversely correlated to
paranoia. Social withdrawal seems to be linked to a poor
understanding both of one's own mind (SR scale), and of
others' mind (UOM scale). It is possible to identify
metacognitive dysfunctions within the narrations of
patients suffering from schizophrenia. Such dysfunctions
seem to be actually correlated to symptoms, quality of
life, neurocognitive functioning and to a less disease
awareness.

Effects of Labeling and Symptom Focus on


Stigma of Schizophrenia: An AffectiveCognitive Analysis
Rebecca Y. M. Cheung, Kong; Olivia H. C. Jung,
; Winnie W. S. Mak, Pui Shan Tsang,
Department of Psychology, The Chinese
University of Hong Kong
Psychiatric stigma has gained much attention in health
services research in the past ten years (e.g., Penn &
Martin, 1998; Raguram, Weiss, Channabasavanna, &

Devins, 1996). Among all psychiatric disorders,


schizophrenia is the most stigmatizing (Schulze &
Angermeyer, 2003). In attempt to reduce stigma and
encourage early identifications of schizophrenic
symptoms among the youth population, the Hong Kong
government launched the more easily comprehensible
label of cognitive dysregulation (si-jue-shi-tiao in Chinese)
for the early identifiable positive symptoms of
schizophrenia (mind-split disease in Chinese) through a
promotion campaign in 2001. The present study tested
the effects of label (cognitive dysregulation vs.
schizophrenia), symptom focus (positive vs. negative
symptoms), and target gender (male vs. female) on
cognitive attributions, behavioral mechanisms, and
affective reactions of psychiatric stigma. A 2x2x2 vignettebased telephone survey was administered to 533 Hong
Kong Chinese adults aged 18 to 60 in 2005. For both
labels, the symptoms depicted were based on the criteria
of DSM-IV-TR for schizophrenia. Descriptive statistics
showed that almost all of the participants (96.2%) had
heard of the label of cognitive dysregulation; 73.4%
thought that cognitive dysregulation differed from
schizophrenia; 76.5% believed that schizophrenia was a
more serious disease; and 70.7% thought that cognitive
dysregulation had a more benign prognosis. Results from
MANCOVA identified that both label and symptom focus
accounted for significant effects on intentionality,
controllability, despicability, and social rejection of the
person with psychiatric problems. Regression results
showed that public responses to individuals with cognitive
dysregulation or schizophrenia fit in the attributional
model. Both cognitive attributions and affective emotions
led to behavioral responses (Weiner, 1993), in this case,
rejection to the stigmatized target. In the present study,
socio-cultural perspective was highlighted. Further
implications and research directions for stigma reduction
and mental health services promotion through a cognitive
behavioral approach were also discussed.

My brain hurts: Biological and


psychological explanations of the cause of
mental illness
Lam CK, Kingston University. St Geroge's.
University of London UK
Biological approaches have tended to dominate
psychiatry for the last decade. Scientists and clinicians
advocating strong biological positions tend to argue that
biological disease models are de-stigmatising, as they
suggest that people with diagnostic psychiatric conditions
are less likely to be blamed (or feel guilty) than if
psychological explanations were used. However, it could
equally be argued that biological accounts may induce
pessimism regarding the likely treatment outcome and
undermine the public's confidence that patients with
mental health problems are able, with appropriate help, to
control or even remove their symptoms. The tension
between psychological and biological accounts of the
cause of mental illness is evident in theoretical work, in
research and professionals' dissemination of information
to both patients and the public. The merits of these
conflicting arguments are best addressed empirically One
hundred and ten community volunteers were asked to
rate a range of these problems, having been randomly
allocated to three conditions in which the cause of such
disorders were described as psychological or biological;
the third (control) group were told that the causes were
unclear. Participants in the psychological condition rated
patients with mental health problems as significantly more
likely to be curable and significantly less likely to harm
themselves, require porfessional help and frequent
hospitalisation; the problems were also rated as
significantly less disabling. A psychological acount of
psychiatric problems may be relatively de-stigmatizing. It
is unclear from these results whether biological accounts
are stigmatizing or neutral in their impact.

Attachment, experiential avoidance, selfesteem and paranoid beliefs


Sam Fitzpatrick, Aisling O'Kane St Catherine's
Hospital, Birkenhead, UK, Richard Bentall
University of Manchester, UK
Some theories of paranoia argued that persecutory
beliefs arise from attempts to avoid feelings of low selfesteem (Bentall etal. 2001). Trower and Chadwick (1995)
have proposed that there are two types of paranoia:
'poor-me' in which persecution is believed to be
undeserved and bad-me in which it is believed to be
deserved, and there is evidence that self-esteem is
higher in the former group. Previous research has also
implicated insecure attachment in both clinical (Dozier &
lee, 1995) and non-clinical (Mickelson et al. 1997)
samples. The aim of the present study was to investigate
the relationships between insecure attachment,
experiential avoidance (avoidance of negative mental
contents) and poor-me and bad-me paranoia in a nonclinical sample. The following measures were
administered by the internet to 249 undergraduates at the
University of Liverpool (198 female and 51 male, median
age 20): Persecution and Deservedness Scale, (PaDS;
Melo et al. in submission; a measure of poor-me and
bad-me paranoia), the Acceptance and Action
Questionnaire version II (AAQ-II; Hayes, 2006,
unpublished; a measure of experiential avoidance), the

Relationship Questionnaire, (Bartholomew & Horowitz,


1991; a measure of attachment style), the Self-esteem
Rating Scale (Nugent &Thomas, 1993) and the Freiburg
Mindfulness Inventory (Walach et al., 2006). Multiple
regression revealed that insecure attachment (beta = .19,
p < .001), negative self-esteem (beta = .22, p < .01) and
AAQ-II scores (beta = .40, p < .001), but not positive selfesteem or mindfulness scores, were strong predictors of
paranoia (r2 = .42, F[8,240] = 22.35, p < .001). Negative
self-esteem and AAQ-II scores partially mediated the
relationship between insecure attachment and paranoia.
The fifty most paranoid students were divided into poorme and bad-me groups by median split of their PaDS
deservedness scores and compared non-paranoid
students. Both paranoid groups were insecurely attached,
but poor-me participants had less negative self-esteem (p
< .005) and higher AAQ-II (p < .002) scores than the
poor-me participants. The findings highlight the
importance of attachment in paranoia. Negative selfesteem and experiential avoidance may be related to
attachment difficulties in the development of paranoid
thinking. Non-clinical participants who believe their
persecution is deserved have a higher need for
experiential avoidance than those with poor-me beliefs.
However, a limitation of the study is that deservedness
scores on the PaDS in the poor-me participants were
relatively high compared to those previously found in
acutely psychotic patients. Further research will assess
the relationships between types of paranoia, attachment,
self-esteem and experiential avoidance in first-episode
psychosis.

Pathways to emotional dysfunction in young


adults 'at-risk' for psychosis
Ruchika Gajwani, Max; Birchwood University of
Birmingham; Early Detection and Intervention
Service (ED:IT), Birmingham and Solihull Mental
Health Trust, Paul; Patterson Early Detection and
Intervention Service (ED:IT), Birmingham and
Solihull Mental Health Trust, Amanda; Skeate
Early Detection and Intervention Service (ED:IT),
Birmingham and Solihull Mental Health Trust UK
Introduction: Recent research emphasises the
significance of examining affective difficulties (i.e.
depression/anxiety) as a foreground issue in psychosis
rather than peripheral to positive & negative symptoms
(Birchwood, 2003). It is clear that isolate positive
symptoms do not predict psychosis; high levels of
depression and/or anxiety, poor functioning at intake, low
level positive symptoms and prolonged 'prodromal'
symptoms increase the risk for transition to psychosis.
Aims This research aims at examining levels of and
pathways to emotional dysfunction in the 'at risk' group,
by studying specific risk factors that contribute to client
distress and predict transition to psychosis; such as
trauma, attachment, neuroticism and life events.
Research Questions: 1. What are the factors that affect
the pathways to emotional dysfunction in the UHR group
of psychosis? 2. What is the role of early attachment in
emotional dysfunction in the UHR group? Do anomalous
attachment styles provide a meaningful explanation of
depression/social anxiety in the UHR group? 3. Do
differences in personality and temperament have
important consequences for later adult emotional
functioning in the 'at-risk group' Specifically, do
differences in 'neuroticism' have an impact on
symptomatology in UHR group? 4. What is the impact of
aversive life events (traumatic life events, loss/ separation
from caregiver) on emotional dysfunction and positive
symptoms in the 'at risk' of psychosis? Method Design
and Participants: Participants at high risk of developing
psychosis (UHR group) will be recruited from the Early
Intervention Service, Birmingham by trained research
psychologists working at the Early Intervention Service,
under ED:IT (Early Detection and Intervention Team).
UHR group recruited from mental health services, 16-30
years & had; familial risk & reduced level of functioning
over past year or experienced attenuated psychotic
symptoms or Brief, Limited, Intermittent Psychotic
Symptoms Assessments: Additional to the baseline
measures used by ED:IT:
Calgary Depression Scale for Schizophrenia (CDSS;
Addington et al, 1993), Beck Anxiety Inventory (BAI; Beck
et al, 1988), Eysenck Personality Inventory (EPI; Eysenck
& Eysenck, 1987)
Childhood Trauma Questionnaire (CTQ; Bernstein &
Fink, 1998), Revised Adult Attachment Scale (RAAS;
Collins & Read, 1990), Measure of Parental Style
(MOPS; Parker et al, 1997), Autobiographical Memory
Test (AMT; Williams & Broadbent, 1986) The study is in
the process of collecting data, therefore, preliminary
results will be presented in the form of two graphs. High
levels of depression and/or anxiety are prevalent in those
at-risk of psychosis Emotional dysfunction is also a
significant predictive factor in transition to psychosis.
Emotional dysfunction in psychosis is not seen as
peripheral to positive symptoms but an additional
dimension alongside. It is relavent to focus on specific
risk and protective factors (premorbid and prodromal) for
transition to psychosis in the ultra-high risk group.

The Role of Beliefs About Others in the


Preferential processing of Threat Related
material in Paranoia
James Greer, University of Sunderland; Robert
Dudley, Mark Freeston, Department of
Neurology, Neuroscience and Psychiatry,
University of Newcastle; Helen Spencer, Early
Interventions Team, Northumberland, Tyne and
Wear NHS Trust UK
People with paranoia are suspicious and mistrustful of
others. Hence, beliefs about other people seem to be
particularly pertinent in understanding this experience.
However, there is a paucity of research of how these
beliefs may affect information processing. Hence, we
were interested in examining how emotional material may
be differentially accessed when encoded in relation to
one self or to other people, in people who are high or low
in paranoid ideation. In keeping with previous research
we expected people to recall more about themselves than
other people (Bower and Gilligan 1979), however, we
predicted that people high in paranoid ideas would recall
more threat related material about others than people low
in paranoid ideation as they are particularly alert to
threats from other people. A within subjects design was
used with two groups of 30 participants who were
selected from a larger sample of 121 students (102
female and 19 males), aged 18- 58. Scores on the
Fenigstein scale (Fenigstein and Vanable 1992) were
used to identify two groups consisting of the lower (n= 30)
and upper (n=30) quartiles. There were two conditions
described as self referent and other referent. In each of
the conditions participants were played an audio tape
consisting of a spoken list of 20 threat related and 20
positive emotion words (matched for length and
vividness). In the self-referent condition participants were
asked to imagine themselves in a situation evoked by
each word. In the stranger-referent condition they were
asked to visualise a hypothetical stranger (described in a
vignette), in a situation evoked by each word. The
hypothetical stranger's description was potentially
threatening and intended to invoke schema about danger
from others in individuals with trait paranoia. Participants
subsequently completed recall and recognition tests. All
participants completed the Positive and Negative Affect
Schedule Expanded Form, PANAS-X (Watson 2000) and
the Fenigstein Paranoia scale. Free recall of words was
analysed using a three way mixed ANOVA (group,
condition (self or stranger) and valence of material
(positive or threat). There was a main effect for condition
(self or stranger, F=21.86 p< 0.001), with participants
recalling more words processed in relation to the self than
the hypothetical stranger. There were no other main
effects or two way interactions. There was a three way
interaction between group, condition and valence. High
Fenigstein scorers recalled more threat words
(mean=4.40 SD= 2.39) than positive emotion words
(mean= 3.30 SD= 1.82) in the stranger focus condition
and more positive emotion words (mean= 5.57 SD= 2.45)
than threat words (mean= 4.83 SD=2.56) in the selfreferent condition. The low Fenigstein group showed the
opposite pattern. For recognition the only difference was
for condition with both groups recognising more words in
relation to self. Across the whole group (n= 121),
significant negative correlations were found between
Fenigstein score and PANAS-X scales of Negative Affect
(r= 0.45 p< 0.001), Fear (r= 0.35 p<0.001), Hostility (r=
0.34 p<0.001), Guilt (r= 0.48 p< 0.001) and Sadness
(r=0.51 p< 0.001). The main effect for condition is
consistent with previous research which found that
processing of words in relation to the self leads to more
recall than processing in relation to a less well developed
cognitive structure of another person. The greater recall
of threat-related than positive words in the stranger
referent condition by high Fenigstein scorers is consistent
with the ambiguous stranger description activating
threatening schema about strangers. Greater recall of
positive words in the self-referent condition for high
Fenigstein scorers may be consistent with a defensive
role for paranoia (Bentall 2003). The correlations between
PANAS sub-scales and Fenigstein suggest that future
investigation into the relationship between affect and
paranoia would be useful. People high in paranoid
ideation process threat preferentially in relation to other
people. Such information processing biases may play an
important role in helping understand the development and
maintenance of persecutory beliefs. Beliefs about others
may be specific targets for change using Cognitive
therapy.

An Experimental Project Within Two Mental


Health Centers Near Milan
Silvia Grignani, Chiara Paglia l, Francesco
Brambilla , Antonio Lora A.O. Vimercate - Desio
Hospital
It is becoming more evident, in clinical practice and
literature, that early detection and intervention in
psychosis can improve disease outcomes.
This approach has to consider not only the
psychopathology of patients but also their quality of life,
relations with relatives and interaction with society.
The mental health department of Desio Hospital - A.O.
Vimercate since March 2006 has been managing an

experimental project of early intervention in psychosis; it


helps patients reducing their disabilities, controlling
symptoms and increasing social skills, while a psychoeducational intervention supports patients' relatives. The
project involves 18-35 years old people with first episode
psychosis and with a DUP (Duration of Untreated
Psychosis) no longer than two years. The peculiarity of
this project is its inclusion in traditional psychiatric
structures (such as hospital, psycho-social centres,
therapeutic community).
During initial phase of assessment patients are submitted
to some tests such as: CBA 2,0 questionnaire, Checklist
ERIraos interview and SAT-P questionnaire on
satisfaction.
There are also encounters of psycho-educathion with
persons who live with patients during which they made
the Disablity Assessment Schedule from the World
Health Organization (DAS II) and a questionnaire on
familiar problems QPF.
After this phase of assessment, patients begin
psychologocal or psychoteraputic therapyes (expecially
cognitive-behavioral psycho-therapy) and eventually
social support. During this first year of project,
observations, made on a small number of patients (35
with diagnosis of first psychotic episode), show: 3
admissions, improvement of estimated personal
satisfaction (tested by SAT-P questionnaire), compliance
with psychotherapy and with drug assumptions, reduction
of emotional and physical patients' relatives burdens
(estimated with DAS II). The poster briefly presents
characteristics and potentiality of the project.
We believe that this project, still in rising phase, offers
new possibility to young people at their first psychotic
episode, determining an improvement of their quality of
life and better managements of eventual relapses.

The First Episode (of psychosis) Research


Network (FERN): A novel approach to the
national training and implementation of goldstandard measures as integral components to
the clinical assessment and service
evaluation process.
Zaffer Iqbal, Kieran Fahy, ; Emily Earle,
University of Sheffield UK; Max Birchwood,
University of Birmingham UK
The Care Services Improvement Partnership (CSIP) in
England has been a driving force in the promotion of
evidence-based approaches to serious mental illness. A
central component to this approach has resulted in the
development of the 10 High Impact Changes (HIC's) for
Mental Health. The HIC's can be described as an attempt
to distil core activities undertaken by Mental Health
workers which would impact positively on the user
experience of services and also on the organisation and
workforce. FERN's evaluation of recently developed Early
Intervention in Psychosis (EIP) services, across 26
Mental Health providers in England, incorporated the
HIC's ethos by undertaking an ambitious programme of
training and supervision of 500+ care-coordinators, to
enable the systematic use of a gold-standard battery of
assessments as standard practice at client inception. The
battery consists of the Positive and Negative Syndrome
Scale (PANSS, Kay et al, 1987), a measure of the
Duration of Untreated Psychosis (DUP; www.irisinitiative.org.uk), Pathways to Care (adapted from Gater
& Goldberg, 1991) and Premorbid Adjustment (PMA;
Cannon-Spoor et al, 1982). The training process and
establishment of concordance through a top-down
supervision process are described and data for
concordance suggest a high degree of success for this
training programme. In addition, qualitative analyses of
trainees' experiences and the subjective benefits reported
by coordinators employing the battery are outlined. A high
level of concordance on the PANSS and overall
satisfaction of co-ordinators with the training and utility
value of the assessment battery was evident. We propose
that with the imminent launch of an e-learning web-based
training programme to supplement this training, the ability
to develop bespoke packages to enhance service delivery
and evaluation are realistic and practical prospects for
Mental Health services' improvement.

A Study on the effectiveness of SocialCognition Enhancing Rehabilitation Program


(SERP) for individuals with Schizophrenia in
community.
Jin-Sung Kim, Jung-Hye Kwon, Seul Ah Lee,
Department of Psychology, Korea University
Deficits in cognition are closely related to social
impairments of schizophrenia, the most debilitating
aspect of schizophrenia. Social cognitive processes are
how we perceive other's emotion, how we weigh social
contextual factors in making these inferences. The social
cognition enhancement training (SCET) is a psychiatric
rehabilitation program which has been demonstrated to
improve schizophrenics' social context appraisal and
perspective-taking abilities. The purpose of this study was
to modify and enhance SCET from the original version to
produce further changes in improving emotional
perception and examine its effectiveness on emotional
perception and social cue appraisal of individuals with

schizophrenia. Thirty persons with DSM-? diagnosed


schizophrenia and schizoaffective disorder in community
psychiatric rehabilitation centers were randomly assigned
to a SCET group or Control group. The SCET program
was composed of 30 sessions and was presented in
twice-weekly sessions over 4 months. In SCET, fourcolumn cartoons are employed as major training material
in social cognitive exercises in which participants are
encouraged to perceive social cues in each piece of the
cartoon, arrange the four pieces in order based on
contextual information, and provide coherent explanations
of the social situation depicted in the cartoon. In the
upgraded version used in this study, SCET also provides
an opportunity to express emotion depicted in the cartoon
and utilized it in the role play. The following measures
were administrated at the beginning and the end of the
program: The Korea-Social cue Recognition Test-Revised
(K-SCRT-R; Kang, 2005), The Emotion Context
Perception Task (ECPT; Choi, 2006), The Nurse'
Observation Scale for Inpatient Evaluation (NOSIE-30;
Honigfeld, Gillis, & Klett, 1966), the Social Behavior
Sequencing Task (SBST; Kwon, 2003), the Korean
Educational Development-Wechsler Intelligence Scale for
Children (KEDI-WISC, Park et al. 1991), the Social Skills
Scales (Park, 1997), the Independent Living skill survey
(Wallace, 1996, Kim & Han, 1997). Analysis of 2 (group) *
2 (time) ANOVA was conducted. The significant
interaction effects were demonstrated on some indices of
ECPT, implying that treatment group improved better in
perceiving neutral facial stimuli accurately than the control
group (F=7.448, p<.05). However, there were no
interaction effects on most indices of ECPT. Therefore the
treatment effects on emotion perception of schizophrenic
individuals were limited. The significant interaction effects
were also shown on the NOSIE-30 (F=8.383, p<.05), and
the Independent Living Skill Survey (F=12.226, p<.05),
indicating that treatment group improved better in social
functioning than the control group. In this study, we
examined the effectiveness of SCET for improving
emotional perception and social cue appraisal of
individuals with schizophrenia. The results revealed that
SCET participants showed limited improvements in the
ability to perceive emotions and social cues. It suggests
that the upgraded SCET have not been fully successful in
enhancing emotion perception for individuals with
schizophrenia.

Cognitive processes during the acute


psychotic state: the role of thought control
and heightened responsibility
Olga Luzon-Canto, Chris Harrop, Royal Holloway,
University of London, Fiona Nolan, University
College London, University of London UK
Some key concepts from the anxiety disorders literature,
such as safety-seeking behaviours and intrusive thoughts
have been shown to be important in psychosis (e.g.
Morrison, Haddock, & Tarrier, 1995). A number of
cognitive models have been developed to explore typical
psychotic symptoms such as auditory hallucinations or
delusions (e.g. Garety et al., 2001). However, little is
known about cognitive processes during the acute
psychotic state. In this study, it was hypothesised that
further anxiety mechanisms could be significantly useful
in understanding patient's experiences during an acute
psychotic state or crisis. In particular, we were interested
in the role of catastrophic interpretations, thought control
strategies, and sense of responsibility. 60 patients aged
18-65 who met DMS-IV criteria for non-affective
psychosis were recruited from a number of mental health
services across London. Two groups of patients were
recruited: a) 30 patients were experiencing acute
psychotic symptoms severe enough as to require
immediate hospitalisation or the involvement of the local
CRT, with high scores on the Psychiatric Rating Scales
(PSYRATS; Haddock, et al., 1999), and able to provide
informed consent; and b) 30 patients were under the care
of their local CMHT and considered by the team as
stable. Recruitment took place simultaneously at all sites
over six months, with the cooperation of clinical staff, who
identified suitable participants. From 72 patients
approached, 60 consented and were recruited (response
rate 83%). The assessment was completed in one
meeting at their usual NHS clinical setting and lasted
approximately 30 minutes. Additionally, a non-clinical
comparison group was recruited from the general
population, 30 people were recruited for this group.
Catastrophic misinterpretations were measured with the
Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007).
Thought Control and Sense of Responsibility were
assessed with the Obsessive Belief Questionnaire - 44
(OBQ-44; Obsessive Compulsive Cognitions Working
Group, 2004). Both measures have shown excellent
psychometric characteristics with clinical and non-clinical
samples, and were successfully piloted prior to data
collection, in order to establish their validity for the
population of this study. Results indicate that people in
acute psychotic crisis show significantly stronger beliefs
about the probability and cost of aversive events and
have a heightened sense of responsibility, than those with
a similar diagnosis but who were currently stable.
Patients in psychotic crisis also misinterpret cognitive
processes in a catastrophic manner significantly more
than control patients. Both groups scored significantly
higher than the non-clinical sample on all measures. The

findings suggest that these anxiety concepts may be


important to consider when working with acute-state
clients. For example, a person who has been mildly
symptomatic perhaps for years and managing to cope
with their symptoms may, in an acute crisis, be presenting
with an unusually heightened sense of responsibility and
uncharacteristic need to take action, in a manner that has
some similarities to an anxiety patient with overpowering
OCD. This wouldn't indicate that anxiety mechanisms
have caused the crisis, but would identify that these are
important mechanisms to target in the acute distress
phase.

Cognitive-Behavioral Therapy For Early


Psychosis: Exploring Predictors Of Outcome
Marie-Josee Marois, Nathalie Gingras, Centre de
pedopsychiatrie de Quebec, Universite Laval,
Martin Provencher, Universite Laval, Chantal
Mrette, Robert-Giffard, Claudia Emond, Centre
de Recherche Universite Laval Robert-Giffard,
Julie Bourbeau, Clinique Notre-Dame des
Victoires, Centre Hospitalier Robert-Giffard
Canada
Recent meta-analyses have highlighted the efficacy of
cognitive-behavioral therapy for psychosis (CBTp) in
reducing persistant positive symptoms (Cormac, et al.,
2004; Zimmermann, 2005). Nevertheless, CBTp studies
have also reported 27% to 67% of participants who failed
to respond significantly (Drury, et al., 1996b; Kuipers, et
al., 1997; Sensky, et al., 2000; Tarrier, et al., 1998).
Hence, it may be helpful to identify predictors of outcome
in participants to CBTp first, to guide the prioritisation of
the most suitable patients in the context of little
resources; and second, to identify the factors that might
facilitate the effectiveness of CBT. Only few studies have
investigated predictors of response to CBTp and the most
replicated finding to date has been the ability to consider
hypothetical alternatives to the delusions (Chadwick &
Lowe, 1990; Sharp, et al., 1996; Garety, et al., 1997). The
Active Cognitive psychotherapy for Early psychosis (ACE
: Bendall, et al, 2005) is imported from ORYGEN Youth
Health in Australia. This open naturalistic trial offers
individual ACE sessions on a weekly basis for a period of
6 months to 20 clients from two specialised clinics for
early psychosis of Quebec (Canada), aged from 14 to 35.
This paper explores a variety of predictors of outcome in
all 20 participants: comorbidities, initial level of awareness
of illness (SAI-E) and executive functioning (Wisconsin
Card Sorting Test) were particularly investigated. Four
participants (20%) were identified as nonresponders to
therapy as they failed to show an improvement of =5
points on the PANSS total score between baseline and
end of CBTp. Regarding comorbidities at baseline,
Wilcoxon tests found a significant difference in outcome
in favour of participants with a comorbid diagnosis of
substance abuse or dependence (n=6) compared with
participants without such a diagnosis; and in favour of
participants without a diagnosis of personality disorder
(n=16) compared with participants with such a diagnosis.
Also, Spearman analysis showed a statistically significant
correlation between cognitive flexibility (as assessed by
the number of perseverative errors on the WCST) and
better outcome; and a trend towards significance between
abstract thinking (as assessed by the number of
categories completed on the WCST) and better outcome.
No significant correlation was found between initial level
of awareness of illness and outcome. CBTp is suitable for
patients with psychosis and comorbid substance abuse or
dependence while an adapted version of CBTp may need
to be developed in order to reach out to the patients with
a comorbid personality disorder. This exploratory study
replicates some findings suggesting that cognitive
flexibility may play an important role in facilitating change
via CBTp. Executive functioning may play a role in
participant response to CBT techniques, for example in
facilitating the transfer of the skills acquired in therapy to
their day to day life via homeworks. More specifically,
cognitive flexibility may facilitate the generation of
alternative hypothesis to their delusional thinking in
response to Socratic questioning.

Cognitive insight in patients with


schizophrenia: A pilot study using the
Japanese version of the Beck Cognitive
Insight Scale
Kazunori Matsumoto, Tomohiro Uchida, Division
Of Clinical Psychology, Graduate School Of
Education, Tohoku University, Sendai, Japan;
Akiko Kikuchi, National Institute Of Mental
Health, National Center Of Neurology And
Psychiatry, Tokyo, Japan; Fumiaki Ito, ; Tetsuo
Miyakoshi, ; Takashi Ueno, Hiroo Matsuoka,
Department Of Psychiatry, Tohoku University
School Of Medicine, Sendai, Japan
Insight is considered to have a multidimensional construct
and cognitive insight is supposed to have a metacognitive
process to evaluate and correct distorted beliefs and
misinterpretations. Beck Cognitive Insight Scale (BCIS)
was developed to measure the cognitive insight (Beck et
al., 2004) and several studies have demonstrated

impaired cognitive insight in schizophrenia. To apply this


instrument to Japanese population, we tried to develop
the Japanese version of the BCIS (BCIS-J). In the
present study we investigated validity of the BCIS-J and
the relationship between the cognitive insight and
psychiatric symptoms in Japanese patients with
schizophrenia. This study is still in progress. Eighteen
patients with schizophrenia were recruited from the
outpatient and inpatient units of the Tohoku University
Hospital (9 men and 9 women with mean age of 27.0
6.0). The BCIS-J, the Japanese version of the Schedule
for Assessment of Insight (SAI-J), the Positive and
Negative Syndrome Scale (PANSS), and the Beck
Depression Inventory-II (BDI-II) were used to assess
awareness of the mental disorder, self-reported
depression, and psychiatric symptoms. The SelfReflectiveness, Self-Certainty, and Composite-Index
(Self-reflectiveness minus Self-certainty) scores were
used according to the original BCIS. The research
protocol was approved by the local ethics committee.
Mean of the Self-reflectiveness, Self-certainty, and
Composite-index scores were, respectively, 12.0 3.7,
8.1 4.4, and 3.9 7.0. The Composite-index score has
a significant correlation with the SAI-J score (r=0.49,
p=0.041) and a nonsignificant correlation with the insight
subscale of the PANSS (r=-0.46, p=0.054). The Selfcertainty score has significant correlation with the insight
subscale of the PANSS (r=0.57, p=0.014) and a
nonsignificant correlation with the SAI-J score (r=-0.44,
p=0.069). The Composite-index and the Self-certainty
scores have significant correlations with the BDI score
(r=0.56, p=0.005; r=-0.63, p=0.015). The Compositeindex and Self-reflectiveness scores were negatively
correlated with the abstract-thinking subscale of the
PANSS (r=-0.56, p=0.021; r=-0.55, p=0.019). The present
study showed adequate convergent validity of the BCIS-J
with correlations with objectively assessed clinical insight
scales. The mean of each BCIS-J score was quite similar
to the results of previous studies using the original BCIS
in patients with schizophrenia (e.g., Beck et al., 2004;
Warman et al., 2006). The result of the correlation of
cognitive insight with depression replicated a previous
study (Warman et al., 2006). Impaired cognitive insight
may be associated with a type of thought disorder
(difficulty in abstract-thinking) in schizophrenia. The BCISJ is a useful instrument to measure cognitive insight in
schizophrenia. Beck AT, et al., A new instrument for
measuring insight: the Beck Cognitive Insight Scale.
Schizophr Res (2004) Warman DM, et al., Cognitive
insight and psychotic disorder: The impact of active
delusions. Schizophr Res (2006)

The relation between schizotypy and creative


activities
Rumiko Miyoshi, Yoshihiko Tanno Tokyo
University, Graduate School of Arts and
Sciences, Jun Sasaki Japan Society for the
Promotion of Science Japan
Schizotypy is paid to attention as a trait which is related
to schizophrenia. In studies of schizotypy, the relation
between schizotypy and creativity is one of the most
interesting things. O 'Reilly et al.(2001) administered the
Oxford-Liverpool Inventory of Feelings and
Experiences(O-LIFE) assessing schizotypy
comprehensively to humanities and creative arts
students. As a result, students in the creative arts scored
higher than humanities students on unusual experiences
that measures positive schizotypy. In present study, I
aimed to verify the relation between schizotypy and
creativity, and to examine how its relation changes
according to fields of creative activities. 108
undergraduate students were asked to complete O-LIFE
and the Revised Creative Behavior Inventory (RCBI).
RCBI is based on the Creative Behavior Inventory (CBI;
Hocevor, 1980) which is an inventory of creative activities
and achievement. RCBI consists of six subscales: Art,
Crafts, Performing Arts, Math-Science, Literature and
Music. The total scores of RCBI were positively correlated
with scores of unusual experiences and impulsive
nonconformity. Seeing subscales of RCBI, Art and Crafts
were positively correlated with unusual experiences and
impulsive nonconformity. Performing Arts, Math-Science
and Music were positively correlated with only unusual
experiences. Literature was positively correlated with
unusual experiences and cognitive disorganization.
Negative correlations with introvertive anhedonia were
also observed on Crafts and Performing Arts. Like
previous studies, the relation between positive schizotypy
and creativity was seen in this study. In addition, other
factors of schizotypy were also related with some creative
activities. From now on, we need to consider the
difference of sex and to examine whether negative
schizotypy also has positive dimensions or not.

The flexibility of coping strategies with


paranoid ideation in a non-clinical population
Sachiko Morimoto, Saitama Institute of
Technology
Previous findings have shown that paranoid ideation
exists in a non-clinical population. They used more
emotional and avoidant coping, less used rational and
detached coping with paranoid ideation (Ellett, et al.,
2003; Freeman, et al., 2005). Although these coping

strategies are generally maladaptive coping, such


strategies can reduce distress. To understand of coping
may require a microanalysis of coping processes in which
individuals flexibly deploy different coping strategies in
stressful contexts (Cheng, 2001). Therefore, the aim of
the present study was to examine the flexibility of coping
strategies with paranoid ideation. Paranoia Scale
(Fenigstein & Vanable, 1992) and Interpersonal Stress
Coping Inventory (ISI; Kato, 2000) were completed by
141 individuals (mean age 19.581.18). ISI is constructed
to 3 types of coping strategies: positive relationshiporiented strategies (Try to find the positive side of
others.), negative relationship-oriented strategies (Avoid
family or friends in general.), and postponed-solution
coping (Keep thinking that I don't have make any
decision about things.). Subjects were first required to
complete the ISI about paranoid thought (ISI-pre). They
were then asked to complete ISI again (ISI-post)
assuming that the coping strategy they adopted in ISI-pre
did not work well. People with high level of paranoid
ideation used more negative relationship-oriented coping
in both ISI-pre and ISI-post, compared with low level of
paranoid ideation. For positive relationship-oriented
coping of high level of paranoid ideation, ISI-pre was
higher than ISI-post. These results showed that people
with paranoid ideation keep using the negative
relationship-oriented coping and reduce positive
relationship-oriented coping, even if the primary coping
did not work well. People with high level of paranoid
ideation use same negative relationship-oriented coping
strategies when these coping strategies have no effect.
These findings suggest that their coping strategies may
not be flexible

Association of memory specificity and


general cognitive functioning in
schizophrenia
Hilde Nachtergael, Universit Libre de Bruxelles,
CHU Brugmann, Dpartement de Psychiatrie,
Unit 74, Bruxelles; Aurore Neumann, Universit
catholique de Louvain, Unit ECSA, Louvain-laNeuve; Sylvie Blairy, Universit de Lige,
Dpartement des Sciences Cognitives, Lige;
Damien Lecompte, Universit Libre de Bruxelles,
CHU Brugmann, Dpartement de Psychiatrie,
Unit 74, Bruxelles; Pierre Philippot, Universit
catholique de Louvain, Unit ECSA, Louvain-laNeuve Belgium
Autobiographical memory (ABM) relates to the capacity of
people to recall personal events from their lives.
Schizophrenia is associated with a reduction of specific
ABM (e.g., Riutort et al., 2003). This impairment is
consistent with the existence of an abnormal
development of personal identity in patients with
schizophrenia. Williams et al. (1996) suggest that the
specificity with which people retrieve episodes from their
past determines the specificity with which they imagine
the future. The first aim of the present study is to
investigate this hypothesis in patients with schizophrenia.
Another question is whether ABM impairment reflects a
broader deficit in cognitive functioning. A French
adaptation of the Autobiographical Memory Test (AMT,
Williams & Broadbent, 1986); the Stroop Color-Word Test
(Hammes, 1978); the Digit Span Test (subtest of the
WAIS-III; Wechsler, 1997); and the Verbal Letter Fluency
Task (Benton & Hamsher, 1976) were administrated to 20
patients with schizophrenia (10 men) and 20 control
participants. Results showed that patients retrieved fewer
specific autobiographical memories and generated fewer
specific future events than controls. In addition, their
difficulty to imagine the future was correlated to their lack
of specificity in the retrieval of past memories. And the
proportion of specific future events showed also a
significant relationship with scores for the Stroop, the
Verbal Fluency Task, and the Digit Span Backward. The
pattern of results exhibited by patients with schizophrenia
is likely to have clinical implications. Specific ABM play an
active role in the construction and maintenance of
personal identity because they contain detailed
information about past experiences of goals attainment or
goals failure (Conway & Pleydell-Pearce, 2000).

Characteristics of Eye Movement During


Facial Affect Recognition in Patients with
Schizophrenia
Kazuya Norikane, Yuko Shiraishi Miyazaki
University
The purpose of this study was to identify differences in
eye movement between patients with schizophrenia and
healthy subjects when identifying facial expressions. The
eye movements of four subjects with schizophrenia and
six healthy subjects were recorded with an eye
movement recording device while the subjects
categorized facial expressions of emotions in
photographs. The results clearly showed a significantly
shorter mean fixation time and a significantly higher mean
velocity of eye movement in schizophrenic subjects
compared to healthy subjects. In addition, schizophrenic
subjects also had a significantly lower number of fixation
points. These results suggest that deficits in facial affect
recognition in patients with schizophrenia may be related

to the following factors: inadequate visual information


arising from difficulties experienced in perceiving the
faces of others and a strong tendency to focus on one
part of the face during interpersonal relations, and
insufficient active eye movement when selectively
identifying facial parts.

The Relationship of Autobiographical Memory


Retrieval Specificity to Social Problem
Solving Deficits in People with Schizophrenia
Lee-Anne Organ, University of Wollongong;
Hamish McLeod, University of Wollongong
Impairments of autobiographical memory (AM) retrieval
specificity are widely reported in people experiencing
psychopathological conditions such as depression and
PTSD (Williams, Barnhofer, Crane, Hermans, Raes,
Watkins, & Dalgleish, 2007). These individuals display an
overgeneral retrieval style marked by slowed or
impoverished recall of specific events and the functional
consequences of this type of retrieval pattern include
phenomena such as mnemonic interlock and impaired
performance on tasks that require social problem solving
(Goddard, Dritschel, & Burton, 1996). There is emerging
evidence that people with schizophrenia show a similar
deficit in AM retrieval (Wood, Brewin, & McLeod, 2006)
but the functional consequences of this have not been
extensively examined. Goddard et al demonstrated that
AM retrieval impairments were associated with poor
performance on a social problem solving task in people
with depression. As impairments of social functioning are
commonly experienced by people with schizophrenia, we
sought to determine whether abnormalities of AM retrieval
are related to social problem solving deficits in people
with a current diagnosis of schizophrenia. A crosssectional between groups design was used. The clinical
sample comprised 21 outpatients with a DSM-IV-TR
diagnosis of schizophrenia and no co-morbid diagnosis of
depression, traumatic brain injury, or other neurological
condition. The control group consisted of 20 university
students without psychopathology and matched to the
clinical sample on NART IQ. Autobiographical memory
retrieval was measured using Williams and Broadbent's
(1986) single word cueing paradigm (the AMT) and social
problem solving was assessed with the Means Ends
Problem Solving task (MEPS; Platt & Spivack, 1975). The
Beck Depression Inventory and selected Wechsler
Memory Scale subtests were administered to allow
supplementary analyses of the effects of depressed mood
and general memory functioning on performance of the
critical tasks. As predicted, the subjects with
schizophrenia produced significantly fewer specific
autobiographical memories and performed more poorly
on the MEPS than control subjects. Subjects with
schizophrenia produced significantly fewer and less
effective solutions to the social problems posed in the
MEPS. Social problem solving effectiveness and AM
retrieval specificity were positively correlated. The
between groups difference in autobiographical memory
specificity remained after analyses controlling for general
memory functioning and BDI scores. The results of this
study add to accumulating evidence that impairments of
AM retrieval specificity are reliably observable in people
with schizophrenia. The results also indicate that this AM
deficit may be functionally related to social problem
solving difficulties experienced by people with
schizophrenia. In particular, the tendency for the subjects
with schizophrenia to truncate their AM search at the level
of categorical rather than specific memories may
constrain or limit their ability to effectively use past
experiences to generate solutions to current social
problems. Cognitive and behavioural interventions should
take account of this deficit when attempting to help
patients learn strategies for solving social problems.

After de-institutionalization: Burden in


relatives of patients with Severe Mental
Disorders
Nuria Palau, Nohemi Marcos, Roser Cirici,
Mutua de Terrassa Hospital; Susana Herzog, ;
Montse Mora, Mutua de Terrassa Hospital
Caring of patients with schizophrenia and other severe
mental disorders supposes a personal, social and
economic challenge to their relatives. After deinstitutionalization, relatives are playing the main role of
caregivers, and experience an important level of burden
due to that reason. Demands of caregiving involve
economic restrictions, relational problems, impact on
private life or emotional distress. Burden of care is
associated with less quality of life and poorer health in
caregivers. The aim of this study is to assess burden of
care on relatives of psychiatric patients with severe
mental disorders and examine its associatons with some
social and demographic variables of caregivers and
clinical features of patients. fifty relatives were assessed
with the spanish version of the Zarit Caregiver Burden
Scale (Martin et al, 1996). Patients were attending a
Mental Health Outpatient Center or a Psychiatric Hospital
Unit. Some variables of caregivers such as age, working
status, educational level or economic support were also
collected, as well as clinical features of patients:
diagnosis, age of onset or number of times being
hospitalized. Data are undergoing statistical analysis and

will be presented at Congress celebration We expect to


find similar results to those found in other studies of this
area. A study of Caqueo-Urizar and Gutierrez-Maldonado
(2006) suggests that older caregivers, mainly mothers,
who are unemployed and have low educational levels
show the highest burden. In addition, we are comparing
the differences in family burden between outpatient and
inpatient caregivers. With this page we want to note the
need of developing more psychosocial programmes for
giving support to psychiatric relatives.

Cognitive-Behavioural Therapy In People At


High Risk Of Developing Psychosis: Three
Case Report
Trini Pelez, Albert; Pends Sant Joan de Deu,
Serveis de Salut Mental, Merc; Borrs Sant
Joan de Deu, Serveis de Salut Mental
Many recent studies has been shown that cognitivebehavioural therapy is an effective treatment for first
episodes of psychosis (1). Furthermore, in some
controlled trials people that met criteria of an Ultra High
Risk (UHR) had been reported a decrease in the rate of
transition to psychosis (2). There is some evidence that
show an association between Duration of Untreated
Psychosis (DUP) and time of recovery in first episode of
psychosis (3). Therefore, intervention in the early stages
improves the prognosis of the illness. A description of the
clinical symptoms of two patients who meet UHR criteria
and one patient with first episode of psychosis will be
done. The cognitive and behavioural techniques used in
each of three patients will be exposed. The three patients
will be monitored at six months to measure the state of
psychotic and comorbid symptoms. The evolution of the
psychotic symptoms after cognitive- behavioural therapy
each case will be described. The evolution of comorbid
symptoms such anxiety and depression will be described
as well, before and after the cognitive-behavioural
intervention. The improvement of functional performance
will be assessed by means of the GAF score. The
implications about early psychological interventions in the
initial phases of psychosis will be discussed. We will take
into account the improvement of psychotic and comorbid
symptoms. We will make a brief comparison between the
prognosis of the two patiens with UHR and the patient
with a full-blown psychosis. We will compare the results
of the three cases of our Mental Health Community
Service with the previous studies of CBT in early
psychosis made in other European teams.

Adolescent-Onset Schizophrenia Spectrum


Disorders: Neuropsychological Profile
Olga Puig, Susana Andrs, c., Luisa Lzaro, ,
Imma Baeza, ., Elena De la Serna ., Rosa Calvo
Neurosciencies Institute. Hospital Universitari
Clinic
Neuropsychological impairment is a core trait of
schizophrenia spectrum disorders in adulthood and its
impact in social functioning has been demonstrated in
several studies. Adolescence is a crucial period
regarding social development and also regarding brain
maturation processes. A significant part of the social
competence skills learning is developed during
adolescence. Also, adolescence implies several
neurodevelopmental events which are related with
maturation brain reorganization processes. These
neurobiological changes have been related with the rise
of risk for schizophrenia spectrum disorders during
adolescence (Kenny et al, 1997). In the last years it has
been a growing interest to study the neuropsychological
functioning in adolescent-onset schizophrenia spectrum
disorders (AOS) but there are still few neurocognitive
studies in young patients with early-onset of the disorder.
The aim of this study is to examine neuropsychological
functioning in a sample of adolescents with AOS. A group
of 14 AOS adolescents (12 schizophrenia disorder, 2
psychotic disorder) was compared with a group of healthy
controls (n=12) after the first weeks of clinical
exacerbation in the following measures: intelligence (IQ
estimated by Vocabulary and Blocks of WAIS-III), verbal
(RAVLT) and visual memory (Visual Reproduction WMSIII), executive function (Trail Making Test TMT - B,
COWAT Verbal Fluency Test, Rey Copy Figure Task
RCFT- recall and organization according to Savage
criteria (Savage et al, 1996), speed (TMT-A, RCFTspeed) and attention (Digits WAIS-III). Two patients were
excluded due to their estimated IQ lower than 70. The
groups did not differ in age or sex. All AOS patients
except one (6 inpatients, 7 outpatients) were taken
second-generation antipsychotic treatment at the moment
of evaluation. Non-parametric test were used due to the
sample size. AOS patients had a lower estimated IQ as a
group (p = 0.001) and had worse performance than
controls in RAVLT, both in immediate (p = 0.022) and
delayed recall (p = 0.005), Visual Reproduction
immediate recall (p = 0.002), RCFT both recall (p <
0.001) and organization (p = 0.038), TMT part B (p =
0.029) and in COWAT Verbal fluency test (p = 0.001).
AOS adolescent sample showed worse results than
healthy controls in intelligence, verbal memory, immediate
visual memory and executive functions. Attention and
speed functions were not impaired in our sample of AOS
adolescents. Preservation of attentional function has

been found in other studies of adolescents with recent


onset schizophrenia disorders (Kravariti et al, 2003).
These results are compatible with literature and suggest
that global intelligence, memory and executive functions
could be the most impaired areas in adolescents with
AOS.

Psychoeducational group intervention


focused on caregivers of euthymic bipolar
patients: impact on the illness course
Maria Reinares, ; Eduard Vieta, Francesc
Colom, a; Jose Sanchez-Moreno, ; Carla Torrent,
; Jose Manuel Goikolea, Bipolar Disorders
Program, ; Manel Salamero, Clinical Psychology
Department, Institut of Neurosciences, Hospital
Clinic, IDIBAPS, University of Barcelona Spain
There is a mutual influence between bipolar disorder and
the family, family's attitudes can affect the course of the
illness and bipolar disorder has a great impact on family
distress and functioning (Reinares et al., 2002). Although
there are some studies that highlight the positive role of
family-focused treatment added to pharmacotherapy in
bipolar disorder (Miklowitz et al., 2003; Rea et al., 2003),
no studies have analysed the specific effect of working
with caregivers-only groups. The aim of this study was to
assess the efficacy of a psychoeducational group
intervention focused on caregivers of euthymic bipolar
patients. One hundred thirteen medicated euthymic
bipolar outpatients who lived with their caregivers were
randomized into an experimental (n=57) and a control
group (n=56). Caregivers of patients from the
experimental group received 12 psychoeducational, 90minute group sessions focused on knowledge of bipolar
disorder and training in coping skills. The patients did not
attend the groups. Caregivers of the patients assigned to
the control group did not receive any specific intervention.
Subjects were assessed monthly during the intervention
and 12 month follow-up. Psychoeducational group
intervention focused on the caregivers of bipolar patients,
when added to pharmacological treatment, carried a
reduction of overall recurrences (chi-square=6.53;
p=0.011) and longer relapse-free intervals (log rank=
4.04; p=0.044). When different type of episodes were
analysed separately, the effect was significant for both the
number of patients who experienced a hypomanic/manic
recurrence (chi-square=5.65; p=0.017) and the time to
such an episode (log rank= 5.84; p= 0.015). The
differences in preventing depressive and mixed episodes
were not significant. Psychoeducational group
intervention for the caregivers of euthymic bipolar patients
is a useful adjunct to pharmacotherapy in reducing the
risk of recurrences, particularly mania and hypomania, in
bipolar disorder.

Multifunctional role of case managers and


their relationship with clients: A qualitative
exploration of tensions in managing Bipolar
Disorder
Peters Sarah, University of Manchester; Ellie
Pontin, University of Liverpool; Fiona Lobban, ;
Anne Rogers, University of Manchester UK
Bipolar disorder is a common and severe form of mental
illness characterised by repeated relapses of mania or
depression. When well, limited contact with health
professionals may be needed, however recurrence rates
are high and rapid intervention can prevent the need for
hospitalisation. Recommendations are that mental health
services are managed by a named coordinator. Typically
case managers' backgrounds are nursing or social work
with limited opportunities for specialist training in bipolar
disorder or other mental health problems. Changes in
delivery of services over time have led to an increase in
the range of responsibilities expected from care
coordinators e.g. care plans, risk assessment,
psychoeducation and relapse prevention. However little is
known about how the increase in complexity and
responsibility of workload for this professional group
impacts on their relationship with patients with bipolar
disorder. The aim of the study was to understand the role
of the case manager and their relationship with clients
with bipolar disorder. Using a qualitative methodology,
semi-structured interviews were conducted with 21 case
managers and 21 service users. Data were analysed
using an iterative approach to develop conceptual
categories from the dataset. Analysis was conducted by
researchers of different professional backgrounds
including clinical and health psychology, sociology and
psychiatry. Early analyses of the two sets of interviews
show that case managers move between multiple roles
which change between periods of relapse and stability.
Monitoring mood, behaviour and medication was viewed
as essential to maintain stability, reduce risk and enable
case managers to be reactive at times of crisis. At the
central hub of a service users care package, case
managers balanced the role of advocate, resource
gateway and mediator as well as having a therapeutic
and preventative role in relapse. The relationship with the
case manager was valued very highly by service users
and the quality of this determined their expectations of
the case manager's role. However, for case managers,
tensions can arise between these multiple and, at times,

competing roles. Patients valued their relationship with


case managers and the service they provided. However,
for case managers the role was complex, multifunctional
and, at times, problematic. Implications for training and
support are discussed.

The study on the efficacy of the preparation


program for discharge on schizophrenic
patients in Japan.
Sayaka Sato, Emi Ikebuchi, Department of
Psychiatry, Faculty of Medicine, Teikyo University,
Rie Ogawa, Nagoyai Medical Center,, Tetsuo
Honma, Shimofusa Kohkichi Takata, Department
of Psychiatry, Tottori Hiroshi Omori, Department
of Psychiatry, Kure Medical Center, National
Hospital Organization
Schizophrenic disorders has facilitated more action of
psychiatric care system in Japan toward their discharge
and re-entry to the local community. It is clear that a
standardized program is necessary to advance such
processes effectively. The purposes of this study are to
develop such a preparation program, which is suitable for
the underlying mental health and welfare situations in this
country, and further to confirm and define its efficacy.
First, we modified The Community Re-Entry Program
(Liberman,1995) at the following points: 1) the social
resources and services available in a community that
were taken up on the above program were replaced by
those of Japan, 2) because of the Japanese, special and
local situation of many, long-term admission cases, some
extra training sessions were added to improve ADL
regarding households account and dietary life, 3)
homework was put at every session basis, 4) field
excursion was added to exercise their skills in a real
situation. Second, we recruited 40 subjects (25 male and
15 female) who had less than 70 points in REHAB
(rehabilitation evaluation Hall and Baker; Hall and Baker,
1986) and approved for participation in our study. They
were classified by RCT protocol into the participation
group (21 subjects) and the control group (19). Then they
all were scaled by BPRS (Overall & Gorham,1962 ),
REHAB, Self-efficacy for community life (Ohkawa et al,
2001), DAI-10 (Awad et al, 1983), Knowledge test and
Discharge Difficulty Scale (Sato et al, 2004). The last 2
scales were newly developed for this study. In
comparison with the control group, the participants
showed significant improvement in the items of flattening
of emotion, drug compliance, knowledge about illness
and community life, and difficulty in discharge. A study
on the attempt to ascertain the effect of the program by
RCT on the return of schizophrenic patients to the
community life is still very few. In this context, our study is
unique, and can provide suggestions especially to some
countries that are on the way to deinstitutionalization.

Development of a group normalization


programme to facilitate engagement in
cognitive behaviour therapy for schizophrenia
Sakie Shimotsu, Department of Forensic
Psychiatry, National Institute Of Mental Health,
Center Of Neurology And Psychiatry; Sayaka
Iwasaki, ; Chihiro Asanami, Musashi Hospital,
National Center Of Neurology and Psychiatry
Japan
In recent years it has been established that Cognitive
behaviour therapy for psychosis (CBTp) as an adjunct to
pharmacotherapy can make substantial difference in the
course of recovery in schizophrenia. However,
dissemination of its practice is in its early stage in many
countries including Japan. We developed a group
normalization approach, Introductory CBT to bridge the
gap between illness psycho-education and individual
CBTp so as to enhance patient's engagement in
individual work. Preliminary results are discussed to
evaluate programme feasibility. Twenty patients with
schizophrenia from a forensic psychiatric inpatient unit in
Musashi Hospital participated in the Introductory CBT
programme (18 men and 2 women, mean age 34.29.7 ).
The group consisted of 5 weekly one hour sessions with
4-8 participants in each group. The two main contents
were information and interactive exercise on
normalization and CBT model of psychosis. The
programme was designed to be delivered after a period
of psycho-education focusing on information on
schizophrenia. Beck Cognitive Insight Scale (Beck et al.,
2004), Schedule for Assessment of Insight (SAI-J),
Positive and Negative Syndrome Scale (PANSS), Beck
Depression Inventory-?(BDI-?), were used for
assessment before commencement and after completion
of the programme. Client Satisfaction Questionnaire
(CSQ-8J) was administered after the fifth session.
Significant improvements were observed in depression
(p<.05), both positive and negative symptoms (p<.05),
cognitive insight (p<.05) and insight subscale of PANSS
(p<.05) but not for insight as measured by SAI-J. Mean
score of CSQ-J was 23.96.3 showing moderately higher
than average satisfaction. The present study suggests the
possibility that a group normalization programme may
enhance insight further in schizophrenic patients who
have already received psycho-education focusing on
illness information. It can be hypothesized that the

normalization rationale and CBT model of psychosis


enhance the metacognitive process to evaluate one's
psychotic experience and hence reduce stigma and
alleviate distress caused by fear of madness and
therefore leading to reduction in depression. To further
evaluate programme effectiveness, study design with
control group and follow up is necessary.

A Study of Facial Affect Recognition in


Schizophrenic Patients
Yuko Shiraishi, Kazuya Norikane, Hirosaki
University Japan
Patients with schizophrenia often experience difficulties in
interpersonal relationships in social situations due to
deficits in facial affect recognition. It has also been
pointed out that these deficits result in a greater
possibility that they will experience delusions arising from
mistaken inferences concerning other people. Nine
patients with schizophrenia (Schizophrenic group: SC
group) and 8 hospital staff (Control group: C group) were
selected as subjects for this study and the characteristics
of facial affect recognition in the SC group were
examined using an eye movement recording device. The
SC group had a higher number of correct responses for
anger and a lower number for fear compared to the C
group. Data that fulfilled the criteria for fixation points
were compared and the results showed that the SC group
had a significantly lower number of fixation points
(p<0.01) and a significantly shorter fixation time (p<0.01)
than the C group. A significant difference was not
observed in the SC group concerning fixation time for
each expression. In comparison, the fixation time for
anger in the C group was longer than that for surprise,
happiness, fear or sadness and also longer for hate
than for fear. The results of this study suggest that the
SC group were able to read the negative emotion of
anger despite the lower number of fixation points and
shorter fixation time for this group and the fact that these
subjects did not carefully observe people's expressions. It
can also be inferred that the C group, which had a longer
fixation time for the negative emotion of anger than for
any other emotion, evaluated the facial expression of
anger in others more carefully.

The effect of the Cognitive Enhancement


Therapy for the schizophrenic patients
Hyunjoo Song, Bruce Wexler, Bell Morris, Yale
University, School of Medicine USA
This study aimed to investigate the change of the
attentional network(ANT) among the schizophrenic
patients group taken the Cognitive Enhancement Therapy
as well as the work rehabilitation training In particular, we
tried to discriminate the real training effect except the
exercise effect through the retest at 10 week after pretest
as well as posttest (after about 1 year). Subjects (N=39)
were diagnosed the schizophrenia by DSM-IV, the
measurements were included 'attentional network
test'(Fan & Posner, 2002) 'CPT' 'TMT' as the attention
measurement. Also IQ and symptom(PANSS) were used.
In the result, the symptom revealed the significant change
between the pretest and post test as well as the retest
and posttest, while the attentional measurements didn't
reveal the predominant changes. The simple reaction
time in ANT and TMT showed the significant change
between the pretest and posttest, while the orienting
network in ANT reached the normal level at just one time
exposure(retest). Also the conflict network in ANT and
TMT B didn't reach the normal level in spite of the one
year training. Besides, CPT didn't reflect any training
effect at all. Based on there results, it was suggested that
the attention training effect was the area specific, the
retest process was very important and the sensitive and
proper measurement should be used to perform the good
CET treatment effect study.

Mindfulness Based Cognitive Therapsy for


Bipolar Disorder
Anna Swift ; Anne Palmer, Norfolk and Waveney
Mental Health Partnership UK
Bipolar Disorder is a chronic and disabling illness with an
estimated prevalence of 1.5 to 5%. Relapse rates are
high and even when in remission, residual symptoms and
social cognitive deficits persist (see Thompson et al,
2005; Gray et al, in press). Our understanding of the
process involved in relapse into mood episodes has been
enriched by the Teasdale & Barnard (1993) Interacting
Cognitive Subsystems (ICS) model of emotion. The ICS
model has led to the development of Mindfulness Based
Cognitive Therapy (MBCT) as a relapse prevention
treatment for unipolar depression. Subsequently, ICS has
been extended to account for bipolar symptomatology.
This theory gives a clear rationale for using MBCT in
reducing relapse into mania aswell as depression.
Therefore, this paper presents the findings of a pilot study
into MBCT for bipolar disorder. Specifically, the
hypothesis is that MBCT will increase mindfulness and
hence awareness of early warning signs and reduces
rumination. Furthermore, it was hypothesised that MBCT
would reduce relapse rates in the 12 months post
treatment. As this is a new psychological treatment,
participant views and feedback was also collated. The

design is a series of single cases. A total of six


participants with a diagnosis of bipolar disorder (using
DSM-IV criteria as assessed by an Independent
Psychiatrist) attended group MBCT. The treatment took
place over nine sessions and each session lasted one
and a half hours. There were two facilitators, both
Clinical Psychologists with experience of CBT and an
established personal mindfulness practice. Mood was
assessed weekly and measures of Mindfulness (Kentucky
Inventory of Mindfulness Skills, Baer, Smith & Allen 2006)
and Rumination (Response Style Questionnaire, NolenHoeksema et al, 1993) were administered pre and post
treatment. Furthermore, using a matched pairs design,
relapse rates/service contact were monitored the 12
months post treatment and compared with equivalent
TAU participants. The preliminary analysis shows that
MBCT was effective in increasing mindfulness and
reducing ruminative thinking style. Follow up data
demonstrated lower relapse rates as compared with
matched TAU participants. Furthermore, interview data
demonstrated that participants valued the approach and
found the content acceptable. They stated that they were
more aware of negative thought patterns and more willing
to remain in contact with difficult feelings. Furthermore,
they were more aware of their attachment to hypomanic
states. MBCT for bipolar disorder has been developed
using knowledge from CBT for bipolar disorder and
MBCT for depression. The pilot data suggests that this
may prove to be an efficacious psychological treatment
for bipolar disorder and this warrants further research.

How Time Flies: The Perception, Perspective


and Experience of Time in Bipolar Disorder
Anna Swift, Norfolk and Waveney Mental Health
Partnership; Malcolm Adams, University of East
Anglia; Vincent Walsh, University College London
UK
Bipolar disorder is a devastating and debilitating illness.
Our understanding of the disorder has advanced
considerably since the connection between melancholia
and mania was first made. However, despite our
knowledge, almost one out of every five individuals with
the disorder will commit suicide (Isomets, 1993) and
research suggests high rates of relapse and chronicity in
over 10% of patients (Solomon et al, 1995). Therefore, it
is not surprising that bipolar disorder is ranked as one of
the ten most burdening diseases in the world today
(Murray & Lopez, 1996). Consequently, in order to
develop effective psychotherapies for bipolar disorder, we
need to understand the psychological processes involved
in relapse into mood episodes. Despite a growing
interest in investigating cognitive processes in bipolar
disorder, much of the research has focused on deficits in
memory, attention, perception, representation, problemsolving and reasoning. Interestingly, the experience of
time is often seen as a more specialist area pertaining to
the biological sciences despite it being a cognitive
construct. Given the biological theories that link internal
clocks and circadian rhythms, the phenomenology of time
in bipolar disorder appears a logical and important area
for investigation. This study aims to address a gap in the
literature and systematically investigate judgments of
objective time; subjective experience of time passing or
temporal perspective in bipolar mood states. In a cross
sectional, quasi-experimental design, 58 participants with
a diagnosis of Bipolar Disorder completed a clinical
interview and were assigned to one of three mood state
groups; euthymic, depressed or hypomanic/manic.
Furthermore, 20 health professionals without a diagnosis
of bipolar disorder were recruited as a control group. 78
participants completed a temporal generalization task
(Wearden, 1992); a visual analogue scale of time
experience (Blewitt, 1992) and the Zimbardo Time
Perspective Inventory (Zimbardo and Boyd, 1999).
Results indicated that the manic participants were
significantly less accurate on the temporal generalization
task indicating a deficit in time perception. However, no
significant differences were found between the control,
euthymic and depressed groups. Furthermore, in an
unfilled duration, depressed participants rated the
subjective passing of time a significantly slower than the
other groups. Additionally, the manic group rated time as
passing significantly faster than the other groups in an
unfilled duration. However, when focused upon a task
(filled duration) this effect was eliminated. Finally,
significant differences were found between the mood
groups on the ZTPI profiles indicating that different
temporal perspectives characterize bipolar mood states.
Results are discussed in relation to further hypotheses
regarding the impact these differences in temporal
phenomenology may have on relapse into mood states.
Specifically, the relevance to psychotherapy is
emphasized and areas for future research are presented.
Comparison of subjective quality of life

between good and poor insight groups in


people with schizophrenia
Masahito Tomotake, Hirofumi Aki, University of
Tokushima Graduate School, Ken Yamauchi,
Yasuhiro Kaneda, Department of Psychiatry,
Iwaki Clinic, Shu-ichi; Ueno , Tetsuro Ohmori, T
University of Tokushima Graduate School Japan

People with schizophrenia suffer distress, reduced


productivity, and lowered quality of life (QOL). QOL has
been measured from two different viewpoints. One is
self-rated QOL and the other is interviewer-rated QOL.
As patients with schizophrenia have been thought to be
unable to assess their own QOL by themselves because
of their cognitive deficit, objective QOL measures have
been frequently used in many studies. However, now
there is general agreement that stabilized patients could
assess their QOL by themselves. Recently, several
studies reported that subjective and objective QOL did
not correlate and had different predictors. However,
these studies used the data from both good and poor
insight patients. So it is required to investigate the
relationship between subjective and objective QOL in
each group. The purpose of the present study is to
investigate the comparison of QOL between good and
poor insight groups and the relationship between the
subjective and objective QOL measures in each group.
The subjects for the current study were eighty outpatients
with schizophrenia. Informed consent was obtained from
all subjects for the research involved in the study.
Subjects were excluded if they presented with any
organic central nervous system disorder, epilepsy, mental
retardation, and severe somatic disorder. Mean age of
the subjects was 40.6 (SD=11.3) years and 41 were men
and 39 were women. Subjective QOL and objective QOL
were evaluated using the Schizophrenia Quality of Life
Scale (SQLS) and the Quality of Life Scale (QLS),
respectively. Clinical evaluations were done using the
Positive and Negative Syndrome Scale (PANSS), the
Calgary Depression Scale for Schizophrenia (CDSS), the
Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS),
and the Global Assessment of Functioning (GAF). Based
on the score of the PANSS insight item, subjects were
divided into two groups, poor insight group and good
insight group. The PANSS positive and negative
symptoms score and the CDSS score in poor insight
group were higher than those in good insight group. The
GAF score and the QLS score in poor insight group were
lower than those in good insight group. However, only
motivation/energy scale of the SQLS was better in poor
insight group than in good insight group. In each group,
subjective and objective QOL did not correlate, and
psychosocial and symptoms/side effects scales of the
SQLS were correlated with the CDSS score, and the QLS
total was correlated with the GAF score. These results
suggest that there is a discrepancy between subjective
and objective QOL in both good and poor insight groups
and good insight patients may have lowered subjective
QOL. It is also suggested that subjective and objective
QOL measures should be used as separate and
complementary outcome variables.

Cognitive insight in Japanese healthy


volunteers: An investigation using Beck
Cognitive Insight Scale
Tomohiro Uchida, Tohoku University, Sendai, ;
Kazunori Matsumoto, Tohoku University School
of Medicine, Sendai; Yasunori Oyama, Tohoku
University School Of Medicine, Sendai, Akiko
Kikuchi, National Institute Of Mental Health,
National Center of Neurology and Psychiatry,
Tokyo, Hideo Ambo, Division Of Clinical
Psychology, Graduate School Of Education,
Tohoku University, Sendai, Hiroo Matsuoka, ,
Tohoku University School of Medicine, Sendai,
Takashi Ueno, Division Of Clinical Psychology,
Graduate School Of Education, Tohoku
University, Sendai, Japan
Cognitive insight is supposed to be an important
dimension of insight; an ability to examine and question
beliefs and interpret experiences (Beck et al., 2004). To
measure the cognitive insight, the Beck Cognitive Insight
Scale (BCIS) was developed by Beck et al. (2004).
Although reliability and validity of the BCIS has been
demonstrated in psychiatric patients and the instrument
has been applied to healthy subjects in the United States,
its generalizability to other culture has not been
established. In the present study, we developed the
Japanese version of the BCIS (BCIS-J) and applied the
instrument to healthy Japanese subjects to evaluate the
reliability of the BCIS-J. The BCIS-J was developed after
translation of the original BCIS and back-translation of its
Japanese translation. The BCIS-J was administered to
134 college students (68 men and 66 women with mean
age of 18.9 0.9). Factor analysis was conducted to see
the factor structure of the BCIS-J. Reliability of the BCISJ was tested by the coefficient alpha and the test-retest
method. Result of factor analysis revealed that the BCISJ was constructed by 2-factors, Self-reflectiveness and
Self-certainty, as was shown in the original BCIS (Beck et
al., 2004). The coefficient alpha of the Self-reflectiveness
and Self-certainty scores were 0.62 and 0.80. The mean
of the Self-reflectiveness score, the Self-certainty score,
and the Composite-index (Self-reflectiveness minus Selfcertainty) were, respectively, 11.2, 4.1, and 7.1. The Selfcertainty score in male subjects was higher than that in
female (t=2.9, p<0.01). Test-retest correlations of the Selfreflectiveness, Self-certainty, and Composite-index scores
for the 52 subjects from the same sample were,
respectively, 0.85, 0.80 and 0.83. The factor analysis of

the BCIS-J in Japanese healthy volunteers replicated the


factor structure observed in psychiatric patients in the
United States (Beck et al., 2004). Reliability of the BCIS-J
was confirmed by the results of the coefficient alpha and
the test-retest method. The sex difference of the selfcertainty was consistent with the previous study in normal
sample (Warman et al., 2006). These findings support
generalizability of cognitive insight to Japanese healthy
population. On the other hand, lower Self-reflectiveness
and Self-certainty scores in our sample compared with
those observed in American healthy sample (Warman et
al., 2006) imply that cognitive insight can be differently
expressed between cultures. The BCIS-J is reliable
instrument and the concept of cognitive insight is
generalizeable to Japanese population. References Beck
AT, et al., A new instrument for measuring insight: the
Beck Cognitive Insight Scale. Schizophr Res. 319-29
(2004) Warman DM and Martin JM. Cognitive insight and
delusion proneness: An investigation using the Beck
Cognitive Insight Scale. Schizophr Res. 297-304 (2006)

Paranoid thought, psychopathologies and


psychosocial correlates in Japanese nonclinical population
Takashi Yamauchi, Anju Sudo, Yoshihiko Tanno,
Graduate School of Arts and Sciences, The
University of Tokyo Japan
Paranoid thought is a common experience that is not
unique to clinical population. Freeman et al.(2005)
developed the Paranoia Checklist to measure paranoid
thoughts multi-dimensionally (frequency, degree of
conviction and distress) in college students. The
purposes of the present study were to develop Japanese
version of Paranoia Checklist (JPC), and examine
paranoid thought correlates in Japanese undergraduates.
In the first study, two hundred and forty-four
undergraduates completed the JPC and the Paranoia
Scale (Fenigstein & Vanable, 1992). In the second study,
one hundred and twenty-four undergraduates completed
the JPC, the State-Trait Anxiety Inventory (STAI;
Spielberger, Goursh, & Lushene, 1970), Rosenberg SelfEsteem Scale (Rosenberg, 1965), the Fear of Negative
Evaluation Scale (FNE; Leary, 1983), the State-Trait
Anger Expression Inventory (STAXI; Spielberger, 1988),
the Social Support Scale (Fukuoka, 2000) and the Social
Skill Scale (Kikuchi, 1988). In the first study, results
revealed that JPC had one-factor structure and high
internal consistency (Cronbach's alpha was 0.90 or
above). The Paranoia Scale scores were positively
correlated with scores of JPC frequency (r=.65, p<.01),
conviction (r=.57, p<.01) and distress (r=.45, p<.01). In
the second study, results revealed that JPC frequency
scores were positively correlated with scores of STAI
(r=.46, p<.01), FNE (r=.35, p<.01) and STAXI (r=.35,
p<.01), and negatively correlated with scores of selfesteem (r=-.18, p<.05) and social support from family
member (r=-.34, p<.01). Multiple regression analyses
using the STAI, FNE, STAXI and social support scores as
explanatory variables revealed that JPC scores were
positively associated with STAI (B=.25, p<.01), FNE
(B=.20, p<.05) and STAXI (B=.19, p<.05), and negatively
associated with social support (B=-.23, p<.01). Results
suggested that JPC had high reliability and construct
validity as a measure of paranoid thoughts in Japanese
non-clinical population. Results of the present study
limited the conclusion concerning causal relationships
between psychosocial correlates and paranoid thoughts.
However, our findings suggested that anxiety, social
anxiety, anger and social support played important roles
in the development and maintenance of paranoid
thoughts. These results generally supported our
hypotheses and were consistent with previous study.

Adult Psychosis
Spanish Programme
Validacin de la versin espaola de la escala
de Insight de Birchwood
Alberta Almela, Parc Hospitalari Mart Juli
(PHMJ). Institut d'Assistncia Sanitria (IAS);
Natalia Camprub, Parc Hospitalari Mart Juli
(PHMJ). Institut d'Assistncia Sanitria (IAS)
Introduccin: El objetivo de este estudio fue realizar una
adaptacin y validacin al castellano de la Insight Scale
(IS) (Birchwood y cols., 1994) escala autoaplicada que
evala el insight multidimensionalmente Mtodo: Estudio
observacional de una muestra clnica de pacientes
psicticos. Se realiz una traduccin y retrotraduccin de
la IS. Se calcul la factibilidad, la validez de criterio
concurrente con el item 12 de la PANSS, la validez de
constructo convergente con la DAI y divergente con la
BPRS, la validez de constructo discriminante entre las
puntuaciones de la IS de pacientes ingresados voluntaria
e involuntariamente, la fiabilidad test-retest y la
consistencia interna Resultados: La muestra const de
55 pacientes. La factibilidad fue del 100%. El CCI entre el
tem 12 de la PANSS y la IS fue de 0,51. El CCS entre la
IS y la DAI, y la IS y la BPRS fue de 0,398 (p=0,003) y 0,064 (p=0,645) respectivamente. Las puntuaciones
medias de la IS fueron significativamente diferentes (U

de Mann-Whitney=176; p=0,001) entre pacientes


ingresados voluntaria (8,50) e involuntariamente (6,08).
El CCI entre test y retest de la IS fue de 0,795. El
coeficiente a de Cronbach fue de 0,723. Discusin: La
versin espaola de la IS es un instrumento de
evaluacin del insight breve, sencillo, autoaplicado y
mulidimensional, con adecuadas propiedades
psicomtricas.

Propiedades Psicomtricas de la Entrevista


de Carga del Cuidador de Zarit en Cuidadores
Primarios Informales de Enfermos CrnicoDegenerativos: resultados preliminares
Virginia Alpuche Ramirez, Ramos-del Ro
Bertha,; Islas-Salas Noem, ; Figueroa-Lpez
Carlos G, Facultad de Estudios Superiores
Zaragoza-UNAM
Actualmente, existe un consenso generalizado entre los
investigadores respecto a que la situacin de cuidar a
una persona con enfermedad crnica o discapacidad
fsicas o psquicas constituye una situacin estresante.
Se han publicado diversas escalas que evalan los
efectos de cuidar a un familiar; siendo as, la escala ms
utilizada la Entrevista de Carga del Cuidador de Zarit
(ZBI). El objetivo de este trabajo fue conocer sus
propiedades psicomtricas, a partir de la versin
espaola de Izal y Montorio (1994). La muestra consta de
170 CPI de pacientes con enfermedades crnico
degenerativas de diversas instituciones de salud pblica
de la Ciudad de Mxico, con una edad promedio de 49.1,
en su mayora mujeres (79.8%), casadas (74.2%),
dedicadas al hogar (48.5%) y que cuidan a un familiar
con enfermedades del sistema respiratorio (44.2%) o del
sistema cardiovascular (23.9%) y sin remuneracin
econmica (94.4%). Los resultados muestran que la
consistencia interna de la escala es de 0.903 con
respecto al Alpha de Crombach. Al realizar un anlisis de
factor exploratorio, ajustado a tres factores subyacentes
a la carga, que sumados explicaron el 50.3% de la
varianza. Los puntos de corte establecidos para esta
muestra van de 0-16 sin carga a carga leve, de 17-27
de carga leve a moderada, de 28- 40 de carga
moderada a alta y por arriba de 41 carga muy alta o
severa. Se concluye que el ZBI posee adecuadas
propiedades psicomtricas para evaluar la carga
percibida de los CPI de enfermos crnico degenerativos.
Descriptores:
Entrevista de carga, cuidador primario
informal, propiedades psicomtricas.

Evaluacin del estigma hacia las personas


con trastornos mentales: Estudio piloto en
estudiantes y profesores universitarios de
psicologa
Milagros Ascencio Guirado, Instituto Jalisciense
de Salud Mental; Vila Ruiz, Instituto Jalisciense
de Salud Mental; Mara Guadalupe, Instituto
Jalisciense de Salud Mental; Robles Garca,
Instituto Jalisciense de Salud Mental; Rebeca.,
Pez Agraz, Instituto Jalisciense de Salud
Mental; Francisco, Ornelas, Patricia, Instituto
Jalisciense de Salud Mental
Este estudio no tiene modificaciones, queda tal cual fue
enviado en la propuesta inicial.Muchas gracias.

Perfil psicopatolgico de pacientes


ingresados en el hospital de da de
psiquiatra de la clnica Ntra. Sra. De la Merc
Caterina Caldern, Psicoclnica N S de la
Merced; R Cano, Psicoclnica N S de la
Merced; I Haro, Psicoclnica N S de la Merced;
N Martin, Psicoclnica N S de la Merced
Perfil psicopatolgico de pacientes ingresados en el
hospital de da de psiquiatra de la clnica Ntra. Sra. De la
MercEl Hospital de Da de Psiquiatra (HDP) es un
recurso asistencial dirigido a personas con trastornos
mentales graves o enfermos crnicos en reagudizacin.
Se ofrece un tratamiento integral (psiquitrico,
psicolgico y rehabilitador) e intensivo, durante un
periodo de tiempo que puede oscilar entre 1 y 3 meses.
Nuestro objetivo es realizar un estudio descriptivo
retrospectivo sobre la poblacin ingresada en el HDP
durante 2005-06. Se analizaron 81 historias clnicas y se
aplicaron distintas pruebas diagnsticas: DSM-IV-TR
(APA, 2002) y el cuestionario de 90 sntomas SCL-90-R
(Derogatis, 1977). RESULTADOSDel total de ingresos,
49% eran mujeres de entre 40 y 49 aos. Los
diagnsticos ms frecuentes fueron: TP del cluster B
(67,5%), Tr. del estado de nimo principalmente distimia
(38%) y Tr. Esquizoafectivo (30%). Los hombres
representaban el 51% de la muestra con edades entre 20
y 49 aos. Los diagnsticos ms frecuentes fueron: Trs.
relacionados con sustancias (44%), Esquizofrenia (41%),
TP cluster A y B (41%) y Depresin
(41%).CONCLUSIONESNo se encontraron diferencias
entre hombres y mujeres en cuanto al nmero de
ingresos y estancia media. Las mujeres presentan ms
TP que los hombres (2:1 o 3:1). Los hombres consumen
y son ms dependientes a sustancias txicas que las
mujeres. Dentro del espectro psictico, los hombres

presentan trastornos ms severos. En nuestra muestra,


el SCL-90-R no permiti apreciar la gravedad de los
distintos trastornos de los pacientes, por lo que nos
planteamos para futuras investigaciones utilizar pruebas
psicodiagnsticas especficas segn el trastorno.
Intervencin psicoeducativa en familiares de

afectados de esquizofrenia: experiencia de


abordaje grupal interdisciplinar
M de la Cruz Crespo Maraver, ; Flor Lpez, .;
Antonia Masjuan, .; Magda Prez, Montserrat
Flores, a; Ruth Vilanova, Pere Bonet, Hospital
St. Joan de Du. Fundaci Althaia
Introduccion: Las intervenciones familiares en
esquizofrenia (IFE) se recomiendan en guas de
tratamiento consensuadas por expertos, pues han
demostrado su eficacia: mejora la evolucin clnica del
paciente (reduce recadas al 50% al ao de seguimiento
y mejora la adherencia farmacolgica, el ajuste social y la
calidad de vida); aumenta el conocimiento sobre la
enfermedad; y reduce la sobrecarga familiar. Estas IFE
coinciden en el marco conceptual (basado en la
evidencia cientfica y acceptando las bases biolgicas de
la esquizofrenia), en el tipo de abordaje, psicosocial, e
incluyen psicoeducacin como componente clave.
Existen diferentes modalidades de aplicacin, sin
haberse demostrado cules son relevantes para su
eficiencia. Adems, son conocidas las limitaciones
existentes para su aplicacin en la prctica asistencial.
Se pretende describir nuestra experiencia de aplicacin
de un programa psicoeducativo para familiares de
pacientes esquizofrnicos (PPFE) basado en la evidencia
aportada por las IFE, pero desarrollado a partir de las
necesidades reales de nuestra poblacin diana y
articulado en base a los recursos de que disponemos
actualmente. Metodo: Ofrecemos a nuestros usuarios
PPFE grupal interdisciplinar conducido por psiclogo en
nuestro centro asistencial. Previa participacin, se recoge
cuestionario de datos sociodemogrficos, clnicos y
expectativas. Consta de 10 sesiones semanales de 90
minutos que siguen una estructura comn que incluye
tema central, discusin, intercambio de experiencias y
recursos, exceptuando las sesiones primera
(presentacin de profesionales, programa y participantes)
y ltima (resumen, entrega de material escrito y
valoracin final). Un experto en la materia (psiquiatra,
psiclogo, enfermero, terapeuta ocupacional y trabajador
social) desarrolla cada tema: aspectos mdicos de la
enfermedad, manejo de la medicacin, potenciacin del
autocuidado y de actividades teraputicas, recursos para
familiares de actuacin ante la enfermedad, recursos
para reducir el estrs familiar, recursos hospitalarios,
extra-hospitalarios, econmicos, y aspectos sociolegales.
Al finalizar el PPFE se admi! nistra cuestionario de
satisfaccin (escalas visuales analgicas-VAS y
preguntas abiertas). Resultados: De Octubre 2002-Junio
2005 se realizan 5 PPFE (9-15 participantes/grupo), se
incluyen N=61 familiares, de edad=58+/-12 (mn=31;
mx=82; mediana=59). La mayora padres (86%), 38%
de ellos trabajan a jornada completa, 40% juvilados o con
invalidez, cuidan de enfermos de edad=30+/-9 (mn=19;
mx=58; mediana=27), 29% desocupados sin recibir
subsidio alguno, y la mayora con tiempo de evolucin de
la enfermedad de >24 meses (65%), la mayora han
estado hospitalizados alguna vez (73%) y la mitad de
ellos acuden a centro de da. Ms de la mitad de los
familiares conviven con el enfermo >50h/semana, 26%
tambin cuidan de otros familiares dependientes, y 45%
solicitan ms ayuda para atenderle. Grado de asistencia
al PPFE: 8+/-3 sesiones (mn=1; mx=10; moda=9). Se
obtiene VAS-satisfaccin=9+/-1 (mn=7;mx=10;
moda=10). N=43 (100% de los encuestados)
recomendara el PPFE a otros familiares. N=40 (93% de
los encuestados) estara interesado en asistir a otros
PPFE. Discusion: Tras el PPFE el grado de satisfaccin
de los familiares es muy alto. En el contexto de las
dificultades conocidas para aplicar las IFE, el PPFE es
un recurso satisfactorio para los familiares. Nos
planteamos medir los efectos del PPFE sobre aspectos
clnicos de la esquizofrenia y sobre su impacto emocional
en el familiar

Propiedades Psicomtricas del Cuestionario


General de Salud en Cuidadores Primarios
Informales de Pacientes con Enfermedad
Crnico-Degenerativa: Resultados
Preliminares
Noem L. Islas Salas, , UNAM; Bertha Ramos del
Ro, ; Virginia J. Alpuche Ramrez, , UNAM;
Mario E. Rojas Russell, Carlos G. Figueroa
Lpez, Facultad de Estudios Superiores
Zaragoza, UNAM Spain
El progresivo envejecimiento de la poblacin y la mayor
supervivencia de personas con enfermedades crnicodegenerativas (ECD), dependientes o discapacitadas, ha
incrementado el nmero de personas que requieren ser
asistidas por un Cuidador Primario Informal (CPI). La
literatura ha hecho evidente los costes fsicos,
psicolgicos, sociales y econmicos que acarrean los
CPI, lo que se traduce en altos niveles de estrs, carga,
depresin, problemas de salud, as como una amplia

variedad de trastornos emocionales, llevando al cuidador


a convertirse en pacientes ocultos. Objetivo: Determinar
las propiedades psicomtricas del Cuestionario General
de Salud de Goldberg (CGS-28) en su versin de 28
reactivos (versin adaptada por Romero y Medina-Mora,
1987). Mtodo: Se aplic el cuestionario a 162 CPI de
pacientes con ECD de diversas instituciones de salud
pblica de la Ciudad de Mxico. Los resultados
sociodemogrficos muestran al CPI de sexo femenino
(79.6%), con edad promedio de X=49.1 aos (DE 13.74),
74.1% casadas, 35.2% hijas del paciente, 18.5% con
estudios de primaria; 43.8% cuidan de un paciente con
enfermedad del sistema respiratorio y 24.1% del
cardiocirculatorio. La consistencia interna del CGS-28 fue
de a=.87; y para cada escala: ideacin suicida a=.84,
depresin leve a=.76, sntomas somticos a=.86 y
ansiedad a=.71. El Anlisis Factorial identific siete
componentes que sumados explicaron el 64.8% de la
varianza. El 71.9% de los CPI obtuvo puntuaciones
superiores a 5 (punto de corte 5/6), por lo que se les
consider casos; de los cuales 63% present sntomas
leves, 18% moderados y 19% severos. Respecto a la
prevalencia de sntomas en las diferentes reas; 49.84%
present sntomas de depresin leve, 26.36% somticos,
17.24% de ansiedad y 6.56% de ideacin suicida.
Conclusiones: esta versin del CGS-28 posee adecuadas
propiedades psicomtricas para evaluar la salud
percibida de los CPI de enfermos crnico
degenerativos.Descriptores: cuidador primario informal,
salud autopercibida, enfermedad crnico degenerativa.

El papel de psiclogo clnico en los equipos


de seguimiento comunitario para trastornos
mentales graves
Jos Lpez-Santiago, Complejo Hospitalario
Universitario de Albacete
La presente investigacin analiza el grado de
convergencia existente entre las diferentes escalas
clnicas (bsicas, de contenido y suplementarias) del
MMPI-2 y las escalas de los sndromes clnicos
(moderados y graves) del MCMI-II descritos en el eje I
del DSM-IV. Tambin se analiza la existencia de
diferencias de sexo en la manifestacin de perfiles
psicopatolgicos especficos, as como el poder
predictivo de las distintas escalas clnicas del MMPI-2
(ej.: D, DEP, Pt, LSE) respecto del MCMI-II (ej.: D) que
valoran un mismo sndrome clnico (ej.: depresin).Para
ello, se ha administrado el MMPI-2 y el MCMI-II a 109
pacientes clnicos no hospitalizados (50 hombres y 59
mujeres) con edades comprendidas entre los 18 y los 60
aos. La correspondencia entre las diferentes escalas de
uno y otro cuestionario respecto de un mismo cuadro
clnico se mantiene significativamente en los dos sexos,
aunque la magnitud de las mismas vara en uno y otro
sexo (ej.: la correlacin entre la escala de ansiedad del
MCMI-II (A) y del MMPI-2 (ANX) es significativa entre
ambos instrumentos, aunque de diferente magnitud entre
hombres (0.65) y mujeres (0.81)). Por otra parte, del
conjunto de escalas del MMPI-2 que evalan depresin
(D, Pt, DEP, LSE), la nica que la predice en el MCMI-II
(D) es la escala DEP (=0.85, p<0.0001; R2=0.72). Estos
resultados constatan la existencia de un elevado grado
de convergencia entre las distintas escalas clnicas del
MMPI-2 y del MCMI-II que evalan los principales
sndromes clnicos descritos en el eje I del DSM-IV.

Lateralidad Manual Y Esquizotipia En Familias


Con Psicosis De Inicio Precoz
Ma Jose Muoz Flores, CASM "Benito Menni";
Mar Fatj-Vilas, "CASM" Benito Menni" ,
Universitat de Barcelona; Maria Aguilera, CASM"
Benito Menni", Universitat de Barcelona; Ma
Eullia Navarro Hurtado, "CASM" Benito Menni",
Universitat de Barcelona; Lourdes Faanas,
"CASM" Benito Menni", Universitat de Barcelona
Introduccion: Diversos estudios han puestos de
manifiesto que personas con psicosis, particularmente
con esquizofrenia, presentan con mayor frecuencia una
lateralidad manual no-diestra, sugiriendo que la
esquizofrenia podria estar asociada a una alteracin de
la lateralizacin cerebral (Crow 1997, Sommer 2001,
Annet 2002). Ms recientemente, la lateralidad no-diestra
y/o el ambidextrismo se han correlacionado con la
presencia de caractersticas de esquizotpia en poblacin
general sana y en pacientes esquizofrnicos (Stefanis
2006, Annett y Moran 2006). El objetivo es estudiar, en
una muestra de pacientes psicticos de inicio precoz, sus
familiares de primer grado y un grupo control, la
lateralidad manual y su relacin con las dimensiones
esquizotpicas. Metodo: El estudio se ha realizado en una
muestra de 53 pacientes (32H, 21M;edad=16.34
(1.46))con un diagnstico de trastorno del espectro
esquizofreniforme (DSM-IV-TR)de inicio anterior a los 18
aos; 64 familiares de primer grado de los pacientes
(26H, 38M; edad=42.06 (10.28)) y 64 controles sanos
(32H, 33M; edad=19.64(4.56)).La dominancia manual fue
evaluada con la escala "Hand Preference
Questionnaire"(Annett,1970).La esquizotpia en los
familiares y controles se evalu con el cuestionario
autoadministrado "Schizotypal Personality QuestionnaireBrief"(Raine, 1991). Resultados: Los pacientes
mostraron lateralidad manual izquierda con mayor

frecuencia que sus familiares de primer grado (p=0.033)


y que los controles (p=0.013). No se observaron
diferencias en la proporcin de dominancia manual mixta
entre los tres grupos. No se ha observado asociacin
entre la dominancia manual y las puntuaciones en las
dimensiones esquizotpicas, ni en familiares ni en
controles. Discusion: La mayor frecuencia de lateralidad
zurda observada en pacientes respecto a controles y
familiares de primer grado apoya la sugerencia que la
esquizofrenia podria estar asociada a una alteracin en
el desarrollo de la lateralizacin cerebral. Por otra parte,
nuestros datos no constatan la asociacin de la
lateralidad zurda o ambidextra con caractersticas de
personalidad esquizotpica en los grupos de familiares y
en el grupo control, aunque una limitacin podra ser la
falta de poder estadstico de la muestra.

Rehabilitacin cognitiva y adaptacin


funcional en el paciente esquizofrnico
Irene Ramos, ; Gemma Garrido, ; Patrcia
Escobedo, ; Marc Fabra, ; rsula Gonzlez, ;
Mart Santacana, a; Maite Garolera, Hospital de
Terrassa
INTRODUCCIN: Actualmente permanece la
controversia sobre la generalizacin de los efectos
positivos obtenidos en programas de rehabilitacin
cognitiva. Considerando los niveles de adaptacin
funcional del paciente como un indicador de dicha
generalizacin, el objetivo de nuestro estudio es analizar
si se producen cambios en la adaptacin funcional del
paciente a partir de un programa de rehabilitacin
cognitiva.MTODO: Se reclut una muestra de 49
pacientes esquizofrnicos, diagnosticados segn criterios
DSM-IV y clnicamente estables bajo tratamiento
antipsictico. Posteriormente se dividi la muestra en
dos grupos (experimental y control). Inicialmente, no se
encontraron diferencias estadsticamente significativas
entre los dos grupos en variables demogrficas, clnicas,
neuropsicolgicas ni respecto a los niveles de
funcionamiento psicosocial medidos a partir de la escala
LSP. Los pacientes del grupo experimental (N=31)
realizaron un programa de rehabilitacin cognitiva de 48
sesiones de una hora, en las que se trabajaron las
siguientes reas: atencin y funciones ejecutivas. Los
pacientes del grupo control (N=18) no fueron estimulados
cognitivamente. Al finalizar el programa de rehabilitacin
cognitiva se administr de nuevo la escala LSP a ambos
grupos, y se procedi a comparar los resultados pretratamiento y los resultados post-tratamiento en el grupo
experimental y en el grupo control. RESULTADO: Se
encontraron diferencias estadsticamente significativas
entre las puntuaciones de la escala LSP antes y despus
del tratamiento en el grupo experimental (p<0.05);
mientras que en el grupo control no se hallaron
diferencias significativas (p=0.107) en el perfil de
habilidades de la vida cotidiana entre las evaluaciones
pre y post-tratamiento.CONCLUSIN: Se puede concluir
que el programa de rehabilitacin cognitiva llevado a
cabo en nuestro centro aument los niveles de
funcionamiento psicosocial de los pacientes. Adems, la
mejora registrada en la adaptacin funcional se puede
interpretar como un cierto grado de generalizacin de los
resultados conseguidos en la intervencin
neuropsicolgica. Por lo tanto, la rehabilitacin cognitiva
debera ser considerada como una intervencin relevante
en los programas de tratamiento de los pacientes
esquizofrnicos.

Funcionalidad, discapacidad y salud de


pacientes con trastornos mentales severos y
persistentes asilados en Mxico
Rebeca Robles,; Rafael Medina Dvalos, ;
Francisco Pez Agraz, Benjamn Becerra
Rodrguez, Instituto Jalisciense de Salud Mental
Introduccion: La Organizacin Mundial de la Salud
(OMS), con su reciente lanzamiento de la Clasificacin
Internacional de Funcionalidad, Discapacidad y Salud
(CIF), demuestra que las ciencias de la salud pblica
procuran la superacin del abordaje mdico tradicional,
sin necesidad de eliminarlo. Desde esta perspectiva, la
enfermedad en general, y la mental en lo particular, no
puede ser entendida slo como la presencia de sntomas
fsicos; debe tomarse en cuenta tambin el grado de
discapacidad y funcionalidad asociado a la misma. En
este trabajo se presentan los resultados de la evaluacin
de funcionalidad, discapacidad y salud de las personas
con trastornos mentales severos y persistentes que son
atendidas en el Centro de Atencin Integral en Salud
Mental de Estancia Prolongada (CAISAME-EP), del
Instituto Jalisciense de Salud Mental (SALME),
Secretara de Salud Jalisco; que se llevara a cabo en el
entendido de que ello constituye un prerrequisito para la
toma de decisione! s e implementacin de los programas
de atencin en salud mental locales, que puedan elevar
el estatus funcional y bienestar vital de estos individuos.
Metodo: Los pacientes hospitalizados en los pabellones
de la institucin denominados de estancia permanente
fueron evaluados con base en: 1) el apartado de
Actividades y Participacin de la lista corta de cotejo de
la CIF (AP-LC-CIF); 2) la Escala de Evaluacin de la
Actividad Global (EEAG), y 3) el Perfil de Habilidades de
la Vida Cotidiana (PHVC). Resultados: De un total de 205

usuarios, el 64.9% eran hombres, con una edad de


40.28+14.39 aos, y tiempo de hospitalizacin de
18.04+10.29 aos. El diagnstico ms frecuente fue el
retraso mental severo (29.8%), le sigui el moderado
(15.6%), la esquizofrenia residual e indiferenciada
(8.3%), y la paranoide (7.8%). El 48.8% de la muestra
present alguna otra enfermedad fsica (n=102). La
mayora de los usuarios tuvieron entre 31 y 40 de
puntuacin en la EEAG (n=54, 26.3%); el rea de mayor
deterioro en PHVC es la relativa al contacto social
interpersonal, seguida de la de auto cuidado; y los
dominios del AP-LC-CIF con mayor disfuncin son: Vida
comunitaria, social y cvica; Vida domstica;
Interacciones y relaciones interpersonales, y reas
principales de la vida. Discusion: La evaluacin de la
discapacidad y funcionalidad de la poblacin asilada en
la Institucin fue de utilidad para impulsar la planeacin y
desarrollo de instancias y programas de rehabilitacin
psiquitrica comunitaria en la entidad. Se identificaron
tres grupos grandes de pacientes asilados en el Estado
de Jalisco, Mxico; con necesidades de atencin
diferentes entre s. Por una parte, existe un alto
porcentaje de usuarios con retraso mental severo que no
requiere de la atencin psiquitrica continua bajo una
norma hospitalaria costosa. Por otro lado, prcticamente
un 70% de los pacientes asilados en la institucin es
tericamente susceptible a rehabilitacin comunitaria, y
no hay razn que justifique que vivan en un hospital
psiquitrico. Lamentablemente, un tercer grupo de
pacientes, que constituye adems un altsimo porcentaje,
han estado asilados ah durante muchos aos; lo que
implica sumar a las tareas para implementar un sistema
de rehabilitacin comunitari! a, un proceso de
desinstitucionalizacin psiquitrica.

Mejora la rehabilitacin cognitiva la calidad


de vida de los pacientes esquizofrnicos?
Mart Santacana, ; Gemma Garrido, ; Marc
Fabra, ; Marta Pajares, Patrcia Escobedo,;
Irene Ramos, ; Maite Garolera, Consorci Sanitari
de Terrassa
Distintos estudios han aportado evidencia sobre la
relacin entre neurocognicin y calidad de vida en la
esquizofrenia. Nuestro objetivo es valorar si se producen
variaciones en la percepcin de la calidad de vida de los
pacientes despus de realizar un programa de
rehabilitacin cognitiva.A partir de una muestra de 49
pacientes esquizofrnicos, diagnosticados segn criterios
DSM-IV, se estableci un grupo experimental (N=31) y un
grupo control (N=18). A partir de una evaluacin pretratamiento, se pudo concluir que no existan diferencias
estadsticamente significativas entre los dos grupos en
variables demogrficas, clnicas, neuropsicolgicas ni
respecto a las puntuaciones en la escala de calidad de
vida QLS. Los pacientes del grupo experimental
realizaron un programa de rehabilitacin cognitiva de 6
meses de duracin; mientras que los pacientes del grupo
control no fueron estimulados cognitivamente. A ambos
grupos se les administr, antes y despus del programa
de tratamiento, la escala de calidad de vida QLS.
Posteriormente se llev a cabo una comparacin entre
los resultados pre-tratamiento y post-tratamiento en
ambos grupos. Se encontraron diferencias
estadsticamente significativas en el grupo experimental
entre las puntuaciones en la escala QLS antes y despus
del tratamiento (p<0.001). En el grupo control no se
hallaron diferencias significativas (p=0.4) entre los niveles
percibidos de calidad de vida pre y post-tratamiento.Se
podra establecer una relacin entre la mejora en las
capacidades cognitivas y el aumento de la sensacin de
calidad de vida de los pacientes diagnosticados de
esquizofrenia. Estos resultados sugieren la rehabilitacin
cognitiva como va para mejorar la satisfaccin y el
bienestar de los pacientes esquizofrnicos.

Adult Trauma
English Programme
How am I Feeling?: Work Stress and
Secondary Traumatization in Mental Health
Workers in Turkey
Zara Page Ayten, Gulcan Akcalan, Istanbul Bilgi
University Turkey
In their day-to-day work mental health workers come into
direct contact with other peoples' distress, especially in
the course of working with victims of traumatic events,
and workers themselves can fall victim to secondary
traumatic stress reactions brought on by helping. A
number of studies have shown that secondary traumatic
stress is experienced both similarly and somewhat
differently by trauma workers. The observed symptoms
appear to result from assimilating other peoples'
traumatic material and have general distress plus some
burnout as a shared symptom manifestation. This study
examined specifically the traumatic stress and burnout
levels of mental health workers who work in the trauma
field in the Marmara and South East Regions of Turkey
using a questionnaire measure of Burnout and Traumatic
Attachment Belief. The overall prevalence of current

traumatic stress and the prevalence according to


covariates of interest were calculated. Chi-square test
and multiple regression analyses were also used to
identify risk factors for secondary traumatization and work
stress. The findings of this study indicated a high levels of
deporsonalization and emotional exhaustion among
mental health workers, especially in those who work in
South East Region of Turkey and in those newer to the
work seemed in particular to have a higher burnout level.
Mental health workers who work with both natural caused
and human-made trauma reported a significant
disruptions in cognitive schemas, especially with issues
with their own safety, self-trust and other-trust. Also,
personal trauma history, the place where the work is, the
work case load, supervision, the therapist's variables
such as experience, coping skills and having professional
social support were important confounding variables. This
study suggests that mental health workers who work with
trauma victims are vulnerable to secondary traumatic
stress and therefore personal, professional and
organizational support play an important protective role
for them in continuing working. The information gathered
from this study is crucial for planning mental health
services to target at risk mental health professionals for
early interventions.

Effectiveness of Eye Movement


Desensitization and Reprocessing (EMDR)
treatment in Iranian war veterans suffering
from chronic Posttraumatic Stress Disorder
Ali Reza Bakhshayesh, Wolfgang; Ihle Academy
for Psychotherapy and Intervention Research at
the University of Potsdam, Germany, Gnter;
Esser Academy for Psychotherapy and
Intervention Research at the University of
Potsdam, Germany
Within a short period of time, EMDR treatment (Shapiro,
1990) developed to one of the best-evaluated therapies
for posttraumatic stress disorders. This is well
documented by recent meta-analyses (Davidson &
Parker, 2001; Maxfield & Hyer, 2002; van Etten & Taylor,
1998) and by the consideration in various international
treatment guidelines of PTSD (APA, 2004; Chambless et
al., 1998; Foa et al., 2000). Substantial advantages of
EMDR include short-time duration, high acceptance by
participants and low attrition rates. In the present study
we examined the applicability and efficiency of a shorttime EMDr-therapy in Iranian war-veterans suffering from
PTSD. The method was a randomized controlled trial. 30
male veterans meeting DSM-IV-criteria for PTSD were
randomly divided into three subgroups: EMDR-treatment
(three sessions of weekly EMDR-treatment) placebo
group (three weekly sessions of individual interviews with
problem-discussions), and control group (three times
weekly meeting for evaluation purposes, no treatment).
Pre-, post- and one-months-follow-up evaluation using
the SCL-90R and a specially designed PTSD-checklist
based on DSM-IV. Post-treatment-evaluation of the
EMDR-group showed significantly lower scores of
depression, anxiety, hostility, and the positive symptom
distress index of SCL-90R in comparison with the other
groups. The observed differences continued until the onemonth-follow-up evaluation, partly the differences even
increased. The placebo-group did not differ from controlgroup on any of the variables at either post-test or followup. Results indicate the applicability and efficacy of EMDtreatment in case of PTSB as a consequence of warinvolvement.

The early identification of Posttraumatic


Stress Disorder (PTSD): Utilising the Trauma
Screening Questionnaire in a specialist
sexual assault centre
Nicoletta Capuzzo, Haven - Sexual Assault
Referral Centre - St. Mary's Hospital, London;
Sarah Heke, Jenny Petrak, Haven - Sexual
Assault Referral Centre - St. Mary's Hospital,
London UK
It is estimated that one in four women in the UK have
experienced rape or attempted rape in their lifetime
(British Crime Survey, 2007). Individuals who are raped
experience far higher rates of PTSD than any other
traumatic life events (Norris, 1992).
Recent studies suggest that providing brief trauma
focused CBT within 4 weeks of an assault for individuals
with severe PTSD can accelerate the recovery process
(Foa et al., 2006). As such, effecitve methods of
screening for the presence of traumatic stress responses
might help identify individuals most likely to benefit from
early intervention, yet no studies have been published
evaluating the use of screening tools with this population.
The Trauma Screening Questionnaire (TSQ; Brewin,
2002) has been widely administered to train crash
survivors and victims of crime and performed consistently
well in comparison to other screening tools designed to
predict PTSD (Brewin, 2005). The aim of this study is
therefore to evaluate the clinical usefulness of the TSQ
with individuals following rape or sexual assault.
Participants were drawn from the 'Haven' (Sexual Assault
Referral Centre) which were developed jointly by the
National Health Service and the Metropolitan Police.

They provide a specialist actue forensic, medical and


psychological service to adults and children who have
recently experienced sexual assault or rape. The TSQ
was adminsitered to adults attending for follow-up after
forensic medical examination either at one month or three
months post assault. Data was also collected on
demographics, details of the assault, past and current
psychiatric history and services involved in after-care.
Fifty seven women and 3 men completed the TSQ at the
Haven; mean age was 27 (range 16-51). Preliminatry
data indicates that 57% (n=19/35) of the sample scored
above the cut off range on the TSQ at 1 month post
assault. A further 36% (n=9/25) presented with
posttraumatic symptoms on the TSQ at three months
after the assault. Of thesem 39% reported prior mental
health problems. This constituted primarily depression,
but also self-harm and suicidal behaviour. For several
individuals suicidal ideation was a direct consequence of
the trauma. Thirteen percent of the attendees were
rreferred to Clinical Psychology; 18% to counselling and
10% to other services including GPs and local community
mental health services. Ten percecent elected to have
private therapy. The TSQ is a useful tool in identifying
individuals at risk of developing severe PTSD following
sexual assault. Problems were encountered in ensuring
that the TSQ wqas routinely administered in the context
of primarily an acute forensic medical setting. Further
training may be required to ensure staff awareness and
acceptability in using the TSQ and initiating appropriate
referral. The implications of using screening tools for the
identification of individuals who may benefit from early
trauma-focused CBT interventions will be discussed.

The changed and the unchanged: Mediation


and moderation roles of thought-action fusion
and thought suppression in the maintenance
of PTSD symptoms.
Sue-Hwang Chang, En-Chang Wu, ; Jei-Tun
Wu, Department of Psychology/National Taiwan
University; Ming-Been Lee, Department of
Psychiatry/National Taiwan University Taiwan
The purpose of this study was to explore some possible
cognitive diatheses that might play roles in the etiology,
maintenance, and/or treatment of PTSD. Specifically, this
study tested the hypothesis that PTSD sufferers might
have cognitive diatheses related to tendency for 'thoughtaction fusion (TAF)' and 'suppression of unwanted
thoughts' which render themselves more inclined to suffer
from and/or maintain vivid and intrusive traumatic images
and avoidance symptoms. The sample consisted of 63
survivors with traumas including the 921 Taiwan Chi-Chi
Earthquake (1999), severe burns, serious traffic
accidents, industrial accidents, life-threatening injury, and
witnessing the death of a loved one. There were 26
males and 37 females, ranging in age from 21 to 62
years (M = 41.52, SD = 8.401). The mean time after their
exposure to trauma was 4.82 years (SD = 0.6 years). The
instruments included the Revised Thought-Action Fusion
Questionnaire, White Bear Suppression Inventory, Impact
of Event Scale, and MINI International Neuropsychiatric
Interview. Based on their scores on MINI, participants
were divided into symptom changed group (present nonPTSD group) and symptom sustained group (present
PTSD group). There were no significant differences on
demographic variables and years since trauma happened
between the two groups. The present PTSD group scored
significantly higher than the present non-PTSD group on
subjective ratings of trauma severity, initial and present
IES scores, and WBSI scores as well; nonetheless, no
significant differences on TAF score. Based on these
preliminary analyses, a series of hierarchical regression
analyses were performed to test the mediation and/or
moderation roles these two cognitive diatheses might play
in the etiology and maintenance of PTSD syndrome with
subjective ratings of trauma severity being controlled. The
results showed that both TAF and thought suppression
served the roles of mediators between the subjective
appraisal of trauma severity and severity of PTSD
symptoms, with thought-action fusion being the distal
mediator for the initial PTSD symptoms, whereas thought
suppression being the proximal mediator for both the
initial and recent PTSD symptoms. Besides, the influence
of thought-action fusion subsided as time, as contrary to
the augmenting effect of thought suppression. The
moderation hypothesis was not supported. Thoughtaction fusion and thought suppression play differential
roles in the psychopathology of PTSD. It is proposed that
cognitive behavior treatment for PTSD should take in to
consideration these two cognitive diatheses in terms of
their respective mediating roles in the initial and later
phases of PTSD symptom manifestation. Besides, the
results of the present study together with other research
findings regarding therapeutic mechanisms of
mindfulness and EMDR might theoretically shed light on
the understanding of the psychopathology of PTSD, and
would clinically promote the treatment efficacy of
sufferers of PTSD.

The effect of immediate exposure on


intrusions after a traumatic film
Krans Julie, BSI Grard Nring,; Eni Becker, BSI
Radboud University Nijmegen Netherlands

One of the most pronounced features of PTSD is the


experience of intrusions. Intrusions are unwanted
thoughts or images of the traumatic event. They are
usually experienced as very stressful, and are one of the
main reasons that patients seek treatment. Several
theories have tried to explain the development of
intrusions. They converge on the idea that a traumatic
event is encoded differently and isolated from normal
autobiographical memory. One problem is that these
theories can only explain symptoms retrospectively.
Researchers are now challenged to study the
mechanisms during trauma that explain intrusions. Some
research has focused on information processing during
an analogue trauma. These studies found that several
visuospatial tasks have a protective effect against
intrusions. Holmes, Brewin, and Hennessy (2004), for
example, found that subjects who tapped a visuospatial
sequence while watching a trauma film experienced less
intrusions than subjects who watched film without an
extra task. In a replication of this study, Krans, Nring,
Holmes, and Becker (in progress), studied the influence
of chewing gum and tapping during a trauma film on the
subsequent number of intrusions. Results showed no
effect of chewing gum or tapping. One major
methodological difference compared to the Holmes,
Brewin, and Hennessy (2004) study, was that we
administered a recognition task right after the film, which
Holmes did not. This recognition test may have caused
the null result. Being forced to think about the traumatic
event right after it happened, may have led to memory for
this event that is more integrated with normal
autobiographical memory, and so lead to fewer intrusions.
We are currently testing this hypothesis in a new
experiment. Healthy subjects fill in questionnaires about
trait dissociation (DES-C), state dissociation (DSS),
mood, and state and trait anxiety (STAI-DY1 and 2).
Then, they watch the trauma film. Afterwards, subjects fill
in a recognition test about a particular part of the film
(counterbalanced). In the week following the experiment,
subjects keep a diary in which they record their intrusions
of the film. Subjects return to our laboratory after one
week and the intrusion diary is discussed. We
hypothesize that subjects will have fewer intrusions for
the part of the film for which they filled in a recognition
test right after the film and more intrusions for the part for
which they did not. The findings will give insight in the
cognitive processes that play a role in intrusion
development. A further step could be to look at the effects
of debriefing procedures that are being offered to victims
of trauma. Currently, it is not clear if debriefing is
beneficial or not.

Development and evaluation of an internetbased intervention for the treatment of acute


PTSD and the treatment and prevention of
chronic PTSD.
Gilson Kathryn, Britt Klein, Joanna Mitchell,
Litza Kiropoulos, David Austin, Department of
General Practice, School of Primary Health Care,
Monash University; Gwenda Australia
Many people will experience at least one traumatic event
in their lifetime and the experience of trauma can lead to
the development of posttraumatic stress disorder (PTSD).
Cognitive behaviour therapy (CBT) has shown to be an
effective treatment for PTSD and other high prevalence
disorders (e.g., depression and panic disorder). However,
this form of specialised treatment is unavailable to many
sufferers due to difficulties in accessing qualified
professionals (especially in rural or regional
communities), financial and time constraints and stigma
attached to seeking help for a mental health problem.
However, internet-delivered CBT offers a unique
opportunity to deliver mental health treatment to large
segments of the population, who are otherwise unable to
receive such treatment. Currently there is no other online
treatment program for a diagnosable PTSD. In this study,
we developed and evaluated an internet-based CBT
treatment for PTSD (PTSD Online), with the additional
provision of information to assist people who also have
secondary comorbid issues such as panic, depression,
substance/alcohol abuse, sleeping difficulties and stress.
Participants self-registered for the study online. Once
registered, participants were contacted by a research
psychologist to ascertain their eligibility for the study. Only
adult participants who had a DSM-IV diagnosis of PTSD
(assessed with ADIS-IV) as their primary presenting
problem were accepted. Eligible participants were offered
the PTSD internet-based program using a pre-, postintervention, and 3-month follow-up single group
experimental condition design. Participants were
assessed with the following: demographic information,
Post-traumatic Stress Disorder Checklist - Civilian
Version; Impact of Event Scale-Revised; Depression
Anxiety and Stress Scales; WHO-Quality of Life
Questionnaire-Brief; Dissociative Events Scale; Novaco
Anger Inventory (Short Form); Thought Control
Questionnaire; Treatment Credibility; Treatment
Satisfaction; Therapy Alliance. This paper will report on
the preliminary pre-post assessment treatment outcome
results (n = 15) of the CBT online intervention (PTSD
Online). Specifically this study will report the impact of
PTSD Online treatment on clinical diagnoses and on
trauma-related issues such as depression, anxiety and
stress, and quality of life. The study will also compare

treatment outcomes to those reported in the literature


(i.e., face to face CBT and internet-based treatment for
post traumatic stress symptoms) and it will discuss the
cost-effectiveness of this open trial. The incidence of
mental health problems is high, especially for anxiety and
depressive disorders. PTSD is a disabling condition,
almost completely associated with psychiatric
comorbidity, impairment to functioning, a chronic, often
lifelong course and high economic burden. Currently, less
than 40% of people with mental disorders receive any
mental health care in a 12-month period. Therefore
greater access to efficacious preventative and curative
mental health treatments is imperative. This study will
report on the treatment effectiveness of PTSD ONLINE
and consider its cost effectiveness.

PTSD in the absence of trauma memory:


adapting CBT models and treatments
Anna Keegan, Primary Care Psychology &
Counselling Service, Tower Hamlets PCT, UK
There is emerging empirical and clinical evidence that
despite the centrality of memory to our understanding of
PTSD, that PTSD can develop in the absence of any
memory (i.e. neurogenic amnesia), or only extremely
fragmentary memory for the traumatic event, e.g. after
traumatic brain injury (Bryant and Harvey, 1995), or
following a drug facilitated sexual assault (GauntlettGilbert, Keegan and Petrak, 2004). In such
circumstances, individuals can present with a variety of
anomalous memory phenomena which contribute to the
development and maintenance of their PTSD symptoms.
Those documented include 'islands' of memory, i.e. small
fragments of emotionally charged memory,
'pseudomemories' i.e. memories that are inconsistent with
what is known to have happened and 'implicit' memories,
based on strong S-S and S-R connections formed during
a traumatic event, which can become associated with
default predictions of severe danger.
Ideas of disturbances to implicit and explicit memory
processes during traumatic events have been
incorporated into contemporary cognitive understandings
of the development and maintenance of PTSD (e.g.
Ehlers and Clark 2000). I propose that similar
mechanisms operate where PTSD develops with NA.
Thus contemporary cognitive models can provide a basis
both to understand and treat PTSD and NA. Standard
CBT treatments, such as integration and elaboration of
the trauma memory, working with implicit memories,
working with self-generated images, addressing negative
appraisals and maladaptive coping strategies can be
adapted to address PTSD with individuals who develop
PTSD in the context of neurogenic amnesia. These are
described using case examples drawn from clinical
experience of work within an inner London sexual assault
clinic with survivors of drug-facilitated sexual assault.
Symptom reduction and other relevant areas of clinical
improvement will be included. Although such cases
represent a small and rather anomalous proportion of
PTSD sufferers, the existence of this phenomenon is
relevant as it can shed light on memory processes
operating within PTSD generally. Clinical evidence of the
amenability of PTSD in such circumstances to
adaptations of standard CBT treatment approaches is
important for the development and provision of suitable
treatments for affected individuals.

PTSD in National Guard Soldiers and


Spouses after Deployment to Iraq
Renshaw Keith, Department of Psychology
University of Utah USA
Combat deployments leave soldiers vulnerable to
posttraumatic stress disorder (PTSD). Furthermore,
relatives of soldiers with PTSD experience elevated
symptoms of secondary PTSD (e.g., Jordan et al., 1992).
Such research has been limited to full-time soldiers, but
part-time National Guard (NG) troops are now frequently
exposed to combat. They and their families have less
structured support than full-time soldiers and families
(e.g., often live far from military bases, work non-military
jobs). Thus, there is a pressing need to study postdeployment PTSD in NG soldiers and families. Combat
deployments leave soldiers vulnerable to posttraumatic
stress disorder (PTSD). Furthermore, relatives of soldiers
with PTSD experience elevated symptoms of secondary
PTSD (e.g., Jordan et al., 1992). Such research has been
limited to full-time soldiers, but part-time National Guard
(NG) troops are now frequently exposed to combat. They
and their families have less structured support than fulltime soldiers and families (e.g., often live far from military
bases, work non-military jobs). Thus, there is a pressing
need to study post-deployment PTSD in NG soldiers and
families. Soldiers reported a wide range of combat
exposure, with 48.9% reporting at least moderate
exposure. Thirteen percent of soldiers had scores above
the standard cutoff for PTSD in military populations (PCLM = 50), and 55.3% had scores above the standard cutoff
for depression (CESD = 16). Twelve percent of spouses
had scores above the standard cutoff for PTSD in the
general population (PCL-C = 44), and 73.3% had scores
= 16 on the CESD. Spouses' own PTSD was significantly
correlated with their perceptions of soldiers' PTSD (r =
.57, p < .001), but not with soldiers' self-report of PTSD (r
= .04, ns) or combat exposure (r = -.02, ns). However,

spouses' perceptions of soldiers' PTSD were significantly


correlated with soldiers' self-report of PTSD (r = .51, p <
.001) and combat exposure (r = .38, p = .01). Follow-up
regressions of spouses' own PTSD symptoms revealed a
significant interaction ( = -.32, p = .02) between
spouses' perceptions of soldiers and soldiers' self-report.
Specifically, spouses' perceptions of soldiers' PTSD were
consistently directly related to spouses' own symptoms of
PTSD ( = .72, p < .001). However, soldiers' self-report of
PTSD was unrelated to spouses' own symptoms of PTSD
( = .09, ns) when spouses perceived low levels of PTSD
in soldiers, and inversely related to spouses' own
symptoms ( = -.40, p < .01) when spouses perceived
high levels of PTSD in soldiers. Large numbers of NG
soldiers and spouses report clinically significant
symptoms of depression and PTSD, particularly when
compared to a prior report of active component troops
who served in Iraq (12.9% with PTSD, but only 7.9% with
significant depression; Hoge, et al., 2004). Moreover,
spouses report equal or greater levels of PTSD and
depressive symptoms than soldiers themselves,
indicating a strong need to address such problems in
spouses of soldiers. Finally, it appears that spouses are
most likely to experience symptoms of PTSD themselves
when they perceive high levels of PTSD in soldiers but
soldiers themselves report low levels of PTSD. This most
likely occurs when soldiers are minimizing their distress,
which causes even greater difficulty for spouses.

Prediction of Postraumatic Stress Disorder


following a traumatic birth.
Alcorn Kristie, Analise O'Donovan, ; Debra
Creedy, Griffith University; Grant Devilly,
Swinburne University; Jeff Patrick, University of
Southern Queensland Australia
The examination of Posttraumatic Stress Disorder
(PTSD) resulting from childbirth is a relatively new
phenomenon. There is some evidence that a proportion
of women perceive childbirth as traumatic and some
develop PTSD postpartum. What is less clear is who are
most at risk of developing PTSD and PTSD symptoms,
and what the course of PTSD and PTSD symptoms are
postpartum. The current research examined the
predictors of PTSD, PTSD symptom severity, and
changes in PTSD symptom severity. A prospective,
longitudinal study was conducted with a convenience
sample of 933 women who attended one of four antenatal
clinics. Data was collected during the last trimester of
pregnancy (from 28 weeks gestation); and at 4 to 6
weeks, 3 months, and 6 months postpartum. PTSD was
assessed in pregnancy and postpartum using the
Posttraumatic Diagnostic Scale (PDS) (Foa et al., 1997).
The performance of the PDS was examined against the
Clinician Administered PTSD Scale (CAPS) (Blake et al.,
1995; Blake et al., 1998). Clinically significant depression
and anxiety was also assessed in pregnancy and
postpartum. In order to provide a conservative estimation,
antenatal depression and anxiety along with antenatal
PTSD, subsyndromal PTSD, and PTSD-like symptoms,
were controlled for when examining the rates of PTSD
postpartum. Findings revealed that six women (1.2%) met
diagnostic criteria for PTSD at 4 to 6 weeks postpartum,
15 women (3.1%) met criteria 3 months postpartum, and
14 (3.1%) women met criteria for PTSD at 6 months
postpartum. Cross-validated results using a random
sample of participants revealed that 87% of participants
were correctly classified as either meeting or not meeting
criteria for PTSD at 6 months postpartum. Of the
examined variables, the best predictors of PTSD at 6
months postpartum were meeting PTSD criteria at 3
months postpartum and total dissociation experienced at
6 months postpartum. Other key predictors of PTSD
included greater stress associated with worrying about
coping with possible obstetric interventions during
pregnancy, greater average life stress during pregnancy,
previous experience of a miscarriage or abortion, and
higher levels of helplessness during or immediately after
the birth event. Further predictors included, but were not
restricted to, greater stress associated with family
relationships and physical complaints, lower levels of
perceived total support, less satisfaction with partner
relationship and lower perceived support from partner,
total state anxiety, hazardous alcohol consumption, and
use of avoidance coping were also predictive of PTSD at
6 months postpartum. The findings have practical and
theoretical implications. Given the high rate of correct
classifications, the variables may be useful in identifying
women in pregnancy that are likely to develop PTSD
postpartum. The findings also offer avenues for the
development of treatment strategies. For instance,
treatment efforts could be directed towards reducing
environmental stressors, to altering an individual's
tendency to engage in dissociation, to foster adaptive
coping behaviour, to increase social support, and to
address such cognitive factors as negative birth event
appraisals and unresolved issues regarding prior,
potentially traumatic life events.

Prospective Analysis of Children's Persistent


PTSD in Reaction to A Natural Disaster
Annette La Greca, Wendy Silverman, Department
of Psychology, Florida International University,
Miami, FL USA, Lisa Bailey, Olivia Hsin,
Department of Psychology, University of Miami,
Coral Gables, FL USA, Rebecca Siegel,
Department of Psychology, University of Miami,
Coral Gables, FL USA
Over the past 15 years there have been significant
advances in understanding the effects of trauma on
youth. Fueled by research on Hurricanes Hugo and
Andrew (e.g., La Greca et al., 1996; Lonigan et al., 1991),
it is clear that a significant percentage of youth who are
exposed to catastrophic natural disasters develop
posttraumatic stress disorder (PTSD) and its symptoms,
at least in the initial months postdisaster. However, very
little is known about the predictors of persistent PTSD
reactions in youth. The present prospective study
examined children's reactions to Hurricane Charley over
a 21-month period. Charley was a Category 4 hurricane
(sustained winds exceeding 135 miles per hour) that
struck Florida in August 2004, damaging 93% of the
households in Charlotte County; families suffered loss of
power, contaminated water supplies, and substantial
destruction that displaced thousands. Children's disaster
exposure and disaster-related experiences and their
adjustment at 9 months post-disaster (Time 1) were
examined as predictors of persistent PTSD symptoms
measured 21 months post-disaster (Time 2). Time 1
participants included 385 students in grades 2 - 4 (55%
girls; 85% Caucasian; M age = 8.7 years) from four
schools that were significantly affected by Hurricane
Charley; most of the children (n = 245; 64%) also
participated at Time 2. There were no differences
between the Time 1 only participants and those present
at both time points. The most common reason for
attrition was a change in schools. At Time 1, children
completed the Hurricane Related Traumatic EventsRevised (HURTE-R) that assessed life-threat during the
hurricane, loss/disruption events immediately following
the hurricane, and ongoing hurricane-related stressors;
the Survey of Children's Social Support; major life events
from the Life Event Schedule (LES), and the PTSDReaction Index (PTSD-RI). At Time 2, the HURTE-R
(ongoing hurricane-related stressors), the LES, and the
PTSD-RI were readministered. Several predictors of
initial (Time 1) and persistent (Time 2) PTSD symptoms
(initial life threat, initial and ongoing hurricane-related
stressors, perceived social support, and major life events)
were examined. Structural Equation Modeling revealed
that the specified model fit the data (?_(32)=36.72, p=.26,
CFI=.989, RMSEA=.020, SRMR=.035), explaining 39.6%
of the variance in PTSD symptoms at Time 1 and 28.1%
at Time 2. Perceived life threat during the hurricane
(=.32), initial losses and disruptions after the hurricane
(=.16), children's initial distress about these losses
(=.12), and the occurrence of major life events (=.17)
all were associated with greater Time 1 PTSD (p's < .05).
Social support approached significance (=-.22; p=.07),
with greater social support associated with lower levels of
PTSD symptoms. Controlling for Time 1 PTSD (=.43),
significant predictors of persistent PTSD symptoms
included: major life events occurring since Time 1
(=.23), children's perceived life threat during the
hurricane (=.14), initial losses and disruptions (=.09),
and initial distress over the losses ( =.06); the effects of
social support at Time 1 approached significance (p=.08).
These findings indicate that children's exposure to
catastrophic natural disasters, in terms of perceived life
threat and initial loss and disruption of everyday life (and
distress over this loss), are significant and substantial
predictors of persistent PTSD reactions. This implies that
children who are most at risk for persistent PTSD may be
identified early on in the aftermath of a disaster. In
addition, those who endure additional major life events
(e.g., death or illness of a family member) also have a
difficult time recovering from the effects of a disaster and
may show persistent and chronic difficulties. Efforts to
develop evidence-based interventions for children in the
immediate aftermath of natural disasters are lacking but
very much needed to address this significant public
health concern.

How Efficient Tough Guys Cope With Stress:


a study of coping styles used by Romanian
Special Forces personnel
Stefan Lita, Andreea Mihalcea, General
Inspectorate of Romanian Police, Caterina
Zaharia, Centre for Psychology, Ministry of
Administration and Interior, Mirela Turc, Centre
for Psychology, Ministry of Administration and
Interior Rumania
Police work could be described as a tough job, due to the
constant tensions associated with the need to cope with
multiple and conflicting demands. Although experiencing
acute stress is inherent in police work, the policemen
seem to have a higher level of well-being compared with
other professionals. In the last years police stress have
been the focus of many studies, all over the world, in
South Africa (Pienaar, et al., 2007), Israel (Malach-Pines,
Keinan, 2006), Norwegia (Burke, Mikkelsen, 2006), China

(Dai et al., 2002) Singapore (Bishop et al., 2001) Australia


(Leonard, Laurence, 1999) New Zealand (Stephens,
Long, 1999) Scottish (Biggam et al., 1997) United States
(Harvey-Lintz, Tidwell, 1997), Great Britain (Brown, et al.,
1996), Germany (Kirkcaldy, Furnham,1995). In the same
time, Romanian law enfocement institutions have started
to employ psychologists, and one of their main roles in
this settings is to train people to better manage job
stress. In this context the present study investigate the
influence of both behavioral and cognitive copying styles
as well as personality on the posttraumatic stress of
officers involved in multinational peacekeeping operations
(MPO). The sample consists of 167 subjects (116 officers
who apply for MPO and 51 officers who serve for MPO).
They fill in 4 questionnaires: Dispositional Resilience
Scale, Indices of Coping Responses, The Mississippi
Scale for Combat-Related PTSD and a scale about the
perceived effect of job and life stress. The main
hypothesis was that hardness and cognitive/behavioral
coping strategies play an important explicative role in
understanding policemen's stress reactions. We
performed different hierarchical regression analyses with
posttraumatic, job and life stress scales as dependent
variables and hardiness scales (commitment, control,
challenge) and coping scales (behavioral, cognitive,
avoidance) as independent measures. Data confirm the
main hypothesis showing that: (a) low scores on
hardiness and behavioral coping as well as high scores
on avoidance coping are associated with more
posttraumatic stress in both groups (Applicants: r2=37%,
Specialists: r2=49%), (b) the specialists (officers involved
already in MPO) present a higher level of PTSD (t=-3.44,
p=.001) and have higher mean on avoidance coping (t=4.36, p=.001) and challenge scale (t=-3.48, p=.001), but
lower mean on behavioral coping (t=4.57, p=.001) and
commitment scale (t=3.97, p=.001), and (c) the
subcomponent of job and life stress explain much more of
the variance of PSTS for the specialists (r2=49%) than for
the applicants (r2=13%). This study brings additional
proves that hardness and active coping strategies prevent
posttraumatic stress even in high risk jobs. The results
are interesting especially because all the subjects, both
applicants and specialists, represent a very special
population (Special Forces) which have already passed
different psychological exams and it's used to work under
different high-stress condition. The data also suggest that
psychologists from law enforcement field should select
people with high hardiness (because this explain 29% of
PTSD) and train officers to use more active coping
strategies instead of avoidance, which is a maladaptive
coping styles (it account for 43% of the PTSD).

I felt that this was a mental rape as well as


possibly physical rape A qualitative
investigation of cognitive appraisals following
Drug Facilitated Sexual Assault (DFSA):
relevance to CBT
Beth Major, ; Jackie Hetherton, Royal Holloway,
University of London; Jenny Petrak, Infection &
Immunity, Barts and the London NHS Trust UK
There is a paucity of studies on the psychological
consequences of DFSA. Media stereotypes usually
implicate drugs such as Rohypnol, GHB and Ketamine,
however, a recent report by police in the UK suggests
that alcohol is most commonly detected following DFSA
(ACPO, 2006). Substances used in DFSA cause
disinhibition, relaxation of muscles, confusion, and
possible loss of memory for the event (Slaughter, 2000).
Gauntlett-Gilbert et al (2004) stress the need for further
research in the area. On the basis of their clinical
experiences of treating survivors of DFSA, the authors
identify several features of DFSA which potentially
differentiate the experience from that of other sexual
assault: memory, the nature of the assault and the
response of others to the assault. While most research
amongst survivors of sexual assault indicate vulnerability
to developing a number of psychological difficulties
including anxiety, depression, Post Traumatic Stress
Disorder (PTSD), substance abuse, and panic disorder
(Petrak & Hedge, 2002), less is known whether such
difficulties persist despite impaired memory for the event.
Current models emphasise the importance of negative
cognitive appraisals in the onset and maintenance of
PTSD (Ehlers & Clark, 2000). This study aims to identify
cognitive appraisals that may be specific to the
development of psychological morbidity following DFSA.
Women reporting DFSA were invited to participate in indepth interviews and also completed questionnaires
measuring PTSD, anxiety and depression, and posttraumatic cognitive appraisals. Interpretive
Phenemonological Analysis (IPA) was used to analyse
interview transcripts. Women's narrative accounts
highlighted the dramatic effect that this particular
traumatic event has on psychological well-being, selfesteem and the survivor's view of the trustworthiness of
others. Preliminary analysis of interviews highlight the
following themes: 1) loss of control and confusion
associated with not remembering the event; 2) searching
for memories (e.g. ruminating, attempts to reconstruct
event, trying hypnosis); 3) distress at flashbacks, triggers,
and partial recall; 4) not feeling believed by others; 5)
PTSD and other psychological phenomena (e.g. selfblame). Preliminary findings suggest that cognitive
appraisals (e.g. repeated attempts to re-construct details

of the DFSA in the absence of memory) may exacerbate


psychological morbidity. Strategies to address such
cognitive appraisals within a CBT framework will be
discussed.

Long-Term Clinical and Social Outcomes


After War and Conflict Experiences In The
Balkans
Nexhmedin Morina, Friedrich-Schiller-University
Jena, Germany
A large body of literature shows that war experiences
may lead to short-term and long-term mental disorders.
The present paper describes the result of the CONNECT
study (funded by Commission of the European
Community; full title: Components, organization, costs
and outcomes of health care and social interventions for
people with posttraumatic stress following war and
conflict in the Balkans) that has investigated long-term
clinical and social outcomes of people with war
experience in five countries of Ex-Yugoslavia (Bosnia and
Herzegovina, Croatia, Kosovo, Macedonia, and Serbia)
and in refugees from these countries in three Western
Europe countries (Italy, Germany and United Kingdom).
The data were gathered through a survey in community
populations with a high risk to have experienced
potentially war-related traumatic events (N=640 in each
country in Ex-Yugoslavia and 250 in each Western
European country). Current social and clinical
characteristics (including the MINI International
Neuropsychiatric Interview and five other questionnaires)
were obtained, and social and health care interventions
received in the past were assessed. The sampling
followed the random walk technique in the Balkan
countries and a random selection of people in resident
registers or respective community centres in the Western
countries. The findings regarding the clinical outcomes as
well as the use of community based interventions that are
currently being analyzed will be discussed.

Effect of the psycho-education for individuals


with trauma:A pilot study to enhance the
motivation for treatment
Shun Nakajima, ; Nobuyuki Takatsuji, Isa
Okajima, ; Kaori Osawa,Yuji Sakano, School of
psychological Science, Health Science University
of Hokkaido Japan
To Provide individuals with trauma an effective treatment,
it is necessary to enhance the motivation for treatment
and reduce the risk of drop out from treatment. Some
studies suggested the importance of psycho-education (e.
g., Konishi, 2001). However, the effect of psychoeducation has not clarified, in terms of a motivation for
treatment on individuals with trauma. The purpose of the
present study is to clarify the effect of psycho-education
as a motivation for treatment on individuals with trauma.
participants: participants were three undergraduate (2
female, 1 male; Mean age=20.00; SD=0.00) students who
were selected based on their scores on the IES-R (?25)
and, who had experienced trauma more than a month
ago. Measures: Impact of Event Scale-Revised (IESR:Asukai, 1999), Japanese version of Posttraumatic
Cognition Inventory (JPTCI:Nagae et al., 2004), Anxiety
and Depression subscale in the mood check list
(MOOD: Sakano et al., 1994), Self-efficacy on motivation
for PTSD treatment (SE-PTSD). This scale consists of
two items (I: What do you think that you can solve PTSD
symptoms or problems related to the PTSD? II: What do
you think that you can receive treatment for PTSD?), and
items are scored on a 11-point scale (0-10). Procedure:
participants completed the IES-R, MOOD, JPTCI and SEPTSD at pre-psycho-education. Psycho-education
consisted of two sessions (1: Explanation of symptom
about PTSD, 2: Explanation of treatment about PTSD),
based on the treatment program described by Andrew et
al. (2004) and Chen et al. (2001). After psycho-education,
participants completed the JPTCI, MOOD, and SE-PTSD
at post-psycho-education. After the psycho-education 1
week later, participants completed the IES-R, JPTCI,
MOOD and SE-PTSD at follow up psycho-education.
Results of Comparison during scores at pre psychoeducation, post psycho-education, and follow up psychoeducation by Friedman test and Wilcoxon test showed
that there was a significant tendency on the SE-PTSD
item I (?2 (3) =7.56, p<.10). Other scores were not
significant. On the SE-PTSD item I, to examine for time
difference, results of multiple comparison by Wilcoxon
test was not significant. It was revealed that psychoeducation alone did not lead to change the PTSD
symptoms and their cognition for trauma experience.
However, the results of SE-PTSD item I indicated that
psycho-education for individuals with trauma had
possibility for enhancing the motivation for treatment. This
reason was considered that explanation of symptoms
decreased patient's resistant to therapy (Foa et al., 2000).

Cognitive-Behavioral Intervention for Young


Tsunami Victims in Thailand
Nuttorn Pityaratstian, King Chulalongkorn
Memorial Hospital; Ketsiri Liamwanich, King
Chulalongkorn Memorial Hospital; Nattawat
Ngamsamut, King Chulalongkorn Memorial

Hospital; Atsawin Narkpongphun, King


Chulalongkorn Memorial Hospital; Natthinee
Chinajitphant, King Chulalongkorn Memorial
Hospital; Kanthika Jayasvasti, King
Chulalongkorn Memorial Hospital
The impact of Asian tsunami generated by the
earthquake in Sumatra on December 26, 2004 was
devastating. In Thailand, six southern provinces along the
Andaman coastline were severely affected. The Thai
Government reported the fatalities of 8,212 and missing
people of 2,817, which included non-Thai casualties from
37 other countries. An estimated 50,000 Thai children
were impacted by the tsunami and an approximated
1,480 children lost one or both parents. During disaster,
children, like adults, may be repeatedly exposed to many
different sorts of horrific traumatic events which can lead
to various sorts of psychological problems. It is now
recognised that early help for children in how to cope with
the stresses of disasters can be beneficial and may
prevent later problems from developing; and when whole
communities are affected, it is often a priority to provide
assistance for large numbers of children as quickly as
possible. In this study, we evaluated the efficacy of the
cognitive-behavioral intervention provided to children by
volunteer professionals in tsunami-hit area in Thailand.
The intervention was aimed to prevent post traumatic
stress symptoms from developing seriously, and to help
the children who might recover spontaneously to do so
more quickly. One hundred sixty children in Ranong
province voluntarily participated in 2-day group activities
on the 57th day after the tsunami. The manualized
intervention had been designed based on cognitivebehavioral model. Three domains of post traumatic stress
reactions were targeted: intrusion, arousal, and
avoidance. The Children's Revised Impact of Events
Scale(13) (CRIES-13), a respondent-rated instrument
assessing the post traumatic stress symptoms across 3
domains: Intrusion (4 items), Avoidance (4 items), and
Arousal (5 items), was completed by the participants
before and 2 weeks after the intervention. The scores
above the cut-off point (sum of Intrusion and Avoidance
scores of 17 or more) suggested the significant impact of
trauma on the child that the probability was very high that
he/she would obtain the diagnosis of PTSD after formal
diagnostic procedures. The program was generally well
understood by the children. No significant difference in
CRIES scores was observed before and after the children
entered the intervention program. However, when the
sample was categorized into 2 groups according to
CRIES scores, the group with high scores showed postintervention significant reduction in the scores, whereas
the group with low scores showed significant increase in
the scores, albeit not exceeding the cut-off point. The
findings supported the efficacy of cognitive-behavioral
intervention in the children who were prone to develop
PTSD. The program needed to be adapted to suit the
religious, socioeconomic, and cultural background of the
sample. The increase of post-intervention scores in
otherwise normal sample raised some concern, and
possibly the need for screening before the intervention.

A Literature Review Of Post Traumatic Stress


Disorder In Adult Survivors Of Intensive Care
Jacobus M. Preller, Addenbrooke's Hospital,
Cambridge University Hospitals NHS Foundation
Trust. Cambridge, UK; Mabel Martinelli, OBMH
NHS Trust, Oxford UK
The reported prevalence of Post Traumatic Stress
Disorder (PTSD) and PTSD symptoms varies widely
between 2.7% and 59% of patients who survive intensive
care (ICU). Some patients experience intense physical
and emotional stress during their stay in the ICU. Factors
such as mechanical ventilation, sedation, muscle
paralysis, corticosteroids and adrenergic stimulators, as
well as other medications and procedures, exacerbate the
disorientating and frightening effect of the stay in the ICU.
Dysfunction of memory storage and integration further
contribute to the formation of fragmented and delusional
memories, which are associated with the development of
PTSD. Background risk factors for the development of
PTSD include younger age, female gender and previous
psychological difficulties. In concurrence with the
research aims, the search methodology included a
literature review of articles on PTSD in adult ICU
survivors using: Medline; EMBASE; Psychlit; Psycinfo;
Biomed Central; WEB of Science; Cochrane library and
CINAHL. It also referred to NICE, TRIP (National
Guideline Clearing House (US)), SUMSearch and used
snowballing of references and similar articles. The
literature review brought to light 25 original articles, which
met the search criteria. The articles were analysed and
discussed in terms of the following areas:
-Prevalence of PTSD in ICU survivors
-Study sample factors, which may influence results and
applicability to a wider ICU population (Age, gender and
pre-existing psychopathology has repeatedly been shown
to be risk factors for the development of PTSD)
-Study designs
-Etiology of ICU related PTSD
-Risk factors for PTSD unrelated to the ICU environment
-ICU related factors
-ICU environment stressors This review brings to light

that attempting to establish the true incidence of PTSD in


the ICU survivor population is complex. This difficulty
could be related to the state of current knowledge and
research and the intrinsic difficulty that the population
investigated creates per se.
It has been discussed that the study of PTSD in ICU
survivors is relative recent and has been lead by a small
number of authors. This limitation could be related to the
fact that the diagnosis of PTSD in this population, could
only recently be made, following diagnostic criteria
changes. Furthermore, it is also relative recent that the
scientific community has developed an interest in
researching the needs of the ICU survivor and the
possible psychological obstacles for their recovery.
This review has discussed methodological problems that
exist, which could be interfering with the ability of
extrapolating the research findings of current studies to a
wider population and therefore establishing the
prevalence of PTSD. These problems were found related
to the instruments used to measure PTSD as well as the
times when the diagnosis was made.
With regards to characteristic associated to the ICU
survivor, it has been found that age, gender and preexisting psychopathology are important factors in the
development of PTSD. Furthermore, the circumstances
leading to their ICU admission and the social network and
variables associated to their post-ICU adjustment also
play an important role in the development of PTSD.

Emotional Age Reallocation & Identity


Allocation in Intrusive Trauma Survivors
Darker-Smith Susan M., University of Derby UK
Intrusive Trauma is defined for the purposes of this
abstract as being where rape or physical abuse has
affected the sense of self to such a point as to reset
emotional age to 0 at the point of trauma and to create a
sense of ambiguity in survivors, concerning their identity.
Structured interviews & the use of self-rating measures
were utilised with 12 intrusive trauma survivors. All 12
clients were given the same therapy comprising of :
Imagined recorded exposure of traumatic event to
facilitate processing of traumatic memories (Resick &
Schnicke, 1992); Schematic restructuring; Grief-work &
redefining a new personality (Leahy, 2005; Padesky,
2005) 10 out of 12 intrusive trauma survivors self-rated
their emotional age as being the approximate time
duration from their trauma to the present year (i.e. not
chronologically relevant to actual age but relevant to the
time delay from traumatic onset). In the 2 clients where
emotional age reallocation did not occur, these were
intrusive trauma survivors from childhood abuse. Their
age-regression was approximate to their chronological
age at the onset of their traumatic experience. Because
of the differences between non-childhood-abused
subjects and childhood abused subjects, the data was
analysed separately. In non childhood abused subjects,
self-rated emotional age was approximate to the time
duration from trauma onset to the present year. Their
'post grief work & redefined personality' score reflected a
70% increase in self-rated emotional age. At 3 month
follow-up, emotional and chronological ages appeared to
be congruent on self-rating scores for emotional age of
non-childhood abused subjects. In childhood abused
subjects, a slower emotional age progression was evident
with congruency between pre-therapy self-rated
emotional age and the actual age of trauma. Similarly to
the other group, an increase in self-rated emotional age
of 61% occurred 'post grief work & redefined personality'
but at 3 month follow-up, there remained a minor
discretion between chronology and perceived emotional
age in this group. These clients did continue to ageregress in certain situations which acted as triggers and
consequently required substantially more schematic
restructuring than non childhood abused clients.

Metacognitive therapy for Post-traumatic


Stress Disorder: Three case studies
Yaghoob Vakili, Ladan Fata, , Azizeh; Afkham
Ebrahimi Iran University of Medical Sciences and
Health Services, Tehran Psychiatric Institute Iran
This study investigated the effects of a metacognitive
based therapy for Post-traumatic Stress Disorder (PTSD;
Wells & Sembi, 2004), in a series of patients, using a
single case design. Three consecutive chronic outpatients
fulfilling DSM-IV and ICD criteria for PTSD were treated
according to Core treatment manual of PTSD (Wells &
Sembi, 2004). Patients were assessed pre and post
treatment, and at 1-month, 3-month, and 6-month with a
battery of measures, including the Impact Event ScaleRevised (IES-R), Beck Depression Inventory-II (BDI-II),
Beck Anxiety Inventory (BAI), Thought Control
Questionnaire (TCQ), Subjective Units of Distress Scale
(SUDs), and Meta Cognitive Questionnaire (MCQ). The
treatment was associated with large reductions in the
specific measures of PTSD (IES-R total score),
reductions in general measures of anxiety (BAI),
depression (BDI-II), distress (SUDs), worry and
punishment (TCQ) and negative metacognitive beliefs
(MCQ), and an increase in social control (TCQ). These
results were largely maintained at the follow-up
assessments. The results of these case studies provide
further support for the clinical efficacy of metacognitive

therapy, and in a different culture than the treatment was


originally developed. Allthough this study is limited by the
absence of a control group, these results clearly imply
strong and generalized results for metacognitive therapy.
The treatment appears therefore promising, although a
controlled evaluation is necessary to draw a definitive
conclusion.

The process of recovery from traumatic


experiences
Asako Yagisawa, Nao Niwa, Graduate School of
Human Sciences, Waseda University, Kazutaka
Nomura, Graduate School of Human Sciences,
Waseda University, Hironori Shimada, Faculty of
Human Sciences, Waseda University, Eiichi
Kamimura, Faculty of Education and Human
Sciences, Niigata University
Recently, people have interests in the way of recovery
from traumatic experiences. But in many previous
studies, enough results of study about recovery from
traumatic experiences have not been investigated in
Japan.
While previous studies focused on occurrence or
maintenance factors about post-traumatic stress
disorders (PTSD) in variety points, present studies
suggest that we should reveal a process of psychological
changes after traumatic experiences to understand and
develop more successive interventions for PTSD.
However, few studies about the process of adaptation to
traumatic experiences have examined.
The purpose of this study was to examine turning points
for recovery from traumatic experiences and the process
in the view of cognitive behavior theory. Six female
college students who recovered from traumatic
experiences were interviewed (mean age SD of
22.50).
Semi-structured interview was conducted (to all
participants). It was set three stages: the stage of
experience, T1; the stage of turning points, T2; the stage
of recovery, T3. The Modified Grounded Theory Approach
was conducted to analyze what they talked about in their
interview.
As a result, it was classified into 19 concepts and 7
categories at all stages.
This process had unique points at each stage. Although
they avoided related things at T1, they began to feel
impatient with adjustment experiences and the present
condition at T2. At this time, they gained cues that they
were able to put their feelings in order. Then, they tried to
have problem-solving thought, adjust their thinking and
turn their's attention to more positive side of the event by
new attitudes that accept the fact or theirselves.
Additionally, they began to have alternative thoughts,
compromised the fact, and interpreted the whole of the
event positively. Finally, they got comprehensive
viewpoints at T3. Thus, they were able to put their's
feelings in order, in other words, they were recovered
from traumatic experiences. The result found that people
who recovered from traumatic experience underwent
similar cognition or behavior at each stage.
It is necessary for people who suffer from traumatic
experience to take appreciate cognition or behavior at
appreciate stage. Therefore, supportive interventions
function at first and instructive interventions function later.
Considering each stage of this process, it is supposed
that those interventions will provide them practical
supports. Also, with this process model, both therapists
and patients get prospects of recovery from traumatic
experience easily.
This study investigated that there was a common process
of recovery from variety traumatic experiences. In the
future, this process should be conducted a follow-up
survey by prospective study satisfactorily and it is
suppose that comparative studies enables to improve the
validity of this process.

Risk factors and course of PTSD: The Polish


studies on flood survivors.
Bogdan Zawadzki, Warsaw University; Agnieszka
Popiel, Warsaw School of Social Psychology
Poland
The paper summarizes the results of the three studies
done of flood survivors in Poland from 1999 to 2006. The
studies were done in cross-sectional as well as
longitudinal paradigm, with quantitative (PTSD symptoms
intensity) and qualitative diagnosis of PTSD (with different
PTSD forms), done in some weeks and some years after
the flood and obtained by different methods of PTSD
assessment. The results indicate that temperamental
traits (mainly emotional reactivity) influence PTSD
symptoms intensity. The findings of the studies
demonstrated also the important role of several well
known factors - above the temperament - like traumas,
preceding the flood, trauma severity, intensity of emotions
during the trauma, long-lasting material flood
consequences ('secondary stressors), posttraumatic
social support (emotional, financial) as well as
demographic variables (gender, age & education). The
findings of these studies suggest that temperament
should be concerned as a basic risk factor of PTSD.

Based on these results the implications for therapy will be


discussed.

Therapeutic & Applied


Issues
English Programme
The Effect of Occupational Self-Efficacy on
the Realistic Career Interests of University
Students and its Implications in Career
Development
Miskry Abdullah Seif, UAE University
This study was an attempt to explore the effects of
occupational Self-Efficacy on the variance of realistic
career interests among university students. Gender
difference in occupational self-efficacy was also
examined. About 238 subjects participated in the study of
which 101 participants were male and 137 female
undergraduate students from Malaysian universities. The
Occupational Self-efficacy Scale (OSES) and the
Vocational Preference Inventory (VPI) were used to
measure students' occupational self-efficacy and career
interests respectively.The Regression correlation analysis
and the T-test were performed to determine the
contribution of OSE as a predictor of realistic career
interests and scrutinise the OSE differences respectively.
The findings suggested considerable gender difference in
OSE and that OSE was a strong predictor of realistic
career interests. The implications for career development
were discussed.

Women In A Single-Parent Role: The Effects


Of A Multilevel Counselling Intervention
Program On The Psychological And
Biological Status Of Mothers
Argiro Angelosopoulou, ; Anastasia Triga, i
Argyrakouli, ; Georgia Karanastasi,; Konstantina
Kontogianni, ; Stelios Piperakis, Department of
Pre-School Education, University of Thessaly,
Volos, Greece
In the present study, the effects of a three-month
counselling intervention program on maternal adjustment,
self-esteem and anxiety were investigated. DNA damage
and repair as a result of mothers' psychological status
before and after intervention was also investigated. 38
mothers (single, divorced, or widowed) took part. The
group sessions were focused on a here and now
approach, which increased the degree of member
engagement. The aim was to initiate a responsibilityassumption sequence by learning how their feelings
influences behaviour, how it shapes the way they cope
with others and how it modifies family behavioural
interactions. Participants:Single mothers who had children
from 2 to 18 years old were recruited through
advertisements. Intervention:CBT strategies were used to
assess and modify belief systems that involve distortions
which contribute to negative perceptions about maternal
and social functions and result in dysfunctional interaction
(Dattilio, 1998). Members of the intervention group were
particularly focused on self-awareness, communication
training, problem solving training, stress management
and assertive training. Imagery techniques and role
playing were used to flush out feelings and thoughts,
particularly in those members who were defensive and
less-communicative. Measures:Four questionnaires were
used for pre and post intervention measures: a) Parenting
Stress Index (Abidin, 1995), b) Beck Depression
Inventory (1978), c) Battle's Culture-free Self-esteem
Inventory (1981) and d) State-Trait Anxiety Inventory
(Speilberger et al., 1978). DNA damage:The effects on
the genetic material (DNA) of mothers before and after
intervention was estimated using the comet assay
technique (Piperakis et al., 2006). In this presentation,
only preliminary results are presented. T-tests (paired
samples) were used for the analysis. Preliminary
statistical analyses showed that there is a significant
difference between the way women in the experimental
group were able to manage their stress before and after
intervention. Also, a statistically significant difference in
their depression levels was found as it appeared reduced
after intervention. Finally, women's self-esteem was also
found improved at post-test measures, but only for certain
sub-scales. An increased DNA damage (although nonsignificant) in the group of the participants was observed
in comparison to corresponding controls, which did not
appear to reduce significantly after intervention. It was the
purpose of this study to design and implement a
multilevel intervention program for the psychological
support of single mothers and to assess the effects on
self-esteem, depression and state-trait anxiety including
the effects on their genetic material. The intervention
program accelerated improvements and had significant
effects on self-esteem, depression and anxiety. Some
increased (pre-test) DNA damage was observed in
participants in comparison to controls. Our results are in
the process of further analysis.

Some Researches Regarding CBT Usage In


The Treatment Of Work Disorders
George-Claudiu Apostol, Incdpm "Alexandru
Darabont"
The research was built to help the great number of young
apprentices which are injuring themselves each year at
workplace. Causes are various but they have a common
clue the unsatisfactory knowledge and perception work
environment . The main objective of this research was
oriented towards the development of a set of CBT based
tools in order to facilitate the quick integration of young
workers at workplace. Based on the latest CBT advances
(Bush, 2005) The system is based on some essential
steps,the more important being shown below: oThe
definition of cognitive zones (Hooley,Hiller 2000) around
the dangerous activities and installations ,like: o A
confidence perimeter, where the apprentices are feeling
themselves in safety and confident o A trust perimeter,
where the apprentices rely on the advice of experienced
workers in order to access the zone and perform various
activities inside o The safety perimeter ,where there is
really safe for a worker with certain knowledge and skills
to be -this division of workplace into zones is approaching
the exact mach of the confidence and the safety
perimeter in time, through simulated trials (as the real
ones could be harmful) o The usage of incomplete
knowledge as a quick way to establish a safety balance;
o The development of safety seeds of knowledge which
will be developed not just independently but also as a
group activity ,taking into account that a worker must not
just protect his/hers safety but also actively contributing to
the safety of the team
The methodology of this research was based on some
previous work like (Linehan M.M 1993),
(Robins,Ivanoff,Linehan 2001),(Kovacs,Apostol 2005) .
The developed cognitive structure of the application is
structured around two essential knowledge concepts: -the
concept of assisted cognitive training towards risk
research- or risk finding; -the development of protection
strategies ;through the simulation instrument the
apprentices are developing-testing-and scraping-or
improving their strategies through simulated trial and
error; The main lot of apprentices worked two weeks in
the simulated work environment building up their
knowledge . The failure rate reduced progressively in this
environment from 30% in the first days to 5% at the end
of simulated training .At the end of this period they had
allready the neccesary skills to enter and work directly on
the machines. At the end of the one month stage the
failure rate expressed in rebuted products was below 1%
and the quitting rate 0. The proposed method has specific
advantages and also disadvantages. For starting
apprentices ,with no work experience it is very helpful in
order to eliminate "workplace fright" and to help to built
his/hers own knowledge regarding the workplace. The
method could be developed further for other workplace
related disorders. The main disadvantage of the method
is represented by the relative high costs needed to built a
specific simulated environment

Comorbidity between panic disorder and


depression: Implications on psychological
treatment
Karin Arbach, Arturo Bados Lopez, University of
Barcelona Spain
In spite of the frequent comorbidity between depression
and panic disorder (40-80 % lifelong), few studies have
examined the efficacy of psychotherapy when depression
coexists with panic disorder. These patients present
higher psychopathology, weaker response to
pharmacotherapy, a smaller tendency to improve, higher
suicidal risk, and greater disability than those people
without a comorbid condition. This pattern suggests that
they would also be less likely to respond to
psychotherapy. A bibliographical search was made in
databases Psycinfo and Medline, focusing on articles
published since 1990 with adult subjects samples. The
articles deal with the repercussions of major depression
and depressive symptoms as comorbid to panic disorder
on psychological treatment. The material was analyzed in
tables. Studies supporting the hypothesis that comorbidity
has a detrimental effect on the course of psychotherapy
use behavioral, interpersonal or support treatments,
sometimes combined with medication. They suggest
modifying conventional treatment protocols when treating
patients with panic disorder and comorbid depression.
Other investigations do not find any significant influence
of comorbidity on the outcome and their results show
comparable improvement for comorbid and noncomorbid
patients. In these studies, the comorbid disorder does not
suffer modifications beyond those attributable to the
passage of time. Most of them apply cognitive-behavioral
therapy and suggest a specific treatment approach for
each disorder. It must be underlined that the severity of
comorbid depression was moderate in these studies.
Probably some basic interventions of cognitive behavioral therapy would have beneficial effects in both
disorders, since they promote the learning of coping skills
and a decrease in dysfunctional cognitions. More
information is needed about the psychotherapy results
when severe depression is associated to panic disorder.

Examination of the cognitive behavioral


intervention to the temporary employee who
does request for the career counseling
Tanoue Asuka, Shimada Hironori, Faculty of
Human Sciences, Waseda University Japan
Recently, it has been pointed out that the employment
system in Japan has diversified and that 30 percent of
the total labor falls under non-regular employment.
Therefore, besides the support given to full-time
employees and to students' in their course selections, it is
necessary to examine the ways to support non-regular
employees such as temporary employees who do not
belong to a specific organization in the long term. On the
other hand, it has been suggested that cognitive
behavioral intervention, where assessment is conducted
from both the cognitive and behavioral aspects, is
effective for career counseling. Following these
suggestions, this study classified temporary employees
into distinct types based on their state of employment in
order to examine the suitable intervention for each type,
from the cognitive behavioral viewpoint. Items describing
the viewpoints of temporary employees regarding their
state of employment were collected. A factor analysis
was conducted, and a measure was prepared. The
measure comprised 26 items and 5 factors; using it,
temporary employees were classified into four types: the
dissatisfied with present post type, the realizing margin of
temporary employment type, the burdened with work
type, and the satisfied with present condition type.
Subsequently, in order to clarify the features and
statistical effectiveness of counseling for each type, the
effectiveness of counseling for 61 female temporary
employees (mean ageSD of 30.765.01) and the
differences in the cognitive and behavioral aspects
among the four types were examined in the study.
Measures of self-control over career, stress, and coping
were mainly used. The scores of self-control over career
and stress had a main effect of time: the former increased
significantly, while the latter decreased significantly (p <
.001). Regarding the differences among the four types of
temporary employees, the helplessness score as a
subscale of stress (p < .001) and the gathering
information score as a subscale of coping (p < .05) were
significant at the point of pre-treatment/post-treatment. As
a result of career counseling, the client's feelings of selfcontrol over career increased, and stress reactions
decreased. Furthermore, the effectiveness of intervention
was analyzed according to the classification defined in
this study. From the cognitive angle, feelings of
helplessness, which implies a negative cognition about
things, differed among the four types. From the
behavioral aspect, the tendency toward the act of
gathering information also differed. Thus, these results
provided suggestions regarding the method of career
counseling to be provided to temporary employees,
considering their present state.

Towards a Cognitive-Behavioral Approach:


The Therapeutic Value of Implicit Theories in
Promoting Mental Health and Job-search
Behaviors
Al Au, The Chinese University of Hong Kong
Unemployment, as an involuntary career change, often
puts people in heightened levels of anxiety and
depression after the job loss. Meanwhile, a positive
relationship between unemployment and mental health
problems (from a meta-analysis by Mckee-Ryan, Song,
Wanberg, & Kinicki, 2005) and a positive relationship
between job-search behaviors and employment (from a
meta-analytic study by Kanfer, Wanberg, & Kantrowitz,
2001) has clearly been identified. Yet, few studies have
tried to use a theoretical framework to explicate the
possible cognitive-behavioral process of unemployment
that eventually constitute to the differential mental health
and behavioral patterns. The present study proposed to
address the impacts of unemployment from a cognitivebehavioral approach: a cognitive process to mental health
and a behavioral process to job-search behaviors after
job loss. Under the framework, both individual's tendency
to withstand the psychological problems and tendency to
commit in job-search behaviors after unemployment can
be traced back to their beheld implicit theories (whether
human attribute is regarded as a fixed or a malleable
quality by the individuals, Dweck, Chiu, & Hong, 1995).
Participants were 152 unemployed Hong Kong Chinese
recruited from multiple sources: retraining courses, job
recruitment fair, and a government run career information
centre. They completed the questionnaire in person. After
controlling for major predictive factors in past
unemployment literature (e.g. demographics, employment
importance, social support, financial strain), and
individual-difference variables heavily researched in
applied psychology (e.g. self-efficacy, hopelessness),
implicit theories still hold an incremental and substantial
predictive value on mental health and job-search
behaviors. Malleability belief of unemployed individuals
was found to uniquely account for mental health ( = -.46,
p < .001, R square change = .19) and job-search
behaviors ( = .26, p =.011, R square change = .05). The
negative correlation between implicit theories and mental
health (r = .57, p < .001) and the positive correlation
between implicit theories and job-search behaviors (r =
.298, p < .001) indicate that the more malleable belief

unemployed individuals hold, the more positive they face


the setback of unemployment and the more engaged they
are to remedial behaviors. This study is among the first to
show support in the application of implicit theories to
sample of unemployed clients using a cognitivebehavioral approach. Unemployment as an activating
event can either a 'threat' or 'challenge for growth' to an
individual consequentially, depending on one's belief of
whether positive self-change is possible (the malleability
belief). It may well be this underlying belief of whether
trusting the effort put on remedial actions can change that
predicts their vulnerability to the mental problems or
illnesses and engagement in job-search behaviors.
Practical implications are discussed in terms of the
therapeutic value of enhancing the malleable belief of
unemployed individuals in counseling and clinical settings
to protect them against vulnerability to mental health
problems, and direct their engagement to remedial
behaviors.

Emotional awareness in Group CBT


interventions for psychiatric outpatients
Rodrigo Becerra, Ellen S Fremantle Hospital;
Chandra Salgado-Kent, Curtin University
CBT has not been notably involved in investigating the
role of emotions in therapy; therefore this domain remains
largely unexamined. If the goal of therapy is to reduce
emotional suffering, awareness of one's emotions would
need to be investigated in clinical research and play a
part in its therapeutic implementation. Surprisingly, not
many studies examine this. The present investigation
explores the relationship between emotional awareness
and its role in a CBT group intervention for a
heterogeneous psychiatric population. To this end, the
construct Alexithymia (no-words-for emotions) was
deployed, as a useful way of operationalising emotional
awareness. Alexithymia is a construct normally described
in a componential fashion that includes difficulties
identifying and describing emotions. Direct studies
looking at the role of alexithymia in psychological
interventions are rare. The present study explored these
issues by monitoring levels of alexithymia before and
after a CBT program run in three groups: Mood
Management, Self-Esteem, and Anxiety Management. 27
Psychiatric outpatients were allocated to one of these
groups which followed a standardized CBT group
protocol. Eligibility for inclusion involved a psychiatric
diagnosis as prescribed by the DSM-IV. It was
hypothesized that on presentation, psychiatric outpatients
would score higher than the normal population on a
measure of Alexithymia (the Toronto alexithymia Scale,
version 20 [TAS-20]) and that there would be
improvements on measures of Anxiety, Depression,
Stress and Self Esteem after the CBT groups. In
exploring the role of Alexithymia in therapy TAS-20,
scores were compared before and after treatment. This
study also commented on the absolute versus relative
stability of Alexithymia. Parametric statistical analyses
were used to test the hypotheses since the data met
assumptions for these tests. Homogeneity of variances
was tested for all data with Cochran's Test. Three types
of analyses were conducted: repeated measures ANOVA,
t-test, and regression analyses. For ANOVAs a
comparison of means for factors found to be significant
was done using Tukey's HSD test (p = 0.05). Out of 27
subjects 18 displayed either full Alexithymia or borderline
features, that is, 66.6% of the CBT sample had difficulties
identifying and expressing their emotions. The regression
analysis revealed that there were significant relationships
(p < 0.05), albeit weak, between the full TAS and
depression (R = 0.46); full TAS and anxiety (R = 0.56);
and full TAS and stress (R = 0.41). Before and after
treatment comparisons revealed that Alexithymia levels
remained unchanged, and that there were significant
differences between depression, anxiety, stress and selfesteem (p < 0.05). Given the importance that CBT places
on cognitions and behaviors as favoured intervention
points, and the fact that more than half of our subjects
showed deficits in identifying and expressing their
emotions before the actual treatment, it appears prudent
to revisit the role of emotions in CBT. Assessing
alexithymia before treatment may inform the therapist as
to the skills the clients bring to therapy. As expected,
improvements in depression, anxiety, stress and selfesteem were observed, but it was also found that
Alexithymic levels did not vary before and after treatment.
This might be due to the fact that Alexithymia may
possess an absolute stability (personality trait), or that
emotional awareness (a pre-requisite of emotional
regulation) was not targeted in the CBT program.
Targeting emotional awareness in future studies will
answer this. Including an emotion module in the CBT
format might maximize therapeutic benefits.

How and how much participants in


Mindfulness based Cognitive Therapy
practice Meditation: Preliminary results of the
Geneva MBCT Study
Lucio Bizzini, Franoise Jermann, ; Lydia Lanza,
;Lusmila Myers-Arrazola, Batrice Weber
Rouget, Guido Bondolfi, Hpitaux Universitaires
de Genve Switzerland

Mindfulness Based Cognitive Therapy (MBCT) is a


manualized preventive group treatment, whose efficacy
has been demonstrated for patients with 3 or more
previous depressive episodes by two randomised
controlled studies performed by the founders of the
method (Segal, Williams and Teasdale, 2002). We
performed the third randomized controlled study (the first
in the French speaking countries). Training in Mindfulness
Meditative Practice helps patients to re-deploy their
attention in the midst of negative, ruminative processing
cycles. Two different type of practice of mindfulness are
instructed in MBCT, namely formal practice (body scan
meditation, sitting meditation, yoga movement and
mindful walking), and informal practice (3' breathing
space, mindfully everyday's activities, mindfully watching
and hearing, etc). Other ingredients related to meditation
practice in the program are Intention to meditate (to
formulate the intention to be in the present moment),
Sitting with thoughts as thoughts (a new attitude
considering that thoughts are not facts) and Taking action
when the mood is low (as strategy to deal with periods of
low mood). Twenty seven participants followed an
intensive 8 weeks MBCT program and for the next 12
months, they had the opportunity to attend monthly free
practice sessions and/or 4 booster sessions. We ask
participants to fill a home practice notebook that
assesses both formal and informal meditation practices,
so the amount of practice could be measured. Moreover,
we ask participants and instructors to estimate the
Intention to practice, the new attitude regarding thoughts
and the use of action plan to deal with low mood. Finally,
after twelve months, instructors ask participants to
quantify the frequency of meditation practices and
ingredients related to meditation. The amount of formal
practice varies a lot between participants. Those who
participate to the monthly free practice sessions and to
the booster sessions are also those who practice at home
more intensively. Informal practice and Intention to
practice are well present in the everyday life; participants
declare that they often think about and consider
mindfulness to be a new way of being in their life. The
change of attitude toward the thoughts seems possible
even if participants are not regular practisers. Regarding
take action when mood is low, some participants consider
useful to plan nourishing activities before low mood
occurs. MBCT asks participants to have an intensive
practice in order to successfully prevent depressive
relapse. The amount of formal practice during the 8
weeks program is very high, but it decreases after the
intensive period. However, participants continue to use
informal practice and other MBCT strategies such as
Intention to connect with the present moment, considering
thoughts as thoughts and taking action. Finally, we will
consider the link between practice and the occurrence of
depressive relapse.

Differences between therapists with higher or


lower grades of experience in the application
of cognitive restructuring technique
Ana Calero Elvira, Montserrat Montao Fidalgo
Universidad Autnoma de Madrid, Mara Xess,
Frojn Parga Universidad Autnoma de Madrid
In a previous work of our research group (Calero,
Montao, Garzn y Frojn, 2006) we presented a model
of application of the cognitive restructuring technique
elaborated through the observation of video-recorded
clinical sessions.
Using the obtained results, we want to study if there are
differences in the application of the technique between
therapists with more o less experience: do expert
therapists use reinforcement and punishment more
systematically after certain verbalizations of the client?,
do therapists with less experience take more time to
present alternative adaptative verbalizations to the client?
These and other questions guided the research
presented here. For this objective we used a sample of
more than 30 video-recorded fragments of cognitive
restructuration obtained from different clinical cases. In
this study participated several behavioral therapists with
difference grades of experience that work in the private
field in Madrid. Sessions were observed and coded using
a validated category system elaborated by our research
group; it has 7 categories that classify verbal behaviour of
therapist based upon basic behavioral operations. For
making the registration we used the software The
Observer XT. The obtained results show that there are
differences in verbal functions between more or less
experienced therapists in some phases of restructuring
technique and all these differences will be listed in this
poster session. The continuation of this research agenda
could have clinical implications that would improve the
training of novel therapists for a more effective application
of this technique in their professional activity. These
results have not been published at this time in the
scientific literature in the area.

Group interventions for emotional distress in


first year students: Does a rational-emotive
cognitive behavioral intervention bring added
value?
Ioana-Alina Cristea, Eva Kallay, , Adrian Opre,
Babes-Bolyai University, Cluj-Napoca Rumania

The freshman year is considered a stressful transition


point for college students (Lu, 1994). Transition to college
was shown to be associated with greater levels of
loneliness, depression, physical health problems (Fisher,
1988). Declining levels of emotional health have been
observed for both male and female college students (Sax
& al., 2001). Research conducted by Rickinson (1998) on
1st year students assessed as having significant
academic and social integration difficulties pointed out
that counseling in the first year of college can aid
students overcome these difficulties and successfully
graduate. Our aim was to assess if there are specific
benefits that can be obtained from a structured cognitive
behavioral intervention by students who experience
problems connected to emotional distress. Moreover we
wanted to investigate whether the gains following this
intervention (in terms of reduced emotional distress) were
higher than those achieved through a supportive
counseling intervention. The specific cognitive behavioral
intervention we employed was based on the principles of
REBT - Rational Emotive Behavior Therapy (Ellis, 1962) therefore seeking to ameliorate emotional distress by
identifying and disputing subjects' irrational beliefs.
Participants were 31 freshman students, with high levels
of emotional distress (over a cut-off point). They were
randomly assigned to 3 groups, which received different
interventions: rational-emotive cognitive behavioral
intervention (REBT group), supportive counselling
intervention (sham group) or no intervention (control). The
interventions consisted of 10 sessions. We assessed
aspects regarding cognitive, behavioral and emotional
functioning. For cognitive aspects we used: Attitudes and
Belief Scale 2 (ABS2; DiGiuseppe & al., 1988) for
irrational beliefs, Automatic Thoughts Questionnaire
(ATQ; Hollon & Kendall, 1980), Unconditional SelfAcceptance Questionnaire(USAQ; Chamberlain & Haaga,
2001). For emotional distress we used: Beck Depression
Inventory (BDI; Beck & al., 1996), Spielberger's State
Trait Anxiety Inventory (STAIX2; Spielberger, 1968),
Positive and Negative Affect Schedule (PANAS; Watson
& Clark, 1994). We also measured optimism/pessimism
using the Life Orientation Test (LOT; Schreier & Carver,
1992) and coping using Brief COPE (BCOPE; Carver,
1997). Measures were collected before and after the
intervention and at 6 months follow-up. Results indicated
that there were no significant differences between the 3
groups at pretest. Within group comparisons showed
significant differences for the REBT group on measures
of irrationality (t= 7.83, p<.05), depression (t=3.57, p<.05),
anxiety (t=3.33, p<.05), unconditional self-acceptance (t=4.03, p<.05). Significant within group differences were
also present in the sham group for some measures of
irrationallity (t=2.69, p<.05) and depression (t=6.01,
p<.05). Between group comparisons revealed significant
differences for irrationality among the 3 groups at posttest
and follow-up (F=11.43, F=10.87 respectively, at p<.05),
with the REBT group having significantly fewer irrational
beliefs. Effect size calculation indicated medium to high
effect sizes. However differences for measures of anxiety
and depression were significant at post-test (F=9.47,
F=7.65 respectively, at p<.05), but not at follow up. Effect
sizes were again medium. Discussions highlight the idea
that a structured cognitive behavioral group intervention
(REBT) can provide significant added value over a
supportive counselling intervention in reducing irrational
beliefs and emotional distress in college students. The
modifications in irrationality seem to show stability over
time.

Changing Self-Construing In Cognitive


Therapy: A Case Study Of A Patient With
Adjustment Disorder
Gloria Dada Snchez, Guillem Feixas, Mara
Jos Pubill, Universitat de Barcelona Spain
The cognitive system can be viewed as a set of
distinctions a person creates for anticipating, organizing
and interpreting experience; they can be represented as
bipolar dimensions of meaning, which are organized in a
hierarchic network (Kelly, 1955). This system guides our
interpretations and constructions about ourselves and
about the world, and allows us to integrate new events by
giving them meaning. Stressful life events may invalidate
interpretations and constructions about the self and
others, thus generating painful emotions that may lead to
an adjustment disorder.
Within this cognitive system, some constructs have a
higher hierarchic level, because of their importance in
defining the person's sense of identity. Changes in these
core constructions may lead to greater invalidation than
changes in more peripheral constructs. Thus, the
possibility of change has to be harmonized with the need
to preserve the person's core construct -his o her identityfrom invalidation. In this process, some conflicts,
described as implicative dilemmas (Feixas & Sal, 2004),
may appear, which block the person and hinder the
therapeutic process. The dilemma arises from the
peculiar association between constructs, whereby the
acquisition of desirable characteristics would imply giving
up others that the person wants to keep. This is a case
study of a 53-year-old woman with Adjustment Disorder
with Mixed Anxiety and Depressed Mood (309.28). In
addition to symptom questionnaires (BDI-II, SCL-90R),Kelly's Repertory Grid (RG) technique (Fransella,
Bannister & Bell, 2004) was used to assess cognitive

features of self-construing at pre-therapy, post-therapy


and follow-up. RG data was analysed using Gridcor
software (Feixas & Cornejo, 2002). Therapeutic
interventions for this case, which were focused on
resolving implicative dilemmas, included the use of
narratives and metaphors. We found a significant
reduction in the number of cognitive conflicts, as well as
in symptoms, both at the end of therapy and follow-up..
We also found positive changes in self-construing
measures: better self-esteem (self-ideal discrepancy), a
decrease in self-perceived social isolation, and an
improvement in other measures were found in
comparison to therapy onset. From this patient's grid we
can infer that a desired change (e.g., being stronger) may
also carry negative consequences (e.g., becoming
selfish) for personal identity. Thus, from her point of view,
moving to the desirable pole of the constructs associated
with the current problem would also imply a change in
core constructs. Therefore, symptoms might be explained
as an attempt to protect identity from invalidation. In sum,
implicative dilemmas and measures of self-construing
might be relevant to explain certain disorders and
symptoms, as well as guiding therapeutic interventions.

Trial-Based Thought Record (TBTR): A


strategy to deal with core beliefs by
combining sentence reversion and the use of
analogy with Law
Irismar Reis de Oliveira, Department of
Psychiatry, Federal University of Bahia, Brazil
Because some patients do not improve with available
dysfunctional thought records, I propose the Trial-Based
Thought Record (TBTR), a modified, 7-column thought
record addressing core beliefs by an analogy with Law.
The rationale for proposing the TBTR is that it could be
useful in making patients aware of their core beliefs about
themselves (self-accusations), and engaging them in a
constructive trial to develop more positive and functional
core beliefs. Patients: Charts of all patients with any
psychiatric diagnoses for whom this sequence of
techniques was used in my private and university practice
from January to June 2006 were consulted and the first
simulation was used. Statistics: Friedman's one-way
analysis of variance was used to assess the global
difference both for the percentage of credit in the selfaccusation/core belief and the intensity of the main
emotion between baseline (after the uncovering of the
self-accusation/core belief) and each intervention
(prosecutor, defense attorney, replica by the prosecutor,
replica by the defense attorney, and the jury's verdict).
The Wilcoxon signed-rank test was used to compare the
results of each intervention with baseline and among
them. Clients (n= 30) participated in a simulation of a trial
and exhibited shifts in their adherence to core beliefs and
in the intensity of corresponding emotions after each step
(investigation, prosecutor, defense attorney, prosecutor
replica, defense attorney replica, and juror verdict).
Significant reductions existed between percent values
after investigation (taken as baseline) and defense
attorney's plea (P< 0.001), and after the juror's verdict,
either in beliefs (P< 0.001) or in intensity of emotions (P<
0.001). Significant differences also emerged between the
defense attorney's first and second pleas (P= 0.009) and
between the defense attorney's second plea and juror's
verdict concerning core beliefs (P= 0.005) and emotions
(P= 0.02). In conclusion, TBTR may help patients
constructively reduce attachment to negative core beliefs
and corresponding emotions.

Relation between Early Maladaptive Schemas


and characteristics of Anxiety and Depression
in university students.
Sanchez Ortiz Diana Lucia,Claudia Patricia
Casadiegos Garzon, Diana Maria Agudelo Velez,
Universidad Pontificia Bolivariana, Facultad de
Psicologa, Bolivia
Anxiety and depression are important health problems,
because of the high prevalence rates in normal and
clinical population. In this sense a lot of studies have
centered in the evaluation of these clinical patterns,
standing out the university students population, by reason
of the high number of attended consultations in these
samples through the University Well-Being Service. Most
of the studies have been centered in the identification of
the personality characteristics associated to these clinical
patterns, indicating, for example, the presence of
psychological vulnerability for developing one or other
one, according to the memory and attention biases,
cognitive and emotional interpretation of the vital stressful
events, the beliefs system, the strategies and own coping
styles of every person. In agreement with the previous
thing, this study's aim is to identify the cognitive profile,
by means of the early maladaptive schemas that
appeared in students from the Universidad Pontificia
Bolivariana Bucaramanga-Colombia (UPB), related to
depression and anxiety scores. This is a non
experimental, transversal, correlative study, whose
objective is to contribute to the identification of personality
patterns that could help in the prevention of these
disorders. Psychology students where evaluated from the
first to seventh semester at the UPB, by means from the
following questionnaires: BDI, ST/DEP, STAI and YSQ-

L2. The results don't show the presence of specific


schemas in function of the presence of the State/Trait
depression and State/Trait anxiety, which might suggest
through the dimensional paradigm, the presence of a
cognitive pattern for an anxiety and depression mix
disorder. This is based on the theoretical perspectives
that defend the existence of mood and anxiety disorders,
from a dimensional approach unlike the categorial in
force at present. In that way, both clinical patterns could
shared a series of symptoms, defined by some authors
as negative affect, which includes symptoms like
sadness, somatic alterations, lost of energy, negative
thoughts and others, which can give account of both
types of disorder. In the line of the previous thing, in
opposition to the indicated in the scientific literature, there
are no significant differences by sex, although there are
by academic level, according to which the beginning of
career students, had higher scores in the schemas with
respect to the rest of the sample. However that
information needs more empirical evidence, reason why it
is suggested to make more studies with other samples,
including clinical population. This last one, due to the
conditions of the evaluated sample; issue that could
interfere in the obtaining of an specific profile, taking into
account that the sample was a non clinical one, specially
if it is considered that according to the theory, the
schemas are mental structures that can be inactive for a
long time and only be activated before environmental
stressful events.

The effect of three method of learning


strategies (reciprocal teaching, direct
explinnation and cycle of thought)on
comprehension,problem solving,
metacognitive knowledge,academic
self_concept, speed of learning and planning
time management on guidance school
Soghra Ebrahimy Qavam, Allameh tabatabaee
University
Resaerches show that reciprocal teaching effect on
increasing of comprehension,direct explanation lead to
increase the speed of learning and cycle of thought
increase students' motivations( Brown and Palniscar
1989; Mac cober 1995; Dowfy 1984), but there is no
evidence that assess these methods on
metacognition,problem solving ,comprehention,self
concept,speed of learning,so It seemed to be necessary
to this. this research has been done on four groups by
pretest and post test .subjects were selected randomly
from two guidance schools of 19 grade in
Tehran.Subjects have been matched by numbers and
sociologically.In first step 30 students were assessed to
determine the reliablity of scales.The result of reliablity of
split half method was between 0.81-0.67.In second step
40 students were selected randomly among 60 students
who their mean of scores were under 15,then classified
them in four groups and took them scales(meta
cogintion,educational self concept,problem solving
scales) T-test corrolation groups used for analysing data
and result showed reciprocal teaching effected on
increasing comprehension(t= *26/4,df=002/0),direct
lexplanation andreciprocal teaching teaching strategies
effected on power of problem solving(t direct lexplanation
=25.3df=01.0;reciprocal teaching=19.2 df=5).Direct
learning effected on self concept(t=71/4- df=001/0).Those
three strategies effected on speed of learning((t direct
lexplanation =58.3 df=6;reciprocal teaching=74.4 df=1;t
cycle of thought=64.4 df=1).Reciprocal teaching effected
on metacognition (t =64.2 df= 27) result showed for
promoting the learning of students we should use those
three methods.

Function and outcome evaluation of a CBT


web-consulting programme
Georgios Efstathiou, Konstantinos Efthimiou,
Institute of Behaviour Research and Therapy,
Anastasia Kalantzi-Azizi, Institute of Behaviour
Research and Therapy Greece
A computer-mediated CBT Web Consulting Service in
question-and-answer form is available to students at the
University of Athens. Students submit a question to the
clinical staff of the Service using an online anonymous email and the answer is published on the website along
with the question. Answers to similar problems are
grouped together and remain at the website for further
reference by other students facing similar problems. The
aims of the programme at its current form are not to
replace traditional in person CBT. It is regarded as a
supplemental delivery method for psychotherapeutic
services and as a means of transitioning students to
traditional CBT, through the use of new technologies,
familiar to students An anonymous online questionnaire
was used for evaluation purposes. Two versions of the
questionnaire were prepared, one for users of the service
(students who actually submitted a question) and one for
visitors (students who visited the web site and read
answers to other students' messages). In addition, all
questions and answers were submitted to content
analysis by two independent judges. Overall, users and
visitors evaluated the quality of the answers favourably,
although users seem to give more positive evaluations.
Users also reported that they found that the lack of

personal contact, the anonymity and the use of written


communication facilitated the expression of deeper
thoughts and feelings. Users also stated that they used
the Service about problems that they perceived as very
intense and that they intent to follow the suggestions
provided in the answers they received. They reported a
comparatively lower level of intention to conform to
suggestions to seek professional help or to use a CBT
self-help guide, but not low by absolute standards. The
vast majority of users and visitors stated that they intend
to use the service in the future if needed and to suggest it
to fellow students facing personal difficulties. The Service
enjoys high popularity among Greek students and its
current functioning is deemed satisfactory by both users
and visitors. An intervention of this type seems to offer
significant advantages, such as (a) the creation of a
database of information accessible to all future visitors
with similar difficulties, (b) the asynchronous nature of the
communication which allows for better preparation of the
material on the part of the therapist and on the part of the
client, (c) the facilitation of the disclosure of personal
thoughts and feelings and (d) the accessibility of the
provided services. In addition, the extent to which users
make good use of the information and conform to the
suggestions they receive seems satisfactory.

Emotional intelligence and general health as


predictors of job satisfaction
Ladan Fata, Fereshteh Mootabi, Shima Shakiba,
MS Segal CBT center, Tehran, Iran., Esmat
Barooti, MS Shaheed Beheshti University of
Medical Sciences and Health Services, Tehran,
Iran., Keith Dobson, University of Calgary,
Canada
Adults spend more than one third of their lives after
puberty in workplaces, employment is often a central
feature of the adult's identity and life satisfaction. As the
workplace can be full of stressors and challenges,
providing mentally healthy workplaces is in a priority.
Recent studies have shown that CBT based interventions
and workplace training can improve job satisfaction,
however, it is important to determine carefully the target
variables for intervention. Goleman and Bar- On (2004)
have shown that the enhancement of Emotional
Intelligence (EI) is relevant in workplaces, whereas other
interventions have concentrated on general health. The
current study was designed to investigate EI and general
health, as predictors of job satisfaction, to identify the
effective intervention targets in Iranian office workers.
Measures relevant to the above constructs were
administered to 451 office workers in 14 provinces
throughout Iran. These measures included the Persian
versions of the Emotional Quotient Inventory (EQI; BarOn, 1997), General Health Questionnaire (GHQ) and Job
Descriptive Index (JDI; Smith et al, 1969). The EQ- I
consists of 5 factors and 15 items including intrapersonal
(emotional self-awareness, assertiveness, self-regard,
self-actualization, independency), interpersonal (empathy,
responsibility, interpersonal relations), adaptability
(problem solving, reality testing, flexibility) stress
management (stress tolerance, impulse control), and
general mood factor (happiness, optimism). The GHQ
also includes scores for somatic preoccupations (G1),
anxiety (G2), social function (G3), and depression (G4).
The JDI has 5 facets of job, supervision, payment,
promotion and coworkers. The sample consisted of 156
men and 295 women, with a mean age of 35.5 6.8.
Stepwise multivariate regression analyses was used for
statistical analyses, predicting job satisfaction. There was
a significant regression effect for EI scales and job
satisfaction (R= .44, F= 19.50, p< .001) and the best
predictors of EI for job satisfaction were stress tolerance
( =.23), interpersonal relations ( =.17), reality testing (
=.16), emotional self awareness ( = -0.21) and assertion
( = .14). Also there was a significant regression effect
between GHQ scales and job satisfaction (R= .31, F =
20.30, p< .001) and the best predictors of general health
for job satisfaction were G1 somatic preoccupations ( =
-.22) and G4, depression ( = -.12). The best combined
predictive model, was the combination of stress tolerance
( =.24), interpersonal relations ( =.17) and G1somatic
preoccupations ( = -.14). In addition, it was found that
job satisfaction was predicted by different variables for
men and women. The best predictors of job satisfaction in
men were anxiety, optimism and flexibility, whereas in
women the predictors were self regard and interpersonal
relations. Both emotional intelligence (EI) and general
health are significant predictors of job satisfaction,
although emotional intelligence is the stronger predictor
(Gannon & Ranzijn, 2005). These results suggest that EI
enhancement, especially skills in mood-state control and
adaptability skills like effective reality- testing for problem
solving and flexibility in interpersonal relations, and less
health preoccupations, leads to increased job satisfaction.
The results revealed somewhat different predictors of job
satisfaction for men and women. Although these results
do not specifically indicate optimal treatments to enhance
job satisfaction, CBT based EI promotion programs,
communication skills and positive affect induction in
workplaces could be applicable interventions. It may also
be that such programs will need to be tailored differently
to males and females, to maximize treatment benefits.

Assessment of client satisfaction in a


cognitive-behavior therapy
Vzquez Fernando L., Mara Lpez, Vanessa
Blanco, Universidad de Santiago de Compostela
Spain
The consumer perspective provides unique information
that is essential to a complete and balanced evaluation of
the quality of care (Ferris et al., 1992). Client satisfaction
occupies an intermediate step in establishing a healthy
culture for evaluation within a program or a setting. Client
satisfaction evaluations are an excellent opportunity to
involve patients in the process of evaluating the
programs. Patient satisfaction is also an important
variable in the evaluation of psychiatric services and it
complements the measurements of other outcome
variables. It has been suggested that satisfaction is
strictly linked to the effectiveness of the care provided
(Kalman, 1993). The purpose of the present study was to
examine client satisfaction in a cognitive-behavior therapy
(CBT) through the Client Satisfaction Questionnaire-8
(CSQ; Larsen, Attkisson, Hargreaves & Nguyen, 1979).
The CSQ - 8 is a brief and self-administred instrument
designed to be direct measure of an individuals personal
experiencies with a specific service. The CSQ-8 was
administrated to 28 subjects (4 men and 24 women with
mean age SD of 23.5 5.7) who participated in an 8
group sessions CBT program. At the end of the program,
respondents answered eight questions on 4-point
response scales with individually specified anchors
(excellent, good, fair, and poor). Items on the CSQ-8
specifically address the domains of quality of service,
kind of service, outcome, and general satisfaction. CSQ-8
showed satisfactory internal consistency (Cronbach a =
.74). Mean CSQ-8 score was 27.8 (SD = 2.53), reflecting
a mean item score of 3.5 on a 4-point scale. The 32.1%
of participants scored a medium satisfaction level (21 to
26), and the 67.9% of them a high satisfaction level (27 to
32). Satisfaction was not significantly related to years of
education, family income, and social class. Likewise there
was not significant correlation between CSQ-8 score and
outcome measures. The high mean CSQ-8 totals
observed in this study are coherent with the results of
other studies (Attkisson & Greenfield, 2004). The majority
of participants showed a high satisfaction level with the
CBT programme. It is, however, important to recognize
that evidence of positive client satisfaction is not, in itself,
sufficient to establish the effectiveness or accessibility of
treatment. Finally, there are some potential limitations.
Mean scores was quite high and negatively skewed. It
was consequently difficult to discriminate among the
majority of respondents who reported high levels of
satisfaction.
Acknowledgments: This study was
supported by grant PGIDT05PXIA21101PR from the
Directorate General for Research and Development
(Counsellery of Innovation, Industry and Trade) of the
Xunta de Galicia (Spain).

Cognitive restructuring with the aid of a


computer - a new tool for psichotherapy
Antonio Frota Neto, Universidade Federal de
Goias
The cognitive therapy, as developed by Aaron Beck, in
the early sixties, is centered on the relations between
the patients' problematic thoughts and their feelings and
behavior. Modifying their thoughts (cognitions) may result
in improvement. The main strategy is leading the patients
to question their interpretations of the situations, while
increasing their objectivity. These outcomes are not
restricted to patients with depression or anxiety, but also
to those experiencing marital problems, antisocial
behavior, and addiction.

Empirical Investigation of an Acceptance


Based Behavioral Intervention for Enhancing
Athletic Performance
Frank Gardner, La Salle University; Zella Moore,
Manhattan College
Despite widespread use, traditional psychological skills
training approaches based upon change based
cognitive behavioral interventions, have not demonstrated
strong empirical support for the enhancement of athletic
performance. Psychological interventions based upon
mindfulness, acceptance, and commitment take a
different view of cognition and emotion, and their role in
functional and dysfunctional human behavior than the
traditional psychological skills based approaches typically
utilized with athletes. Psychological interventions utilizing
mindfulness, acceptance, and commitment suggest that
negative cognitive and emotional states need not be
eliminated, changed, or controlled in order to facilitate
positive behavioral outcomes. Based upon self-regulatory
models of human performance and the extant research in
cognitive-behavioral psychology, optimal athletic
performance may be best achieved by intervention
strategies that target the development of mindful, presentmoment acceptance of internal experiences such as
thoughts, feelings, and physical sensations, rather than
by efforts to change or control them. The MindfulnessAcceptance-Commitment (MAC) approach to athletic
performance enhancement directly promotes clarification
of valued goals and attention to cues and contingencies

that are required for actions in the committed pursuit of


those goals. This paper presents the theoretical basis for
utilization of the MAC approach in the athletic domain,
describes the development of the MAC, and details
empirical evidence for its efficacy. Twenty-two (22)
volleyball and field hockey players underwent a 7-week
MAC protocol and fourteen (14) volleyball and field
hockey players served as a control group. Both groups
were from a midsize university in the Northeastern United
States. The MAC protocol consisted of psychoeducation,
sport specific mindfulness training, use of cognitive
defusion procedures, decentering techniques, exposure,
values clarification, and behavioral commitment
exercises. Coach ratings of subjects' performance were
collected pre and post intervention. Subjects' self report
measures of metacognition, avoidance and believability of
thoughts, sport anxiety, and quality of athletic life were
also collected pre and post intervention. Subjects were
compared based on group (MAC vs Control). It was
hypothesized that subjects receiving the MAC protocol
would demonstrate significant increases in performance
as compared to controls and would do so via
enhancement of attention and sport-specific aggressive
behavior. In support of the hypothesis, results indicate
that the MAC treatment group demonstrated significantly
greater performance increases compared to the control
condition (ES=.80). There appeared to be no changes in
level of anxiety, regardless of change in performance,
suggesting that the athletes in this study either viewed
their sensations of anxiety as functional, did not notice
their anxiety, or chose not to concentrate on their anxiety.
Subjects who increased performance appear to have had
fewer beliefs about uncontrollability and danger, more
positive beliefs about cognitive competence, more
positive beliefs of cognitive self-consciousness, and were
rated higher in terms of overt signs of attention and
aggressiveness. In conclusion, it appears that the MAC
intervention holds considerable promise for enhancing the
performance of athletes who have minimal psychological
barriers (those who do not have clinical or subsyndromal
clinical issues). These results also call into question some
of the theoretical assumptions inherent in the traditional
change-based models of performance enhancement.

The effects of learning the decision-making


strategy for occupational choice in Japanese
college students
Rui Hashimoto, Asuka Tanoue, Hidetoshi
Mizushima, Hironori Shimada, Faculty Of Human
Sciences, Waseda University Japan
Occupational choice is known as a problem that imposes
a heavy psychological burden on college students
because of necessity to process a lot of information.
Many studies has been shown the effect of learning the
decision-making strategy as a help of occupational
choice. However, previous studies tended to examine
the effect without considering the general process of
decision-making in occupational choice. The purpose of
this study was to develop a new decision-making strategy
and examine the effect of it. College students(n=35)were
randomly assigned to 4 groups: the Elimination by
Aspects Strategy(EBA), the Subjective Expected Utility
Strategy(SEU), the Compound Strategy(narrow down by
EBA, and decide ultimately by SEU), and the control
group. SEU, EBA, and the Compound Strategy group
were asked to choose one among many companies from
information magazine by each strategy. The effect of
decision-making strategy was examined by mood
inventory, career decision-making self efficacy, and
evaluation of strategy. The control group did not do the
task, and replied only to career decision-making self
efficacy. A one-way between subject ANOVA found the
difference of decision-making self efficacy between the
control group and the others (F(1,33)=3.753, p<.10). In
order to compare the effect of learning the decisionmaking strategy, a one-way between subject ANOVA was
conducted on each of the 3 self-reported scales. As a
result, significant difference was shown in the item of
evaluation of strategy that asked possibility of application
to actual job hunting (F(2,21)=5.102, p<.05; SEU>EBA,
Compound). Other variables have no significant
difference of the effect among 3 strategies. This study
found that there is the effect of learning decision-making
strategy, but no difference among the decision-making
strategies. In other words, it is effective to learn the
decision-making strategy itself. It suggested that this
result is an effect of the change in cognition to college
student's job hunting by learning logical decision-making
strategy, getting information about many companies, and
rehearsing job hunting.

Validity Of A Rating Scale For Measuring


Psychological Well-Being: Preliminary Report
In A Sample Of Italian Geriatric In-Patients
Marco Innamorati, 'Universit Europea' di Roma,
Italy
Assessment of Health-Related Quality of life and
Psychological well-being are important in both clinical
practice and clinical trials, and may help to improve the
quality of care in geriatric patients affected by medical
conditions. Aim of the study is to perform an item analysis
on a pool of item to build a rating-scale for evaluating

psychological well-being in Italian elderly affected by


general medical conditions. We administered a
questionnaire consisting of 23 true-false items to a
sample of 31 in-patients (average age = 73.29 years (SD
= 8.35); min./max. = 60/87) admitted in a Department of
Rehabilitation of Villa delle Querce, Nemi (Rome). The
items are structured as positive (e.g., I always felt
anxiety for my situation) or negative statements (e.g., I
never felt disheartened for the actual situation), covering
sensations and feelings (e.g., I often felt down in the
dumps or sad), symptoms (e.g., I had memory loss),
perceived self-efficacy (e.g., I felt insecure in overcoming
problems) and thoughts (e.g., I never thought life wasn't
worth living); individuals are instructed to rate each item
as it applies to the past two weeks. Patients also
completed the Geriatric Depression Scale - short version
(GDS; Sheikh, & Yesavage, 1986). We calculated the
Pearson's correlation Index (r) between the item and the
GDS, and the corrected item-total Index of correlation
(rc). Thus, we considered problematic each item with rc
or r < .2. Two items (I never had sleep problems, I
always had confidence in supporting or help from people
close to me) with rc or r < .2 have been considered
problematic and excluded from the final scale. This one,
consisting of 21 items, characterizes by an average interitem correlation index of .34 (r min./max = -.14/.80), a
Cronbach's a = .92, and discriminates between
depressed (GDS > 5) and non-depressed (F (df: 1;28) =
58.37 p < .001).Two items (I never had sleep problems,
I always had confidence in supporting or help from
people close to me) with rc or r < .2 have been
considered problematic and excluded from the final scale.
This one, consisting of 21 items, characterizes by an
average inter-item correlation index of .34 (r min./max = .14/.80), a Cronbach's a = .92, and discriminates between
depressed (GDS > 5) and non-depressed (F (df: 1;28) =
58.37 p < .001). Preliminary results suggested that our
scale is a potentially reliable and not redundant
instrument for evaluating psychological well-being in
geriatric patients affected by general medical conditions.
Because of this, we may plan further studies in larger
samples to define more sharply psychometric properties
of this new scale. References Sheikh, J.I., Yesavage, J.A.
(1986). Geriatric Depression Scale (GDS): Recent
evidence and development of a shorter version. In T.L.
Brink (Eds.), Clinical Gerontology: A Guide to Assessment
and Intervention, 165-173. New York: Haworth Press.

Is The Client Suitable For Cognitive


Behaviour Therapy?
Lefteris Konstadinidis, Giota Goga, Association
for Mental Health and Social Rehabilitation
(EPSIKA), Thessaloniki, Greece, Thomai Lioura,
Association for Mental Health and Social
Rehabilitation (EPSIKA), Thessaloniki, Greece,
Gregoris Simos, CMHC/Central District of
Thessaloniki, Greece, Nikolas Nikolaidis,
CMHC/Central District of Thessaloniki, Greece,
Agis Gouzaris, CMHC of Vyronas-Kessariani,
Athens, Greece
Safran and Segal have developed the Suitability for
Short-Term Cognitive Therapy Rating Scale which can be
used to assess clients formally by rating them from 0-5
on ten items, where a total of (0) indicates least and (50)
indicates greatest suitability. They also developed a short
manual, Suitability for Short-Term Cognitive Therapy
Interview, which takes approximately one our. In order to
socialize the client into Cognitive Behavioural model we
developed the Collaborative Interviewing in Mathematical
Analogy Technique (CLIMATE), which is a highly
structured interviewing technique that takes
approximately 19 minutes complete. This technique is
applied during the very first session and client achieves
from the first session a cognitive restruction relating to his
problem and what needs to be done to solve it. At the
same time he finds out and expresses indirectly that the
basic solution to his problem is Cognitive Behavioural
Psychotherapy, irrespectively of whether he chooses to
participate in it or not later on. The present study
examines the hypothesis that the consecutive questions
and responses and some other variables of Collaborative
Interviewing in Mathematical Analogy Technique
(CLIMATE) can be used to establish whether the client is
suitable for cognitive behaviour therapy or not.
CLIMATE was applied to 96 consecutive clients suffering
of various DSM-IV disorders. 73 clients (76%) completed
treatment (group A) while 23 clients (24%) dropped out of
treatment (group B). There were Non-significant age and
sex differences between group A and group B. We
compared the two groups of clients along a series of
answers given to structured CLIMATE questions as well
as other CLIMATE variables such as time required to
complete this technique. The mean time required to
complete CLIMATE was 19 minutes (SD: 6min, range:
10-35min) and it was not related to educational level. A
variety of specific responses given to the structured
questions of CLIMATE can predict adherence or
premature termination of treatment and if the client can
work in a cognitive way. Paying attention to a client's
specific answers may help us predict this client's
response and acceptability (credibility) of CBT and the
client's suitability for CBT.

Making CBT Duration Briefer Using the


Collaborative Interviewing In Mathematical
Analogy Technique (CLIMATE)
Lefteris Konstadinidis, Giota Goga, Thomai
Lioura, Association for Mental Health and Social
Rehabilitation (EPSIKA), Thessaloniki, Greece,
Gregoris Simos, Nikolas Nikolaidis,
CMHC/Central District of Thessaloniki, Greece,
Agis Gouzaris, CMHC of Vyronas-Kessariani,
Athens, Greece
Socrates said that if we are to investigate whether virtue
is teachable or not we must follow the way of the
geometers and the method of geometrical analysis.Also
Socrates considered that all the knowledge we are
capable of possessing is already within us, and the
process of reasoning something out is really just an act of
recollection, i.e., remembering things we already
somehow know. In order to socialize the client into CB
model and taking into consideration all the above we
developed a technique that seems to be especially
promising, which called CLIMATE. CLIMATE is a highly
structured dialogue and an acronym for Collaborative
Interviewing in Mathematical Analogy Technique. This
highly structured technique has the form of a Socratic
dialogue between the therapist and the client, during
which the therapist asks the client to answer a series of
35 specific questions. Since the range of given answers
is rather restricted, what actually happens is that the
therapist gets almost invariably the answer he anticipates.
The purpose of this study is to examine if CLIMATE can
be used to reduce cognitive behavioural therapy duration.
A total 190 consecutive clients with a variety of DSM-IV
disorders completed CBT. CLIMATE was applied in 110
clients (CLIMATE group, 57.9%) at the context of the
early socialization face of treatment while in the other 80
clients CLIMATE wasn't applied (Non-CLIMATE group,
42.1%). There were Non-significant age differences and
Non-significant male-female ratio between CLIMATE and
Non-CLIMATE group. We compared the two groups of
clients (CLIMATE group and Non-CLIMATE group) in
respect to the mean duration of treatment (number of
sessions). Chi-squared test was used. Clients from the
CLIMATE group had significantly lower mean duration of
treatment (17.3 sessions, SD=7.94) than clients from the
Non-CLIMATE group (20.9 sessions, SD=10.51). There is
a briefer duration of treatment when CLIMATE is used
(P<0.05). Socializing and educating the patient about the
cognitive model and also the nature of his problem is a
very important step of treatment. Quite often this process
has an additional therapeutic effect. Using CLIMATE at
the context of the socialization face may increase this
therapeutic effect.

Korean College students's thought about the


counseling and psychotherapy
Park Kyung Ae,Hyun Ju Cho, Kwang Woon
University Korea
This study investigated the thought of counseling or
psychotherapy for college students who took Thought
About Counseling or Psychotherapy Inventory (TACI).
The participants were a total of 683 college students
(male 309: female:374) who lived in 6 different
providances in Korea. TACI consists of four factor
structured which are counselor responsivesness, social
stigma, coercion concerns, image concerns. The four
factor structures of TACI were confirmed with Korean
college students same as Western people. The students
in Seoul had more positive thought of counseling or
psychotherapy compared to the students in non capital
regions. Also students in high economical level had more
positive thought of counseling or psychotheraopy
compared to the students in other economical levels.
There were no significant differences of the thought of
counseling or psychotherapy between male, female and
among three groups which were counseling, no
counseling, and need counseling group.

Developing a Mindfulness Meditation Manual


for Women in a Therapeutic Community
Bernadette Lange, Florida Atlantic UniversityUSA
Women with substance use disorders (SUD) have
complex issues related to chronic illnesses, risky sexual
practices, maternal responsibilities, mental health issues,
and lack of access to health care. Helping women to
remain in treatment programs is an urgent call to address
these needs. Length of stay in programs is also a
determinant to sustain recovery. The broad focus for this
study is to contribute to the foundation of research and
publications for the behavioral therapy intervention of
Mindfulness Based Stress Reduction (MBSR) in
therapeutic communities (TCs). The use of MBSR in TCs
is attributed to the work of Marcus, Fine, & Kouzekanani
(2001) and Marcus, Fine, Moeller, Kahn, Pitts, & Liehr
(2003). Their research was focused on decreasing the
attrition rate in TCs by decreasing the stress level
associated with entering a TC using the behavioral
therapy of MBSR. Stage 1a, Phase I- Model for
Behavioral Therapies Research, as outlined by the
National Institute on Drug Addiction in the United States,
is specific for manual development concerning content,
format and duration. This research is intended to explore

these areas for manual development for MBSR with a


target population of women Participatory Action Research
(PAR) is a good fit for conducting research with women in
a TC as it is a method that encourages community
participation with an action goal of promoting the welfare
of others in the community. The method of PAR also
supports the philosophical principle of TCs to promote
social learning. MBSR programs usually follow an 8 week
format using a teaching manual for the general
population. The manual is used as a template for 6 group
meetings, each lasting about 11/2 hours, to explore how
the manual may be adapted for women in a TC. Women
and staff members are asked to voluntarily participate
and express their views and opinions about the
adaptability of the manual for women in a TC. The
participants are invited to participate in the experiential
activities of Mindfulness Meditation, such as seated and
walking meditation; eating meditation; and a body scan
using gentle Hatha yoga. Comments and opinions are
collected during the group meetings and written on large
display charts for verification and group discussion.
Participants are also encouraged to note any thoughts or
ideas in between group meeting sessions in a journal. At
each subsequent group meeting, the display charts are
reviewed again, journal notes added, and a transcript of
the audio taped previous sessions is circulated and
creates an audit trail. Using group consensus, the validity
of the data is evaluated and notations are made
concerning the content of the teaching manual. Each
section of the teaching manual is reviewed by the women
and the researcher. The researcher and participants have
assumed roles as co-researchers in a continuous process
to form and shape and then re-form the content of the
manual. This replicates the pattern of social psychologist
Kurt Lewin's concept of unfreeze, change and refreeze.
Evaluations and analysis are a democratic process and
are ongoing. The manual development is ongoing and the
project has been extended to more than one TC for
women. Access and introducing MBSR to TCs for women
contribute to the field experiences of utilizing the PAR
method.

The Effectiveness of Computer-assisted


Cognitive Behaviour Therapy for Alleviating
Anxiety and Depression: a controlled pilot
study in Northern Ireland
Kildea Laura, ; Deborah Mairs, ; Martin
Dempster, ; Gallagher Micheal, McCrum Brian,
Homefirst Community Trust, Northern Ireland UK
This study evaluated the effectiveness of 'Beating the
Blues' - a computer-assited cognitive behaviour therapy,
in alleviating anxiety and depression in two clinical
groups, compared with a waiting list control group.
Participant feedback was sought on the acceptability of
the program. Data were analysed from standardised
questionnaires and self-report measures in two
experimental groups and a waiting list control group.
Between-group and within-group results were analysed
and qualitative analyses of participant feedback evaluated
the acceptability of the program. Scores indicate that
symptoms of anxiety and depression reduced
significantly, though differently, over the course of
treatment for the experimental groups, compared with the
waiting list control group. Patterns of scores suggest
these effects were maintained at six month follow-up.
Results suggest 'Beating the Blues' is effective in
alleviating symptoms of anxiety and depression.
Particpant feedback was mostly positive, indicating the
intervention is acceptable to service-users.

Comparison between Cognitive-Behavioral


and Psychodynamic Therapy and the
Translation of their Constructs
Schattenburg Lothar, Psychosomatic Clinic Bad
Neustadt/Saale
The zeitgeist in psychotherapy is integrative. In Germany
since 1999 psychoanalysis, psychodynamic approaches
ansd behaviour therapy is acknowledged by the
assurances. There are attemps to develop an integrative
psychotherapy (Grawe, 2004). Many psychotherapists
have two or more training in psychotherapy which they
apply in their daily practice. Four aspects will be
discussed: 1) the role of interpretation in DBT and TFP, 2)
the use of contracts in DBT and TFP, 3) the comparison
between coping strategies and defence mechanism and
4) the 'translation' of some constructs in CBT and PT. 1)
Both the dialectic behavioral therapy (DBT) of Marsha
Linehan (1993) and the transference focused
psychotherapy (TFP) of Yeomans, Clarkin, Kernberg
(2002) in the treatment of borderline patients make use
of interpretations. The aim of interpretations made by the
therapists is the connection of behaviour, aims, motives
and affects. Very often the patient is not aware of these
aspects. The aim is insight. Linehan points out that also
DBT makes use of interpretations like: Do you try to
sabotage the therapy and to devaluate me?. The
approach of Yeomans, Clarkin and Kernberg focuses on
the interpretation of the object relations dyad which is
currently aktive in the transference. 2) The use of
contracts: Both DBT and TFP use contracts which could
be verbal or written. The aim in both approaches is to
avoid the interruptions of the therapy. The therapist has to

find out what past behavior or elements of the patient`s


history are likely to threaten the therapy and how to deal
with these threats. 3) The comparison of coping
strategies and defence mechanism: Coping is a construct
of stress psychology, defence a construct of
psychodynamic therapy. Beside the different sources of
these concepts a comparison points out the active role
which the patient plays in his effort to reduce tension and
to adapt to the environment. Both defence mechanism
and coping strategies could be analyzed under the
perspective if they are appropriate or effective. Defence
mechanism are rehabilitated under the influence of
stress psychology. Regarding patients with severe illness
defence mechanism could be considered as normal
(Lang & Faller, 1998). 4) The question is if some
contructs of CBT can be translated into the constructs of
PT or vice versa and to what extent? Some vignettes will
be illustrated: transference (PT) and generalization
(CBT), to stimulate the patient to remember critical events
and confrontation, unconscious conflicts and inhibiting
plans or schemata, biography and the history of learning ,
attacking a malignant object and desensitization of
anger, projective mechanism and attribution theory
(Schattenburg, 2005).The conclusion of the paper: it is
very fruitful to try a 'bilingual approach' to overcome some
stereotypes still hold in DBT and PT. The question if the
translation is one to one remains open to be discussed.

The relationship between career decision


making and locus of control among
educational counsellors of Karaj township
Maryam Mashayekh, Khatam Institute of Higher
Education
Counsellors help people to choose the best situation for
solving their problems,so they should be the best
decision makers themselves.Researchers have found
,there is the relationship between locus of control and
ethical decision making(street,2005) and there is the
relationship between choose the career and gender(betz
and etal1990),but there are afew studies about career
decision making(processes of thinking and functioning
that leads to choice a behavior among people who have
alike situation in institute,office or workshop) and locus of
control and gender ,so this research has investigated the
relationship between these factors. The instruments
were:Career decision making inventory which has been
made by researcher,this inventory has 48 questions ,the
eight questions of it assess the processes of decision
making which are based on Dewey and Polya theories
and the other questions are based on Dinklage theory
which assess ten kinds of decision makers,the cronbach's
alpha of it has gained 0.8872.The other instrument was
Rotter's locus of control inventory.These inventories have
been given to 60 counsellors(23 men and 37 wemen)
who have been selected by unplaced random sampling
through four area of Karaj township. There was
relationship between career decision making and locus of
control( Chi square was 9.020 and significance level was
0.061).The relationship between career decision making
and gender has been confirmed ( chi square was
7.491and significance level was 0.112),but result showed
there was not relationship between locus of control and
gender (chi square was 0.694 and significance level was
0.698). According to this study career decision making
can be perdicted by locus of control and vice versa
because there is the relationship between these
factors,so if there is a problem in which of these factors
by improving one of these factors the other can be
changed.As result mentioned the relationship between
career decision making and gender suggest to recognize
the differences between male and female in processe of
decision making and kinds of decision makers.

What did Jesus really teach and how does


that relate to cognitive therapy?
Free Michael, Griffith University; Marian Free,
Anglican Church of Australia
Cognitive Therapists often find themselves treating
people with a commitment to the Christian religion and/or
belief system. In these cases the beliefs derived from the
Christian belief system frequently appear to be integral to
the process and content of therapy. It is potentially useful
to therapists to have a working knowledge of the
Christian belief system to treat such clients, however the
Christian belief system is full of inconsistencies and
confusion. One approach to the confusion is to use the
authentic teachings of the historical Jesus, as much as
they can be ascertained using the methods of biblical
scholarship. The paper uses the authentic teachings of
Jesus as promulgated by the Jesus Seminar, and
interpretations of those passages by standard
authoritative commentaries to estimate the main themes
of Jesus teaching. Implications are then drawn for the use
of those teachings in cognitive of therapy with persons
with a commitment to the Christian religion and/or belief
system. The main themes found include the following: the
nature of the kingdom of God, the value of extravagant
commitment, the value of the lost, reversal of worldly
values, Satan has fallen/new age has broken in, but don't
look for it, enjoy life while you can, relationship to God,
the value of persistence, respect the system, God treats
us as we treat others, be open and transparent, be on
guard, prepare rationally/be rational, anti-legalism, worth

of thing shown by outcomes, accept hospitality, value of


subversion. Many of these themes are consistent with,
and relevant to, issues and approaches discussed in
cognitive therapy, included with worth of persons, taking
an empirical approach to issues, being logical, and living
for the process, rather than the outcome. Ways in which
the teachings of Jesus can be used in cognitive therapy
are introduced.

Successive Changes of Cognitive, Behavioral


and Emotional Responses in Early Turnover.
Hidetoshi Mizushima, ; Asuka Tanoue, Fumito
Takahashi, ; Hironori Shimada, Faculty of Human
Sciences, Waseda University Japan
Early turnover of female employees is a kind of social
problem in Japan. A lot of studies suggested that turnover
was related to subjective job satisfaction. However,
successive changes of subjective job satisfaction in the
lead up to early turnover were not enough examined. The
purpose of this study was to examine successive
changes of job satisfaction along with cognitive,
behavioral and emotional responses in early turnovers for
effective cognitive behavioral intervention. Six female
employees who were introduced by personnel
department were interviewed. They worked at private
enterprise in the Tokyo metropolitan area and felt
dissatisfaction of works at the time. All subjects were
office workers. Three in six women who experienced
early turnover, were administered for the early turnover
group(mean age SD of 271.73 ; the mean duration
was 2.13 years). The other women who were not
experienced early turnover, were recruited for the control
group (mean age SD of 240 ; the mean of service with
the company was 1.67yaers). Semi-structured interview
was conducted (about 60min). It was set three stages
each group; turnover group (the stage of entrance on
office, T1; the stage of exercise of their office, T2; the
stage of turnover, T3) and control group (the stage of
entrance on office, T1; the stage of exercise of their
office, T3 and T2) The Modified Grounded Theory
Approach was conducted to analyze what they talked
about in their interview. As a result, it was classified into
22 categories at all stages and both groups. Cognitive,
behavioral and emotional differences were investigated
between ea