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Couple distress is associated with cardiovascular disease (CVD) risk factors, whereas support is associated with heart-healthy behaviors and better CVD outcomes. OBJECTIVE To assess the clinical benefit of the Healing Hearts Together (HHT) intervention, an attachment-based relationship enhancement program for couples in which 1 partner has CVD, on relationship quality, mental health, and quality of life (QoL). METHOD Patients from a tertiary cardiac care center and their partners (N = 78; 39 couples) attended the 8-session HHT group. Participants completed validated, self-report questionnaires pre- and postintervention, including the Dyadic Adjustment Scale (DAS), Couple Satisfaction Index (CSI), Hospital Anxiety and Depression Scale (HADS), and the SF-36 (QoL). At intervention completion, participants completed a satisfaction survey. Between-groups comparisons (patient/partner) were examined with analysis of variance. Paired-sample t tests were used to assess changes over time with HHT participation for the complete sample and for patients and partners separately. RESULTS Many participants reported relationship and psychological distress at baseline. Clinically and statistically significant changes from pre to postintervention were observed for relationship distress (DAS: +7.8 points; p < .001; CSI changes [+3.6] were clinically significant) and depression (-1.8; p < .001), whereas statistically significant changes occurred for anxiety (-1.5; p < .001), and physical (+2.1; p = .047) and mental (+3.3; p < .001) QoL. Patients, but not partners, reported statistically significant changes in QoL-mental component summary. Clinically and statistically significant changes were observed for anxiety for partners, but not patients. CONCLUSIONS The HHT intervention was beneficial for patients' and partners' relationship quality, mental health, and QoL. A larger randomized controlled trial evaluating the impact of this intervention on relationship quality, mental health and QoL is warranted. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Reductions in marital relationship quality are pervasive post-cardiac event. It is not yet understood how relationship quality is linked to mental health outcomes in couples where one member has established cardiovascular disease (CVD) and the interdependence within dyads is seldom measured. This research is required as psychological distress has been independently linked to CVD incidence, morbidity, and mortality. This study assessed associations of relationship quality with depression and anxiety among patients with CVD and their spouses. Participants completed questionnaires measuring four dimensions of relationship quality and mental health. Data were analyzed using an Actor-Partner Interdependence Model with hierarchical moderation analyses. 181 dyads (N = 362 participants) comprised the study sample. Most patients had coronary artery disease (66.3%) and 25.9% were female. Patients reported higher relationship satisfaction and fewer anxiety symptoms than did spouses. Patients and spouses with high dyadic consensus and affectional expression reported fewer mental health symptoms, but only when the other partner also perceived high levels of consensus and affectional expression in the relationship. Patients and spouses with low dyadic cohesion reported worse mental health symptoms (actor effects), but those effects were no longer significant when both the patient and the spouse appraised the relationship as having high levels of dyadic cohesion. Taken together, relationship quality is linked to mental health symptoms in patients with CVD and their spouses. Longitudinal and experimental studies are now warranted to further substantiate the cross-sectional findings of this study.

This study seeks to validate the cross-cultural effectiveness of emotionally focused couple therapy (EFT) training in a sample of Spanish-speaking clinicians. The 28-hr formalized training for EFT was offered in six different Spanish-speaking countries, covering Europe, North America, Central America, and South America. Two hundred and seven therapists of 14 different Spanish-speaking nationalities completed pre-training assessments, 153 of them completed post-training assessments, and 92 therapists also completed the follow-up assessment. Using multilevel growth modeling (MLM), results indicated that therapists experienced significant and positive changes in terms of EFT competence (knowledge and skill acquisition), mature empathy, self-compassion, and attachment over time. Implications for transnational EFT training, specifically in Spanish-speaking countries, are discussed.

Objectifs : Offrir une thérapie par videoconference pour soulager la peur de la récidive du cancer (PRC) par l’entremise de la vidéoconférence. Déterminer la faisabilité et l’efficacité de ce traitement dans un contexte clinique. Matériel et méthodes : Thérapie par vidéoconférence cognitivoexistentielle une fois par semaine pour six semaines. Résultats : Diminution progressive de la PRC et de la détresse psychologique reliée au cancer. Satisfaction adequate de la vidéoconférence. Conclusion : L’utilisation de la vidéoconférence permettrait à un plus grand nombre de survivants de cancer d’être traités pour leur PRC.

Background It is imperative for health care professionals to have access to valid and reliable tools to evaluate the quality of romantic relationships, as it has been repeatedly shown to be related to psychological and physical health outcomes. The Couples Satisfaction Index (CSI) was developed to address the shortcomings of the most widely cited measures of satisfaction by increasing precision and power of measurement. However, the use of this questionnaire is limited due to a lack of translated versions. The purpose of the current study was therefore to translate the CSI to Canadian French (CanFrench-CSI) and to evaluate its reliability in a sample of male Canadians. Methods The CSI questionnaire was adapted and translated into Canadian French using a forward-backward approach. Its reliability was then evaluated by means of Cronbach’s alpha internal consistency coefficients, corrected item-total correlation coefficients, and a test-retest intraclass correlation coefficient at a two-week interval. Results Data from 53 men in committed relationships were analyzed. The French adaptation of the CSI demonstrated satisfactory internal consistency and test-retest reliability. Conclusions Overall, the results provided evidence supporting the translation consistency and reliability of the CanFrench-CSI, and thus, paved the way for further research on romantic relationships and health outcomes among French-speaking individuals.

The effects of mental health on quality of life (QoL) over the course of a couple's recovery from a patient's cardiac event are unknown as partner outcomes are rarely considered within cardiac rehabilitation. To capture the transactional nature of recovery from a cardiac event, this research investigated the link between longitudinal changes in the mental health of couples in which at least one of the partners had cardiac disease and changes in their QoL during cardiac rehabilitation. Participants (N = 184 dyads) completed questionnaires measuring anxiety, depression, and QoL at baseline (enrollment) and 3 months (discharge). Dyadic data were analyzed using the Actor-Partner Interdependence Model with integrated latent change scores. The results indicated that improved anxiety was associated with significant positive changes in physical and emotional QoL for both the patient and partner (actor effects). A reduction in depression in both partners from baseline to follow-up predicted an increase in emotional QoL for patients and partners, and an increase in physical QoL for partners (actor effects). Patients whose depression decreased from enrollment to the completion of cardiac rehabilitation were associated with partners' greater positive changes in emotional QoL than were patients whose depression did not decrease, and reductions in partners' anxiety over time predicted positive changes in patients' physical QoL (partner effects). Findings underscore the need to screen for and attend to patients' and partners' mental health outcomes postcardiac event, as positive changes in mental health symptoms may optimize changes in patients' and partners' emotional and physical QoL. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

UNSTRUCTURED Supportive couple relationships are associated with reduced risk of chronic illness development, such as cardiovascular disease, as well as improved secondary prevention. Healing Hearts Together (HHT) is an 8-week couples-based intervention designed to improve relationship quality, mental health, quality of life, and cardiovascular health among couples in which one partner has experienced a cardiac event. A randomized controlled trial began in October 2019 to test the efficacy of the in-person, group-based HHT program as compared to usual care. In March of 2020, all recruitment, assessments, and interventions halted due to the COVID-19 pandemic. Guided by optimal virtual care principles, as well as by Hom and colleagues’ four-stage framework—consultation, adaptation, pilot-testing, and test launch—this paper is a tutorial for the step-by-step transition planning and implementation of a clinical research intervention from an in-person to a web-based format, using the HHT program as an example. Clinical and research considerations are reviewed, including (1) privacy, (2) therapeutic aspects of the intervention, (3) group cohesion, (4) research ethics, (5) participant recruitment, (6) assessment measures, (7) data collection, and (8) data analyses. This tutorial can assist clinical researchers in transitioning their research programs to a web-based format during the pandemic and beyond.

Caregiver psychological distress (i.e., depression and anxiety) is harmful to both caregiver and patient. Different affect-regulation strategies associated with attachment orientations may impact a caregiver’s perception of their caregiving role as a burden, thereby contributing to their psychological distress. The aim of the present investigation was to examine the links among attachment orientations, caregiver burden, and psychological distress in a cardiac context. Participants (N = 181, Mage = 61.79, SD = 10.49; males = 24.7%) were romantic partners of patients with heart disease (i.e., informal caregivers) who completed validated questionnaires. The majority of caregivers had partners with coronary artery disease (n = 127, 70. 2%). 66.3% of caregivers reported low burden, 87.6% reported low levels of depression and 89.9% reported low levels of anxiety. The mean anxious attachment score was 2.74 (SD = 1.37) and the mean avoidant attachment score was 2.95 (SD = 1.26). Four mediation analyses were run using PROCESS macro for IBM SPSS (version 26). Statistical models showed that the relationships between attachment anxiety and psychological distress were mediated by caregiver burden [abanxiety= 0.15, 95% C.I. (0.04, 0.29); abdepression = 0.15, 95% C.I. (0.05, 0.28)] and that attachment avoidance was not a significant covariate (cvanxiety = −0.02, p>0.05; cvdepression = 0.40, p>0.05). The relationships between attachment avoidance and psychological distress were also mediated by caregiver burden [abanxiety = 0.23, 95% C.I. (0.10, 0.42); abdepression = 0.21, 95% C.I. (0.09, 0.37]with attachment anxiety as a significant covariate (cvanxiety = 1.09, pcvdepression = 1.09, p

The relationship between body and mind is increasingly recognized in the occurrence and prognosis of cardiac disease. Based on reports detailing the potential (and the influence of certain risk factors) of developing depression and anxiety following cardiovascular disease, or a cardiac event, most notably acute coronary syndrome (ACS), we investigated whether such symptoms also existed in patient cases found at the cardiac rehabilitation unit of an academic hospital of Eastern Ontario. We examined data from charts during a 6-year period (2012–2017). The Hospital Anxiety and Depression Scale cumulated data within a retrospective cross-sectional study, was used to estimate the prevalence of anxious and depressive symptoms that might reflect the presence of psychological distress. Overall, our sample included 1178 patient files, 81.3% of which were diagnosed with ACS and 69.6% were male. 63.1% of the patients were between 60 and 79 years old at the time of diagnosis. Most patients were Caucasian (81.1%), married (60.3%), and living with their family (74.3%), and 49.7% were recorded as overweight or obese. We found that 29.3% of patients reported symptoms of psychological distress. Regression analyses revealed strong negative correlations between the proportion of symptoms of psychological distress and factors like age and functional capacity as measured by metabolic equivalents. Significant associations were also established between symptoms of psychological distress and factors such as obesity, sedentary lifestyle, smoking, and sex (female). This study was undertaken as part of a business case to implement a new cardiac rehabilitation programme in an academic hospital of Eastern Ontario and illustrate to the managers and decision-makers, the important factors to consider and to target when developing a stepped-care program for patients in cardiac rehabilitation in order to prevent psychological distress and how such a program was relevant to their institution.

ObjectivesCardiovascular disease (CVD) not only affects the patient, but has implications for the partner. Emerging evidence suggests that supportive couple relationships enhance CVD outcomes and reduce patient and partner distress. To date, however, little research has been done to address the couple relationship as a potentially important component of cardiac care. This article examines the impact of CVD on the couple relationship and assesses the perceived needs and desired intervention components of patients with CVD and their partners.DesignQualitative study using directed and conventional content analysis.SettingSingle-centre, tertiary cardiac care hospital that serves a population of 1.4 million in the Champlain region of Ontario, Canada.ParticipantsPatients with CVD and their partners (n=32, 16 couples) participated in focus groups. Patients were mainly male (75%), white (87.5%), aged 64.4 years (range 31–81 years), with varied cardiac diagnoses (50% coronary artery disease; 18.75% valve disease; 18.75% heart failure; 12.5% arrhythmia).ResultsFive categories were generated from the data reflecting changes within the couple relationship as a result of CVD: (1) emotional and communication disconnection; (2) overprotection of the patient; (3) role changes; (4) adjustment to lifestyle changes; and (5) positive relationship changes. Three categories were constructed regarding intervention needs and desired resources: (1) practical resources; (2) sharing with peers; and (3) relationship enhancement.ConclusionsOverall, the data suggest that there were profound changes in the couple relationship as a result of CVD, and that there is considerable need to better support the caregiving spouses and the couple as a unit. These results call for interventions designed to provide instrumental support, peer-sharing opportunities and relationship quality enhancement to help couples cope with CVD. Future studies should examine whether couples-based programming embedded into cardiac rehabilitation can be effective at improving relationship quality and reducing patient and partner stress in the aftermath of a cardiac event.

Background Heart disease is related to the etiology of mental health problems such as depression, anxiety, and posttraumatic stress. Objective The goal of this scoping review was to determine which factors pose a significant risk for the onset of symptoms of depression, anxiety, and posttraumatic stress in patients with heart disease, as well as to identify what might protect them from these afflictions. Method We conducted a thorough search of relevant medical and psychological databases (Scopus, PsycARTICLES, Psychology and Behavioral Sciences Collection, Sage Journals, and MEDLINE) and identified 41 studies that met inclusion criteria, which included all types of heart disease. Results The results of our review indicate that mental health history, the tendency to stifle negative emotional experiences (known as "type D personality"), and social support in patients with heart disease are related to the onset of or protection from depression, anxiety, and posttraumatic stress. These factors, along with gender and younger age, seem to be relatively consistent predictors of mental health problems in this population. Conclusions As per our results, it is important for clinicians to attend to the mental health history, type D personality, and presence and quality of social support in patients with heart disease. More research into prevention and gender differences is necessary to hone the detection and treatment of these problems in people with heart disease. Clinical implications Attention to their mental health history, their ability to express and regulate affect, their age, and their gender will most likely assist in identifying symptoms of depression, anxiety, and posttraumatic stress in people with cardiac disease. Gender differences, particularly in the manifestation of depression, ought to be taken into account.

Spouses report elevated levels of distress upon assuming a caregiver role; this role and related distress might, ironically, increase the cardiovascular risk of spousal caregivers of patients with cardiovascular disease (CVD). Physiological, behavioural, and emotional factors experienced by caregivers can contribute to enhanced CVD risk. Despite an appreciation of these established associations few approaches have shown effectiveness in reducing a caregiver's stress. It is known that CVD can produce additional strain on a caregiver-patient relationship, in turn accentuating caregiver distress. Poor relationships are known to be a detriment to cardiovascular health and negatively influence behaviours affecting CVD risk and outcomes. In light of these findings, we argue in this nonsystematic narrative review that enhancing caregiver-patient relationship quality in secondary prevention programs might afford an appropriate and timely opportunity to reduce caregiver distress and improve the cardiovascular health of the patient and their spousal caregiver. Evaluations of the effect of couples-based interventions on patient and caregiver CVD risk and health outcomes are required.

“Hold Me Tight” (HMT) groups are an adaptation of emotionally focused therapy (EFT) for couples and have emerged out of 30 years of research into the efficacy and process of EFT. The goal of this s...

ObjectivesEmotional issues such as depression, anxiety and post-traumatic stress disorder are common following a cardiac event. Despite their high prevalence, they often go undiagnosed and research suggests that men in particular are at higher risk. Therefore, a better understanding of men’s experiences with a cardiac event and ensuing health services is key for adapting approaches that meet their needs. The aim of this study was to describe the self-reported emotional challenges that men face following a cardiac event and to understand their patterns of psychosocial adjustment.DesignQualitative study (focus groups and one-on-one interviews) using an interpretive phenomenal analysis.SettingClinical settings (cardiac departments in hospitals, cardiac rehabilitation programme and family medicine clinics) and in the community in three Canadian provinces.ParticipantsA total of 93 men participated in the study through 22 focus groups and 5 semi-structured interviews, none has been excluded based on comorbidities.ResultsFour major themes emerged: (1) managing uncertainty and adversity; (2) distancing, normalising and accepting; (3) conformity to traditional masculine norms and (4) social, literacy and communication challenges.ConclusionsHealthcare professionals caring for men following a cardiac event must be aware of the psychological and social adjustments that accompany the physical challenges. However, there is a lack of explicit guidelines, tools and clinical training in men-sensitive approaches. Further research is required to better inform clinical practices and healthcare services.

Supportive couple relationships are associated with reduced risk of chronic illness development, such as cardiovascular disease, as well as improved secondary prevention. Healing Hearts Together (HHT) is an 8-week couples-based intervention designed to improve relationship quality, mental health, quality of life, and cardiovascular health among couples in which one partner has experienced a cardiac event. A randomized controlled trial began in October 2019 to test the efficacy of the in-person, group-based HHT program as compared to usual care. In March of 2020, all recruitment, assessments, and interventions halted due to the COVID-19 pandemic. Guided by optimal virtual care principles, as well as by Hom and colleagues’ four-stage framework—consultation, adaptation, pilot-testing, and test launch—this paper is a tutorial for the step-by-step transition planning and implementation of a clinical research intervention from an in-person to a web-based format, using the HHT program as an example. Clinical and research considerations are reviewed, including (1) privacy, (2) therapeutic aspects of the intervention, (3) group cohesion, (4) research ethics, (5) participant recruitment, (6) assessment measures, (7) data collection, and (8) data analyses. This tutorial can assist clinical researchers in transitioning their research programs to a web-based format during the pandemic and beyond.

Purpose of review To review the link between couple relationships and cardiovascular health, the plausible mechanisms by which relationship quality affects heart health, and to provide an overview of couple-based interventions aimed at improving cardiovascular health. Recent findings Marriage and the quality of the couple relationship bond are robust predictors of long-term health outcomes. Chronic relationship conflict and disconnection can be deadly. There are direct and indirect pathways by which couple relationship quality affect cardiovascular health. Direct pathways include effects of relationship quality on cardiovascular, neuroendocrine, and immune functioning. Indirect pathways include effects of emotional, cognitive and behavioural factors that impact lifestyle choices and adherence to treatment regimens. Effects of couple-based interventions addressing traditional cardiovascular risk factors have been null to modest and there is only one couple-based intervention that addressed relationship quality and heart health. On the basis of the literature, this is major oversight. We propose attachment-based interventions, such as our Healing Hearts Together program, for patients with heart disease and their partners. Summary Previous research indicates that couple-based interventions are promising. Large randomized controlled trials that aim to improve relationship quality among patients with CVD and their partners, as well as study mechanistic, surrogate, and clinical outcomes, are required to appropriately assess their impact.

Objective To evaluate the relation between alexithymia and Referential Activity (RA), a linguistic measure of the process by which non-verbal emotional experience is connected to language. Methods The 20-Item Toronto Alexithymia Scale (TAS-20) and the Toronto Structured Interview for Alexithymia (TSIA) were administered to 20 postgraduate students and 15 outpatients with hypertension. The Weighted Referential Activity Dictionary (WRAD) and other linguistic measures (Reflection, Disfluency, and Somatic Sense) were applied to texts derived from the TSIA using the Discourse Attributes Analysis Program (DAAP). Results Multiple linear regressions performed in the whole sample showed a relation between TSIA scores and Somatic Sense. Comparing the two groups, hypertensive subjects yielded higher scores on the TSIA than the young adult sample; no differences in DAAP measures emerged. A significant negative correlation was found between the TAS-20 Difficulty Describing Feelings score and the DAAP measure of references to body activations (Somatic Sense) both in the young adult sample and in hypertensives. In the young adult sample, negative relations emerged between different TSIA factors, WRAD score, and Somatic Sense; a positive relation with fragmented speech (Disfluency) and use of rationalization (Reflection) was also found. In hypertensive subjects, using the TSIA, a negative correlation between alexithymia and Somatic Sense and a positive correlation between alexithymia and the Mean High WRAD (a measure of intensity of engagement during the speech) were found. Conclusion The TSIA seems to be a more adequate instrument than the TAS-20 to explore relations between alexithymia and RA. Results appear to suggest a complex, nonlinear relation between alexithymia and RA, presumably influenced by subject-specific characteristics. Practitioner points A relation between alexithymia and RA has been proposed on theoretical grounds, but there has been minimal empirical investigation. This was the first study to employ both a self-report measure and a structured interview for measuring alexithymia in relation to RA. The results of this study suggest a complex, nonlinear relation between alexithymia and RA; this finding is essentially obtained with the structured interview measure of alexithymia. This relation is presumably influenced by subject-specific characteristics.

Emotionally focused therapy (EFT) for couples is an empirically supported treatment for relationship distress (Johnson and Greenberg Journal of Consulting and Clinical Psychology 1985a;53:175–184; Johnson, The practice of emotionally focused marital therapy: Creating connection. New York: Brunner-Routledge, 2004). Despite strong evidence of a link between experiences of childhood abuse and problems in intimate relationships during adulthood (Paradis and Boucher, Journal of Aggression, Maltreatment & Trauma 2010;19:138–158; Walker et al., Journal of Family Violence 2009; 24:397–406), there have not yet been any controlled trials of the efficacy of EFT for adult survivors of childhood abuse. In light of evidence of the effectiveness of individual EFT in the treatment of the sequelae of complex trauma (Paivio and Pascual-Leone, Emotion-focused therapy for complex trauma: An integrative approach. Washington, DC: American Psychological Association, 2010), we conducted the first randomized controlled trial of EFT for couples in which the female partner had a history of intrafamilial childhood abuse. Our primary hypothesis was that couples treated with EFT would experience a significant reduction in relationship distress. To test this hypothesis, 24 couples in Toronto, Ontario, Canada (mean relationship length 14 years), were randomly assigned to either a treatment group (24 sessions of EFT) or a control group (waiting list). Analyses of covariance with treatment condition as the fixed factor and baseline scores on the Dyadic Adjustment Scale (Spanier, Journal of Marriage and the Family 1976;38:15–28) as the covariate yielded a statistically significant effect of treatment group on relationship distress. Hierarchical regression analyses unveiled the particular circumstances under which EFT appeared to be effective. These results attest to the effectiveness of EFT for relational distress in trauma survivors and are discussed in light of the relevant clinical literature.

The focus of this article is on the link among theory, process, and outcome in the practice of Emotionally Focused Therapy (EFT) for couples. We describe the EFT model of change and the EFT perspective on adult love as the reflection of underlying attachment processes. We outline the manner in which theory and research inform EFT interventions. This leads into a detailed review of the literature on the processes of change in EFT. We highlight the client responses and therapist operations that have emerged from process research and their relation to treatment outcomes. We discuss the implications of this body of research for clinical practice and training.

We present emotionally focused therapy (EFT) for couples as a viable treatment option for posttraumatic stress disorder (PTSD). We outline the empirical evidence of a link between interpersonal relationships and posttraumatic stress, with an emphasis on social support as a buffer for the development of PTSD symptoms. This leads into a discussion of the usefulness of attachment theory in the conceptualization and treatment of PTSD, followed by a description of the EFT approach and its empirical evidence. We present a clinical case with excerpts from EFT couple therapy sessions in which one partner was diagnosed with PTSD. The article concludes with clinical recommendations for helping people confront and overcome the pain and the fear that PTSD provokes. © 2012 Wiley Periodicals, Inc. J. Clin. Psychol. 68:1-9, 2012. Language: en

Les buts de cette étude étaient l’intégration et la mise à l’épreuve d’un traitement psychologique au sein du Service de réadaptation cardiaque à l’Hôpital Montfort. Des patients (hommes et femmes), âgés entre 35 et 85 ans, avec une maladie cardiaque et qui se plaignaient de symptômes d’anxiété et de dépression ont participé à cette étude. Les résultats suggèrent que la thérapie cognitivo-comportementale (TCC) peut réduire de façon significative les symptômes de dépression et d’anxiété chez les patients cardiaques. Dans notre échantillon (N = 11), les patients ayant suivi au moins dix séances de traitement ont présenté une diminution importante de leurs symptômes, et personne ne répondait aux critères d’un diagnostic de dépression ou d’anxiété après l’intervention., The goals of the study were to introduce and test a psychological treatment at the Montfort Hospital’s Cardiac Rehabilitation Service. The participants were male and female patients between the ages of 35 and 85 with heart disease who reported symptoms of anxiety and depression. The results suggest that cognitive-behavioural therapy (CBT) may significantly reduce symptoms of depression and anxiety in cardiac patients. In our sample (N = 11), patients completing at least 10 treatment sessions showed a significant decrease in their symptoms, and none met the criteria for a diagnosis of depression or anxiety after the treatment.

Poor school adjustment is a known correlate of peer rejection in childhood. However, the impact of change in sociometric status on children's academic performance over time is unclear. The aim of this study was to determine whether improvement or decline in children's sociometric status would predict corresponding changes in their academic performance trajectories. Two hundred and seventy-two boys and 252 girls in Florence, Italy (mean age at Time 1: 7.42 years) and their teachers participated in this 18-month investigation. Hierarchical linear models indicated that children who were rejected by their peers across the four measurement points of the study demonstrated consistently worse academic performance than did children who were not rejected throughout, whereas children who were regularly accepted by their peers performed better in school than did their peers who were rejected one or more times. A number of children who became rejected exhibited an academic decline, but others who became accepted showed improvement. The implications of these results for children, parents, teachers and school administrators are discussed.

Le but de cette etude etait d’evaluer si les couples dont la femme a le cancer du sein reagissent a la therapie de couple axee sur l’emotion (EFT) de la meme facon que les couples en bonne sante, c’est-a-dire avec un niveau croissant d’interactions positives ainsi qu’avec un niveau croissant d’experiencing (capacite a prendre conscience de ses emotions et a les verbaliser). Les enregistrements des seances de therapie de deux couples dont la femme presente un cancer du sein ont ete evalues. Les resultats suggerent que le processus therapeutique des couples dont la femme a le cancer du sein est semblable a celui des couples en bonne sante. Les implications cliniques des resultats sont discutees.

People who suffer from depression, post-traumatic stress, or anxiety following cardiac events and treatment are more likely to have further cardiac complications resulting in death than are people who do not. Although there have been advances in psychological techniques to elicit behavior and lifestyle changes in heart patients [1], there is currently a dearth of information on how to address the psychological sequelae of heart disease effectively. The goals of this pilot study were therefore to develop and test a cognitive-behavioral psychological treatment that was specifically tailored to the needs of people with cardiac disease and symptoms of psychological distress. Fifteen men and 12 women between the ages of 35 and 85 who exhibited clinically significant symptoms of depression, anxiety, or post-traumatic stress following a diagnosis of heart disease participated in a maximum of 20 sessions of cognitive-behavioral therapy. By the end of treatment, there were statistically significant reductions in all symptoms of psychological distress, as measured by the Beck Depression Inventory Fast Screen for Medical Patients [2], the Beck Anxiety Inventory [3], the Hospital Anxiety and Depression Scale [4], and the Impact of Event Scale, Revised [5]. We present the treatment protocol in detail and discuss our results in terms of the utility of the integration of psychological services into cardiac care.

Emotion-Focused Therapy (EFT; Greenberg & Johnson, 1988) is anchored in attachment theory (Johnson, 2003) and considers change in attachment schemas essential in the process of improving satisfaction in relationships (Johnson, 1999). However, there is little data on how measures of attachment change over the course of EFT or any other couple therapy. The current study examines whether increases in attachment security predict improvements in marital satisfaction during behavioral couple therapy, which would suggest that change in attachment style is a key process variable even for a non-attachment focused treatment. Multilevel models of data from 134 couples participating in a randomized clinical trial of Integrative Behavioral Couple Therapy and Traditional Behavioral Couple Therapy (Christensen et al., 2004) indicate that although there is a trend for early change in attachment-related anxiety and avoidance to predict later change in marital satisfaction, early change in marital satisfaction strongly predicts change in attachment-related anxiety through the end of treatment and two-year follow-up. These findings suggest that changes in satisfaction may lead to changes in attachment rather than the reverse and that change in attachment may not be the mechanism of change in all efficacious couple therapy.

Emotionally focused therapy (EFT) for couples combines experiential and systemic techniques to expand emotional responses and cycles of interaction. This approach has also been used to treat depression, chronic illness, and anxiety disorders. EFT appears to translate well across culture and class, focusing on universal key emotions and attachment needs. From the EFT perspective, adult love is a hardwired, adaptive attachment response. The therapist's in-session focus is on the processing of emotions and key interactional patterns as they occur in the present, because emotional experiences are the primary instruments of change in this approach. The therapist is a relationship consultant who offers a safe platform whereby each partner can distill, expand, and transform experience and find new ways to connect with the other. The case presented here illustrates the three stages of EFT: de-escalation, restructuring interactions, and consolidation.

Most school transitions are characterised by sweeping changes in children's social and learning environments, often accompanied by important biological and cognitive changes; the multiple changes occurring within the child and the environment make the results of school-transition studies difficult to interpret. Italian elementary school children experience a marked transition in teaching and evaluation style at the end of second grade, but do not change schools. Formal academic instruction begins and pupils' progress begins to be evaluated individually by means of oral examinations. The present longitudinal study focuses on the role of friends during this transition. The participants were pupils of 17 classes in 11 schools in the city of Florence, Italy, and surrounding towns. Self-reported liking of school decreased sharply after the transition. There were some indications that having friends contributed overall to successful adjustment after the transition, especially in terms of children's liking of school. There was also some evidence that friendship is an asset to children undergoing stressful life experiences. Both children's liking of school and their antisocial behaviours were predicted by their friends' attitudes toward school and their friends' antisocial behaviour.

Research on the social context of bullying includes children who help the victim, assist the bully or remain outsiders. 96 children from two public schools in Central Italy were classified according to an Italian version of the Participant Role Scale (Sutton and Smith, 1999) as Defenders of the Victim, Outsiders, Victims or Pro-bullies. Teacher reports indicated Friendliness and Emotional Instability as the strongest distinguishing personality factors among the participant roles, followed by Conscientiousness and Energy. Higher levels of Emotional Instability and lower levels of Friendliness typified both Pro-bullies and Victims, relative to their peers. Victims were also low in Conscientiousness. Defenders exhibited high levels of Friendliness, whereas Introversion and Independence characterized Outsiders. These results suggest that personality traits might contribute to children's typical behaviour in bullying situations.

Social relationships are tightly linked to health and well-being. Recent work suggests that social relationships can even serve vital emotion regulation functions by minimizing threat-related neural activity. But relationship distress remains a significant public health problem in North America and elsewhere. A promising approach to helping couples both resolve relationship distress and nurture effective interpersonal functioning is Emotionally Focused Therapy for couples (EFT), a manualized, empirically supported therapy that is strongly focused on repairing adult attachment bonds. We sought to examine a neural index of social emotion regulation as a potential mediator of the effects of EFT. Specifically, we examined the effectiveness of EFT for modifying the social regulation of neural threat responding using an fMRI-based handholding procedure. Results suggest that EFT altered the brain's representation of threat cues in the presence of a romantic partner. EFT-related changes during stranger handholding were also observed, but stranger effects were dependent upon self-reported relationship quality. EFT also appeared to increase threat-related brain activity in regions associated with self-regulation during the no-handholding condition. These findings provide a critical window into the regulatory mechanisms of close relationships in general and EFT in particular.

Research indicates that sexual offenders who do not complete their treatment are more likely to reoffend than are those who do complete it (Hanson et al., 2002; Losel & Schmucker, 2005). Several investigators have attempted to identify the characteristics of those individuals who do not complete treatment, most likely with the aim of preventing recidivism and the disastrous consequences that offenders' behavior has for their victims and for society at large. The objective of the present article is to review studies of treatment noncompletion among sexual offenders. We found that between 15% and 86% of sexual offenders do not complete treatment. In addition, results of the 18 studies reviewed diverge to the point where it is difficult to draw unequivocal conclusions about the variables related to the phenomenon. Only antisocial personality disorder and certain features of antisocial personality disorder appear to be related consistently and significantly to the discontinuation of treatment. These features are conceptualized under the three principles of effective treatment for general offenders. We present an analysis of the methodological limitations common to all of the studies reviewed in order to explain why confusion seems to reign supreme in the literature in this area at the present time, and we offer recommendations for future research in light of these limitations.

The goal of this study was to examine whether psychological dimensions of antisocial personality disorder (ASPD), as conceptualized by Kernberg (1992), could predict psychotherapy noncompletion (PNC) among 50 men found guilty of sexual abuse of children. All participants began a 65-week, court-mandated course of cognitive-behavioral psychotherapy, which 20 (40%) of them did not complete. Pretherapy personality was assessed with the Structured Clinical Interview for DSM Axis II Disorders (First, Spitzer, Gibbon, Williams, & Benjamin, 1997), the Personality Organization Diagnostic Form (Diguer, Normandin, & Hebert, 2001), and Blatt and colleagues' (Blatt, Bers, & Schaffer, 1993; Blatt, Chevron, Quinlan, Schaffer, & Wein, 1988) scales of mental representations, as well as the State-Trait Anger Expression Inventory (Spielberger, 1988). A discriminant function analysis, which explained 46% of the total variance, showed that descriptive (antisocial and narcissistic personality disorders), psychological (primitive defense mechanisms, identity diffusion and self-representations), and demographic (work status and income) variables predicted PNC. The classification analysis correctly classified 78% of the participants. These findings support the hypothesis that psychological dimensions of ASPD help explain PNC among sexual offenders. The authors discuss the theoretical and clinical implications of these results.

Cette recension présente les résultats de 14 recherches portant sur l’efficacité de la thérapie de couple axée sur l’émotion (TCÉ). Elle offre également un aperçu critique de ces études. Les résultats obtenus démontrent que la TCÉ est efficace dans la diminution de la détresse conjugale et que ses effets semblent se maintenir dans le temps. Il apparaît également qu’il s’agit d’une approche efficace auprès de couples en détresse vivant diverses problématiques spécifiques. Ces résultats doivent toutefois être considérés en fonction des limites des études (p. ex., petits échantillons homogènes, courts délais de relance, peu d’études comparatives)., This review presents the results of 14 studies on the effectiveness of emotionally focused couple therapy (EFT). It also offers a critical overview of these studies. The results obtained demonstrate that EFT is effective in reducing marital distress and that its effects seem to be sustained over time. It also appears to be an effective approach for couples in distress living with various specific issues. These results, however, should be considered in relation to the limitations of the studies (eg, small homogeneous samples, short follow-up periods, few comparative studies).