Global Psychological Functioning Research Articles

Cognitive behavioural therapy including habit reversal training for treating dermatillomania in the context of anxiety and low mood

Abstract Dermatillomania is characterised by repetitive skin picking, resulting in tissue damage and significant distress and/or functional impairment. Cognitive behavioural therapy (CBT) is the recommended psychological intervention for dermatillomania in clinical guidelines, with the evidence base also supporting habit reversal training (HRT) as part of CBT. However, research evaluating CBT and HRT for dermatillomania remains scarce. This case study describes a young woman with dermatillomania, in the context of co-morbid anxiety and low mood, treated with 20 sessions of CBT including HRT in a community setting. Guided by her formulation, additional techniques such as those fostering self-compassion were also integrated, and sociocultural factors were adapted for. Improvements were reported in client-centred goals and outcomes of global psychological distress, functioning, anxiety and symptoms and psychosocial impacts of skin picking. The intervention was well received by the client. Limitations as well as clinical practice implications and research recommendations for dermatillomania are discussed. Key learning aims (1) To understand using CBT, including HRT, to treat a case of dermatillomania in the context of anxiety and depression. (2) To use a formulation-driven approach to guide the intervention. (3) To consider adapting interventions for sociocultural factors.

A - 119 A Case Study: the Cognitive Functioning of an Adult Patient with Recurrent Craniopharyngiomas.

Craniopharyngiomas are extremely rare (incidence rate of 1.34 per million). Due to its proximity to the sellar/suprasellar prefrontal regions region, cognitive impairment, behavioral changes, and adverse endocrinological outcomes are common. Further, surgery and radiotherapy can further impact functioning. Currently, there is no parsimonious cognitive profile of adult patients following interventions. This case highlights the role of neuropsychological evaluations in monitoring global psychological functioning and frontal behavioral syndrome in an adult with recurrent craniopharyngioma. The patient is a 39-year-old Black female first evaluated as an inpatient prior to resection surgery. She was evaluated on four additional times post-surgically. At the most recent evaluation, she and her family reported memory problems, apathy, and gait instability. Complicating factors included hypothyroidism, chronic kidney disease, diabetes, obstructive sleep apnea, pulmonary embolism, hypotension, COVID-19, and recurrent tachycardia, with inconsistent adherence to treatment recommendations. She displayed global cognitive deficits two years post-surgery, particularly in language and memory. Neurobehaviorally, she exhibited pervasive signs of severe frontal lobe syndrome, including, abulia, hypophonic and dysarthric speech, psychomotor retardation, bradyphrenia, and anosognosia. Neuropsychological evaluations remain critical in monitoring the patient's neurocognitive status and provide valuable insights into treatment planning and need for additional support and care to optimize patients' quality of life in the context of significant cognitive disability.

Posttraumatic stress-related psychological functioning in adult survivors of childhood cancer.

The majority of research examining posttraumatic stress symptoms/disorder (PTSS/PTSD) among adult survivors of childhood cancer has been oriented to cancer, assuming that cancer has been the most traumatic experience in their lives. Whether that assumption is valid, and how it might impact assessment of PTSS, is unknown. Survivors in the St. Jude Lifetime Cohort study completed an assessment of PTSS without cancer orientation, global psychological functioning, perceived stress, and cancer-related anxiety. Participants (n=2969; Mage=32.5±8.5years, 24.1years since diagnosis, 49.1% female) obtained a mean score on the PTSD Checklist of 27.7, which is comparable to a normative population. Using established cutoffs, 11.8% obtained scores in the at-risk range. Multivariable modeling indicated that psychological factors [global distress (p<0.0001), perceived stress (p=0.001), cancer-related anxiety (p<0.0001)] and demographic variables [female gender (p<0.0001), survivors with less than a college education (p=0.002)] were risk factors for increased PTSS. Only 14.5% identified a cancer-related traumatic event, and there was no difference in PTSS scores between those who identified cancer vs. non-cancer events as most stressful (28.4±12.6 vs. 28.5±12.7, p=0.93). One in eight adult long-term survivors of childhood cancer had PTSS above the cutoff, though subgroups (e.g., females and those with lower education) report more distress symptoms. Most adult survivors do not identify cancer as their most stressful event. Screening for distress in survivorship clinics should not assume that distress is directly related to the survivor's cancer experience.

The effect of animal-assisted therapy on emotional and behavioral symptoms in children and adolescents hospitalized for acute mental disorders

IntroductionAnimal-Assisted Therapy (AAT) may be useful therapeutically to improve patient outcomes. The objective of this study was to examine the effects of AAT on behavioral and emotional symptoms reported by children and adolescent psychiatric patients hospitalized for acute mental disorders. MethodsA pre-post experimental design, randomized controlled trial (RCT) was carried out. 20 patients provided with an AAT intervention were compared with 20 patients receiving standard therapeutic treatment. A Youth Self-Report (YSR) was used to measure patients’ emotional and behavioral symptoms. Global functioning was assessed by the Children Global Assessment Scale (C-GAS). ResultsResults indicated a significant decrease in internalizing symptoms (p<.001) and an increase in total competence (p<.001), as well significant improvements in global functioning (p<.0001) in the AAT treatment group, but not in the control group. ConclusionsThe effects of AAT in reducing emotional and behavioral symptoms and increasing global competence and psychological functioning were substantiated in this study. We have also found that for internalization symptoms, AAT could be the more effective.

Abord de la vie affective et sexuelle des déficients intellectuels

The sexual and emotional life of people with intellectual disability is linked to their personality, and inserted to their global psychological functioning. We have made a review of the literature on the subject, which focused on the social representations linked to the sexuality of the disabled, the way these persons perceived and lived their sexuality, and the sexual education that concerned them. The review included studies from 1980 to 2009. We have found that parents, educators and the community as a whole tend to recognize more and more the presence of a sexual and emotional life in the people with intellectual disability, which indicates a beginning of an evolution of the social representations concerning sexuality and intellectual disability. The question now is not weather people with intellectual deficiency have a sexual life or if they have the right to live it, but what are their specific needs in this field. All studies indicate the necessity of a sexual education to help these persons live better the expression of their sexuality.

From Symptom to Process: How the PDM Alters Goals and Strategies in Psychological Assessment

In many respects the Psychodynamic Diagnostic Manual (PDM) P and M Axes represent psychoanalytic versions of Diagnostic and Statistical Manual of Mental Disorders (DSM) Axes II and V: Whereas the DSM axes focus on surface behaviors and their associated mental states (e.g., thought patterns, affective responses), the PDM axes emphasize underlying psychodynamic processes (e.g., implicit motives, conflicts, defenses), with more modest attention to expressed behavior. The paradigmatic shift envisioned by the PDM creates tremendous opportunities for clinicians and researchers, and significant assessment challenges as well. This article discusses those opportunities and challenges. After briefly contrasting the DSM and PDM conceptualizations of personality pathology and global psychological functioning, I discuss the implications of these contrasting perspectives for diagnosis and psychological assessment, outline strategies for documenting the construct validity of DSM and PDM symptom criteria using symptom-focused and process-focused methods, and offer suggestions for how DSM symptom-focused data can be integrated with PDM process-focused data to facilitate case conceptualization and treatment planning.

First-year adaptation of female, expatriate religious and humanitarian aid workers: a mixed methods analysis

Previous research has demonstrated that international religious workers struggle more than other expatriate groups; our purpose was to investigate these differences. Data were from a larger project where 32 American female expatriate spouses were evaluated at three-month intervals during their first year of expatriation to a Middle Eastern country. Disaggregating the data allowed a comparison of worker outcomes (n = 5) to other expats (n = 25). Results indicated that worker marital satisfaction and global psychological functioning means were lower at most time-in-country intervals. Moreover, normative comparisons, a statistical procedure used to compare worker scores of global psychological functioning to a normative sample of chronically ill medical patients, indicated that worker scores were meaningfully lower at three- and nine-month intervals. In contrast, workers valued marital, parental, occupational, and homemaker life roles more than other expats. A consensual qualitative research analysis provides a longitudinal narrative unfolding of the first-year worker adaptation.

Effects of client bisexuality on clinical judgment: When is bias most likely to occur?

In this study, the authors investigated whether psychotherapist bias related to client bisexuality is most likely to occur with respect to judgments about stereotype-relevant clinical issues. Participants were 108 psychotherapists who read a fictitious intake report about a male client who was portrayed as heterosexual, gay, or bisexual. Client sexual orientation was behaviorally operationalized through reference to the sex of the client's present and previous romantic partners. Participants rated the case for the salience of a variety of clinical issues (some of which were related to bisexual stereotypes), global psychological functioning, and anticipated reactions to the client. Client sexual orientation had no effect for outcomes unrelated to bisexual stereotypes. In contrast, clinical issues related to bisexual stereotypes were rated as most salient to the case when the client was portrayed as bisexual rather than when the client was portrayed as heterosexual or gay. This effect remained significant even when participants' self-reported ability to avoid bias, self-presentational concerns, and response set related to perceptions of psychopathology were controlled for. Exploratory analyses suggested that this effect was partially mediated by stereotypes of bisexual men as confused and conflicted.

Cognitive-behavioral stress management interventions for persons living with HIV: a review and critique of the literature.

Psychological adjustment and coping are central to human immunodeficiency virus (HIV) management. To improve HIV-infected patients' ability to cope with stress, a variety of stress management interventions have been designed and evaluated. This paper provides a review and critique of the stress management literature, including a: (1) synthesis of core components of interventions for HIV-infected people, (2) summary of stress, coping, psychological, and health outcomes, and (3) methodological critique and guidance for future research. We reviewed 21 stress management interventions designed for HIV-infected individuals that included both cognitive and behavioral skills training. Most studies noted positive changes in perceived stress, depression, anxiety, global psychological functioning, social support, and quality of life. However, results were mixed for coping and health status outcomes, and a majority of studies employed only brief follow-up periods, focused on HIV-infected MSM, and did not address HIV-specific stressors. Stress management interventions for HIV-infected persons are a promising approach to facilitate positive adjustment. However, this literature is limited by measurement problems, research design features, a narrow focus on HIV-infected men who have sex with men, and feasibility concerns for intervention dissemination. Future stress management interventions should address these limitations and the unique psychosocial needs of HIV-infected patients using briefer, more cost-effective formats.

L’interféron β1-a IM ne modifie pas le fonctionnement psychologique global de patients atteints de sclérose en plaques rémittente pendant les premiers mois de traitement

Psychological troubles are common in multiple sclerosis but their underlying etiology is still controversial. The objective of this open, non comparative, multicenter study was to assess changes in global psychological functioning in new multiple sclerosis patients during the first 3 months of treatment with intramuscular interferon beta-1a once weekly (Avonex). This functioning was rated every 4 weeks with the GAF (Global Assessment Functioning) scale. Depression measured on MADRS (Montgomery & Asberg Depression Rating Scale), clinical global impression (CGI) on patients'psychological status and clinical as well as biological tolerance were also assessed every 4 weeks. Five hundred and ninety-nine patients (71.4 percent women), aged 39.4 years were included. No clinically significant difference in mean GAF score between baseline and the end of the first 3 months of interferon beta-1a IM treatment (main evaluation outcome) was found. Similar results were obtained on MADRS scale. No clinically significant alteration of global psychological functioning, including symptoms of depression, was observed during the first 3 months of treatment with interferon beta-1a IM.

Convergence of Sibling Risk Among Children of Parents with Serious Mental Disorders

We examined child psychiatric diagnoses, behavioral problems, overall symptom impairment, global psychological functioning, intellectual ability, and adaptive behavior in 83 sibling pairs whose mothers were diagnosed with a serious mental disorder. Sibling pairs were assessed for the extent to which they converged on the presence or absence of risk on each adverse outcome and then examined under conditions of high vs. low/moderate family stress. Consistent with the study hypotheses, we found that on each outcome assessed there was evidence for sibling convergence of risk. In addition, family stress was found to significantly moderate sibling risk convergence. The results are discussed in terms of their implications for understanding sibling convergence of risk in these families and for clinical and preventive intervention.

Cognitive-behavioural therapy in a hospital setting for children with severe emotional and/or behaviour disorders

This study examined the effectiveness of a cognitive-behavioural therapy programme for 13 children treated for severe emotional or behaviour disorders in a hospital setting. Data were obtained from multiple informants at pre-treatment, post-treatment, and three months follow-up. Results indicated statistically significant improvement in the children's global psychological functioning and reduction of maladaptive internalizing behaviours with maintenance at follow-up. The children reported statistically significant reduction in clinical maladjustment at discharge only. A positive trend toward healthier adaptive functioning was noted. Prognosis was poorer for children with comorbid diagnoses of internalizing and externalizing disorders. Clinical implications and directions for future research were discussed.

Latino sibling knowledge and adjustment to chronic disability.

Forty matched healthy Latino and non-Latino siblings (ages 8-14 years) of children with developmental and physical disabilities completed interviews and questionnaires assessing sibling knowledge of and adjustment to disability and sibling global psychological functioning. One-way analyses of variance revealed Latino siblings to have significantly less accurate information about the disability and more internalizing problems than non-Latino siblings. Sibling and parent wishes for the healthy sibling reflected cultural values. The results indicate that Latino siblings of children with chronic disabilities may be at risk for internalizing psychological problems. Future research regarding cultural factors affecting sibling adaptation to childhood disability is encouraged.

Cognitive-Behavioral Therapy for Depression in Adolescents With Inflammatory Bowel Disease: A Pilot Study

To evaluate the safety and feasibility of cognitive-behavioral therapy (CBT) for depression in physically ill adolescents. In an open trial, 11 adolescents (12-17 years) with inflammatory bowel disease and either major or minor depression underwent 12 sessions of a manual-based CBT enhanced by social skills, physical illness narrative, and family psychoeducation components. Standardized instruments assessed pre- to posttreatment changes in depression, physical health, global psychological functioning, and social functioning. Perceived helpfulness and satisfaction with CBT were assessed. There were significant reductions in DSM-IV depression diagnoses and depressive symptoms and improvements in global psychological and social functioning. Adolescents' perceptions of their general health and physical functioning improved, although illness severity measures were unchanged. High subject satisfaction and helpfulness ratings for CBT were found along with no adverse events and high subject adherence. A manual-based CBT approach adapted to treat depression in physically ill adolescents appears to be a safe, feasible, and promising intervention.

Development of body image, eating disturbance, and general psychological functioning in adolescent females: a replication using covariance structure modeling in an Australian sample.

The current study is a follow up to a covariance structure modeling (CSM) investigation of predictors of body image, eating dysfunction, and general psychological functioning in U.S. adolescent females. Four hundred and seventy Australian girls (13-17 years old) completed measures of teasing history, body dissatisfaction, global psychological functioning, dietary restraint, and bulimic behaviors. They were also measured in order to compute body mass index (BMI). CSM techniques were used to analyze the relationships between these latent variables. Two a priori models were tested, one was selected, and post-hoc model-fitting was undertaken. The final model indicated that BMI directly influenced teasing, which directly influenced body dissatisfaction. Body dissatisfaction influenced both global psychological functioning and restriction, whereas restriction had a direct influence on bulimia. Global psychological functioning also had a direct influence on bulimia. The results support previous research indicating that teasing and body dissatisfaction are risk factors for the development of eating disturbances.

A standardized and reliable method to apply the Global Assessment of Functioning (GAF) scale to psychiatric case records

AbstractThe Global Assessment of Functioning (GAF) scale is widely used both in routine clinical practice and in research. However, its reliability has never been assessed when used to rate information in clinical records. The present study focuses on the development of a standardized method (an ongoing modelling process between raters) for establishing desired levels of inter‐rater reliability (IRR) in the application of the GAF to psychiatric case records. Fifty‐one patients at first‐ever contact with mental health services were included in the study. They were selected from a total sample of 662 first‐ever patients by using a systematic sampling. Three raters (resident psychiatrists at their third year of training) took part in a 12‐hour training programme, during which they were asked to assess the global psychological functioning of patients, taking into account information recorded in case records. The extent of agreement between raters was estimated by applying the ‘limits of agreement’ method and the ‘concordance correlation coefficient’. The training programme proved to be feasible, easy to administer and acceptable to psychiatrists in training with limited previous experience of using rating scales. Very high levels of concordance (all greater than 0.95) emerged between the three raters. The GAF, completed using information from case records included in the initial assessment form, appeared to be a reliable instrument, even when used by clinical psychiatrists in training. Copyright © 2000 Whurr Publishers Ltd.

Body image, social comparison, and eating disturbance: A covariance structure modeling investigation

Objective To evaluate the role of appearance-based social comparison processes as a possible mediational link between developmental factors (negative social feedback, i.e., teasing about appearance; biological status, i.e.,early physical maturation) and levels of body dissatisfaction, eating disturbance, and global psychological functioning. Method In this study of 173 female undergraduates, covariance structure modeling (CSM) was used to examine direct and mediational relationships among these variables. Results Appearance-based social comparison mediated the effect of appearance-related teasing on body image and eating disturbance; body image mediated the effect of teasing on eating disturbance; eating disturbance had a direct effect on overall psychological functioning. Discussion Implications for devising and testing other theoretical models are discussed. © 1999 John Wiley & Sons, Inc. Int J Eat Disord 26: 43–51, 1999.

Development of body image, eating disturbance, and general psychological functioning in female adolescents: Covariance structure modeling and longitudinal investigations

Covariance structure modeling (CSM) and longitudinal analyses were used to identify a possible causal sequence for factors that might lead to the development of body image and eating disturbance in adolescent females. In Study 1, subjects were measured for level of obesity, perceived weight status, maturational timing, history of being teased about weight/size, body image, eating disturbance, and global psychological functioning. Study 2 was a systematic replication of Study 1 using different indices of body image and a more comprehensive assessment of eating disturbance. In Study 3, subjects from Study 1 were reassessed at a 3-year follow-up. The findings from Study 1 indicated that level of obesity and perceived weight, but not maturational timing, had a directional influence on the other variables. In addition, teasing history was significantly related to the development of body image and eating disturbance. CSM and path analyses with Studies 2 and 3 data generally replicated and extended the results from Study 1. These findings offer important insights into possible causal sequences for the development of body image and eating disturbance.

The feedback on physical appearance scale (FOPAS): Questionnaire development and psychometric evaluation

Abstract The development and initial validation of a measure designed to assess physical appearance-related verbal and nonverbal external feedback are described. The factor structure of the Feedback on Physical Appearance Scale (FOPAS) was replicable across two samples that completed the measure based on different instructional protocols. Reliability and convergence with measures of body image, eating disturbance, and global psychological functioning were acceptable. The results are discussed with regard to the potential importance of appearance-related feedback as a factor in the development and maintenance of body image and eating disturbance.

Multidimensional determinants of psychological adjustment to cancer

AbstractThis study examined the relationship between psychological adjustment and illness‐related, demographic, intrapersonal, family and socio‐ecological variables. A total of 132 men and women receiving active cancer treatment completed a battery of instruments designed to measure global psychological functioning, depression, anxiety, coping strategies, domestic and extended family relations, social support quantity and perceived quality, and satisfaction with the health care system. Results revealed that the majority of subjects were experiencing little or no psychological distress; however, 30–35% reported experiencing clinically significant levels of depression, anxiety or global adjustment difficulties. Results further revealed that coping strategies characterized by avoidance or acceptance‐resignation, family disturbance and quantity and perceived quality of social support distinguished good versus poor adjustment and were most predictive of psychological distress in this sample.