Showing papers in "British Journal of Clinical Psychology in 2004"

The positive and negative affect schedule (PANAS): construct validity, measurement properties and normative data in a large non-clinical sample.

Abstract: Objectives: To evaluate the reliability and validity of the PANAS (Watson, Clark, & Tellegen, 1988b) and provide normative data. Design: Cross-sectional and correlational. Method: The PANAS was administered to a non-clinical sample, broadly representative of the general adult UK population (N = 1,003). Competing models of the latent structure of the PANAS were evaluated using confirmatory factor analysis. Regression and correlational analysis were used to determine the influence of demographic variables on PANAS scores as well as the relationship between the PANAS with measures of depression and anxiety (the HADS and the DASS). Results: The best-fitting model (robust comparative fit index = .94) of the latent structure of the PANAS consisted of two correlated factors corresponding to the PA and NA scales, and permitted correlated error between items drawn from the same mood subcategories (Zevon & Tellegen, 1982). Demographic variables had only very modest influences on PANAS scores and the PANAS exhibited measurement invariance across demographic subgroups. The reliability of the PANAS was high, and the pattern of relationships between the PANAS and the DASS and HADS were consistent with tripartite theory. Conclusion: The PANAS is a reliable and valid measure of the constructs it was intended to assess, although the hypothesis of complete independence between PA and NA must be rejected. The utility of this measure is enhanced by the provision of large-scale normative data.

Criticizing and reassuring oneself: An exploration of forms, styles and reasons in female students.

Abstract: Objectives. Self-critical people, compared with those who self-reassure, are at increased risk of psychopathology. However, there has been little work on the different forms and functions of these self-experiences. This study developed two selfreport scales to measure forms and functions of self-criticism and self-reassurance and explore their relationship to depression. Methods. A self-report scale measuring forms of self-criticism and self-reassuring, and a scale measuring possible functions of self-criticism, together with a measure of depression and another self-criticism scale (LOSC), were given to 246 female students. Results. Self-criticizing vs. self-reassuring separated into two components. Forms of self-criticizing separated into two components related to: being self-critical, dwelling on mistakes and sense of inadequacy; and a second component of wanting to hurt the self and feeling self-disgust/hate. The reasons/functions for self-criticism separated into two components. One was related to desires to try to self-improve (called self-improving/ correction), and the other to take revenge on, harm or hurt the self for failures (called self-harming/persecuting). Mediation analysis suggested that wanting to harm the self may be particularly pathogenic and is positively mediated by the effects of hating the self and negatively mediated by being able to self-reassure and focus on one’ s positives. Conclusions . Self-criticism is not a single process but has different forms, functions, and underpinning emotions. This indicates a need for more detailed research into the variations of self-criticism and the mechanisms for developing self-reassurance.

Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders.

Abstract: Purpose. To review the effectiveness of cognitive behaviour therapy (CBT) as a treatment for anxiety disorders of childhood and adolescence. Method. Studies were included if they treated young people (under 19 yrs) with diagnosed anxiety disorder (excluding trials solely treating phobia, PTSD or OCD), had a no-treatment control group, and used diagnosis as an outcome variable. A search of the literature, incorporating electronic databases, hand search and expert consultation, yielded 10 randomized controlled trials that were appropriate for inclusion. Results. The outcome of interest was remission. of anxiety disorder. Employing conservative criteria, the remission rate in the CBT groups (56.5%) was higher than that in the control groups (34.8%). The pooled odds ratio was 3.3 (Cl = 1.9-5.6), suggesting that CBT has a significant effect. Conclusions. CBT is useful for the treatment of anxiety in children over the age of 6 years. However, we still know little about the treatment of younger children or about the comparative efficacy of alternative treatments. Most of the trials were efficacy trials, and have limited generalizability. Reporting of many aspects of the trials was weak.

The role of body objectification in disordered eating and depressed mood

Abstract: Objectives: The study aimed to extend tests of objectification theory into the realm of depression. The theory's applicability to men was also investigated. Design: A cross-sectional study. Method: A sample of 115 men and 171 women completed questionnaire measures of self-objectification, depressed mood, disordered eating, as well as the proposed mediating variables of body shame, appearance anxiety, flow and awareness of internal states. Results: For women, it was found that depressed mood and disordered eating were both predicted by self-objectification and its corollary of habitual self-surveillance. Path analysis gave strong support to the mediational relationships of the theoretical model. With one major exception (the role of self-objectification), the pattern of relationships was similar for men. Conclusion: Objectification theory provides a useful framework for identifying predictors of depressed mood.

The self‐report version of the Strengths and Difficulties Questionnaire: Its psychometric properties in 8‐ to 13‐year‐old non‐clinical children

Abstract: Objective: To examine the reliability and validity of the self-report version of the Strengths and Difficulties Questionnaire (SDQ) in relatively young children. Method: The SDQ was administered to a large sample of non-clinical children (n = 1111) aged 8–13 years. In a subsample (n = 439), self-report SDQ scores of children with and without behaviour problems were compared, and related to the teacher version of the SDQ, the Youth Self-Report and the Teacher Report Form. Results: Although the reliability of the self-report SDQ was somewhat less satisfactory in the younger children of our sample, most other psychometric properties were acceptable and comparable to those obtained in older youths. Conclusion: While the self-report SDQ was designed for youths aged 11 years and above, the current data seem to suggest that the scale may provide useful information about psychopathological symptoms in children as young as 8 years old.

A cognitive model of bulimia nervosa

Abstract: This paper describes a new cognitive model of bulimia nervosa. It provides a detailed account of the development of the disorder and explains, in detail and encompassing cognition, behaviour, emotion, and physiology, how binge eating is maintained. Relevant maintaining factors include positive beliefs about eating, negative beliefs about weight and shape, permissive thoughts, and thoughts of no control. Relevant developmental factors include negative early experiences, negative self-beliefs, schema compensation processes, and different types of underlying assumption. Recent empirical findings on which the new model is based, and which support the model, are described. Existing observations and findings are also presented, and their consistency with the new model is confirmed. Novel features of the model are highlighted, and phenomena unexplained by existing cognitive models of bulimia nervosa, including treatment failure and relatively poor outcome following treatment with cognitive therapy, are assessed in the light of the new model. The relationship to recent findings on the role of dieting in bulimia nervosa and to developments in the understanding or normal eating is considered. Implications for basic and treatment-related research are then discussed. Finally, the clinical implications of the new model, including the use of schema-focused techniques, are briefly discussed.

Rumination and future thinking in depression

Abstract: Objectives. Future thinking is an important domain of cognitive functioning, with reduced ability to imagine positive future events associated with hopelessness in depression and parasuicide. Rumination has been shown to exacerbate negative cognitive biases in depression, and to reduce likelihood estimations for positive future events. We examine the hypothesis that, in depressed patients, rumination would reduce the ability to imagine positive future events, whilst increasing the ability to imagine negative future events. Method. The ability to imagine positive and negative future events was assessed using the future thinking paradigm (MacLeod, Rose, & Williams, 1993). Depressed and nondepressed participants completed the future thinking task after being randomly allocated to either a rumination or distraction manipulation (Nolen-Hoeksema & Morrow, 1993). Mood was measured before and after the manipulation. Participants also completed a standard verbal fluency task. Results. In the depressed group, compared to distraction, rumination increased both negative and positive future thinking, although the effect was only significant for negative future thinking once baseline levels of hopelessness were controlled for. These findings are consistent with the prediction that rumination would increase negative future thinking, but inconsistent with the prediction that rumination would reduce positive future thinking. Previous findings that, compared to controls, depressed patients generated fewer positive future events were replicated. Conclusion. Ruminative self-focus leads to greater negative future thinking in depressed patients, further confirming that rumination exacerbates negative cognitive biases in depression. The relationship between rumination and positive future thinking was unexpected, but might potentially reflect a general priming of self-related information by rumination.

Awareness in early-stage Alzheimer's disease: a review of methods and evidence.

Abstract: Purpose: This review has three main aims: (1) To illustrate the strengths and limitations of current approaches to assessing awareness of difficulties and impairments in people with early-stage Alzheimer's disease (AD). (2) To consider the evidence regarding factors associated with level of awareness. (3) To highlight the implications for assessment and intervention. Methods: A comprehensive range of literature on awareness in AD published in the past 20 years is critically reviewed. Results: Four main approaches to the assessment of awareness can be discerned, each with significant conceptual and methodological limitations. These limitations affect the quality of the available evidence regarding factors associated with level of awareness, which is contradictory, with few clear findings emerging. Awareness does, however, appear to be related to the outcome of rehabilitation, and this has important implications for the selection of appropriate and sensitive interventions. Conclusions: The review highlights the need for a broad conceptualization of awareness. Greater clarity about theoretical frameworks, and improved assessment methods, are required in order to enhance understanding of variations in awareness in early-stage AD. Awareness is an important variable for clinicians to consider.

The construction of awareness in early-stage Alzheimer's disease: a review of concepts and models.

Abstract: Objectives: This review considers the concepts and models that, often implicitly, underlie accounts and studies of variations in awareness of difficulties in people with early-stage Alzheimer's disease (AD). In order to do this, it is necessary to draw on explanations presented within the discourses of different disciplines. The review aims to explore the key tensions and debates that arise in attempting to conceptualize awareness, and attempts to specify what kind of conceptual framework is needed in order to advance our understanding of variations in awareness in AD. Methods: A range of literature relating to concepts and models of awareness, drawn from different disciplines and published during the past 30 years, is critically reviewed. Results: The literatures of different disciplines present varying constructions of the concept of awareness. Neuropsychological, psychiatric and psychosocial explanations are considered and their relevance to understanding awareness in early-stage AD is discussed. Conclusions: An understanding of variations in awareness in early-stage AD requires a biopsychosocial model of awareness that incorporates the influence of both neuropsychological impairments and psychosocial responses. Improved understanding of variations in awareness is essential for the development of person-centred approaches to intervention and care in AD.

The effects of emotional salience, cognitive effort and meta-cognitive beliefs on a reality monitoring task in hallucination-prone subjects

Abstract: Objectives: A tendency to externalize internal information on reality monitoring tasks has been documented in psychiatric patients with hallucinations. Furthermore, previous studies suggest that factors such as the emotional salience of the material, cognitive effort and meta-cognitive beliefs are important contributory factors in this tendency to externalize internal information on reality monitoring tasks. However, few studies have investigated these aspects in hallucination-prone subjects. Also, these factors have never been examined simultaneously. In the following study we wished to examine the effects of emotional salience, cognitive effort and meta-cognitive beliefs on reality monitoring functioning in hallucination-prone subjects. Design: Between-participants group design. Method: One hundred normal subjects were administered a reality monitoring task. Words were presented by the experimenter. After each word, subjects were asked to say the first word that came to their mind. Words varied in terms of emotional valence and cognitive effort (high cognitive effort for words requiring longer latency times to associate a word and vice versa). Following a delay, words were presented consisting of those already presented by the experimenter or the subject (old) and those never presented before (new). For each word, subjects were required to identify whether the word was old or new. If the word was identified as old, subjects were required to identify the source of the word (subject or experimenter). Subjects also completed a questionnaire assessing meta-cognitive beliefs. Results: Subjects were grouped according to their scores on a revised and elaborated version of the Launay-Slade Hallucinations Scale (LSHS). Those with scores within the top 25% were included in the hallucination-prone group (HP) (N = 25), whereas scores within the lower 25% were included in the non-hallucination-prone group (NHP) (N = 25). Results showed that the HP subjects had significantly more source discrimination errors than NHP subjects for self-generated items. In other words, HP subjects tended to misattribute to the experimenter items that they had produced themselves. This pattern was especially marked with emotionally charged material and with words that required more cognitive effort. In addition, HP subjects scored significantly higher on a scale assessing meta-cognitive beliefs compared with NHP subjects. Finally, scores on a scale assessing meta-cognitive beliefs were positively associated with source discrimination errors. Conclusions: These results suggest that cognitive effort, emotional salience and meta-cognitive beliefs all play a prominent role in the externalizing bias in hallucination-prone subjects. The results also provide evidence for the validity of the idea of a continuity between hallucination-prone subjects and psychotic patients with hallucinations on reality monitoring tasks, including a number of contributing factors in the occurrence of hallucinations.

Illness representations in depression.

Abstract: Background and objectives. Illness representations in physical health problems have been studied extensively using the Self-regulation Model (SRM) focusing on five dimensions of illness beliefs (identity, consequences, causes, timeline and control, or cure). Associations have been found between beliefs about illness and a range of health outcomes. This study aimed to examine models of depression, to assess whether the five dimensions of the SRM are relevant, to compare depression models with those for physical illness, and to examine the psychometric properties of the Illness Perception Questionnaire (IPQ) when used with depression. Design and method. A sample of 101 women either currently depressed or with a history of depression was asked to write about their experiences of physical sickness and depression. Their responses were analysed in terms of the dimensions of beliefs expressed and the two experiences were compared. The IPQ was also administered to assess the women’s perceptions of depression. Results. The women used the same five dimensions of illness as identified in the SRM in describing both their experience of depression and physical sickness. There was evidence of some consistency across the models of the two illnesses in terms of their content and structure. The IPQ was a reliable measure for depressed experiences and discriminated between women who were currently depressed or not. Comparing the women’s descriptions of their depression with their IPQ scores showed some relationships between their responses on the two different measures, at least for the consequences and cause dimensions. Conclusion. The SRM model and associated methodology may provide an appropriate framework to further explore illness representations in depression. Problems inherent in the study of illness models in depression including the influence of mood on the model are described. Applications of this research area to the understanding of treatment preferences and adherence to treatment in mood disorders are discussed. Different models of psychopathology and treatment have developed within mental health and this is well illustrated in the case of depression. For example, Beck’s

Targeting cognitive-behaviour therapy to patients' implicit model of psoriasis: Results from a patient preference controlled trial

Abstract: Objectives: The purpose of this study was to investigate the effects of a cognitive-behavioral psoriasis symptom management programme (PSMP) on patient-held perceptions about their condition and patients' use of self-reported coping strategies, and to examine the influence of alexithymia scores at induction on response to treatment. Design: Age- and sex-matched case-controlled prospective study. Methods: A total of 40 patients with psoriasis were treated in the PSMP, and an age- and sex-matched cohort received standard pharmacological care only. The Illness Perception Questionnaire was used to assess patients' beliefs about illness identity, time-line, consequences, cure/control and perceptions of the cause of their psoriasis. Participants also completed the COPE questionnaire and the Toronto Alexithymia Scale (TAS-20). Results: Results suggested that at 6-month follow-up, patients who chose the PSMP showed significant reductions in illness identity (the frequency and severity of symptoms that patients associate with their condition), the strength of belief in severity of consequences of their illness, and their attributions for emotional causes of their psoriasis. Perceptions about the anticipated course of the disease (time-line), its cure or controllability, ideas about physical agents of causation, and coping strategies did not differ between PSMP patients or controls at 6-week or 6-month follow-up. Alexithymia had no effect on response to treatment. Regression analyses demonstrated the importance of both participation in the PSMP and demographic/clinical history variables in accounting for significant variance in illness-perception-change scores. Conclusion: The findings are generally supportive of multivariate models of intervention, but the lack of a demonstrated effect of the intervention on coping may have implications for both the assessment of coping in psoriasis and the nature of psychological interventions proposed for its management.

Cognitive representations in alcohol and opiate abuse: The role of core beliefs

Abstract: There are clinical indications that alcohol and drug abuse are associated with unhealthy core beliefs (unconditional, schema-level representations) This study examined levels of such cognitions among four groups: alcohol abusers; opiate abusers; combined alcohol and opiate abusers; and a non-clinical group Each patient completed the short version of the Young Schema Questionnaire, measuring levels of 15 pathological core beliefs These schema-level cognitions were less healthy in the clinical groups than in the non-clinical group, particularly among individuals who abused alcohol These findings provide preliminary support for the utility of therapies that address schema-level representations among substance abusers

Monitoring cognitive changes: Psychometric properties of six cognitive tests

Abstract: OBJECTIVES: Repeated neuropsychological assessments are often used to monitor change in cognitive functioning over time. Thus, knowledge about the reliability and stability of neuropsychological tests and the effects of age and IQ is of paramount importance. In this study we document, for six cognitive tests: test-retest reliabilities, practice effects, reliable change (RC) indices corrected for practice, and the impact of premorbid IQ and age. DESIGN: A sample of 188 normal adults (aged 40-70 years) were administered, on two occasions, one or more of the following tests: the Graded Naming Test (GNT), the Silhouettes Test, two tests of verbal fluency, the Modified Wisconsin Card Sorting Test, and a new test of speed and attention (the Symbol Digit Test). There was a 1-month interval between assessments. At first assessment, all participants were administered the revised National Adult Reading Test (NART). RESULTS: The test-retest reliability of the tests ranged from very good (the GNT and Silhouettes Test) to moderate (verbal fluency tests and Symbol Digit Test) and to poor (Modified Card Sorting Test). Significant, although modest, practice effects were found on all tests. RC indices were generally large except for the Graded Naming Test and the Silhouettes Test. Premorbid IQ scores significantly correlated with performance on all the tests, the exception being semantic fluency. Age only correlated with the Silhouettes Test and the new Symbol Digit Test. Neither NART IQ nor age correlated with practice effects. CONCLUSION: The psychometric properties of the GNT and Silhouettes Test indicated that they are useful tools for monitoring even small cognitive changes. In contrast, the verbal fluency tests and the new Symbol Digit Test are only suitable for monitoring large changes in performance. The Modified Card Sorting Test is an unreliable tool for monitoring 'executive' functions.

A psychometric evaluation of the Hospital Anxiety and Depression Scale in patients diagnosed with end-stage renal disease.

Abstract: Objectives: To determine the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in patients with end-stage renal disease (ESRD) and determine the suitability of the instrument for use with this clinical group. Design: Between-subjects and cross-sectional design. The independent variable was type of treatment for ESRD. The dependent variables were HADS total (all items) and HADS anxiety and depression subscale scores. Methods: Group differences in HADS scores were determined using between-subjects one-way analysis of variance (ANOVA). Exploratory and confirmatory factor analyses were conducted on the HADS to determine its psychometric properties in 160 patients with ESRD. Seven models were tested to determine model fit to the data. Results: None of the seven models tested proved to be an adequate fit to the data. Treatment modality was found to have a significant impact on HADS-assessed levels of anxiety and depression. Conclusions: The clinical utility of the HADS in the assessment of anxiety and depression in ESRD patients may be enhanced by using the HADS total (all items) score as an index of psychological distress. Further research is required to establish the appropriateness of using the HADS to screen ESRD patients.

The distress experienced by voice hearers is associated with the perceived relationship between the voice hearer and the voice

Abstract: Objectives: To explore the relationship between distress and the perceptions that voice hearers have of their relationship with the voice they hear. We predicted that a dominant style of relating by the voice and a submissive and distancing style of relating by the voice hearer would be linked with distress. Method: Thirty people who were hearing voices took part in the study. Information was gathered about the characteristics of the voice-hearing experience, the level of distress experienced in relation to the voice, the relationship between the voice hearer and the voice, and level of depression. Results: The tendency for the voice to relate in a dominating, insulting manner and the tendency of individuals to react with suspicion and lack of communication with the voice were uniquely associated with distress. Conclusions: Appraisals of the relationship between the voice and voice hearer made by voice hearers are associated with differing emotional responses to voices. Clinical assessments of people who have distressing voices may be enhanced by a detailed consideration of the sort of relationship that exists between the client and their voice.

Parent training for Attention Deficit/Hyperactivity Disorder: is it as effective when delivered as routine rather than as specialist care?

Abstract: Background: The effectiveness of parent training (PT) when delivered as part of specialist tier-two services for preschool AD/HD children has been recently demonstrated. Aims: To assess the effectiveness of the same PT programme when delivered as part of routine primary care by non-specialist nurses. Method: A sample of 89 3-year-old children with preschool AD/HD took part in a controlled trial of an eight-week (one hour a week), health visitor delivered, PT package. Children, allocated randomly to PT (n = 59) and waiting list control (WLC; n = 30) groups, were compared. Results: PT did not reduce AD/HD symptoms. Maternal well-being decreased in both PT and WLC groups. Conclusions: While PT is an effective intervention for preschool AD/HD when delivered in specialized settings, these benefits do not appear to generalize when programme are delivered as part of routine primary care by non-specialist nurses.

Thought-shape fusion in eating disorders

Abstract: Objectives: The aims of the present study were (1) to examine the association between a cognitive distortion (‘thought-shape fusion’) and eating disorder psychopathology and (2) to examine the degree of thought-shape fusion in people with eating disorders and a non-eating-disorder control group. Design: Associations between thought-shape fusion and eating disorder psychopathology were examined and the degree of thought-shape fusion was compared between people with and without clinical eating disorders. Method: Forty-two women with clinical eating disorders and a group of 42 age-matched women with no self-reported history of an eating disorder completed self-report questionnaires to assess thought-shape fusion, eating disorder symptoms, body checking and body avoidance, and depression. Results: Thought-shape fusion was significantly associated with eating disorder psychopathology. The majority of the associations remained significant when controlling for levels of depression. Patients with eating disorders showed significantly more thought-shape fusion than the non-clinical controls. Conclusions: Thought-shape fusion is a cognitive distortion associated with eating disorders. It may be a direct expression of the overevaluation of eating, shape and weight. It is recommended that thought-shape fusion be tackled directly in cases where it is a barrier to changing the core psychopathology of eating disorders.

Personality characteristics in obsessive‐compulsive disorder and individuals with subclinical obsessive‐compulsive problems

Abstract: Objective: To assess the relationship between normal personality traits and obsessive-compulsive (OC) phenomena in individuals with subclinical OC problems and patients whose problems met diagnostic criteria for obsessive-compulsive disorder (OCD). Method: In Study 1, 25 healthy volunteers with high scores on the Padua Inventory (PI) and 28 controls with low scores on the PI were compared on the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ), the Eysenck Personality Questionnaire (EPQ), and measures of depression and state anxiety. In Study 2, 56 treatment-seeking participants meeting DSM-IV criteria for OCD and 40 healthy volunteers of similar sociodemographic characteristics were compared on the same measures. Results: Both individuals with subclinical OC problems and OCD patients scored significantly higher than their respective control groups on sensitivity to punishment, neuroticism and psychoticism. OCD patients, but not individuals with subclinical OC problems, scored lower in extraversion than their respective controls. Neuroticism was the strongest predictor of high scores on the PI in Study 1, while psychoticism was the strongest predictor of the presence of an OCD diagnosis in Study 2. Conclusion: Healthy participants with high scores on OC measures and OCD patients share various personality traits but can also be distinguished according to the level of extraversion, neuroticism and psychoticism.

Autobiographical memory in depressed and non-depressed patients with borderline personality disorder.

Abstract: Objectives: The present study investigated the specificity of autobiographical memories among depressed and non-depressed borderline patients, compared with depressed patients and controls. The influence of childhood trauma, intrusions of traumatic events, avoidance of intrusions, dissociation and depression on memory specificity was also studied. Method: The Autobiographical Memory Test (AMT), a trauma interview and self-report measures of intrusions, avoidance, depression and dissociation were administered to 83 borderline outpatients, 26 depressed outpatients and 30 controls. Results: Depressed borderline patients and depressed patients reported fewer specific memories than controls. Depressed patients generated fewer specific memories than non-depressed borderline patients. Neither trauma nor traumatic intrusions, avoidance of intrusions or dissociation were related to the specificity of memories. Level of depressive symptoms (BDI) was also not related, but the presence of a depression was. Conclusion: In this large sample of outpatients with borderline personality disorder, only the subgroup with a co-morbid diagnosis of depression had trouble remembering specific events from the past. Trauma, intrusions, avoidance of intrusions and dissociation seem to be unrelated to the specificity of autobiographical memories in borderline personality disorder.

The use of a cognitive battery to predict who will fail an on-road driving test.

Abstract: Objectives: There is a growing need to find a valid and reliable neuropsychological battery to screen out those people who are clearly unsafe to drive following brain injury or pathology, and thus alleviate the need to refer for an on-road assessment. Design: A battery of cognitive tests fine-tuned for their relevance to driving was examined in terms of its sensitivity and specificity for predicting who would fail an on-road test following brain injury or pathology. Method: Performance on the battery was compared to the results of an on-road driving test in a consecutive series of 142 clients referred to a driving assessment centre following brain injury or pathology. The group represented diverse neurological conditions which affect brain functioning. Results: The overall accuracy rate of the battery in predicting a fail on-road was 92% and in predicting a pass on road was 71%. It was more accurate for those under 70 with 100% accuracy in predicting a fail on-road and 85% accuracy in predicting a pass on-road, but less accurate for those aged 70 or above with 85% accuracy in predicting a fail on-road and 37% accuracy in predicting a pass on-road. Conclusion: The battery is a useful tool in helping to determine whether someone is safe to drive following brain injury but needs to be used with far more caution for the older driver.

Long‐term emotional consequences of in‐hospital cardiac arrest and myocardial infarction

Abstract: Objectives: Prevalence rates for post-traumatic stress disorder (PTSD) of 10% have been reported following myocardial infarction (MI). However, there has been little research conducted on the long-term emotional sequelae of cardiac arrest (CA). The present study provides new information in that regard. The research aims were: (1) to compare the prevalence and severity of emotional disability in survivors of CA with that of cardiac patients who suffered an MI but no CA, (2) to assess both groups for the symptoms of PTSD, and (3) to assess the validity of a self-report measure for PTSD with a cardiac population. Design: Case-control study. Method: Patients who suffered a cardiac arrest in-hospital (N = 27) were compared with patients who had an MI uncomplicated by cardiac arrest (N = 27), 9.6 (5.0) months following their index event. Each patient completed a series of questionnaires and a structured interview to ascertain affective adjustment, and PTSD symptoms and diagnoses. Results: (1) Most MI and CA patients reported high levels of emotional well-being and stability. (2) Five (19%) CA survivors and two (7%) MI survivors (ns) fulfilled DSM-IV criteria for PTSD when assessed by structured clinical interview (SCID). (3) There was relatively poor agreement between the interview and self-report diagnoses when identifying PTSD cases (κ = .39). Conclusion: The significant minority of cardiac patients warranting diagnoses of PTSD has implications for their management and rehabilitation. Identification of these patients is an important step towards improving their overall health outcomes. The structured clinical interview remains the ‘gold standard’ for the identification of PTSD in cardiac patient populations.

Development and preliminary validation of the Glasgow Content of Thoughts Inventory (GCTI): A new measure for the assessment of pre-sleep cognitive activity

Abstract: Objective: To develop a self-report measure (the Glasgow Content of Thoughts Inventory [GCTI]) for the assessment of pre-sleep cognitive activity in adults with sleep-onset insomnia. Design: A psychometric, scale development approach was used. Method: Over three consecutive nights, 12 people with insomnia provided ‘live’ audio-recordings of pre-sleep thought content, which were used to generate an item pool. The results were compared to the content and categorical structure of pre-sleep cognitive activity identified by Wicklow and Espie (2000), and commonalities in thought content were used to generate a draft scale. Following further piloting, a 25-item scale was developed and administered to two groups (29 people with insomnia and 29 good sleepers), along with other self-report measures, objective (actigraphic recordings) and subjective (diary) sleep indices, and results analysed to evaluate the psychometric properties of the scale. Results: The GCTI demonstrated evidence of construct validity, successfully discriminated between individuals with insomnia and good sleepers, and was significantly correlated with existing measures of sleep disturbance. A score of 42 yielded a sensitivity of 100% and specificity of 83%. The GCTI demonstrated good test– retest reliability (ICC = .88) and internal consistency (α = .87). Conclusions: The GCTI appears to be a valid and reliable instrument for use with patients with sleep-onset insomnia.

A test of integration of the activation hypothesis and the diathesis-stress component of the hopelessness theory of depression.

Abstract: Objectives: This prospective study tested the integration of the diathesis-stress component of the hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989) and Persons and Miranda's (1992) activation hypothesis (i.e. depressogenic inferential styles are typically latent cognitive processes that must be primed in order to be accurately assessed). Design: In order to test the diathesis-stress component of the hopelessness theory, we used a short-term longitudinal design. In order to test the activation hypothesis, inferential styles were assessed both before and after a negative cognitive priming questionnaire. Methods: A group of 165 university students completed measures of inferential styles about the self, consequences, and causes before and after completing a negative cognitive priming questionnaire (Time 1). Participants also completed measures of depressive symptoms prior to completing the cognitive priming questionnaire and 5 weeks later (Time 2). Finally, negative events occurring between Time 1 and Time 2 were assessed. Results: Contrary to the diathesis-stress component of the hopelessness theory, none of the unprimed inferential styles interacted with negative events to predict increases in depressive symptoms. In line with the integration of the hopelessness theory and the activation hypothesis, however, each of the primed inferential styles interacted with negative events to predict increases in depressive symptoms even after controlling for the proportion of variance in depressive symptoms accounted for by the unprimed inferential style stress interactions. Conclusion: Individuals with depressogenic inferential styles are likely to show increases in depressive symptoms following the occurrence of negative events. At the same time, these depressogenic inferential styles are typically latent cognitive processes that must be primed in order to be accurately assessed.

The role of overgeneral autobiographical memory in the development of adult depression following childhood trauma.

Abstract: OBJECTIVE: Overgeneral autobiographical memory (AM) has been associated with episodes of clinical depression in adults and also with reported experience of childhood sexual abuse (CSA). This study investigated whether AM has a role in the development of adult depression in survivors of CSA and whether it is related to circumstances of CSA. METHOD: A community sample of women who reported a history of CSA (N = 41) completed the autobiographical memory test and were interviewed about any adult episodes of depression using the Schedule for Affective Disorders and Schizophrenia-Lifetime. RESULTS: Women who reported episodes of depression recalled fewer categoric memories in response to cue words than those who reported no episodes of depression. Correlations indicated that the number of categoric memories recalled for all cue words was associated with early abuse and greater duration of abuse. CONCLUSIONS: Relationships between AM and the age, and duration of abuse are consistent with previous findings of a relationship between CSA and AM. Categoric AM appears to serve as a defence against distressing memories. However, this suggestion needs to be tested with prospective studies showing whether AM recall style becomes more specific as a result of an episode of depression.

A personality-based taxonomy of sexually abusive adolescents derived from the Millon Adolescent Clinical Inventory (MACI)

Abstract: A personality-based taxonomy of an out-patient sample of 112 sexually abusive adolescents is described. Five subgroups were derived from cluster analytic procedures applied to Personality Patterns scales scores from the Millon Adolescent Clinical Inventory (MACI), and were named: Normal, Antisocial, Submissive, Dysthymic/Inhibited, and Dysthymic/Negativistic. The groups were also found to be differentiated on the psychopathology scales of the MACI. The results of the study provide evidence of the heterogeneity of adolescent sexual abusers in both personality characteristics and psychopathology. Comparison of groups differentiated on the basis of victim characteristics did not indicate a relationship between personality and sexual offence.

Autobiographical memory and post-psychotic depression in first episode psychosis.

Abstract: Objectives: In unipolar depression, the action of early life events has been shown to be linked to a deficit in accessing details of such autobiographical events (‘overgeneral memory’). In this study, we test whether a similar deficit can be observed in post-psychotic depression (PPD) in first-episode psychosis. Method: A group of 29 patients were followed up during the 12 months after their first onset, and monitored for PPD. Results: Of the sample group, 45% developed PPD, which was associated with overgeneral memory (p < .05; effect size = 1.05) and a heightened awareness of the diagnosis. Conclusions: Our findings raise the possibility that anomalies of psychosocial development may confer vulnerability to depression in psychosis.

Overgenerality of autobiographical memory in Alzheimer's disease

Abstract: Objectives: Overgenerality of autobiographical memory (ABM) is well documented in a range of clinical conditions, particularly in depressed and parasuicidal patients (e.g., Williams, 1996; Williams & Broadbent, 1986). This study extended the investigation to Alzheimer's disease (AD), and attempted to identify whether ABM overgenerality in the AD group is specifically expressed through an excess of categoric memories. Design: AD sufferers and control participants were compared on their ABM specificity in a cued-recall task. Method: Ten AD patients and 10 controls, matched for age, gender and educational level, were administered an ABM specificity measure following their mental status assessment. A battery of neuropsychological tests provided an independent estimate of cognitive deficit severity in the following areas: long-term memory, IQ, working memory, processing speed, and verbal fluency. A control for depression was also employed. Results: Compared to control participants, AD participants produced significantly fewer specific autobiographical memories. Additionally, the number of produced categoric overgeneral memories was significantly greater in the AD group in comparison with the controls. Conclusion: This study demonstrates the existence of ABM overgenerality in AD, manifested through an excess of categoric memories. Consistent with the mnemonic interlock theory (Williams, 1996), AD sufferers seem to lack cognitive resources to conduct a directed search for a specific memory, and stop at the categoric descriptions stage. This may contribute to lack of specificity in ABM retrieval.

Brief cognitive therapy of nightmares and post-traumatic ruminations in a man with a learning disability.

Abstract: Objectives: This is a case study of the treatment of two recurrent nightmares, one of which was accompanied by congruent post-traumatic daytime ruminations, in a man with a mild to moderate learning disability. Method: Treatment was by a cognitive intervention in which the patient was taught new positive endings to his dream stories. Results: Both of the nightmares, as well as the post-traumatic ruminations, responded to treatment, and gains were maintained at 12-month follow-up. Conclusions: Cognitive treatment of nightmares can be successful even in a patient with very limited intellectual abilities. The discussion considers the factors that may have been responsible for the success of the intervention in a man who would not be considered an obvious candidate for cognitive therapy.