Change Across Time in Cancer-Related Traumatic Stress Symptoms of Siblings of Children with Cancer: A Preliminary Investigation.

This pilot study examined changes in cancer-related post-traumatic stress symptoms (PTSS) across time for siblings of children with cancer. Siblings (N = 32; aged 8-18) completed a measure of anxiety, the Child PTSD Symptom Scale (CPSS), and the PTSD section of the Structured Clinical Interview for DSM-IV-TR (SCID) at twelve (SD = .9) and eighteen months (SD = 1.3) post-diagnosis. Moderate-to-severe PTSS was reported by 12 siblings (38%) at T1 and 7 (22%) at T2. Cluster analysis of PTSS data revealed five patterns: Few symptoms, stable across time (31%, n = 10); Mild symptoms, decreasing across time (16%, n = 5); Mild, stable symptoms (28%, n = 9); Moderate/severe symptoms, decreasing across time but remaining moderate (19%, n = 6); and Moderate/severe, stable symptoms (6%, n = 2). SCID data and anxiety scores distinguished siblings in the final two clusters from those with more favorable PTSS levels/trajectories. Additional research with larger samples is needed to validate these trajectories and examine factors that distinguish siblings with consistently elevated cancer-related PTSS from those with mild or significantly improving symptoms.

Depression Among Older Adults: A 20-Year Update on Five Common Myths and Misconceptions.

Is depression among older adults symptomatically different than younger adults? Is it more common or chronic or difficult to treat? Is depression in late life more likely to be attributed to psychological problems? Twenty-years ago, Dan Blazer, a pioneer known for his groundbreaking work on depression in older adulthood, conducted an important review of the existing literature to refute five commonly held beliefs about depression in late life. Now, two decades later, we call upon selected articles that are representative of our current knowledge to provide an update and identify research priorities. The research consensus spanning the past 20 years suggests that when compared with their younger counterparts, depression in older adults is not more common and is not more often caused by psychological factors. Although some studies have suggested that depression in late life may be symptomatically different and characterized by a more somatic presentation, there is insufficient empirical evidence to conclude that depression presents differently across adulthood. Overall, older adults respond to psychological interventions as well as younger adults, although evidence suggests that antidepressants are less efficacious in late life. Finally, compared with middle-aged adults, depression in older adults is associated with a more chronic course (i.e., higher rate of relapse), which is likely moderated by medical comorbidity. This special article summarizes our current understanding of the nature and treatment of late-life depression and highlights areas of inquiry in need of further study.

A randomized trial of videoconference-delivered cognitive behavioral therapy for survivors of breast cancer with self-reported cognitive dysfunction.

BACKGROUND: Long-term chemotherapy-related cognitive dysfunction (CRCD) affects a large number of cancer survivors. To the authors' knowledge, to date there is no established treatment for this survivorship problem. The authors herein report results of a small randomized controlled trial of a cognitive behavioral therapy (CBT), Memory and Attention Adaptation Training (MAAT), compared with an attention control condition. Both treatments were delivered over a videoconference device. METHODS: A total of 47 survivors of female breast cancer who reported CRCD were randomized to MAAT or supportive therapy and were assessed at baseline, after treatment, and at 2 months of follow-up. Participants completed self-report measures of cognitive symptoms and quality of life and a brief telephone-based neuropsychological assessment. RESULTS: MAAT participants made gains in perceived (self-reported) cognitive impairments (P = .02), and neuropsychological processing speed (P = .03) compared with supportive therapy controls. A large MAAT effect size was observed at the 2-month follow-up with regard to anxiety concerning cognitive problems (Cohen's d for standard differences in effect sizes, 0.90) with medium effects noted in general function, fatigue, and anxiety. Survivors rated MAAT and videoconference delivery with high satisfaction. CONCLUSIONS: MAAT may be an efficacious psychological treatment of CRCD that can be delivered through videoconference technology. This research is important because it helps to identify a treatment option for survivors that also may improve access to survivorship services. Cancer 2016;122:1782-91. © 2016 American Cancer Society.

Self-focused attention in response to laboratory stressors among women with premenstrual disorders.

The etiology of premenstrual disorders, including premenstrual syndrome (PMS) and premenstrual dysphoric disorders (PMDD), is not well understood. In the current study, the relationship between self-focused attention (SFA) and premenstrual disorders was examined to explore the hypothesis that women with premenstrual disorders tend to respond to symptoms in a maladaptive manner. Based on retrospective report, clinical interview, and 30-day prospective recording of premenstrual symptoms, women (N = 52) were categorized as meeting criteria for premenstrual disorders (PMD; n = 24) or not (controls; n = 28). Key findings indicated that women with premenstrual disorders reported greater use of SFA in response to negative affect elicited by laboratory tasks than controls, despite no significant differences in change in negative affect between the two groups. Women with premenstrual disorders also reported greater trait levels of SFA and maladaptive coping styles compared to controls. Women with premenstrual disorders may tend to respond to menstrual cycle changes using increased levels of SFA. The interaction between psychological and physiological menstrual cycle-related changes may lead to increased distress and impairment. Implications for psychological contributions to premenstrual distress and disorders are discussed.

Prevalence of Sexual Trauma History Using Behaviorally Specific Methods of Assessment in First Year College Students.

There are several challenges associated with evaluating the prevalence of sexual trauma, including child sexual abuse and adult sexual assault. The aim of this study was to assess sexual trauma prevalence rates among first year college students (N = 954) using behaviorally specific questions and a more representative recruitment sample that did not rely on self-selection. Participants completed a list of sexual trauma questions, including general questions containing labels such as "rape" or "abuse" as well as behaviorally specific questions that describe specific behaviors that qualify as sexual trauma without labels. Results indicated that 6.7% of the sample reported at least one incident of child sexual abuse, with similar rates for men and women. Women were more likely to report a history of adult sexual assault, which was reported by 12.4% of the total sample. Participants were also more likely to endorse a history of sexual trauma when answering behaviorally specific rather than general "label" questions. Women survivors in particular were more likely than men to identify their experiences as abuse/assault (66.7% versus 21.1% for child sexual abuse), which may help explain prevalence differences between men and women in prior research. Men may be less likely than women to label their experiences as abuse and may be underidentified in sexual trauma research without the use of behaviorally specific questions. Overall, the results of this study suggest that the prevalence of sexual trauma is better assessed using behaviorally specific questions and that this is an important topic of study among both men and women.

Does a disconnect occur between research and practice for premenstrual dysphoric disorder (PMDD) diagnostic procedures?

Diagnostic assessment recommendations for premenstrual dysphoric disorder (PMDD) include the use of daily symptom monitoring for two consecutive menstrual cycles; however, it is unclear whether medical providers use this established procedure in practice. This study explored typical diagnostic procedures for PMDD among a sample of physicians (N = 87) who were recruited by mail and completed questions about current practices. Results indicated that only 11.5% of physicians in this sample reported routinely using 60-day symptom monitoring, and only 18.4% of physicians reported regular use of any type of daily symptom monitoring. No differences were observed in these procedures based on frequency of contact with patients with PMDD or physician type (obstetrics and gynecology [OB/GYN] or family medicine). Overall, these results indicated that it is important to establish standard assessment methods for PMDD that have clinical utility for physicians, as well as increase awareness of research-based practice in diagnosing PMDD.

Premenstrual disorders and rumination.

OBJECTIVES: Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) involve emotional, behavioral, and physical symptoms; however, there is little understanding of psychological factors that contribute to these disorders. It was hypothesized that rumination, a form of depressive self-focused attention, is related to premenstrual distress. METHOD: Study 1 involved women (N = 735) meeting criteria for No/Mild PMS, Moderate/Severe PMS, and PMDD using retrospective self-report. Study 2 involved women (N = 85) meeting diagnostic criteria for PMS or PMDD (i.e., PMD group) and healthy controls (i.e., No PMD group) following 60-day symptom monitoring. Participants in both studies completed questionnaires of rumination, anxiety sensitivity, and coping styles. RESULTS: Rumination was strongly related to premenstrual disorders using both retrospective and prospective reports, as well as both categorical and continuous approaches to classification of premenstrual distress. CONCLUSIONS: Rumination, a transdiagnostic factor in psychopathology, may contribute to the onset and maintenance of premenstrual distress.

Stress reactivity and coping in seasonal and nonseasonal depression.

Stress, stress reactivity, and coping skill use were examined in individuals with seasonal depression, nonseasonal depression, and nondepressed controls. Although participants in the two depressed groups reported using more avoidance coping strategies than controls, only participants in the seasonal depressed group reported using more season-specific coping (i.e., light-related strategies) than participants in the nonseasonal depressed and control groups. Individuals in the seasonal depressed group also reporting using acceptance coping strategies less frequently than individuals in the control group. Only participants in the nonseasonal depressed group, however, exhibited greater psychophysiological arousal in reaction to a laboratory stressor (i.e., unsolvable anagram task) when compared to participants in the seasonal and nondepressed control groups. Participants in both depressed groups reported greater impact of negative life events during the past 6 months than did controls. Similarities and differences in the two types of depression may have implications for the conceptualization and treatment of seasonal depression.

Are we there yet? A review of gender comparisons in three behavioral journals through the 20th century.

Despite overwhelming evidence that gender plays a significant role in the course of numerous psychological disorders, researchers have historically neglected to address gender similarities and differences in their research. Previous reviews of the psychological literature have indicated that personality, psychotherapy, and behavioral psychology journals have published few studies that focus on gender comparisons. The current review examined published articles in three prominent behavioral psychology journals--Behavior Therapy, Behavior Modification, and Behaviour Research and Therapy--from their inception through 2001. Raters coded each article (N=4,635) for gender content in the title or abstract, analyses of gender differences, and discussion of gender. Overall, very few articles focused on gender content in the title, abstract, or discussion or analyzed data by gender. Implications of these results and suggestions for enhancing attention to gender comparisons are discussed.

Cognitive-behavioral factors in seasonal affective disorder.

To longitudinally examine cognitive-behavioral correlates of seasonal affective disorder (SAD), the authors assessed women with a history of SAD and nondepressed, matched controls across fall, winter, and summer. SAD history participants reported more automatic negative thoughts throughout the year than controls and demonstrated a progression from decreased activity enjoyment during fall to reduced activity frequency during winter. Ruminative response style, measured in fall, predicted symptom severity during the winter. Across assessments, SAD history women endorsed greater depressive affect in response to low light intensity stimuli than to bright or ambiguous intensity stimuli, but less depressed mood to bright light stimuli than controls. These results suggest that the cognitive-behavioral factors related to nonseasonal depression may play a role in SAD.

Physiological and psychological reactivity in women with asthma: the effects of anxiety and menstrual cycle phase.

The relation between menstrual cycle timing, panic attacks, and diagnosis of asthma was explored in this study. Women with or without asthma and with or without a history of panic attacks engaged in a psychophysiological task during either the intermenstrual or premenstrual cycle phase and completed self-report measures of menstrual symptoms and attitudes, general psychological symptoms, and attitudes toward illness. No significant differences were identified for psychological or psychophysiological measures with menstrual cycle phase as a factor. However, women with both asthma and a history of panic attacks reported more general psychological distress than women in the other groups, and more state anxiety than controls. Women in the asthma, asthma and panic, and panic groups reported higher anxiety sensitivity than the control group. After listening to asthma-related scenes, women with asthma exhibited a decrease in peak expiratory air flow, and women with asthma and panic exhibited increased skin conductance response magnitude. Implications for the role of anxiety in lung function are discussed, as well as directions for future research with asthma and anxiety populations.

The role of anxiety level, coping styles, and cycle phase in menstrual distress.

Using three samples, researchers investigated the relation between various anxiety levels, coping strategy use, and menstrual cycle phase to menstrual distress. In Studies 1 and 2, women low in anxiety sensitivity used more acceptance coping strategies and women high in anxiety sensitivity reported using more maladaptive coping strategies. In Study 2, women with medium anxiety sensitivity reported similar coping strategies to women low in anxiety. Menstrual cycle phase did not differentially affect coping strategy use in women varying in anxiety sensitivity levels in Studies 1 and 2. In addition to depressed mood emerging as a significant predictor of premenstrual distress in these two studies for all participants, avoidance coping for women high in anxiety sensitivity and problem-focused coping for women low in anxiety sensitivity were also significant predictors of premenstrual distress. In Study 3, during the premenstrual phase, women with panic disorder, compared to controls, reported using more avoidance coping whereas controls reported used more active coping and seeking social support for emotional and instrumental reasons. Results are discussed within a continuity model from high anxiety sensitivity to anxiety disorder for maladaptive coping and menstrual distress.

Attentional bias to threat and emotional response to biological challenge.

Attentional bias towards threat reliably correlates with clinical anxiety status as well as elevated trait anxiety. Although such findings have led many to posit a potential causative or predictive role of threat-biased attentional processes on anxiety problems, little informative research exists. The present investigation was designed to address the role of threat-biased attentional processes on emotional/fearful responding. Eighty-seven participants provided baseline measures of anxiety vulnerability (i.e., anxiety sensitivity; unmasked/masked emotional Stroop task indices) and then underwent biological challenge procedures (inhalations of 20% carbon dioxide (CO2)-enriched air). Following challenge, participants completed measures of emotional response. Regression analyses indicated that both unmasked and masked attentional bias indices significantly predicted emotional responding above and beyond anxiety sensitivity. Exploratory analyses also revealed a gender effect, with prediction of emotional response largely attributable to females. These findings support attentional bias towards threat as a relatively independent factor predictive of emotional responding.

Processing of intimacy-related stimuli in survivors of sexual trauma: the role of PTSD.

To fully understand the negative impact of sexual trauma and posttraumatic stress disorder (PTSD) upon adult intimacy-related functioning, cognitive models designed to investigate implicit processing of stimuli with emotional content are warranted. Using an emotional Stroop paradigm, the present study examined the impact of sexual trauma history (childhood sexual abuse and/or adult sexual assault) and a PTSD diagnosis on the implicit processing of 3 types of word stimuli: intimacy, sexual trauma, and neutral. Based on the results of a structured clinical interview and a behavioral-specific sexual trauma questionnaire, participants (n = 101; 74 females, 27 males) were placed in 3 groups: sexual trauma only (n = 33), sexual trauma and PTSD (n = 33), and controls (n = 35). Results indicated that men and women with a history of sexual trauma and a current PTSD diagnosis had increased latency for intimacy-related words and trauma words compared to controls, whereas individuals with only a history of sexual trauma did not differ from controls. Thus, it appears that the presence of symptoms associated with a diagnosis of PTSD is important for implicit processing of intimacy stimuli, rather than having a history of sexual trauma alone. Avoidance, a key feature of PTSD, may strengthen this relationship. More research is needed to determine the mechanisms by which individuals with a history of sexual trauma and PTSD experience intimacy difficulties.

Ethical practices and beliefs of psychopathology researchers.

Ethical guidelines are vague concerning how situations should be handled when researchers encounter participants in preexisting psychological distress. Ethical issues of beneficence, autonomy, and the nature of informed consent may arise in these situations. This study investigated the ethical practices and beliefs of 84 psychopathology researchers when confronting research participants in distress. Results indicated that psychopathology researchers in general engaged in diverse ethical practices in providing debriefing, treatment referrals, and providing for distressed participants. Characteristics of the designated studies and of the researchers accounted for significant differences in ethical practices. In addition, the type of psychopathology being assessed accounted for significant differences in ethical practices and beliefs. Guidelines are offered to aid researchers who encounter participants in preexisting distress.

Reporting ethical practices in journal articles.

Little attention has focused on the reporting of ethical research practices in journal articles. In Study 1, published articles in 2 psychopathology journals were reviewed to ascertain the types of ethical research information that were reported. In Study 2, a survey was sent to authors in Study 1 to determine which ethical practices they engaged in, if they reported this information, and reasons for not including this information in their article. In general, there is a great variability regarding the types of ethical research practices reported in journal articles. Commonly cited reasons for not including ethical research practice information in the articles included the need for brevity, belief that it was common practice, and lack of relevance for the project. These results suggest that there is no standard practice for reporting research practices in journal articles and great variability in the implementation of procedures that are generally considered standard.

Effects of consent form information on self-disclosure.

When researchers encounter preexisting psychological distress in participants, ethical codes provide little guidance on how to balance issues of beneficence and autonomy. Although researchers may inform participants what will occur given responses indicating distress, this information may lead to biased self-reports. This important issue was addressed in this study by manipulating consent form information regarding the type of psychopathology to be assessed and various levels of possible follow-up. In comparing responses on self-report measures of anxiety, depression, and general psychological distress, men who believed depression was the focus of the study reported fewer symptoms of depression and less trait anxiety as intrusiveness of experimenter follow-up increased. These results are discussed within the framework of socialization theory. Given that half of the sample did not correctly answer questions regarding information contained in the consent form, guidelines to improve consent form comprehension are offered.

Defining competencies in psychology supervision: a consensus statement.

Supervision is a domain of professional practice conducted by many psychologists but for which formal training and standards have been largely neglected. In this article, supervision is proposed as a core competency area in psychology for which a number of elements reflecting specific knowledge, skills, and values must be addressed to ensure adequate training and professional development of the trainee. Supra-ordinate factors of supervision viewed as permeating all aspects of professional development are proposed. These include the perspective that professional development is a lifelong, cumulative process requiring attention to diversity in all its forms, as well as legal and ethical issues, personal and professional factors, and self- and peer-assessment. A competencies framework is presented with particular elements representing knowledge (e.g., about psychotherapy, research, etc.), skills (including supervising modalities, relationship skills, etc.), values (e.g., responsibility for the clients and supervisee rests with supervisor, etc.), and meta-knowledge. Social contextual factors and issues of education and training, assessment, and future directions also are addressed, with specific elements listed. Suggestions for future work in this area are addressed, including the need to refine further and operationalize competences, develop clear expectations for accreditation and licensure regarding supervision competencies, and expand the description of developmental levels of supervisors from minimal to optimal competence. This is one of a series of articles published together in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.