Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Nevertheless, grief becomes a serious health concern for a relative few. For such ...individuals, intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and potential treatment of bereaved individuals at heightened risk of persistent distress and dysfunction.
A total of 291 bereaved respondents were interviewed three times, grouped as 0-6, 6-12, and 12-24 mo post-loss. Item response theory (IRT) analyses derived the most informative, unbiased PGD symptoms. Combinatoric analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity. Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased) and at least five of the following nine symptoms experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the death and be associated with functional impairment.
The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and ICD-11. Please see later in the article for Editors' Summary.
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For more than 20 years, the Impact of Event Scale (IES) has been widely used as a measure of stress reactions after traumatic events.
To review studies that evaluated the IES's psychometric ...properties.
Literature review.
The results indicated that the IES's two-factor structure is stable over different types of events, that it can discriminate between stress reactions at different times after the event, and that it has convergent validity with observer-diagnosed post-traumatic stress disorder. The use of IES in many psychopharmacological trials and outcome studies is supportive of the measure's clinical relevance.
The IES is a useful measure of stress reactions after a range of traumatic events, and it is valuable for detecting individuals who require treatment.
Formulation as a Basis for Planning Psychotherapy Treatment utilizes a step-by-step structure and copious case illustrations to teach psychiatrists, residents in psychiatry and psychology, social ...workers, and marriage and family counselors how to plan treatment after the initial diagnosis. This new edition arrives two decades after the first, with revised content, updated case studies, and new insights gleaned over the author's noteworthy career. Clinical formulation, also known as case formulation and problem formulation, is a theoretically-based explanation or conceptualization of the information obtained from a clinical assessment. Although formulation systems vary by different schools of psychotherapy, the author has adopted and here explores a systematic approach based on an integrative effort. This system of configurational analysis combines concepts derived from psychodynamic, interpersonal, cognitive-behavioral, and family system approaches. After an overview of psychological change processes, each of the five steps of configurational analysis is covered systematically: Step one involves selecting and describing the patient's currently most important symptoms, signs, problems, and topics of concern. For example, symptoms may consist of trouble sleeping or feelings of depression; signs may include discordant verbal and physical expression; problems may include reluctance to go to work or care for family members; and topics of concern might be unresolved grief the patient feels helpless to process without assistance. Since both patient and therapist want to know if these observable phenomena are changing, this list is modified as treatment progresses. Step two entails describing states in which the patterns of phenomena do and do not occur, with attention to patterns of shifts in states, especially maladaptive state cycles. The therapist is taught how to aggregate and organize this information by describing states of mind-for example, undermodulated (e.g., unthinking rage) or overmodulated (e.g., numbness and lack of affect). Step three involves describing the challenging topics that patients may both approach and avoid because they are conflicted or unresolved, as well as the obstacles patients may create to divert attention from those topics. For example, patients may avoid a topic or shift attention from it by changing the subject and so forth. Step four entails describing the organizing roles, beliefs, and scripts of expression and action that seem to organize repetitions in each state, with an effort made to identify dysfunctional attitudes and how these may have evolved from past attachments and traumas. Finally, step five involves figuring out how to stabilize working states by enhancing the therapeutic alliance and helping the patient contain and master emotional attitudes. At this point, the clinician plans how to counteract avoidances by direction of attention and promotes adaptive social cognitive capacities. From surface observation to deeper inferences, Formulation as a Basis for Planning Psychotherapy Treatment transcends DSM diagnoses, helping clinicians to use information gleaned in the immediacy of the moment to make sound, sensitive, and effective psychotherapeutic decisions.
Ellen had revenge fantasies toward her husband, Max, because she held him responsible for the accidental death of their 10-year-old son, Morgan. Instead of taking Morgan to ski on an intermediate ...slope as planned, Max had impulsively selected an advanced slope. Morgan hit a tree and later died of a head injury. Ellen had been diagnosed as having major depressive disorder and had received several different antidepressant medications and a course of cognitive behavior therapy. The combined treatment was largely successful, and her depression was in remission. She sought additional psychotherapy 2 years after Morgan's death because of persisting intrusive revenge fantasies and destructive acts directed at Max. She experienced depersonalization and derealization about three times a week for about an hour. The result of these symptoms was a diminished sense of self-control, confidence, and safety, although she was caring well for her 8-year-old daughter and keeping her career afloat. PUBLICATION ABSTRACT
The main objective of this meta-analysis was to model the relations between a set of independent variables (age and gender of the trauma group, country where the study was performed, year of ...publication, type of event, time elapsed between event and measurement) and stress symptoms.
Data from 66 studies that used Horowitz's IES to examine the psychological impact of a major life event were subjected to meta-analysis.
Results from hierarchical regression analysis indicated that type of event (episodes of illness and injury, natural and technological disaster, bereavement and loss, violence, sexual abuse, and war exposure) is a strong predictor of levels of intrusive and avoidant symptoms after a traumatic event. Intrusive and avoidant reactions reported by trauma victims tended to decrease linearly over time after the trauma. This finding was supported by the results reported by 20 different studies of stress reactions at two different time points after various events. Gender and cultural difference were relatively insignificant, whereas type of event induced different levels of stress reactions as measured with the IES.
These data provide evidence for the value of the IES as a measure of stress reactions in a number of different populations. Data summarized here will be useful as a comparison resource in future studies of stress response syndromes.
Traumatic events lead to a variety of responses, including disturbances of conscious sensations that range from intrusive thoughts and images to emotional numbing. This brief report focuses on phasic ...alterations of self-identity experiences, using two case examples from psychotherapy. The vignettes clarify contemporary theory about how posttraumatic growth in self-organization may occur.
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... Ms. A assumes that her therapist does not care about her when he asks for clarification about store policy. ... even though the patient may be consciously aware of both dimensions of the split, ...the therapist may still interpret the function of the splitting: Last week you said you hated me, but today you describe me as the smartest therapist in the world.
This article addresses the complex issue of how to clarify conflicts involving value judgments. The author reviews his experiences as therapist, supervisor, and consultant in offering second opinions ...on in-progress therapies. He summarizes six major obstacles to effective value clarifications and interpretations. Therapists can help patients to explicitly verbalize otherwise only implicit values. Distress from guilt and shame can be reduced by helping a patient reprioritize values and gain self-reflective awareness skills for resolving moral dilemmas.
Identity disturbances are common in clinical conditions and personality measures need to extend to assessment of coherence in underlying levels of self-coherence. The problem has been difficult to ...solve because self-organization is a complex unconscious set of mind/brain processes embedded in social roles and values. Theory helps us address this problem and suggests methods and limitations of interpretation that involve self-reports of subjects, observers who rate subjects, and narrative analyses of verbal communications from subjects.
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