<p> Hoarding, the accumulation of a large number of possessions and substantial clutter, is increasingly being recognized as an important public health concern. Emerging consensus suggests that hoarding is an independent phenomenon and it will likely be included as a new diagnosis (Hoarding Disorder) in the forthcoming revision to the <i>DSM.</i> An initial conceptual model of this condition has implicated information processing deficits and emotional distress as key components of hoarding disorder. Although it has shown promise, this model is in need of greater empirical support and verification. The present study reports on an investigation into information processing and affective responses in relation to hoarding. We compared adults meeting criteria for hoarding disorder (<i>N</i>=33) and community controls (<i> N</i>=30) using psychophysiological methodologies based on startle eyeblink responses. Prepulse inhibition of startle (PPI), a measure of sensorimotor gating used in previous studies of schizophrenia and OCD, was used to test for information processing deficits proposed to be involved in hoarding symptoms by the cognitive-behavioral model. Affective valence startle modulation (AVSM) was used to elucidate emotional processing in association with hoarding. We also compared hoarding and control group participants on startle reactivity at baseline and while undergoing a symptom-provocation stressor (discarding task). Contrary to our hypothesis, the hoarding and control group participants demonstrated comparable levels of PPI. There were also no group differences when considering comorbid diagnoses. PPI scores were not related to medication status. AVSM results revealed that both the hoarding and control groups demonstrated a linear pattern of startle modulation to pleasant, neutral and unpleasant stimuli respectively. The hoarding group demonstrated larger general startle reactivity compared to the control group, both at baseline and following the discarding task. We did not find group differences in PPI, indicating that hoarding disorder is not related to sensorimotor gating deficits. The hoarding and control groups had similar affective modulation of startle, but the hoarding group demonstrated higher general startle reactivity. Enhanced general startle suggests that hoarding disorder is characterized by enhanced defensive responding, as is noted in other anxiety disorders such as PTSD and GAD.</p>

<p> This qualitative study explored and analyzed the narrative experiences of senior psychotherapists and their capacity to tolerate and make meaning of uncertainty in their clinical work. While research on therapist development tends to agree that the maturation of the clinician is an ongoing process (Bruss &amp; Kopala, 1993; Eckler-Hart, 1987; Gold, 2005; Guinee 1998; Kaslow &amp; Rice, 1985; Lamb, Baker, Jennings &amp; Yarris, 1982; Solway, 1985; Suran &amp; Sheridan, 1985), little research has been conducted that documents this process from the perspective of the senior analyst. In addition, despite widespread acknowledgment of uncertainty as an ever-present phenomenon among clinicians, there have been few studies that address how a relationship to uncertainty unfolds. In other words, how does one move from a primary position of insecure self-doubt into an openness and tolerance for analytic uncertainty? This study employed a theoretical framework to help organize the inquiry and data analysis. Using Ogden's (1986) interpretation of Klein's (1946/1994) paranoid-schizoid/depressive model, the experiential constructs of analytic uncertainty and insecure self-doubt were explored in the form of an ongoing dialectic. Semistructured interviews were conducted among eight San Francisco Bay Area psychoanalytically oriented psychologists and data were analyzed through open coding. The results yielded a total of 11 core themes and 9 subthemes, distributed among 3 principle sections: Integration of Uncertainty, Early Encounters With Uncertainty and Self-Doubt, and Abstract Analysis: An Ongoing Dialectic. Key findings from the present study include (a) uncertainty is core to analytic work and is what allows for creative discovery; (b) despite its value, uncertainty is difficult to bear; (c) early encounters with clinical uncertainty often lead to feelings of self-doubt; (d) self-doubt, when experienced as a personal failing, has a tendency toward shutting therapists down; (e) therapists' experiences of self-doubt and uncertainty remain in an ongoing dialectic; and (f) faith is the impetus behind tolerance for uncertainty and it enables productive use of self-doubt.</p>

<p> Negative affect can be a highly potent trigger for relapse among those in recovery for alcoholism, whereas self-efficacy has been identified as an important factor for relapse prevention. Much research has attempted to identify factors and interventions that can enhance self-efficacy and improve the coping ability of those in recovery to manage negative affect. This study sought to determine whether dispositional mindfulness might be a useful tool in this regard, by investigating for a possible relationship between this variable and self-efficacy towards coping with negative affect. Additional variables (i.e., length of time abstinent, meditation frequency/duration, history of polysubstance abuse/dependence, and history of psychiatric co-morbidity) were also examined for possible relationships with these two constructs. Adult participants (<i>N</i> = 104) with a history of alcohol abuse/dependence were recruited via online support groups and websites that adhere to the principles of Alcoholics Anonymous (AA), to take an anonymous online survey consisting of: a demographic questionnaire, the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R), and the Alcohol Abstinence Self-Efficacy Scale (AASE). Chi-square analyses, and independent samples t tests and one-way ANOVAs, were conducted to provide information regarding possible meaningful relationships between variables and differences between groups within variables. Results of this study lend some support for the assertion that those with higher levels of dispositional mindfulness may also have greater self-efficacy towards successfully managing negative affect. Findings also reveal some evidence for a positive relationship between length of time abstinent, and both mindfulness and self-efficacy. Caution should be taken, however, when drawing conclusions from these findings due to the disproportionate number of participants who reported doing extremely well in their recovery and having high confidence in their ability to abstain from alcohol use. Limitations of the study are discussed.</p>

<p> Sexual offenders have become today's lepers. California presently has more than 118,500 registered sexual offenders. Those included on the sex offender registry range from teens having consensual (albeit unlawful) sexual contact, or those prosecuted for public urination to predatory child molesters and serial rapists. The inclusion of relatively innocuous offenders on the registry undermines the very purpose of it: to assist law enforcement and help to protect the community. Legislators respond to media driven public fears about the most sensational cases (the monsters among us) with ever more restrictive and punitive sanctions which do little to improve public safety but prevent offenders from successfully reintegrating into society after their sentences are served. These sorts of policies (i.e. residency restrictions and public registries) not only impact the offenders themselves, but can have devastating affects on their families and can increase the risk of reoffense by undermining the very factors research shows prevent recidivism (family support, employment, treatment options, etc.). </p><p> This work attempts to build upon previous research to determine the origins of public perceptions of sexual offenders and to reveal how these perceptions can be changed. It provides evidence that public beliefs about sexual offenders, while generally bound by myths and stereotypes, may alter their views when exposed to the realities of the issue and to real life sexual offenders. Psychologists can play a role in providing treatment and advocating for rational approaches to this marginalized and wounded population.</p>

<p>Families raising autistic children grapple with stressors created by the child's often-unpredictable course of development that affects resilient family function. To that end, this study used a quantitative, non-experimental study design with 103 married parents (103 fathers, 103 mothers) raising autistic children to identify relationships between stress, father's resilience, mother's resilience, and family resilience employing the Baron and Kenny mediation regression technique. Consistent with family resilience theory, the study results demonstrated that families raising autistic children follow a resilient model. The study results suggest that father's resilience is positively related to family resilience (R² = .753,<i>p</i> &lt; .001) and mother's resilience is positively related to family resilience (R² = .602, <i>p</i> &lt; .001). Likewise, the study results further suggest that as parental stress increases, both father's resilience decreases (R² = .041,<i>p</i> = .040) and mother's resilience decreases (R² = .168, <i>p</i> &lt; .001). Equally, the study results suggest that increased stress is linked to decreased family resilience (R² = .191, <i>p</i> &lt; .001). However, stress does not fully mediate the relationship between father's resilience and family resilience (R = .887, R² = .787, <i>F</i> (2, 100) = 184. 707,<i>p</i> &lt; .001), or between mother's resilience and family resilience (mother R = .777, R² = .604, <i> F</i> (2, 100) = 76.182,<i>p</i> &lt; .001). Further, when investigating stress mediation in the combined father and mother resilience and family resilience relationship, stress still did not fully mediate the relationship (R = .623, R² = 389, <i>F</i> (2, 100) = 31.795,<i>p</i> &lt; .001). This means that stress partly explains the relationship between parent resilience and family resilience, but not entirely. Implications are that parent resilience is correlated with family resilience, even after taking into account how stressed parents feel. Thus, despite being in a stressful situation, the more resilient parents are, the more resilient the entire family unit will be. Therefore, since a parent's resilience and the overall family reliance are strongly positively correlated when accounting for stress levels, the results of the present study suggest that parental resilience be considered when examining family resilience. </p>

Emotion plays an important role in psychotherapy. In order to understand more about the interaction between emotional functioning and the psychotherapeutic process, research into the moment to moment fluctuations of emotional experience is essential. However, subjective measurement of the momentary changes of emotion has proved problematic. The current body of work seeks to address this measurement challenge by examining the vocal acoustic properties of participants' speech within therapeutic style interviews, specifically, the momentary fluctuations of the emotion of interest. A second study examines the vocal cues that trainee therapists use in deciphering participants' emotional processing. Results revealed that the vocal parameters of fundamental frequency, volume intensity, volume variance and speech rate changed with participants' self-rated emotional intensity to indicate unique vocal profiles at different levels of participants' interest. The vocal parameters of volume and frequency variance were the vocal cues trainee therapists relied on in decoding the emotional quality of participants' speech.This work seeks to inform future research in the development of ecologically valid instruments with which to assess in-session emotion and offers contributions to the fields of emotion and psychotherapy process research, as well as to the field of psychotherapy training models. / L'émotion joue un rôle important dans la psychothérapie. Afin de mieux comprendre l'interaction entre le fonctionnement affectif et le processus psychothérapeutique, la recherche sur les fluctuations momentanées de l'expérience émotionnelle est essentielle. Cependant, la mesure subjective de l'évolution de l'émotion momentanée s'est révélée problématique. La présente étude vise à relever ce défi de mesure en examinant les propriétés vocales acoustiques de la parole des participants dans les interviews de style thérapeutique, en particulier les fluctuations momentanées de l'émotion d'intérêt. Une deuxième étude examine les signes vocaux utilisés par les thérapeutes stagiaires pour déchiffrer les processus émotionnels des participants. Les résultats ont révélé que les paramètres vocaux de fréquence fondamentale, d'intensité du volume, de variation du volume et de débit de la parole ont changé avec l'auto-évaluation de l'intensité émotionnelle des participants pour indiquer des profils vocaux uniques à différents niveaux de l'intérêt des participants. Les paramètres vocaux de volume et de variation du fréquence ont servi d'indices vocaux aux thérapeutes pour décoder la qualité émotionnelle de la parole des participants.Ce travail vise à informer les recherches futures dans l'élaboration d'instruments valides sur le plan écologique, permettant d'évaluer l'émotion dans la session thérapeutique. Il contribue au domaine de la recherche sur les processus thérapeutiques ainsi qu'aux modèles de formation en psychothérapie.

This study of depressed outpatients (N = 52) examined the role of personal standards (PS) and self-criticism (SC) dimensions of perfectionism in daily stress, coping, and depressive symptoms. Prior to treatment, participants completed interviews and questionnaires in a lab session and then completed daily reports of stress, coping, and depressive symptoms at the end of the day for 7 consecutive days. Trait influences were found in the daily reports of stress, appraisals, coping, and depressive symptoms. In contrast to PS, SC was related to aggregated daily stress, negative social interactions, low perceived control, self-blame, avoidant coping, and guilt controlling for depressive severity. Path analyses demonstrated that the relation between SC and depressive symptoms was mediated by avoidant coping both directly and indirectly through event stress. Overall, these findings demonstrate the importance of clinicians focusing on the maladaptive aspects associated with self-critical components of perfectionism in the treatment for depression. / Résumé Cette étude a examiné le rôle de deux dimensions du perfectionnisme (les «standards personnels» et l'autocritique) dans la perception du stress, les stratégies d'adaptation au stress et les symptômes dépressifs chez les personnes diagnostiquées avec une dépression (N = 52). Avant de commencer leur traitement, les participants ont rempli des questionnaires et ont participé à une séance d'entrevue dans notre laboratoire. Ensuite, pendant sept jours consécutifs, et ce, à la fin de la journée, les participants ont complété à domicile des questionnaires portant sur le stress vécu au quotidien, les stratégies d'adaptation au stress, les traits de personnalité et les symptômes dépressifs. Les résultats indiquent que les traits de personnalité influencent le nombre de stress vécu quotidiennement, l'évaluation du stress, les stratégies d'adaptation au stress et les symptômes dépressifs. Lorsque le niveau des symptômes dépressifs est maintenu égal pour tous, contrairement au perfectionnisme «standards personnels», le perfectionnisme autocritique est lié au stress vécu quotidiennement, à des interactions sociales négatives, à la perception de faible contrôle sur la situation stressante, à l'auto-accusation, à la culpabilité et à l'évitement. Une analyse des pistes causales a montré que le lien entre le perfectionnisme autocritique et les symptômes dépressifs passe directement et indirectement par l'évitement et ce, par le biais du stress. En somme, ces résultats démontrent la nécessité pour les cliniciens de se concentrer sur les aspects dysfonctionnels associés à la dimension autocritique du perfectionnisme lors du traitement de la dépression. fr

Self-determination theory posits that people must satisfy their innate needs for relatedness, autonomy, and competence in order to function effectively in life. The needs for autonomy and relatedness have been identified to be particularly important for identity development. Autonomy is the need to feel authentic and self-determined, and relatedness is the need to be connected and related to others. Although people are naturally inclined towards autonomous functioning and self-actualization, it is the social environment that determines to a large extent whether they are actually able to realize that or not. The social environment can be autonomy supportive and facilitate the integration of values into the self, the expression of intrinsic interests, and the making of deep and meaningful connections with others; or the social environment can be controlling and hinder this natural tendency, leading to the person feeling like a pawn controlled by others, unable to express intrinsic interests and engaged only in superficial relationships with others.In this thesis, I examined a particular type of controlling socializing environment that pits the need for autonomy and the need for relatedness against each other. In other words, the person experiences the conflict between being authentic and yet being connected and related to one's family. Broadly, I was interested in how the tendency towards growth is affected by childhood autonomy-relatedness conflict. I reasoned that this distal variable will continue to influence present functioning by affecting the extent to which the present environment is perceived as supportive of one's needs. / Selon la théorie de l'autodétermination, les gens doivent satisfaire leurs besoins innés de relations, d'autonomie et de compétence pour fonctionner efficacement. Les besoins d'autonomie et de relations ont été identifiés comme étant particulièrement importants pour le développement de l'identité. L'autonomie est la nécessité de se sentir authentique et autodéterminé et le besoin d'affiliation est la nécessité d'être connecté et relié à d'autres. Bien que les gens soient naturellement portés vers un fonctionnement autonome et vers l'auto-actualisation, c'est l'environnement social qui détermine dans une large mesure s'ils pourront ou non les satisfaire. L'environnement social peut favoriser l'autonomie et faciliter l'intégration des valeurs, l'expression des intérêts intrinsèques et l'établissement de liens profonds et significatifs avec les autres; au contraire, l'environnement social peut être contrôlant et entraver cette tendance naturelle, menant la personne à se sentir comme un pion contrôlé par les autres, incapable d'exprimer des intérêts personnels ou de former des relations plus que superficielles avec les autres.Dans cette thèse, j'examine un type particulier d'environnement social contrôlant, qui oppose le besoin d'autonomie au besoin d'affiliation. En d'autres termes, la personne vit un conflit entre son désir d'être authentique et celui d'être connecté et lié à sa famille. Globalement, je me suis intéressée à façon dont la tendance à la croissance psychologique est affectée par les conflits entre l'autonomie et d'affiliation vécus pendant l'enfance. J'ai pensé que cette variable distale continuerait d'influer sur le fonctionnement actuel, en affectant la mesure dans laquelle l'environnement actuel est perçu comme répondant aux besoins.

Urological Chronic Pelvic Pain Syndrome (UCPPS) was long thought to be the direct result of prostate infection. This unidimensional perspective is not supported by current research suggesting a biopsychosocial perspective. Contemporary views take a multifactorial approach to defining UCPPS, and recognize a heterogeneous presentation of symptoms in men with UCPPS. The present thesis examines and describes this heterogeneity and attempts to differentiate UCPPS subtypes. The first chapter of the thesis is a critical review of the literature examining the prevalence and impact of sexual dysfunction in men with UCPPS. Sexual dysfunction was found to be prevalent in this population, but specific conclusions were difficult to reach because the methodologies used were flawed and inconsistent between studies. The second chapter empirically examines the role of sexual dysfunction in the quality of life in men with UCPPS. Sexual functioning was found to be important, and it was recommended that an evaluation of this domain be included in the standard evaluation of UCPPS. The third chapter examines pain thresholds in the genito-pelvic and triceps regions of men with UCPPS compared to matched controls. Pain thresholds were significantly lower in UCPPS men than controls in all locations, indicating increased sensitivity. The fourth chapter used transperineal ultrasound to examine the dynamic pelvic floor morphology of men with UCPPS. Differences in anorectal angles and levator plate angles were found in men with UCPPS as compared to controls. These findings indicate increased resting pelvic floor tension, and decreased pelvic floor strength in men with UCPPS. The fifth and final chapter describes the heterogeneous symptoms of men with UCPPS. A wide variety of biopsychosocial symptoms and medical markers were then used to define seven subtypes of UCPPS. These findings contribute to greater understanding of the underlying mechanisms in UCPPS. The definition of subtypes may allow future research and treatments to be targeted more accurately. / On a longtemps cru que le Syndrome Pelvien Douloureux Chronique (SPDC) était directement causé par l'infection de la prostate. Les recherches actuelles ne soutiennent plus cette perspective unidimensionnelle; elles se tournent plutôt vers l'aspect biopsychosocial de la maladie. Les points de vue contemporains se servent d'une approche multifactorielle pour définir le SPDC, et ils reconnaissent que chez les hommes, les symptômes du syndrome se présentent de manière hétérogène. La présente thèse examine et décrit cette hétérogénéité et tente de différencier les sous catégories du SPDC. Le premier chapitre de cette thèse se veut un bilan critique de la littérature qui examine la prévalence et l'incidence de la dysfonction sexuelle chez les hommes atteints du SPDC. On a trouvé que la dysfonction sexuelle était prépondérante chez cette partie de la population, mais il était difficile de tirer une conclusion, les méthodologies utilisées étant déficientes et incompatibles entre les différentes études. Le second chapitre examine de manière empirique le rôle que joue la dysfonction sexuelle dans la qualité de vie chez les hommes atteints du SPDC. On a trouvé que la fonction sexuelle avait un rôle important et il a été recommandé d'inclure l'étude de ce domaine dans les critères d'évaluation du SPDC. Le troisième chapitre se penche sur les seuils de douleur dans les régions génitopelviennes et du triceps chez les hommes atteints du SPDC en comparaison avec des témoins appariés. Les seuils de douleur étaient nettement inférieurs chez les hommes souffrant du SPDC que chez les témoins pour toutes les régions corporelles examinées, ce qui indique une sensibilité accrue. Dans le quatrième chapitre, il est question de l'utilisation de l'échographie transpérinéale pour évaluer la morphologie du plancher pelvien des hommes atteints du SPDC. On a retrouvé des différences dans les angles ano-rectaux et les angles du plateau élévateur chez les hommes avec le SPDC en comparaison avec les témoins. Ces conclusions indiquent une tension plus élevée dans le plancher pelvien en état de repos, et une moins grande force du plancher pelvien chez les hommes atteints du SPDC. Le cinquième et dernier chapitre décrit les symptômes hétérogènes des hommes avec le SPDC. Une grande variété de symptômes biopsycosociaux et de marqueurs médicaux ont servi à définir sept sous catégories du SPDC. Ces conclusions contribuent à une meilleure compréhension des mécanismes sous-jacents au SPDC. La définition de sous catégories pourrait permettre d'orienter les futures recherches ainsi que les traitements de la maladie avec plus de précision.

Demented persons of the Alzheimer type, and to a lesser degree, persons suffering from major depression, experience a loss of autonomy in their activities of daily living (ADL). This loss of autonomy is often associated with a decrease in the initiation, organization and continuation of the activity. / The Psychogeriatric Basic ADL Scale developed for this study, was especially created for the aged experiencing a loss of autonomy as a consequence of problems other than motor and/or sensorial. It assesses the following activities: taking of a bath (or shower), dressing, grooming, continence and feeding, in relation to some higher cognitive functions. / In this study, the test-retest reliability and concurrent validity of the scale were evaluated using a sample of normal, depressed and demented subjects. The test-retest reliability was high (Spearman's rho = 0.98), and the concurrent validity of this scale with the Rapid Disability Rating Scale-2 was also high (Spearman's rho = 0.93). / These groups of subjects (15 normal, 15 with major depression, 15 demented subjects) were administered this scale and the results indicate that there is a significant difference in the global execution of basic activities in normal, persons with major depression and demented subjects.