Do high-risk couples profit more or less from couple relationship education programs than low-risk couples? Room for improvement and vulnerability effects.

In recent years it has been discussed whether high-risk couples benefit more from Couple Relationship Education programs (CREs) than low-risk couples due to larger room for improvement, or profit less due to greater vulnerability. Pertinent response prediction studies yielded inconclusive results. Careful review suggests this may be due to: statistical handling (not disentangling room for improvement and vulnerability effects), time frame analyzed (not disentangling opposing effects during intervention and follow-up), sampling, and selection of risk factors. We used an analytic strategy that maximized odds for replicability and tested two hypotheses: (1) room for improvement: pre-intervention relationship dissatisfaction predicts gain in satisfaction during intervention, and decline during follow up, and (2) vulnerability: when adjusted for room for improvement (pre-intervention relationship dissatisfaction), risk factors show negative or negligible, but no positive associations with gain in satisfaction. Actor-Partner Interdependence Modeling (APIM) was employed in 79 self-referred (SR) couples and 50 clinician-referred (CR) couples who had completed the 'Hold me Tight' program, a CRE based on Emotionally Focused Couple Therapy. Our findings supported both the room for improvement hypothesis, with pre-intervention dissatisfaction predicting more gain during intervention (both samples) and decline during follow-up (SR sample, for the CR sample the effect was negligible), and the vulnerability hypothesis, as several negative, but no positive effects of risk factors were observed during intervention and follow-up. Specific risk factors did not replicate between samples. To promote replicable results in future research, we advocate disentangling room for improvement and vulnerability effects, separately testing effects during intervention and follow-up, purposeful sampling, and studying a large set of risk factors including partner variables.

Effectiveness of the 'Hold me Tight' Relationship Enhancement Program in a Self-referred and a Clinician-referred Sample: An Emotionally Focused Couples Therapy-Based Approach.

While evidence-based couple therapies are available, only a minority of troubled couples seek help and they often do this too late. To reach more couples earlier, the couple relationship education (CRE) group program "Hold me Tight" (HmT) based on Emotionally Focused Couples Therapy (EFCT) was developed. This study is the first to examine the effectiveness of HmT. Using a three-wave (waiting period, treatment, and follow-up) within-subject design, HmT was delivered to 79 self-referred couples and 50 clinician-referred couples. We applied a comprehensive outcome measure battery. Our main findings were that (1) self-referred couples significantly improved during HmT on all measures, that is relationship satisfaction, security of partner-bond, forgiveness, daily coordination, maintenance behavior, and psychological complaints, with a moderate-to-large mean effect size (d = .63), which was maintained (d = .57) during the 3.5 month follow-up; (2) in clinician-referred couples, who were vulnerable in terms of insecure attachment status and psychopathology, the improvement during HmT was moderate (d = .42), but this was reduced during the 3.5-month follow-up to a small effect (d = .22); (3) emotional functioning (typical HmT target) as well as behavioral functioning (typical Behavioral Couples Therapy-based CRE target) improved during HmT; and (4) individual psychological complaints, although not specifically targeted, were reduced during HmT. These findings suggest that HmT is a promising intervention for enhancement of relationship functioning. Clinical implications are discussed.

Ethnicity and psychiatric comorbidity in a national sample: evidence for latent comorbidity factor invariance and connections with disorder prevalence.

PURPOSE: Prevalence rates, and bivariate comorbidity patterns, of many common mental disorders differ significantly across ethnic groups. While studies have examined multivariate comorbidity patterns by gender and age, no studies to our knowledge have examined such patterns by ethnicity. Such an investigation could aid in understanding the nature of ethnicity-related health disparities in mental health and is timely given the likely implementation of multivariate comorbidity structures (i.e., internalizing and externalizing) to frame key parts of DSM-5. METHODS: We investigated whether multivariate comorbidity of 11 common mental disorders, and their associated latent comorbidity factors, differed across five ethnic groups in a large, nationally representative sample (n = 43,093). We conducted confirmatory factor analyses and factorial invariance analyses in White (n = 24,507), Hispanic/Latino (n = 8,308), Black (n = 8,245), Asian/Pacific Islander (n = 1,332), and American Indian/Alaska Native (n = 701) individuals. RESULTS: Results supported a two-factor internalizing-externalizing comorbidity factor model in both lifetime and 12-month diagnoses. This structure was invariant across ethnicity, but factor means differed significantly across ethnic groups. CONCLUSIONS: These findings, taken together, indicated that observed prevalence rate differences between ethnic groups reflect ethnic differences in latent internalizing and externalizing factor means. We discuss implications for classification (DSM-5 and ICD-11 meta-structure), health disparities research, and treatment.

Dealing with man-made trauma: the relationship between coping style, posttraumatic stress, and quality of life in resettled, traumatized refugees in the Netherlands.

This study investigated the relationship between coping style, posttraumatic stress disorder (PTSD) symptoms, and quality of life in traumatized refugees (N = 335). Participants had resettled in the Netherlands on average 13 years prior and were referred to a Dutch clinic for the treatment of posttraumatic psychopathology resulting from persecution, war, and violence. The majority (85%) of the research sample met diagnostic criteria for PTSD. Path analysis suggested a model in which PTSD symptoms (ß = -.61, p < .001), social support seeking (ß = .12, p < .05), and emotion-focused coping (ß = .13, p < .01) have a direct effect on quality of life. The role of avoidant and problem-focused coping could be interpreted in 2 ways. Either these coping styles are influenced by PTSD severity and have no effect on quality of life, or these coping styles influence PTSD severity and therefore have an indirect effect on quality of life. Intervention strategies aimed at modifying coping strategies and decreasing PTSD symptoms could be important in improving the quality of life of traumatized refugees.

Satisfying and stable couple relationships: Attachment similarity across partners can partially buffer the negative effects of attachment insecurity.

Insecure attachment in couples is negatively associated with relationship functioning. Similarity of partner attachment on the other hand might attenuate such relationship outcomes. We tested the opposing insecurity and similarity hypotheses by examining associations of attachment with relationship satisfaction and instability in a representative community sample of couples (N = 1,014). We expected: (a) negative effects of insecure attachment (main effects of actor and partner avoidance and anxiety, and interaction effects consistent with fearful-avoidance and demand-withdraw patterns); and (b) positive effects of similarity in avoidance and anxiety. Actor-Partner-Interdependence Models showed clear support for the insecurity hypothesis. Main effects of avoidance and anxiety, explained 46.2% of the variance of satisfaction, and 17.9% of instability. We conclude that reducing insecurity of attachment, in particular avoidance, must be a central target in couple therapy. Interestingly, similarity of attachment can partially buffer the negative effects of attachment insecurity. Clinical implications are discussed.

When and how assessment matters: An update on the Treatment Utility of Clinical Assessment (TUCA).

The Treatment Utility of Clinical Assessment (TUCA) has long been a controversial topic, with arguably more (strong) opinions than relevant, well-designed empirical research. We argue that this question has been tackled too broadly and that a more contextualized approach would likely be more informative. Instead of asking "what is the treatment utility of assessment," we suggest specifying and examining more closely the conditions by which assessment can-or cannot-contribute to treatment process and ultimately patient benefit. To this end, we present a heuristic model for conceptualizing the conditions under which clinical assessment may have treatment utility and illustrate its use by distinguishing four specific classes of assessment-driven interventions. We distinguish direct benefits from assessment from indirect TUCA as two principal pathways, emphasize the importance of having some a priori theory regarding working mechanisms, and stress the requirements of ensuring adequate variability of the presumed mediating variables. These considerations in turn argue for a broader view of pertinent outcome measures, the use of more powerful designs in TUCA research, and the implementation of some form of stepped assessment in clinical practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

On categorical diagnoses in DSM-V: cutting dimensions at useful points?

The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-V) will likely place more emphasis on dimensional representation of mental disorders. However, it is often argued that categorical diagnoses are preferable for professional communication, clinical decision-making, or distinguishing between individuals with and without a mental disorder. For these specific aims, utility-based categories can be created on the basis of a dimensional framework by using cut-points. This article addresses several ideas for combining categorical and dimensional approaches like prototype matching, adding scores of symptom-severity, and introducing utility-based categories in dimensional models. The authors identify alternative objectives for specifying cut-points and describe ways of determining the cut-points accordingly. It is recommended that, for creating standard diagnostic concepts, fixed cutoffs be used, as this promotes accumulative science, but these cutoffs may not be optimal for other clinical decisions because of local base rates and decision-specific (dis)utilities. Receiver operator characteristics curves can facilitate the comparative evaluation of the trade-off between sensitivity and specificity for multiple cut-points and diagnostic rules. The authors advocate a DSM-V that contains both categories and dimensions to serve the multiple and complex aims of utility and validity.

Optimal use of multi-informant data on co-occurrence of internalizing and externalizing problems: the TRAILS study.

Strong between-informant discrepancies are found in ratings of (pre)adolescent problems and in co-occurrence rates between different domains of psychopathology. These discrepancies can be caused by differences in the context of measurement and the perspective of informants. The aim of this study was to develop a "Multi-Informant Co-occurrence" model (MIC), which takes into account these differences in context and perspective. In a population-based cohort of (pre)adolescents (n = 2230) from a longitudinal study in the north of the Netherlands, internalizing (INT) and externalizing (EXT) problems were rated by the (pre)adolescents themselves, their teachers, and their parents. As hypothesized Principal Component Analysis revealed four independent main components: Between-domain convergence was captured by a severity component (S), while between-domain discrepancy was captured by a direction component (D). Between-informant discrepancies were captured by a perspective (P) and a context (C) component. The use of this MIC-model will increase reliability and validity of measures of psychopathology and the four components each provide useful specific information.

Change in self-reported personality during major depressive disorder treatment: A reanalysis of treatment studies from a demoralization perspective.

Change in self-reported personality trait scores (especially Neuroticism and Extraversion) over the course of treatment for major depressive disorder (MDD) has been robustly demonstrated. We believe that these observed changes on personality trait scales may reflect reduction in demoralization rather than changes in personality per se. Data were combined from 3 archival samples: a randomized clinical trial and 2 naturalistic follow-up studies. All participants (N = 300) received either psychotherapy or psychopharmacological treatment. Pre- and posttreatment participants were assessed with the revised NEO Personality Inventory (NEO-PI-R), the 17-item Hamilton Rating Scale for Depression (HRSD-I7), and Beck Depression Inventory-II (BDI-II). Comparisons were made between "unadjusted" and "adjusted" NEO-PI-R substantive personality trait scales-in which demoralization-related items were removed from their original trait scale (i.e., adjusted NEO-PI-R scales) and also used to form a separate NEO demoralization scale (NEOdem). The NEOdem scale changed more over the course of treatment (d = .41) compared with the adjusted NEO-PI-R scales, which manifested only small changes (d < |.19|). Moreover, the adjusted NEO-PI-R trait scales revealed much smaller changes compared with their unadjusted counterparts. The study provides further support for the utility of distinguishing between demoralization and NEO-PI-R traits in clinical assessment and research. A substantial part of change in self-reported personality during treatment for depression resulted from a reduction in demoralization. (PsycINFO Database Record

What features of psychopathy might be central? A network analysis of the Psychopathy Checklist-Revised (PCL-R) in three large samples.

Despite a wealth of research, the core features of psychopathy remain hotly debated. Using network analysis, an innovative and increasingly popular statistical tool, the authors mapped the network structure of psychopathy, as operationalized by the Psychopathy Checklist-Revised (PCL-R; Hare, 2003) in two large U.S. offender samples (nNIMH = 1559; nWisconsin = 3954), and 1 large Dutch forensic psychiatric sample (nTBS = 1937). Centrality indices were highly stable within each sample, and indicated that callousness/lack of empathy was the most central PCL-R item in the 2 U.S. samples, which aligns with classic clinical descriptions and prototypicality studies of psychopathy. The similarities across the U.S. samples offer some support regarding generalizability, but there were also striking differences between the U.S. samples and the Dutch sample, wherein the latter callousnesss/lack of empathy was also fairly central but irresponsibility and parasitic lifestyle were even more central. The findings raise the important possibility that network-structures do not only reflect the structure of the constructs under study, but also the sample from which the data derive. The results further raise the possibility of cross-cultural differences in the phenotypic structure of psychopathy, PCL-R measurement variance, or both. Network analyses may help elucidate the core characteristics of psychopathological constructs, including psychopathy, as well as provide a new tool for assessing measurement invariance across cultures. (PsycINFO Database Record

Personality in general and clinical samples: Measurement invariance of the Multidimensional Personality Questionnaire.

A growing body of research suggests that the same general dimensions can describe normal and pathological personality, but most of the supporting evidence is exploratory. We aim to determine in a confirmatory framework the extent to which responses on the Multidimensional Personality Questionnaire (MPQ) are identical across general and clinical samples. We tested the Dutch brief form of the MPQ (MPQ-BF-NL) for measurement invariance across a general population subsample (N = 365) and a clinical sample (N = 365), using Multiple Group Confirmatory Factor Analysis (MGCFA) and Multiple Group Exploratory Structural Equation Modeling (MGESEM). As an omnibus personality test, the MPQ-BF-NL revealed strict invariance, indicating absence of bias. Unidimensional per scale tests for measurement invariance revealed that 10% of items appeared to contain bias across samples. Item bias only affected the scale interpretation of Achievement, with individuals from the clinical sample more readily admitting to put high demands on themselves than individuals from the general sample, regardless of trait level. This formal test of equivalence provides strong evidence for the common structure of normal and pathological personality and lends further support to the clinical utility of the MPQ. (PsycINFO Database Record

Actor and Partner Effects of Attachment on Relationship Satisfaction and Sexual Satisfaction Across the Genders: An APIM Approach.

Previous studies found gender differences in relationship satisfaction and sexuality. We tested gender differences in associations between attachment, a lasting relationship determinant, and two outcomes, relationship and sexual satisfaction. This study improves on earlier research by examining these associations in one Actor-Partner-Interdependence-Model, making direct statistical testing between outcomes possible. Furthermore, a community and a distressed sample (N = 113 heterosexual couples each) were included to attempt replication across samples and to examine clinical implications. In both genders, actor attachment avoidance negatively affected relationship satisfaction and (with one exception) sexual satisfaction. Also in both genders, partner attachment avoidance negatively affected sexual satisfaction. However, whereas partner attachment avoidance influenced female relationship satisfaction, it did not affect male relationship satisfaction. The findings replicated across samples. Clinical implications are discussed.

Mapping the manuals of madness: Comparing the ICD-10 and DSM-IV-TR using a network approach.

The International Classification of Diseases and Related Health Problems (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) represent dominant approaches to diagnosis of mental disorders. However, it is unclear how these alternative systems relate to each other when taking into account the symptoms that make up the disorders. This study uses a network approach to investigate the overlap in structure between diagnostic networks pertaining to ICD-10 and DSM-IV-TR. Networks are constructed by representing individual symptoms as nodes, and connecting nodes whenever the corresponding symptoms feature as diagnostic criteria for the same mental disorder. Results indicate that, relative to the DSM-IV-TR network, the ICD-10 network contains (a) more nodes, (b) lower level of clustering, and (c) a higher level of connectivity. Both networks show features of a small world, and have similar (of "the same") high centrality nodes. Comparison to empirical data indicates that the DSM-IV-TR network structure follows comorbidity rates more closely than the ICD-10 network structure. We conclude that, despite their apparent likeness, ICD-10 and DSM-IV-TR harbour important structural differences, and that both may be improved by matching diagnostic categories more closely to empirically determined network structures. Copyright © 2016 John Wiley & Sons, Ltd.

Distinguishing between demoralization and specific personality traits in clinical assessment with the NEO-PI-R.

Demoralization, a nonspecific unpleasant state that is common in clinical practice, has been identified as a potential source of nonspecificity in the assessment of personality and psychopathology. The aim of this research was to distinguish between Demoralization and specific personality traits in a widely used measure of personality: the Neuroticism-Extraversion-Openness Personality Inventory-Revised (NEO-PI-R). NEO-PI-R and Minnesota Multiphasic Personality Inventory-2 questionnaires were completed by 278 patients of a specialized clinic for personality disorders in The Netherlands. Furthermore, a replication sample was used consisting of 405 patients from the same institution who completed NEO-PI-R questionnaires, as well. A measure of Demoralization was derived (NEOdem, a NEO-PI-R-based Demoralization scale) using factor analytic techniques. Results indicated that the Demoralization Scale scores were reliable and showed expected patterns of convergence and divergence with conceptually relevant Minnesota Multiphasic Personality Inventory-2-RF scales. When items contributing to Demoralization-related variance were removed from the NEO-PI-R scales, increased specificity was notable with regard to external correlates. These results provide supportive evidence for the validity and heuristic potential of distinguishing between Demoralization and specific personality traits within the NEO-PI-R.

Integrating autism-related symptoms into the dimensional internalizing and externalizing model of psychopathology. The TRAILS Study.

Problems associated with Autism Spectrum Disorder (ASD) occur frequently in the general population and often co-occur with problems in other domains of psychopathology. In the research presented here these co-occurrence patterns were investigated by integrating a dimensional approach to ASDs into the more general dimensional framework of internalizing and externalizing psychopathology. Factor Analysis was used to develop hierarchical and bi-factor models covering multiple domains of psychopathology in three measurement waves of a longitudinal general population sample (N = 2,230, ages 10-17, 50.8% female). In all adequately fitting models, autism related problems were part of a specific domain of psychopathology that could be distinguished from the internalizing and externalizing domains. Optimal model fit was found for a bi-factor model with one non-specific factor and four specific factors related to internalizing, externalizing, autism spectrum problems and problems related to attention and orientation. Autism-related problems constitute a specific domain of psychopathology that can be distinguished from the internalizing and externalizing domains. In addition, the co-occurrence patterns in the data indicate the presence of a strong general factor.

Development and validation of the Dutch brief form of the Multidimensional Personality Questionnaire (MPQ-BF-NL).

This study describes the development and psychometric properties of the Dutch brief form of the Multidimensional Personality Questionnaire (MPQ-BF-NL). Representative samples from the Netherlands (N = 1,055) and the United States (N = 1,153) and a Dutch student sample (N = 987) were used for development, cross- and external validation, respectively. The authors' strategy for item selection and scale validation replicated the development of the U.S. brief form (MPQ-BF). Internal consistencies were generally good and comparable to the U.S. version, as were correlations with the U.S. full-length scales and higher order structure. Moreover, convergent and divergent patterns were consistent with prediction, with Positive Emotionality related to social and activating behavior, Negative Emotionality to anxiety, and Constraint to reversed impulsivity and externalizing behaviors. In sum, the MPQ-BF-NL provides the Dutch-Flemish language area with a personality inventory well suited for both psychopathology research and clinical practice and offers new opportunities for fundamental and cross-cultural studies on personality.