By 2020 depression is predicted to be the second most frequent cause of disability worldwide. Research suggests that existing methods of treatment are ineffective for many resulting in a large number of chronic, treatment resistant courses (termed refractory depression [RD]). Further evidence suggests that up to 60% of individuals with RD have a co-morbid Personality Disorder (PD), namely Clusters A and C. As such, it has been proposed that individuals with RD fail to respond to existing treatment interventions because these treatments fail to address maladaptive personality styles (i.e., overcontrol tendencies) that may complicate treatment. This project aimed to test this novel assertion by examining whether individuals with RD exhibit higher levels of overcontrol (e.g., skills deficits in the expression and experience of emotion, in forming close relationships and in receptivity and openness) compared to individuals with current, but not chronic, depression and a normal control group. A total of 180 individuals were recruited and based on eligibility criteria were allocated to the following groups: RD, n = 56; acute, non-chronically depressed (ANCD), n = 61; normal control (NC), n = 63. Participants completed a series of self-report questionnaires and as a whole, between group analyses supported study predictions; individuals with RD displayed significantly higher levels of overcontrol compared to both the ANCD and NC groups. More specifically, individuals with RD demonstrated significantly more difficulties with interpersonal relationships and expressing emotions, a significantly greater need for structure and significantly higher levels of maladaptive perfectionism compared to controls. This study forms part of a large multi-centre randomised controlled trial (RCT; REFRAMED) that is designed to study the efficacy of a novel treatment intervention - Radically Open-Dialectical Behaviour Therapy – for individuals with RD.

Abstract This study seeks to explore mental representations of caregiving, an area of attachment that has been the subject of relatively little research. The Caregiving Styles Questionnaire (CSQ) was developed as a cost effective and efficient alternative to lengthier caregiving interviews, and this study examines its internal and external validity. An initial item critique was used to examine underlying constructs of the measure. Exploratory factor analysis revealed a three factor structure, which was replicated in a subsequent EFA using a data set that differed primarily in the age of the target child. The three factors included (1) Relationship uncertainty, (2) Needy uncertainty, and (3) Rejecting representations of caregiving. Each of these scales had high reliability, and the results reflected existing caregiving representations that have been theorized in previous studies. These findings, particularly the generalizability of the measure across age groups, indicate that it would be worthwhile to continue refining the CSQ items in order to provide a valid measure of an understudied behavioral system.

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The current study examined experiential avoidance (EA) as an explanation for parental overprotectiveness, a behavior often found among parents of anxious children. EA parenting theory posits that parents engage in overprotective behaviors in order to reduce their own anxiety. In order to test the theory, mothers’ electrodermal activity (EDA) and blindly-coded overprotective behaviors were examined when a child with SAD was engaged in a reading performance task. In line with EA theory, it was hypothesized that EDA levels would increase before an overprotective behavior (OB) occurred and decrease afterwards as a result of decrease in anxiety. The sample consisted of mothers with a child diagnosed with SAD (n=5) and mothers with a child with no diagnoses (n=5). Each mother-child dyad participated in an ABAB design protocol consisting of a baseline period, two 10-minute reading tasks, and a recovery period between the two tasks. Although mothers of both groups displayed OBs, mothers of children with SAD displayed OBs more often. In addition, mothers of children with SAD displayed more promotion of avoidance while mothers of normal control children displayed higher frequencies of control over the reading task. The EDA activity that surrounded the first occurrence of any coded OB was examined. Contrary to the hypothesis, all mothers (regardless of child’s anxiety status) displayed similar trends in their EDA data, with levels increasing but then decreasing shortly before an OB behavior occurred, rather than afterwards. However, one mother with an elevated social anxiety score revealed an EDA pattern similar to what was hypothesized. Possible explanations for these alternate findings are discussed and include a multidisciplinary conceptualization. The study’s findings hold theoretical and practical implications, particularly for parent training in the treatment of childhood anxiety disorders. Limitations such as small sample size and directions for future research are discussed.

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