Higher Levels Of General Distress Research Articles

The critical role of affect regulation accounting for increased general distress, risk to self, and lower quality of life in females with EUPD and CPTSD, compared to EUPD alone

BackgroundComplex Post-Traumatic Stress Disorder (CPTSD) and Emotionally Unstable Personality Disorder (EUPD) have shared aetiology and symptomatology, and are associated with multiple comorbidities and poor clinical outcomes. Evidence from studies with clinical populations indicates high levels of morbidity between the two diagnoses. Yet, the cumulative impact of coexisting CPTSD and EUPD diagnoses on levels of general distress, risk, quality of life and resulting treatment needs have not been explored. Accordingly, our understanding of the impact of experiencing both disorders and the relationship between coexisting trauma responses, and associated treatment needs remains limited. MethodologyUsing a convenience sample of 47 women admitted to a specialised DBT inpatient service, associations between general distress, risk, quality of life and diagnostic status were explored. ResultsWomen with comorbid EUPD and CPTSD reported significantly higher levels of general distress and risk to self, and significantly lower quality of life compared to women with EUPD alone. Hierarchical regression analyses revealed that, when exploring the isolated effect of each symptom cluster, only affective dysregulation remained a significant predictor of distress, risk to self, and quality of life (all p < .05). ConclusionsAlthough our results require further replication, the current study indicates that the experience of comorbid EUPD and CPTSD is impactful. Affect regulation may play a critical role in explaining comorbidity between EUPD and CPTSD. Accordingly, the current findings offer novel insights into the relationship between the two diagnoses, with clinical and theoretical consequences explored.

Prevalence and nature of multi-sensory and multi-modal hallucinations in people with first episode psychosis

Hallucinations can occur in single or multiple sensory modalities. This study explored how common these experiences were in people with first episode of psychosis (n = 82). Particular attention was paid to the number of modalities reported and whether the experiences were seen to be linked temporally and thematically. It was predicted that those people reporting a greater number of hallucinations would report more delusional ideation, greater levels of distress generally and lower functioning. All participants reported hallucinations in the auditory domain, given the nature of the recruitment. The participants also reported a range of other unusual sensory experiences, with visual and tactile hallucinations being reported by over half. Moreover, single sensory experiences or unimodal hallucinations were less common than two or more hallucination modalities which was reported by 78% of the participants. The number of hallucinations was significantly associated with greater delusional ideation and higher levels of general distress, but not with reduced functioning. It is clear there is a need to refine psychological treatments so that they are better matched to the actual experiences reported by people with psychosis. Theoretical implications are also considered.

Support for the predictive validity of the multifactor offender readiness model (MORM): forensic patients' readiness and engagement with therapeutic groups.

Treatment non-engagement in forensic health settings has ethical and economic implications. The multifactor offender readiness model (MORM) provides a framework for assessing treatment readiness across person, programme and contexts. To answer the following question: Are the internal factors of the MORM associated with likelihood of engagement in groups by patients in forensic mental health services? In a retrospective design, associations were investigated between internal factors of the MORM, measured as part of assessment for group participation, and the outcomes of treatment refusal, treatment dropout and treatment completion. One hundred and eighteen male patients in a high security hospital consecutively referred for group treatment agreed to participate. Internal factors of the MORM associated with treatment refusals included: psychopathic cognition, negative self-evaluation/affect and effective goal-seeking strategies. Those associated with dropouts included emotional dysregulation, low competencies to engage and low levels of general distress. MORM factors associated with completion included: low motivation, ineffective goal-seeking strategies, absence of psychopathic cognition, high levels of general distress and competency to engage. Internal factors of the MORM could be useful contributors to decisions about treatment readiness for hospitalised male offender-patients. Up to one in three programmes offered were refused, so clinical use of the MORM to aid referral decisions could optimise the most constructive use of resources for every individual. Copyright © 2016 John Wiley & Sons, Ltd.

Coping as a predictor of burnout and general health in therapists working in ABA schools

Background: Little is known about the work-related well-being of applied behaviour analysis (ABA) therapists who work in school-based contexts and deliver ABA interventions to children with autism. Methods: A questionnaire on work-related stress (burnout), general distress, perceived supervisor support and coping was completed by 45 ABA therapists across six schools in the UK. Results: Around 42% of ABA therapists reported low levels of personal accomplishment at work, 13% reported high levels of emotional exhaustion and 40% met criteria for experiencing high levels of general distress. Wishful thinking coping was predictive of higher emotional exhaustion burnout and depersonalisation, and lower personal accomplishment. Conclusions: Given that a wishful thinking approach to coping may contribute to experiencing stress at work, it is important to consider support interventions for ABA therapists that may enhance their well-being. Mindfulness and acceptance-based strategies in particular may be relevant to the support of ABA therapist well-being.

The relationship between child physical abuse and victimization in dating relationships: The role of experiential avoidance.

Research has demonstrated a relationship between childhood physical abuse and subsequent victimization in dating relationships. However a prior history of abuse does not necessarily result in revictimization and knowledge regarding the mechanisms that increase vulnerability for victimization in the form of dating violence is limited. The current study examined the relationship between child physical abuse, dating violence, general distress, and experiential avoidance, in an undergraduate student sample of 314 women. Physical abuse in childhood was associated with significantly higher rates of victimization in dating relationships, and experiential avoidance mediated the relationship between child physical abuse and revictimization. Higher levels of general distress was associated with cumulative experiences of child physical abuse and dating violence, compared with child physical abuse without dating violence. The current findings suggest that revictimization in the form of dating violence may be linked to exacerbated distress in women who are physically abused as children and that prevention and treatment programs on college campuses may benefit from targeting experiential avoidance with survivors of interpersonal trauma.

Do patients trust their physician? The role of attachment style in the patient-physician relationship within one year after a cancer diagnosis

Background. The degree of trust in and satisfaction with the physician has been shown to have important implications for treatment outcomes. This study aims to examine individual differences in patients’ trust, satisfaction and general distress from an attachment theoretical perspective. Material and methods. One hundred and thirty recently diagnosed cancer patients of three medical hospitals were extensively interviewed by trained psychologists to assess attachment style. Patients completed standardized questionnaires three and nine months after diagnosis to assess trust, satisfaction and distress. t-tests and repeated measures ANOVAs were used to examine differences between securely and insecurely attached patients and changes over time. A mediation model based on a bootstrapping method was used to examine whether trust mediated between attachment and satisfaction, and attachment and distress. Results. Insecurely attached patients (N = 45, 35%) reported less trust in and satisfaction with their physician, and reported more general distress than securely attached patients three and nine months after diagnosis (p < 0.05). Trust and distress levels did not change over time. Trust mediated between attachment and satisfaction, but not between attachment and distress. Conclusion. Insecurely attached patients trusted their physician less than securely attached patients, and in turn were less satisfied with their physician. Their higher levels of general distress were not related to their lower levels of trust. Attachment theory provides a framework to interpret differences in patients’ trust, satisfaction and distress, and may help physicians respond in such a way that their patients feel secure, which in turn is expected to result in better health outcomes.

Psychological distress in newly diagnosed colorectal cancer patients following microsatellite instability testing for Lynch syndrome on the pathologist’s initiative

According to the Dutch Guideline on Hereditary Colorectal Cancer published in 2008, patients with recently diagnosed colorectal cancer (CRC) should undergo microsatellite instability (MSI) testing by a pathologist immediately after tumour resection if they are younger than 50 years, or if a second CRC has been diagnosed before the age of 70 years, owing to the high risk of Lynch syndrome (MIPA). The aim of the present MIPAPS study was to investigate general distress and cancer-specific distress following MSI testing. From March 2007 to September 2009, 400 patients who had been tested for MSI after newly diagnosed CRC were recruited from 30 Dutch hospitals. Levels of general distress (SCL-90) and cancer-specific distress (IES) were assessed immediately after MSI result disclosure (T1) and 6 months later (T2). Response rates were 23/77 (30%) in the MSI-positive patients and 58/323 (18%) in the MSI-negative patients. Levels of general distress and cancer-specific distress were moderate. In the MSI-positive group, 27% of the patients had high general distress at T1 versus 18% at T2 (p = 0.5), whereas in the MSI-negative group, these percentage were 14 and 18% (p = 0.6), respectively. At T1 and T2, cancer-specific distress rates in the MSI-positive group and MSI-negative group were 39 versus 27% (p = 0.3) and 38 versus 36% (p = 1.0), respectively. High levels of general distress were correlated with female gender, low social support and high perceived cancer risk. Moderate levels of distress were observed after MSI testing, similar to those found in other patients diagnosed with CRC. Immediately after result disclosure, high cancer-specific distress was observed in 40% of the MSI-positive patients.

Differential Treatment Response for Eating Disordered Patients With and Without a Comorbid Borderline Personality Diagnosis Using a Dialectical Behavior Therapy (DBT)-Informed Approach

Studies have reported conflicting findings regarding the impact on treatment for eating disorder patients comorbidly diagnosed with borderline personality disorder. The current investigation sought to investigate whether individuals diagnosed with an eating disorder vs. those comorbidly diagnosed with an eating disorder and borderline personality disorder differ on measures of eating disorders symptoms and/or general distress over the course of treatment. In light of the success of DBT in treating individuals diagnosed with borderline personality disorder, a group known to have considerable difficulties in regulating affect, the current study also sought to examine whether these two groups would differ on expectancies to regulate affect over the course of DBT-informed treatment. Results indicated that while a comorbid diagnosis of borderline personality disorder did not impact eating disorder treatment outcomes, those comorbidly diagnosed did present overall with higher levels of general distress and psychological disturbance. With respect to affect regulation, results indicated that at the beginning of treatment, eating disordered individuals who carried a comorbid diagnosis of BPD were significantly less able to regulate affect than patients without a comorbid borderline diagnosis. However, at the end of treatment there was no statistically significant difference between the two groups. The role of affect regulation in treating eating disordered individuals with a comorbid borderline personality disorder diagnosis is discussed.

How Do Job Stress and Ergonomic Factors Impact Clinic Visits in Acute Low Back Pain? A Prospective Study

We sought to identify whether ergonomic factors, job stress, health behavior, and emotional distress are prospectively related to return visits for acute back pain. A total of 368 U.S. Army soldiers completed a baseline survey of health and work factors at their first visit for back pain. Multivariable regression and structural equation modeling were used to describe the relationships among ergonomic exposure, job stress, smoking, and emotional distress and their ability to predict repeat clinic visits. The path analysis indicated that higher levels of ergonomic exposures were directly related to increased job stress (beta = 0.29). Higher levels of job stress were directly related to higher levels of general distress (beta = -35). General distress (beta = -0.70) and smoking (beta = 0.67) were directly linked to clinic visits. Efforts to directly impact emotional distress or indirectly reduce distress by intervening at the levels of ergonomic risks and psychosocial workplace stress should prove useful in the management of acute low back pain.

Maternal Stress in Nonverbal Learning Disorder

Maternal stress was assessed in mothers of children ages 8 to 11 years with learning disorders (LD). Age-, gender-, and IQ-matched children with reading disorders (RD; n = 31), children with nonverbal learning disorders (NVLD; n = 21), and typically developing control participants (n = 23) participated. Mothers of children with LD reported higher levels of stress, although the specific nature of the stress appeared to vary by disorder subtype: Mothers of children with RD reported higher levels of general distress, whereas mothers of children with NVLD reported higher levels of dysfunctional interactions with their child. The severity of the LD was strongly associated with maternal stress in the sample of children with NVLD but not in the sample of children with RD. In the sample of children with NVLD, the best predictors of maternal stress were 2 variables associated with the child: The lower the child's Performance IQ, the higher the level of maternal stress. Furthermore, the level of the child's internalizing symptoms was also a strong predictor of maternal stress in the sample of children with NVLD. In our sample of children with RD, the 3 best predictors were all variables associated with the mother, including her age, her level of reported psychiatric symptoms, and her overall level of social support.

Symptom correlates of posttraumatic stress disorder in clients with borderline personality disorder

Limited research has examined the clinical and functional impact of concurrent posttraumatic stress disorder (PTSD) in people with borderline personality disorder (BPD). Such information is particularly lacking for BPD clients with the most disabling symptoms: those who meet criteria for severe and persistent mental illness. We evaluated individuals with severe mental illness to assess whether PTSD in individuals with BPD was associated with more severe symptoms and impaired functioning than BPD alone and replicated these findings in an independent sample. In both the studies, the clients with PTSD and BPD reported significantly higher levels of general distress, physical illness, anxiety, and depression than those with BPD alone. Because individuals with both of these disorders are likely to require more intensive clinical services to reduce distress and improve functioning, work is needed to develop and evaluate interventions designed to address these comorbid conditions.

Impairment and distress associated with relationship discord in a national sample of married or cohabiting adults.

The clinical importance of relationship discord was examined through evaluating the association between relationship discord and multiple measures of impairment and psychological distress in a population-based sample of married and cohabiting adults (N=2,677). In comparison to people that were not in discordant relationships, individuals in discordant relationships reported greater social role impairment with relatives and friends and greater work role impairment. They also reported higher levels of general distress and poorer perceived health and were more likely to report suicide ideation. With the exception of suicide ideation, the associations between relationship discord and impairment and psychological distress remained significant when controlling for current mood, anxiety, and substance use disorders, suggesting that relationship discord is incrementally related to impairment and psychological distress over and above the effects of psychiatric disorders.

Self-Reported Body-Rocking and Other Habits in College Students

A brief survey of eight motor habits, including body-rocking, was administered to two large samples of college undergraduates. A subsample was retested to establish survey reliability and validity. Those indicating engagement in body-rocking were interviewed about their body-rocking. Two psychopathology instruments were administered. The general prevalence of self-described body-rocking was higher than expected, and there were positive correlations among the eight habits. Body-rocking was usually related to negative affect and usually reported to begin during the school years and later. Many individuals said other family members engaged in body-rocking. Psychopathology assessments indicated higher levels of general distress and higher prevalence of Generalized Anxiety Disorder in this subsample compared with a group not reporting body-rocking.

Psychological Impact of Wife Abuse

The present study explored the impact of wife abuse on the general and psychological well-being of Chinese women and their children in Hong Kong. Results indicated that both verbal and physical wife abuse were related to negative effects of the women and their children. Husbands' abusive behavior toward their wives and children was associated with children's aggressive behavior. Comparisons among the shelter, discordant, and intact groups showed that women of the shelter group experienced the most abuse by their husbands and were the most depressed and anxious. Women of the shelter and discordant groups experienced higher levels of general distress than did the intact group. Compared to children of the discordant and intact groups, children of the shelter group witnessed more interparental violence and experienced more abuse by their fathers. Limitations and research implications of the study also are discussed.