A total of 18 maritally-distressed couples, in which the female partner met diagnostic criteria for moderately severe clinical depression, were randomly assigned to Emotionally Focused Therapy (EFT) or to an individualized program of pharmacotherapy (PT) for the female partner. The purpose of the study was to examine the differential effectiveness of EFT, a systemic-experiential couple therapy, and PT in the prevention of relapse. Results suggest that both interventions were effective in reducing depression. Females in EFT were not depressed at follow-up but 2 females in PT did not respond to treatment. Marital adjustment increased significantly for females in EFT but not for their partners. The alleviation of depression in females in PT did not produce the hypothesized increase in their levels of marital adjustment, but their partners showed significant increases in their levels of marital adjustment. A differential pattern of relapse was not detected. Criteria for clinically-significant change suggest that females in EFT had better outcomes in terms of depression and marital distress, but that 2 couples in each group met the criteria of remitted depression and improvement in marital adjustment at 6-month follow-up. Results are discussed in light of an interpersonal approach to depression.

A growing number of psychotherapy researchers are studying in-session events that signify therapeutic change, process or progress. Similarly, a number of psychotherapy theorists have suggested that client strength of feeling is related to therapeutic change, process and progress. The purpose of the present research was to: (a) examine the relationship between client change events and client strength of feeling, (b) identify what particular levels of client strength of feeling are related to given categories of client change events, and (c) examine the effects that type of therapy may have in the relationship between client change events and client strength of feeling. Judges assessed the occurrence of categories of client change events and the level of client strength of feeling in 982 statements in 10 sessions of client-centered, rational-emotive and experiential therapies. The findings indicated that: (a) there is an overall positive significant relationship between client change events and client strength of feeling; (b) given categories of client change events are significantly related to particular levels of client strength of feeling; and (c) type of therapy is a significant variable in the relationship between client change events and client strength of feeling. These findings have implications for psychotherapeutic practice and also for clinical theory, with especial relevance for the role and meaning of level of strength of feeling, in-session client change, and a practitioner relevant matrix of conducting sessions of therapy on the basis of the research variables. Possible directions for further research were outlined.

Sixty head injured patients participated in this research, an evaluation of the validity of the DSM-III/III-R criteria to diagnose cases of Post Traumatic Stress Disorder among the head injured. Data were collected from a battery of tests, including a self-report checklist of symptoms, the Diagnostic Interview Schedule, Life Events Inventory, Novaco Anger Inventory, MMPI, WAIS-R, and the Halstead-Reitan Battery, at three times within the first year of recovery. Results indicated that concordance rates between DSM-III/III-R criteria and alternative criteria were low, while concordance rates between alternative sets of criteria were acceptable. Assessment of the convergent validity of PTSD criteria with external measures of distress and impairment indicated that the largest multivariate group separation and highest discrimination rates were achieved for alternative PTSD criteria. Individuals who met DSM-III criteria at the initial assessment appeared less distressed and more healthy than corresponding non-PTSD groups; this pattern was less obvious at follow-up. In contrast, those who met alternative criteria for PTSD at all assessments appeared more distressed and impaired than corresponding non-PTSD groups at all assessments. Of the external predictor variables, anger or irritability had the highest association with PTSD, regardless of how diagnosed. The PTSD and non-PTSD groups could not be discriminated on the basis of medical/neurological variables even though all subjects had some evidence of impairment; thus, all sets of PTSD criteria had discriminant validity when compared to brain damage. The PTSD groups formed on the basis of "post-concussional" symptoms were generally less seriously injured than either corresponding non-PTSD groups or PTSD groups formed from DSM-III/III-R criteria. This finding makes questionable DSM-III/III-R's dismissal of such symptoms as Organic Mental Disorder. The implications of this research for DSM-IV are that PTSD criteria may need to be less restrictive by (a) including somatic symptoms and those symptoms used in operational definitions of Post-Concussional Syndrome; (b) removing the requirement that both intrusion and avoidance-numbness must be present for a diagnosis; (c) recognizing that global symptoms of maladjustment that occur or re-occur after a trauma may indicate PTSD and not comorbidity; and (d) recognizing that the presence of intrusion and/or avoidance-numbness may indicate an adaptive response to the trauma and not a disorder, especially in the absence of associated distress or impairment. (Abstract shortened by UMI.)

Two studies were designed to test the hypothesis that the severity of an anticipated negative consequence deters women's assertiveness more than the probability of an anticipated consequence. The first study, involving a 2 x 2 factorial design, manipulated two levels of anticipated severity (low versus high) and two levels of anticipated probability (low versus high). The type of response studied involved the refusal of an unreasonable request. Female undergraduate psychology students (N = 198) were randomly assigned to view one of four videotapes reflecting these conditions. After viewing the videotapes, participants were asked to rate their intentions to act assertively (BI) and to rate other variables which could potentially be coeffects or mediators of BI (e.g., anxiety, competence). In study 2, 151 female psychology students completed a survey in which they were required to imagine their own anticipated negative consequences, severities, and probabilities for five vignettes involving the refusal of an unreasonable request. Participants in study 2 completed questions about similar variables to study 1. Personality variables, including social desirability, assertiveness (for studies 1 and 2), and anxiety (for study 2) were measured to see if they moderated the results. Path models showed that in all cases, severity and probability affected BI, either directly or indirectly through distress/low self-efficacy or unfairness/need for support. The hypothesis was mostly confirmed in that in almost all cases, severity contributed more variance to BI than did probability. All personality factors moderated the results some of the time. Support was found for both the rational choice and cognitive distortion models of assertiveness. The results were discussed in reference to Beck et al.'s (1985) theory of social anxiety and implications for assertiveness training.

L'anorexie mentale demeure un probleme enigmatique. La nature de ce desordre provient de ses manifestations qui semblent contraster avec nos conceptions de la nature et des besoins fondamentaux de l'homme. Une facon d'etudier et de comprendre la specificite de ce desordre est d'examiner les modes de traitement de l'information qui lui sont propres. Plusieurs auteurs referent a un mode de penser etroit, concret et irrationnel. J'appelle ce mode d'apprehension du monde "polarisation cognitive". L'expression designe une incapacite et un refus de s'arreter ou de tracer des limites. Au fond, l'anorexique trace des limites absolues et surtout les limites de son corps. Son monde est parfaitement delimite et souvent elle reussit bien dans les activites academique et artistique. Cependant, elle est loin d'etre une personne epanouie. Dans cette recherche, je prends la polarisation cognitive comme point de depart et je pose les questions suivantes: Comment la facon d'interagir avec le monde d'apres la polarisation est-elle problematique? Quelle fonction remplit-elle et dans quelles conditions se developpe-t-elle? Meme si je m'attarde au probleme de la polarisation cognitive chez l'anorexique, le vecu de l'anorexique dans sa totalite fera l'objet de cette recherche. Ce sont les conceptions d'ensemble d'un objet d'etude qui informent davantage sur sa nature que les recherches parcellaires et trop abstraites. La polarisation cognitive chez l'anorexique ne refere pas a un mode de penser mais a un mode d'etre-dans-le-monde. Pour cette raison le concept de polarisation cognitive se "transforme" en polarisation existentielle. La question directrice de cette recherche concerne la facon dont l'anorexique entre en relation avec son monde et cree des sens. Cette question est abordee selon une approche deductive ou la connaissance s'obtient en partant d'un cadre philosophique. Le cadre general de cette recherche est appele "metatheorique". Il comprend des postulats sur l'emergence de l'etre et du connai tre. Ensuite, le discours theorique contient des hypotheses sur la polarisation existentielle. Au niveau pratique de la recherche j'elabore une approche therapeutique basee sur ces formulations theoriques. (Abstract shortened by UMI.)

The primary objectives of this study were: to determine the predictors of psychological distress and social maladjustment (i.e., social interaction, work, and home management functioning), to determine the relationship between specific coping strategies and psychological distress and social maladjustment, and to determine the effects of program participation on patients' level of personal mastery, cardiac functional capacity, frequency of stressors, and coping strategies. The sample comprised 223 males between the ages of 27 and 66 who had heterogeneous CHD diagnoses. The data were collected by means of standardized questionnaires using a mailing procedure which achieved a response rate of approximately 90% across time points. The results of multiple hierarchical regression analyses revealed that number of hassles and disengagement coping contributed significant increments to the variance explained in psychological distress. Higher levels of engagement and symptom management coping, however, were not found to be significant predictors of lower psychological distress in this study. For social maladjustment, in general, neither stress nor coping emerged as consistent predictors of social maladjustment across time points. Coping consistently emerged as a stronger predictor of both psychological distress and social maladjustment when current coping strategies were used as predictors (Model B), as opposed to when coping strategies from the previous time point were entered (Model A). Regarding the relationships among specific coping strategies and psychological distress and social maladjustment, the disengagement coping strategies had stronger positive correlations with psychological distress and one of the three social maladjustment outcomes than did engagement coping, which had fewer and weaker positive correlations with these outcomes. Program participation did not predict personal mastery or use of coping strategies, but did predict fewer hassles. The number of physiotherapy sessions received predicted level of cardiac functional capacity. Furthermore, greater cardiac functional capacity was predicted by higher personal mastery, fewer hassles, lower psychological distress, and less impairment in domestic activity. This study demonstrates the importance of psychosocial variables as predictors of cardiac functional capacity, and provides empirical evidence that these variables moderate the relationship between physical status and recovery level. The findings concerning the identification of predictors of adjustment provide information for developing rehabilitation interventions for CHD patients. Patients' adjustment may be facilitated by reduction of hassles, limiting use of disengagement coping strategies, and strengthening personal mastery. The methodological strengths and weaknesses of this study are discussed, as are its implications for coping theory and research. (Abstract shortened by UMI.)

This study was devised to determine the effectiveness of a theoretically-based pretherapy training procedure in enhancing group cognitive therapy for depressed older adults. Twenty-nine subjects were randomly assigned to a pretherapy training condition or an attention-placebo control condition. All subjects were 65 years of age or older, had a score of 14 or higher on the Beck Depression Inventory or 14 or more on the Geriatric Depression Scale, and had no previous experience in psychotherapy or special knowledge of the psychotherapeutic process. Subjects in both conditions received four sessions in the pretherapy phase, followed by 12 sessions in the therapy phase. The pretherapy training procedure was based on Bandura's social cognitive theory and included verbal persuasion (written and verbal material), vicarious experience (videotape), and performance accomplishment (structured group exercises). Four categories of dependent variables were examined: attendance and dropout rates, immediate effects of pretherapy training (i.e., knowledge about therapy and role expectations), observer ratings of in-therapy client behavior, and outcome as measured by subject and observer ratings of improvement throughout therapy. The results revealed no significant differences between conditions on attendance and dropout rates. Subjects in the pretherapy training condition had significantly greater knowledge of psychotherapy at the end of the pretherapy phase than subjects in the attention-placebo condition. The analysis of subject role expectancies in the pretherapy phase revealed that subjects in the pretherapy training condition exhibited significantly less audience-seeking expectancies than subjects in the attention-placebo condition. The process measure revealed that subjects in the pretherapy training condition made more statements related to the problems they were experiencing than subjects in the attention-placebo condition. There were no significant differences between conditions with respect to outcome. For the two conditions taken together, 53.7% of the subjects exhibited clinically significant improvement by the end of therapy. The results were discussed in terms of the appropriateness of measuring role expectancies, and suggestions were made for measuring other expectancies, based on social cognitive theory. The clinical implications of the findings as well as the feasibility of in vivo use of pretherapy training procedures were also discussed. (Abstract shortened by UMI.)

Cette these theorique propose une conception cognitive de la genese de l'anorexie mentale qui, contrairement aux principaux modeles etiologiques du trouble, permet d'integrer de facon explicite le jeu des facteurs internes et externes. Il y est question notamment de la variabilite dans le rapport entre les fonctions cognitives d'assimilation et d'accommodation, laquelle est posee comme etant attribuable (1) a ces propensions individuelles de nature innee, (2) a des propensions contextuelles dues aux pressions exercees par le milieu et (3) a des propensions developpementales qui agiraient de maniere dachronique sur divers aspects du developpement cognitif des individus. Ces propensions influeraient sur la mise en place des schemes cognitifs en general et sur celle de schemes de soi en particulier, laquelle, au moment du passage au stade operatoire formele, engendrerait un phenomene que nous avons appele de permanence du sujet. Ce phenomene entrai nerait chez les individus la cristallisation d'une representation de soi en tant que sujet detenant le controle parmi un champ de controles possibles. D'autre part, ces propensions seraient responsables, chez les anorexiques, de la misse en place de schemes de soi pathogenes qui, etant donne la conjoncture qui prevaut au moment de leur arrivee a l'adolescence, se caracteriserait par la cristallisation d'une representation de soi en tant que sujet qui ne concoit le controle qu'a travers le controle du corps. C'est ainsi qu'elles en viendraient a ne generaliser le controle qu'a des objets ou des situations qui se rattachent au controle du corps (v.g. exercices physiques excessifs, diete alimentaire, abus de laxatifs), d'ou l'emergence de schemes de soi anorexiques. Ne parvenant plus a se definir autrement que par rapport au controle du corps, perdre du poids representerait pour elles la seule facon d'etre.

This study examined differential outcome between two stress management approaches according to subject characteristics. It was hypothesized that individuals with certain characteristics might benefit more from one form of stress management training (Rational Emotive Therapy) than another (Gendlin Focusing). The implication, were this hypothesis to be supported, would be that individuals could be streamed into one form of training versus another, according to certain personality variables, and the result would be greater effectiveness and efficiency in the delivery of services. Subjects were classed as having one of two sets of characteristics. One class of subjects (N = 34) displayed stress cognitively on the Cognitive-Somatic Anxiety Questionnaire (CSAQ) and were of the Sensing type on the Myers-Briggs Type Indicator (MBTI) while the other class of subjects (N = 31) displayed their stress somatically on the CSAQ and were of the Intuitive type on the MBTI. Based on personality theory, cognitively anxious Sensing types were predicted to have greater decreases in stress as a result of receiving a Rational Emotive Therapy approach to stress management while somatically anxious Intuitive types were predicted to have greater decreases in stress as a result of receiving a Gendlin Focusing approach to stress management. Additional measures of client characteristics were taken in order to explore the predictive potential of variables which the literature indicates might be useful in predicting differential outcome. These included Locus of Control, Verbal Reasoning, Abstract Reasoning, Experiencing Ability, Rational Beliefs. A measure of stress (Symptom Check List-90-R) was taken at three points in time: pre, post-training (or post-waiting as in the case of the waiting-list controls), and at one-month follow-up. A waiting-list control group (N = 30) was utilized to demonstrate a treatment versus no treatment comparison. Treatment group subjects received 12-15 hours of stress management training in either (Rational Emotive Therapy) RET or Focusing spread over 5 weeks. Half of each class of subjects received RET while the other half of each class of subjects received Focusing. Key results include: Both classes of treatment subjects displayed significantly greater reductions (p .05) in stress levels after training as compared to waiting-list control subjects who had not received training over the same period of time. The main hypothesis was not supported. There were no statistically significant treatment by classification interactions. However, there were relationships between client satisfaction, use of the techniques, and decrease in reported levels of stress. Further analyses showed that none of the variables were significant predictors of outcome. This Study introduced Focusing as a viable stress management technique.

This study investigated the relationship between social support within the marital context, and physical ability in chronic pain patients. Fifty patients diagnosed with chronic pain and their spouses participated in the study. Each patient was asked to exercise on a stationary bicycle, with his/her spouse present. The interactions between patient and spouse were videorecorded and the spouse's behaviour was rated for the amount of task-related and emotional support expressed. The relationships among the spouse's behaviour, the patient's perception of that behaviour and the patient's physical ability were examined. Marital adjustment, depressive symptomatology and the spouse's perception of the patient's physical limitations were investigated as predictors of expressed and perceived support. Zero-order correlations replicated the previously demonstrated positive relationships among the patient's report of spouse support, pain intensity and marital adjustment. Using hierarchical regression to control for the patient's depressive symptomatology and marital adjustment, it was found that observed spouse support was positively related to the patient's physical ability, accounting for 13% of the variance. When pain severity was also entered into the equation, results indicated that pain intensity was the only significant predictor and was negatively related to the patient's physical ability, accounting for 43% of the variance. No significant predictor of the spouse's expressed support was identified, while the patient's marital adjustment was positively related to his/her perception of support. Descriptive reports by patients of their perception of support during the physical ability task indicated that patients experienced task and emotional support differently. The majority of patients reported that emotional support was experienced as supportive and helpful, but task-related support was not.