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The aim of this article is to empirically investigate the relationships among interpersonal guilt, as conceived within control-mastery theory (CMT), and attachment, altruism, and personality pathology in an English-speaking sample. An online sample of 393 participants was recruited to complete the Interpersonal Guilt Rating Scale self-report version-15 (IGRS-15s), together with other empirically validated measures for the assessment of attachment, altruism, and personality pathology. On the basis of previous studies conducted in Italian-speaking samples, we hypothesized that survivor guilt, separation/disloyalty guilt, and omnipotent responsibility guilt would be associated with attachment anxiety and avoidance, altruism, and personality pathology; self-hate was hypothesized to be associated only with attachment anxiety and avoidance and personality pathology. Analyses examined bivariate associations as well as the network of partial correlations among variables. The results largely confirmed hypothesized associations, with self-hate evincing the strongest unique association with personality dysfunction. Findings provide a basis for further research regarding interpersonal guilt and personality and relational functioning, with potential implications for clinical conceptualizations of the role of guilt in psychopathology.

This study developed a short form of the Attitudes and Beliefs Scale-2 (ABS-2), a measure of Ellis’s irrational and rational beliefs. We compared the short form (ABS2-SF) to the longer original scale with 2096 participants, including clinical outpatients, American and Romanian college students, and drug/alcohol rehab residents. The ABS-SF correlated highly with the Original ABS-2. Confirmatory Factor Analyses yielded an excellent fit for an eight-factor bifactor model with factors for the irrational and rational cognitive processes and a general factor. The resulting subscales had excellent internal reliability. The ABS2-SF were highly correlated with measures of mental health problems, and these correlations were significantly higher with the symptom distress subscale than with the troubled social relationships subscale. Correlations with screening measures for DSM-4 disorders showed that the correlations significant but higher for disorders that represented disturbed negative emotions such as anxiety and depression and less with disorders characterized by dysfunctional behaviors. The ABS2_SF scores were significantly higher in a clinical sample than in a college sample. The results have implications for future REBT research that assess irrational and rational beliefs and clinical implications for potentially targeting treatment.

Recent studies introduced the suicide crisis syndrome (SCS), a condition associated with imminent suicidal behavior and characterized by (a) a pervasive feeling of entrapment in which the escape from an unbearable life situation is perceived as both urgent and impossible (Criterion A) and (b) affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal (Criterion B). The goal of the present study was to use some of the analytic tools provided by network analyses to further the understanding of the psychological, emotional, cognitive, behavioral, and physiological processes involved in the SCS by testing (a) whether the different symptoms of the proposed syndrome are related to each other, (b) whether symptoms form meaningful clusters, and (c) whether certain symptoms are more central than others. The study included 500 outpatient and 223 inpatient participants. A network analysis of the participants' scores on the various symptoms of the SCS was conducted. The network analysis suggested that most SCS symptoms are linked by strong connections and that entrapment and ruminative flooding are highly correlated with the other SCS symptoms. Three clusters of symptoms were identified, suggesting the existence of several interdependent psychological processes potentially involved in SCS phenomenology. Our findings support both the suggested symptoms of the SCS and the central role of entrapment in the proposed criteria for the syndrome. Emotional pain appears to be closely linked to entrapment and may belong in Criterion A. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

This study tested the factor structure of the Attitudes and Beliefs Scale-2, a measure of Ellis’ irrational and rational beliefs. The scale includes items that assess both irrationality and rationality. Within this framework, items reflect one of four irrational cognitive processes and their rational alternatives, including demandingness versus preferences, frustration intolerance versus tolerance, awfulizing versus realistic negative evaluations, and self-condemnation versus self-acceptance, and one of three content domains including affiliation, achievement, and comfort. The sample of 1500 consisted of college students, psychotherapy outpatients, and patients from a residential substance abuse program. We used the lavaan program with Diagonally Weighted Least Squares estimation procedures to test 11 different models. An 8-factor bifactor model had an excellent fit and appeared better than the other models using. This model had items load on one of the four irrational cognitive process factors of demandingness, awfulizing, frustration intolerance, or self-condemnation, or one of the rational cognitive process factors of non-demanding preferences, realistic negative evaluations, frustration tolerance, or self-acceptance. The second or bifactor solution had all items load on to one general factor. This model has eight factors that are designed to assess factors for the cognitive processes split into the irrational and rationality dimensions, and these results support the factor structure of the test and the theoretical structure of irrational and rational beliefs currently adopted in REBT. The implications for REBT practice were discussed as well as the future of assessment research in REBT.

The aim of this paper is to present further data for the validation of the Interpersonal Guilt Rating Scale-15 self-report (IGRS-15s; Gazzillo et al., 2018). We recruited a sample of 448 subjects, to whom we administered the IGRS-15s together with other empirically validated measures for the assessment of social desirability, shame, self-esteem, empathy, mental health and therapeutic alliance. In line with our hypotheses, the previously established three-factor structure of the IGRS-15s (Survivor guilt, Omnipotence guilt, and Self-hate) was confirmed. Moreover, the internal consistency and test-retest reliability of IGRS-15s were adequate to good. All the IGRS-15s factors were negatively correlated with self-esteem and mental health and positively correlated with shame; Survivor guilt and Omnipotence guilt were positively correlated with empathy; Survivor guilt and Self-hate negatively affected therapeutic alliance; and different traumas had different, theoretically predictable, impacts on the different kinds of guilt. Overall, these data support the reliability and validity of the IGRS-15s.

In October 2017, Northern California experienced devastating and historic wildfires leaving the community in need of support to foster emotional resilience during the recovery process. Adolescents represent a particularly vulnerable population in the wake of disaster, and digital mental health interventions may hold promise for reaching teens at scale. The present study examined the feasibility and efficacy of a mobile mental health app for disaster, Sonoma Rises. A multiple-baseline single-case experimental design (SCED) utilizing a research-enabled version of the app was employed with seven adolescents who experienced significant damage to their homes and schools in the wildfires. Participants completed daily mood ratings, weekly measures of posttraumatic stress symptoms, internalizing and externalizing symptoms, psychosocial functioning, and then pre-post-measures of anxiety, depression, wellbeing, sleep, academic engagement, and perceived social support as well as quantitative and qualitative measures of intervention satisfaction and feasibility. Sonoma Rises was found to be feasible in terms of engagement, satisfaction, and likelihood of recommending to a friend. During the study, another wildfire occurred and all participants underwent a prolonged mandated evacuation and were subject to a series of extended power outages. Uptake of the publicly available version of the Sonoma Rises app among the general population was modest but engagement among users was sustained. Lessons learned are offered to contribute to the science and practice of building, disseminating, and implementing digital tools to conduct more equitable disaster mental health outreach and research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Our research examined patterns of interpersonal problems in patients with a primary diagnosis of cocaine dependence (CD), comparing them with those in a normative sample. We hypothesized that the patterns of individuals with CD would reveal constellations of interpersonal problems distinct from those of the sample, not only at baseline, but also at termination of treatment. Analysis was conducted on 402 CD patients from the training and the main trial phases of the National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Responses to the Inventory for Interpersonal Problems were analyzed—from baseline, from month one, and at treatment termination—according to the Interpersonal Circumplex Model and were compared to the normative sample. The CD sample was described using four distinct subtypes, named according to their relative angular displacement at baseline and highest two subscale means: Cold and Socially Avoidant, Vindictive and Domineering, Overly Nurturant and Intrusive, Nonassertive and Exploitable. Each subtype remained distinct across treatment and consistently reported different types of interpersonal difficulties than the normative population at termination, consistent with the interpersonal pathoplasticity model. In all subtypes, overall interpersonal distress decreased over the course of treatment, to the extent that by treatment termination they were no more or less distressed than the normative sample. These findings have important clinical implications. The interpersonal challenges of patients struggling with addiction to cocaine warrant clinical attention, beyond mediating levels of distress.

This article examines moral hypocrisy and the self-serving bias (SSB) in the sexual infidelity context. We found evidence of self-serving attributions that occur between primary relationship partners following sexual betrayals. Specifically, we found that sexual infidelity perpetrators (a) blamed their primary dyadic partners (i.e., victims) for infidelities significantly more than those victims blamed themselves for such infidelities, (b) blamed the surrounding circumstances for infidelities significantly more than their victims did, and (c) rated the emotional impact of infidelities on their victims as significantly less than victims’ ratings of such impact. Moreover, we found that participants with prior experience as both sexual infidelity perpetrators and victims displayed “sexual hypocrisy” by judging others more harshly than themselves for sexually unfaithful behavior. Our findings demonstrate that personality variables associated with sexual infidelity (narcissism, sexual narcissism, avoidant attachment, and primary psychopathy) are also relevant to self-serving attributions in the sexual infidelity context.

Background and Aim The Suicide Crisis Syndrome (SCS) is an evidence-based pre-suicidal cognitive and affective state predictive of short-term suicide risk. The most recent SCS formulation, proposed as a suicide-specific DSM diagnosis, features a feeling of Entrapment accompanied by four additional symptom clusters: Affective Disturbance; Loss of Cognitive Control; Hyperarousal; and Social Withdrawal. The aim of the present study was to revise the Suicide Crisis Inventory (SCI; Barzilay et al., 2020 ), a self-report measure assessing the presence of the SCS,in accordance with the current SCS formulation, as well as to assess the psychometric properties and clinical utility of its revised version, the Suicide Crisis Inventory—2 (SCI-2). Methods The SCI-2, a 61-item self-report questionnaire, was administered to 421 psychiatric inpatients and outpatients at baseline. Prospective suicidal outcomes including suicidal ideation, preparatory acts, and suicidal attempts were assessed after one month. Internal structure and consistency were assessed with confirmatory factor analysis, convergent, discriminant, and current criterion validity. Receiver-operating characteristic (ROC) curves with Area under the Curve (AUC) were used to examine the predictive validity of the SCI-2 to prospective outcomes. Exploratory analyses assessed the predictive validity of the five SCI-2 dimensions. Results The SCI-2 demonstrated excellent internal consistency (Cronbach's α = 0.971), good convergent, discriminant, and current criterion validity. The SCI-2 significantly predicted all three outcomes, and was the only significant predictor of suicidal attempts with AUC = 0.883. Discussion The results of this study indicate that the SCI-2 is a valid and reliable tool to assess the presence and intensity of the Suicide Crisis Syndrome and to predict short-term prospective suicidal behaviors and attempts among psychiatric outpatients and inpatients regardless of patients’ readiness to disclose suicidal ideation.

OBJECTIVE: The aim of the current study is to explore experiences of trainees engaged in alliance-focused training (AFT), a group supervision modality with an explicit focus on awareness of ruptures and implementation of repair strategies. Using Cognitive Behavioral Therapy (CBT) group supervision as a point of comparison, the study examines supervisory alliance, ruptures, group cohesion and safety, and supervision impact. METHOD: Eighty-three trainees (clinical psychology interns, advanced-level psychology externs and psychiatry residents) at a metropolitan medical center in New York City who received supervision in CBT (N = 38) or AFT (N = 45) reported on their group supervision experience. Participants had a mean age of 29.5 (SD = 4.9); 77% were women; 84% of participants identified as White, 7% as Multiethnic, 6% as Hispanic/Latinx, 1% as Black, and 1% as Asian. Participants reported on occurrence of ruptures with their supervisor, supervisory alliance (Working Alliance Inventory-Short), group safety, supervision depth and smoothness (Session Evaluation Questionnaire), and group cohesion (Group Climate Questionnaire). Mixed and general linear models, and correlation analyses were used for analysis. RESULTS: All trainees reported equally low incidence of ruptures with their supervisor alongside high ratings of supervisory alliance. Trainees in AFT reported experiencing less safety, smoothness, and greater intergroup conflict than trainees in CBT supervision; however, they also reported stronger group engagement and a deeper supervision experience. CONCLUSIONS: Results suggest that AFT may provide a rich environment to foster a certain level of discomfort and risk-taking that may facilitate an engaging and meaningful learning experience.

OBJECTIVE: In order to improve success rates in psychotherapy, an alliance-focused training (AFT) protocol was developed and evaluated with regard to patient-therapist interpersonal behavior in a 30-session protocol of cognitive-behavioral therapy for outpatients comorbid with Axis I and II conditions conducted in a medical center setting. METHOD: Participants included 40 patients treated by 40 therapists in a multiple baseline design in which novice therapists trained to fidelity standards in CBT were introduced to AFT at different time intervals (after either 8 or 16 sessions) during a 30-session CBT protocol. Interpersonal behaviors were assessed with a simplified version of the Structural Analysis of Social Behavior (SASB) on videotaped sessions sampled from the early (between sessions 6–8), mid (14–16), and late (22–24) phases of therapy. RESULTS: As predicted, several significant interactions were observed between within-subject interpersonal change and between-group differences in exposure to AFT. Specifically, there were decreases in patient dependence and in therapist control (including criticism), plus increases in patient expressiveness and in therapist affirmation and expressiveness, all of which could be attributed to AFT. The predictive relationship of several of these variables to session-level and overall treatment outcome was also demonstrated. CONCLUSIONS: This study demonstrates that novice CBT therapists can be trained to improve their interpersonal process with patients who present with comorbid diagnoses, including a personality disorder. PUBLIC HEALTH SIGNIFICANCE: Demonstrating the efficacy of a protocol designed to develop novice therapists’ alliance-focused abilities has important implications for professional training, as well as for outcome in psychotherapy.

In this study, we introduce the construct of the suicidal narrative, a hypothetical personal narrative linked to imminent suicide, and explore its relationship to near-term suicidal risk and the suicide crisis syndrome (SCS). Psychiatric outpatients (N = 289) were administered the Columbia Suicide-Severity Rating Scale (C-SSRS), Suicide Crisis Inventory (SCI), and Suicide Narrative Inventory (SNI), a novel instrument combining the documented risk factors of Thwarted Belongingness, Perceived Burdensomeness, Humiliation, Social Defeat, Goal Disengagement, and Goal Reengagement. Dimensional measures of past month, lifetime, and past suicidal phenomena, incorporating ideation and behavior, were calculated from the C-SSRS. Structural equation modeling was used to explore the interaction among variables. Factor analysis of the SNI yielded two orthogonal factors, termed Interpersonal and Goal Orientation. The former factor was comprised of Perceived Burdensomeness, Social Defeat, Humiliation, and Thwarted Belongingness, the latter of Goal Disengagement and Goal Reengagement. The Interpersonal factor correlated with both SCS severity and suicidal phenomena in each time frame and the Goal Orientation factor with no other variable. As hypothesized, the proposed model was significant for the past month only. Our findings support the construct of the suicidal narrative and its function as a near-term suicidal risk factor.

OBJECTIVE: To develop a brief version of the Multitheoretical List of Therapeutic Interventions (MULTI-60; McCarthy & Barber, 2009) in order to decrease completion time burden by approximately half, while maintaining content coverage. Study 1 aimed to select 30 items. Study 2 aimed to examine the reliability and internal consistency of the MULTI-30. Study 3 aimed to validate the MULTI-30 and ensure content coverage. METHOD: In Study 1, the sample included 186 therapist and 255 patient MULTI ratings, and 164 ratings of sessions coded by trained observers. Internal consistency (Chronbach’s alpha and McDonald’s omega) was calculated and Confirmatory Factor Analysis was conducted. Psychotherapy experts rated content relevance. Study 2 included a sample of 644 patient and 522 therapist ratings, and 793 codings of psychotherapy sessions. In Study 3, the sample included 33 codings of sessions. A series of regression analyses was conducted to examine replication of previously published findings using the MULTI-30. RESULTS: The MULTI-30 was found valid, reliable and internally consistent across 2564 ratings examined across the three studies presented. CONCLUSION: The MULTI-30 a brief and reliable process measure. Future studies are required for further validation.

A goal of clinical trials is to identify unique baseline characteristics that can inform treatment planning. One such target is emotion dysregulation (ED), which contributes to the maintenance of co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) and may be a potential moderator of treatment response. We examined the moderating impact of ED severity on treatment outcomes in an urban, socioeconomically disadvantaged, and racially/ethnically diverse sample with complex trauma and severe SUDs. Participants with co-occurring PTSD and SUD (PTSD+SUD) were randomized to Concurrent Treatment with Prolonged Exposure (COPE, n = 39), Relapse Prevention Therapy (RPT, n = 43), or an active monitoring control group (AMCG, n = 28). Baseline ED severity moderated treatment outcomes such that high ED was associated with greater reduction in PTSD severity among those who received COPE relative to RPT and AMCG. In contrast, low ED was associated with greater reduction in substance use among those in RPT relative to COPE and AMCG. Implications for individualizing and optimizing treatment selection for PTSD+SUD are discussed.

Aim : The Narrative Crisis Model of suicide posits that when individuals with trait vulnerabilities for suicide face stressful life events, they may develop distorted perceptions of themselves and society that culminate in a sense of no future. Referred to as the suicide narrative, these perceptions makes them more likely to experience the Suicidal Crisis Syndrome, an acute affective condition that increases the risk of engaging in suicidal ideation behaviors. The goal of this study was to assess the stage components of this model. Methods : The stage components of the NCM were assessed among adult psychiatric inpatients (N = 223; listwise N = 85) aged 18–65 years old and admitted for suicidal ideation or attempts. Suicidal outcomes were assessed at one month follow-up. Structural equation modeling (SEM) was used to assess the model and its prediction of prospective suicidal outcomes. Results : The model was supported by the SEM and proved to be a good fit for the data. Each temporal stage was significantly predicted by the precedent stage in the model and 13% of the variance in suicidal ideation and behaviors (when assessed conjointly) were explained by the model. When suicidal ideation and attempts were assessed separately, the amount of variance explained was 10.8% for suicidal ideation and 40.7% for suicidal attempts. Discussion : The progression from trait vulnerabilities to suicidal outcomes proposed by the NCM was supported by our findings. These findings have clinical implications in the assessment and treatment of suicide risk and will need replication with larger samples.

Background and objectives Cognitive behavioral therapy (CBT) is a first-line treatment for anxiety, but it is not widely available as clinical guidelines recommend. We examined the feasibility and efficacy of a novel smartphone-based fully automated digital CBT intervention, ‘Daylight™‘, to improve symptoms of Generalized Anxiety Disorder (GAD). Methods In this multiple-baseline design, 21 adults (20 F; mean age 43yrs. range 19–65yrs.) with moderate-to-severe symptoms of GAD were randomized to one of three baseline durations (2-, 4-, or 6-weeks) and then received access to digital CBT. Participants completed daily ratings of anxiety and worry, weekly measures of anxiety, depressive symptoms, and sleep, and measures of anxiety, worry, wellbeing, quality of life, CBT skill acquisition, and work performance at initial assessment prior to baseline randomization, post-intervention, and follow-up. Results Digital CBT was found to be feasible in terms of engagement, satisfaction, and safety. For preliminary efficacy, improvements were detected in daily and weekly outcomes of anxiety for most participants. Despite individual differences, significant improvements occurred with the introduction of digital CBT and not during baseline. Overall, 70% of participants no longer had clinically significant symptoms of GAD, 61% no longer had significant depressive symptoms, and 40% no longer had significant sleep difficulty at post-intervention. Limitations The study sample was recruited using the internet and was mostly female, limiting the generalizability of the findings. Conclusions Findings support the feasibility and efficacy of Daylight. Further examination in randomized controlled trials is now warranted.

OBJECTIVE: To examine whether working alliance quality and use of techniques predict improvement in Panic-Specific Reflection Function (PSRF), and misinterpretation of bodily sensations in treatments for panic disorder. METHOD: A sample of 161 patients received either CBT or PFPP (Panic-focused Psychodynamic therapy) within a larger RCT (Milrod et al., 2016). Data were collected on patient-reported working alliance, misinterpretations, PSRF, observer-coded use of techniques, and interviewer-rated panic severity. Random-Intercept Cross-Lagged Panel Models assessed bi-directional associations, disentangling within- and between-patient effects, and accounting for prior change. RESULTS: Higher alliance predicted subsequent within-patient improvement in PSRF in PFPP, but worsening in CBT. In both treatments, focus on interpersonal relationships predicted PRSF improvement (with stronger effects in CBT), while focus on thoughts and behaviors predicted worsening in PSRF. In CBT only, early focus on affect and moment-to-moment experience predicted reduced misinterpretation, while high focus on thoughts and cognitions predicted subsequent increase in misinterpretation. CONCLUSION: The quality of the alliance has differential effects on PSRF in distinct treatments. Interpersonal, rather than cognitive or behavioral focus, even when delivered differently within distinct treatments with high adherence, could facilitate improvement in PSRF. Additionally, early focus on affect and moment-to-moment experiences in CBT could reduce misinterpretations.

We hypothesize that “being yourself” is the dating strategy of individuals that have successful long-term relationships. Study 1 examined the relationships between authenticity and personality variables that predict relationship outcome. Study 2 employed a two-part acts nomination design to enumerate “being yourself” while dating and to examine personality correlates of “being yourself”. Study 3 explored whether individuals being themselves are attractive and if being yourself results in assortative mating with authentic individuals. Study 4 determined the effect of “be yourself” mindset priming on “be yourself” dating behavior. Study 1 found that authenticity is associated with emotional intelligence and positive relational outcomes. Study 2 found that “being yourself” dating behavior is associated with authenticity, secure attachment, and low narcissism. Study 3 found that “be yourself” dating behavior is attractive and facilitates assortative mating with authentic individuals. Study 4 found that rejection sensitive individuals are more likely to engage in “be yourself” dating behavior when made to feel safe to be themselves. “Be yourself” is the dating strategy that authentic individuals use to facilitate successful long-term relationships.

Background Mental health professionals have a pivotal role in suicide prevention. However, they also often have intense emotional responses, or countertransference, during encounters with suicidal patients. Previous studies of the Therapist Response Questionnaire-Suicide Form (TRQ-SF), a brief novel measure aimed at probing a distinct set of suicide-related emotional responses to patients found it to be predictive of near-term suicidal behavior among high suicide-risk inpatients. The purpose of this study was to validate the TRQ-SF in a general outpatient clinic setting. Methods Adult psychiatric outpatients (N = 346) and their treating mental health professionals (N = 48) completed self-report assessments following their first clinic meeting. Clinician measures included the TRQ-SF, general emotional states and traits, therapeutic alliance, and assessment of patient suicide risk. Patient suicidal outcomes and symptom severity were assessed at intake and one-month follow-up. Following confirmatory factor analysis of the TRQ-SF, factor scores were examined for relationships with clinician and patient measures and suicidal outcomes. Results Factor analysis of the TRQ-SF confirmed three dimensions: (1) affiliation, (2) distress, and (3) hope. The three factors also loaded onto a single general factor of negative emotional response toward the patient that demonstrated good internal reliability. The TRQ-SF scores were associated with measures of clinician state anger and anxiety and therapeutic alliance, independently of clinician personality traits after controlling for the state- and patient-specific measures. The total score and three subscales were associated in both concurrent and predictive ways with patient suicidal outcomes, depression severity, and clinicians’ judgment of patient suicide risk, but not with global symptom severity, thus indicating specifically suicide-related responses. Conclusion The TRQ-SF is a brief and reliable measure with a 3-factor structure. It demonstrates construct validity for assessing distinct suicide-related countertransference to psychiatric outpatients. Mental health professionals’ emotional responses to their patients are concurrently indicative and prospectively predictive of suicidal thoughts and behaviors. Thus, the TRQ-SF is a useful tool for the study of countertransference in the treatment of suicidal patients and may help clinicians make diagnostic and therapeutic use of their own responses to improve assessment and intervention for individual suicidal patients.

The aim of this article is to present validation data about a self-report rating scale for the assessment of interpersonal guilt according to Control-Mastery Theory (CMT; Silbershatz, 2005; Weiss, 1993; Weiss, Sampson, & The Mount Zion Psychotherapy Research Group, 1986), the Interpersonal Guilt Rating Scale-15s (IGRS-15s). In order to perform the validation of this tool in an Italian sample we have collected a sample of 645 nonclinical subjects. They had to complete the IGRS-15s, the Scale for the Measurement of the Impending Punishment (SMIP; Caprara et al., 1990), the Interpersonal Guilt Questionnaire-67 (IGQ-67; O'Connor et al., 1997), the Psychological General Well-Being Index (PGWBI; Dupuy, 1984), and the Affective Neuroscience Personality Scales (ANPS; Davis, Panksepp, & Normansell, 2003), together with an ad-hoc questionnaire for collecting demographic data, the Socio-Demographical Schedule. We have performed a confirmatory factor analysis to verify if the four-factor solution based on CMT and replicated in previous research (Gazzillo et al., 2017) was confirmed. Then, we checked the retest reliability of IGRS-15s after four weeks in a random subsample of 54 subjects. In order to assess its concurrent and discriminant validity, we calculated the correlations between IGRS-15s assessment and SMIP and IGQ-67. Finally, to test its construct validity, we assessed the relationships between the IGRS-15s and the affective systems using the ANPS and the wellbeing assessed with the PGWBI. The data collected support the retest reliability and the concurrent and discriminant validity of the measure, and we have collected preliminary data about its construct validity. Examples of the possible clinical and research applications of this tool are discussed.

This study employed a structural equation modeling (SEM) approach to examine the interrelationships between the self-serving bias and various known predictors of sexual infidelity. Specifically, we sought to generate a path model depicting how the following variables jointly predict sexual infidelity perpetration: (1) insecure attachment, (2) pathological narcissism, (3) sexual narcissism, (4) primary psychopathy, (5) self-serving attributions for retaliatory infidelity, and (6) sexual betrayal victimization. We developed a structural model describing various pathways to sexual infidelity perpetration based on these six variables. Three pathways to infidelity were discovered. In the first pathway, anxious and avoidant attachment predicted primary psychopathy, and self-justification for retaliatory infidelity mediated the relationship between primary psychopathy and infidelity perpetration. In the second pathway, anxious attachment predicted sexual narcissism, which predicted self-justification for retaliatory infidelity, which in turn predicted infidelity perpetration. In the third pathway, being a victim of sexual betrayal directly predicted sexual infidelity perpetration. In fact, suffering sexual betrayal was the best predictor of sexual infidelity perpetration. The clinical implications of these findings are discussed.

The aim of the present study was to assess the effect of initial level of psychiatric severity on treatment outcome in psychodynamic therapy and dialectical behavior therapy (DBT) for borderline personality disorder (BPD). It was hypothesized that DBT would lead to better outcome for patients with high psychiatric severity, whereas dynamic treatment would lead to better outcome for patients with lower psychiatric severity. Data from the 5th-year follow-up of the Stockholm City Council's and the Karolinska Institute's Psychotherapy Project were used in the present study. A total of 106 female patients diagnosed with BPD with at least 2 past suicide attempts were randomized into object-relational psychotherapy (ORP; based on transference-focused psychotherapy), DBT, and treatment as usual. Patients' baseline global severity index was used as a moderator. Global Assessment of Functioning (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [American Psychiatric Association, 1994]) was used to examine outcome. There was a significant 3-way interaction of Time × Treatment × Severity. Post hoc analyses suggested that patients with lower levels of severity had significantly better outcomes in object-relational psychotherapy. For patients with higher severity, the 3 treatments resulted in similar outcomes in terms of level of functioning. Outcome of treatment for BPD might differ significantly for patients depending on their initial levels of overall psychiatric severity. If our findings are replicated for patients with low severity and supported for a high-severity sample, psychiatric severity can be used as a low-cost and effective tool to match patients with BPD to optimal treatments. (PsycINFO Database Record

The Attitudes and Belief Scale-2 (ABS-2) developed in the late 1980s, is a measure of Ellis’ irrational and rational beliefs. Although no publication has described the instrument and it has only appeared in conference presentations, many researchers have used the ABS-2 to test REBT. This article describes the development of the ABS-2 and the original research on its psychometric properties. The scale has three factors that represent 24 different cells in a 4 × 2 × 3 factorial model. The first factor, Cognitive Processes, reflects Ellis’ concepts of Demandingness, Awfulizing, Frustration Intolerance, and Self-Downing. The second factor covers irrationally worded items versus rationally worded items. The rationally worded items were written to counter the irrational beliefs. The third factor includes content or life themes about which the person could be concerned, and includes Achievement, Affiliation, and Comfort. The ABS-2 generates a Total Score, a Total Irrationality Score, a Total Rationality score, and Scales scores representing each of the four Cognitive Processes domains and each of the three Content domains. The ABS-2 scores demonstrate adequate to excellent internal consistency, and correlate significantly with measures of depression, anxiety, life satisfaction, selfcontrol, well-being, and measures of internalizing personality disorders. The ABS-2 did not correlate significantly with measures of anger, externalizing personality disorders, mania, and somatoform disorder. An exploratory factor analysis provided weak support for the factor structure of the scale. The ABS-2 scores distinguish between normal and clinical samples. Rationally worded items discriminated between clinical and nonclinical groups much better than did the irrationally worded scales, suggesting that instruments that only assess irrational beliefs might underestimate the support for REBT.

OBJECTIVE Nonsuicidal self-injury (NSSI) is prevalent and associated with clinically significant consequences. Developing time-efficient and cost-effective interventions for NSSI has proven difficult given that the critical components for NSSI treatment remain largely unknown. The aim of this study was to examine the specific effects of mindful emotion awareness training and cognitive reappraisal, 2 transdiagnostic treatment strategies that purportedly address the functional processes thought to maintain self-injurious behavior, on NSSI urges and acts. METHOD Using a counterbalanced, combined series (multiple baseline and data-driven phase change) aggregated single-case experimental design, the unique and combined impact of these 2 4-week interventions was evaluated among 10 diagnostically heterogeneous self-injuring adults. Ecological momentary assessment was used to provide daily ratings of NSSI urges and acts during all study phases. RESULTS Eight of 10 participants demonstrated clinically meaningful reductions in NSSI; 6 participants responded to 1 intervention alone, whereas 2 participants responded after the addition of the alternative intervention. Group analyses indicated statistically significant overall effects of study phase on NSSI, with fewer NSSI urges and acts occurring after the interventions were introduced. The interventions were also associated with moderate to large reductions in self-reported levels of anxiety and depression, and large improvements in mindful emotion awareness and cognitive reappraisal skills. CONCLUSIONS Findings suggest that brief mindful emotion awareness and cognitive reappraisal interventions can lead to reductions in NSSI urges and acts. Transdiagnostic, emotion-focused therapeutic strategies delivered in time-limited formats may serve as practical yet powerful treatment approaches, especially for lower-risk self-injuring individuals. (PsycINFO Database Record

This study reflects an assessment of the relationship between change in defensive functioning and change in the therapeutic interaction during an eight-year treatment episode of an older personality disordered woman. The patient, Ms. Q, possessed schizoid, avoidant, and depressive personality disor- ders as well as major depression as assessed by the Millon Clinical Multiaxial Inventory-III (MCMI-III). At the end of the treatment episode, Ms. Q still pos- sessed an avoidant personality disorder and significant depressive personal- ity traits but no longer possessed clinically significant schizoid traits or major depression. Ms. Q made significant positive change in her adaptive defensive functioning as assessed by the Defense Mechanism Rating Scale (DMRS). Through time-series analysis it was discovered that positive change in adap- tive defenses was predicted by increases in a specific type of therapeutic inter - action as assessed by the Psychotherapy Q Sort (PQS). In this therapeutic in- teraction the therapist in a didactic and advice-giving manner highlighted the patient's role in a problem in a clear and coherent way that could be perceived as tactless. Time-series analysis revealed a reciprocal relationship in which pos- itive changes in adaptive defenses predicted further increases in that particular quality of therapeutic interaction. This case study reflects a systematic attempt to assess the therapeu- tic interaction and its relationship to defensive functioning during an eight-year treatment episode of an older personality disordered wom- an who was in intensive psychodynamic psychotherapy. The patient, Ms. Q, suffered from schizoid, avoidant, and depressive personality disorders as well as major depression. The patient was a socially isolat

Objective The aim of this study was twofold: (a) Investigate whether therapists are consistent in their use of therapeutic techniques throughout supportive–expressive therapy (SET) and (b) Examine the bi-directional relation between therapists' use of therapeutic techniques and the working alliance over the course of SET. Method Thirty-seven depressed patients were assigned to 16 weeks of SET as part of a larger randomized clinical trial (Barber, Barrett, Gallop, Rynn, & Rickels, 2012). Working Alliance Inventory-Short Form (WAI-SF) was collected at Weeks 2, 4, and 8. Use of therapeutic interventions was rated by independent observers using the Multitheoretical List of Therapeutic Interventions (MULTI). Intraclass correlation coefficients assessed therapists' consistency in use of techniques. A cross-lagged path analysis estimated the working alliance inventory- Multitheoretical List of Therapeutic Interventions bidirectional relation across time. Results Therapists were moderately consistent in their use of prescribed techniques (psychodynamic, process-experiential, and person-centred). However, they were inconsistent, or more flexible, in their use of “common factors” techniques (e.g., empathy, active listening, hope, and encouragements). A positive bidirectional relation was found between use of common factors techniques and the working alliance, such that initial high levels of common factors (but not prescribed) techniques predicted higher alliance later on and vice versa. Conclusion Therapists tend to modulate their use of common factors techniques across treatment. Additionally, when a strong working alliance is developed early in treatment, therapists tend to use more common factors later on. Moreover, high use of common factors techniques is predictive of later improvement in the alliance.

Background: Risk-taking behaviors are common and, unabated, can lead to serious consequences, such as unintended pregnancies, sexually transmitted infections, drug and alcohol abuse, injuries, and death. Despite their prevalence and consequences, the psychological determinants underlying these behaviors are not well understood. Objectives: The study aimed to evaluated the role of Sex, Parent Attachment, Emotional Adjustment on Risk-Taking Behaviors. Patients and Methods: To test the role of close relationships on risk-taking behaviors,we used a correctional field design and examined the influence of parent attachment on these behaviors while accounting for participants’ sex and emotional adjustment, measured in the form of self-esteem and level of depression. A total of 269 participants from Amazon’s MTurk website completed our survey. Results: Results revealed differences between men and women on all six scales that assessed for risk-taking behavior; however no differences were evident by sex on levels of attachment to mother or attachment to father or on levels of adjustment. Our results also indicate that attachment to mother is directly and inversely associated with risk taking behavior, and that adjustment is a mediator between attachment to father and risk-taking behavior. Conclusions: These results and others are presented and discussed in the context of the literature along with implications for counseling and for future research in this area.

This comparative survey contrasted 571 parents who lost children to various death causes: 48 to drug-related deaths and overdoses, 462 to suicide, 24 to natural death cases, and 37 to mostly accidental death cases. Groups were compared in terms of grief difficulties, mental health problems, posttraumatic stress, and stigmatization. Results did not show any appreciable differences in these respects between the suicide bereaved parents and those losing children to drug-related deaths. However, when the suicide and drug-related death survivors were specifically contrasted against accidental and natural death loss cases, a consistent pattern emerged showing the former group was consistently more troubled by grief and mental health problems than the latter two sub-groups. These differences remained when controls of time since the loss and gender differences were employed as covariates. These findings suggest that the powerful and intense stigma against drug use and mental illness, shared among the public-at-large, imposes challenges in healing of immense proportion for these parents as they find less compassionate responses from their significant others, following their losses.

This paper introduces two related measures that can be used to evaluate, describe, and track changes in personality functioning. Both are derived from the Shedler-Westen Assessment Procedure (SWAP-200). The first measure is the Personality Health Index (PHI) that offers an assessment of personality functioning that may be applied to the study of outcome in any treatment purporting to affect overall psychological health, such as long-term psychodynamic therapy and psychoanalysis. Preliminary studies suggest robust construct validity for the PHI. The second measure, RADIO, uses the item content of the SWAP-200 to categorize personality functioning into five domains: Reality testing and thought process, Affect regulation and tolerance, Defensive organization, Identity integration, and Object relations. Referred to by the acronym RADIO, this measure provides a picture of personality health across major dimensions of personality functioning. Applying these measures to the well

With a diverse sample of 462 parent survivors of their child's suicide we explored the association of the personal growth subscale of the Hogan Grief Reaction Checklist (HGRC) with mental health problems among longer-term survivors. In this article we offer additional validation for this scale's association with longer-term survivorship and reduced grief difficulties. We also demonstrate its negative relationship with mental health problems. In addition, we explore the demographic correlates of personal growth, which are likely to enable some survivors to experience personal growth sooner than others. Overall, the findings suggest that personal growth represents an important part in the process of healing after suicide loss.

This analysis explores associations between differing death circumstances and the course of bereavement among a sample of 540 bereaved parents. Comparisons were made between parents whose children died by suicide ( n = 462), those losing children from other traumatic death circumstances ( n = 54), and others whose children died from natural causes ( n = 24). Results were mixed, showing suicide survivors with more grief difficulties and other mental health problems on some criteria, though most findings showed no substantive differences between these subgroups. Results also showed, in the first years after loss, repeated suicide attempts and prior negative relationships with the decedent were associated with greater grief difficulties. However, as more time passed, all death circumstance differences were overshadowed by the importance of the time span since loss. This data also suggested that between 3 and 5 years usually marks the turning point, when acute grief difficulties accompanying a suicide loss begin to subside.

This study examined the relationship of early alliance ruptures and their resolution to process and outcome in a sample of 128 patients randomly assigned to 1 of 3 time-limited psychotherapies for personality disorders: cognitive-behavioral therapy, brief relational therapy, or short-term dynamic psychotherapy. Rupture intensity and resolution were assessed by patient- and therapist-report after each of the first 6 sessions. Results indicated that lower rupture intensity and higher rupture resolution were associated with better ratings of the alliance and session quality. Lower rupture intensity also predicted good outcome on measures of interpersonal functioning, while higher rupture resolution predicted better retention. Patients reported fewer ruptures than did therapists. In addition, fewer ruptures were reported in cognitive-behavioral therapy than in the other treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Taken among parents who sustained the loss of a child to suicide this study explores the participation of parents in Internet support groups, comparing their demographic and loss-related characteristics ( N = 104) to other parent survivors participating in face-to-face support groups ( N = 297). Contrary to expectations that Internet affiliates would be concentrated in under-served rural areas, we found similar levels of urban, suburban, small city and rural residents in both Internet and face-to-face subsamples. Bivariate and multivariate analyses suggested several important factors contributing to interest in Internet grief support including: 24/7 availability and opportunities to invest more time into this type of support group experience. Compared to their face-to-face group counterparts, Internet affiliates experienced greater suicide stigmatization from their families and other associates. Unable to find ready comfort and support from their personal communities, Internet users—and especially highly depressed survivors—sought and obtained valuable help from the Internet support resource.

The aim of the study described in this paper was to develop a method for measuring the therapeutic alliance from an intersubjective perspective and to evaluate the efficacy of the measure in predicting psychotherapy outcome. We conducted the study using data from 22 patient-therapist dyads engaged in a 30-session protocol of a brief relational therapy. The alliance measure chosen for this purpose was the short form of the Working Alliance Inventory. We used the subjective patient and therapist versions of the measure and created a correlation index representing the intersubjective congruence between patients and therapists on their ratings of the alliance. We examined the relations among the measures, as well as their predictive relation to an outcome measure. The results showed significant intercorrelations among the three alliance measures, suggesting that all captured aspects of the therapeutic alliance. In addition, all three measures were significantly predictive of outcome, with the correlation index appearing more powerful.

Using data from all waves of the National Longitudinal Survey of Adolescent Health, we investigated the short-term and long-term impact of an adolescent friend's suicide on an adolescent's depression and suicidality. Results suggest that a friend's suicide is associated with heightened suicide thoughts and attempts and greater depression during the first year after loss. Six years later, analyses show concurrent behaviors most relevant to explain suicidality fluctuations. Findings suggest the importance of therapeutic availability, especially during the first year, for those losing a friend to suicide.

Bedtime struggles are some of the most common childhood behavior problems. These disruptions are associated with children's daytime misbehavior, impaired social functioning, poorer school performan...

This study tested a motivational text message treatment adjunct for individuals with eating disorders (EDs) who exhibited high dietary restraint/restriction.A replicated single-case alternating treatment design was used to examine (a) the feasibility of combining a brief motivational interview with subsequent text messages and (b) the influence of the text messages on eating behaviors and motivation to change in individuals with EDs (N=12). The protocol was 8weeks and the text messages were adjunctive to cognitive-behavioral therapy.The intervention was well accepted (mean rating=7/10) and feasible within the context of monetary compensation (mean daily monitoring compliance =91%). Text messages did not impact behavioral outcomes: dietary restraint and kilocalorie intake. They had mixed effects on motivation to change dietary restraint, measured by the Readiness and Motivation Questionnaire (RMQ). When receiving text messages, RMQ precontemplation scores (desire to restrict) significantly increased, indicating decreased motivation; however, action scores (effort toward reducing dietary restraint) significantly increased, indicating increased motivation. These effects were moderated by weight status. Underweight individuals (n=4; body mass index [BMI]19.0) reported increased ambivalence-that is, an increased desire to restrict and increased action toward reducing restriction-in response to the text messages. Normal weight participants (n=8; BMI19.0) reported only increased action toward reducing restriction in response to the text messages.These data demonstrate text messages are a potentially feasible and acceptable treatment adjunct and may be effective at increasing motivation to change for normal weight individuals, while their influence on underweight patients is more complex. These findings provide a foundation for future research in technology-based motivational interventions for EDs and offer preliminary evidence for using these methods among normal weight individuals.

Data on the duration of transgene expression in the liver, the presence of cytotoxic T lymphocytes (CTLs) against adenovirus, and serum cytokines from 18 strains of C57BL/6×DBA/2 (B×D) recombinant inbred mice were analyzed. Our aim was to detect quantitative trait loci (QTLs) that may have causal relationship with the duration of adenovirus-mediated transgene expression in the liver. Information from β-galactosidase (LacZ) expression; CTL production; and serum levels of gamma interferon, tumor necrosis factor-α, and interleukin-6 30 days after intravenous injection of liver LacZ were summarized by principal component analysis and analyzed using maximum likelihood interval mapping implemented in the QTL cartographer software. Two principal component (PC) scores explained 82.5% of the phenotypic variance in the original variables and identified QTLs not identified by analysis of individual traits. The distribution of original variables among PCs was such that variables in PC1 were predominantly cytokines with little CTL response whereas LacZ and CTL were the predominant contributors to PC2 with practically no contribution from cytokines. PC1 was significantly associated with two QTLs on chromosomes 7 and 9 located at 57.5 cM and 41.01 cM, respectively. Five QTLs were significantly associated with PC2 on chromosomes 12 (23.01 and 31.01 cM) and 15 (29.21, 36.01, and 56.31 cM). These results illustrate the use of principal component analysis in mapping QTLs using multiple correlated traits.

Each of 51 experienced psychiatrist/psychoanalysts was queried about the clinical characteristics of every private psychotherapy patient presently in treat- ment: 551 patients were included in the study; 88% of patients had an Axis I disor- der, 59% had Axis I and Axis II disorders concurrently, and 11% Axis II only. Of these patients, 44% had been prescribed psychotropic medication on a daily basis for at least 2 weeks during the present treatment. Patients treated for the longest time (5 years or more) were the most seriously psychiatrically disturbed. Patients improved with psychotherapy, and the improvement was related to the duration of treatment. The combined impact of diagnosis status, treatment duration, and treat- ment modalities provided a consistent pattern of treatment effectiveness. This article provides a cross-sectional view of the private practices of senior, analytically trained psychiatrists, covering features of the pa- tients, types of treatment, and some indicators of treatment effects. De- spite recent advances in psychoanalytic psychotherapy research (Bucci, 1997; Fonagy, 2002; Freedman, Hoffenberg, Vorus, & Frosch, 1999; Galatzer-Levy, Bachrach, Skolnikoff, & Waldron, 2000; Wallerstein, 2001), only sparse data of this nature have previously been available. A number of institutional and scientific factors may be identified as con- tributing to this gap in our clinical research

The meta-analysis of the treatment outcome studies of cognitive-behavioral therapy (CBT) for anger-related problems in children and adolescents included 21 published and 19 unpublished reports. The mean effect size (Cohen's d=0.67) was in the medium range and consistent with the effects of psychotherapy with children in general. The differential effects of skills training, problem solving, affective education, and multimodal interventions (d=0.79, 0.67, 0.36, and 0.74, respectively) were variable although also generally in the medium range. Skills training and multimodal treatments were more effective in reducing aggressive behavior and improving social skills. However, problem-solving treatments were more effective in reducing subjective anger experiences. Modeling, feedback, and homework techniques were positively related to the magnitude of effect size.