Development and validation of a system of assimilation indices: A mixed method approach to understand change in psychotherapy.

OBJECTIVES: Assimilation is an important process in understanding change in psychotherapy. Similar to other psychological processes, assimilation may be traceable in the speech of clients by attending to its signs or indices. In the present research, we aimed to build a system of indices of assimilation. DESIGN AND METHODS: This research follows a mixed method design. The indices were derived through qualitative analysis, using grounded theory. Subsequently, the indices were adjusted quantitatively and applied to 30 single psychotherapy sessions of adult clients with depression and 11 therapists. Forty-two indices were found and grouped into the following five process categories of assimilation: external distress, pain, noticing, decentring and action. RESULTS: The indices showed good inter-rater reliability and internal consistency. Except for noticing, all process categories correlated significantly with each other according to conceptual proximity. The system of indices also showed convergent validity with an existing coding system of assimilation for two process categories. CONCLUSIONS: The results suggest that the system of indices is a useful approach for understanding assimilation. The consideration of assimilation in a continuous fashion through sub-processes may help to extend our knowledge of this process and provide a tool for clinical practice. PRACTITIONER POINTS: Assimilation is an important process in understanding change in psychotherapy in the sense that it takes into account insight and action-related processes. Clients convey in their speech signs or indices of the assimilation process which can be observed both in the style and content of their utterances. Using these indices, therapists can continuously assess assimilation and use this information in choosing interventions. Limitations: This study follows a cross-sectional design and does not allow consideration of the predictive value of the indices. The outcome of the therapy was not taken into account, which restricts validity considerations to the comparison with an existing instrument and the observation of the relation between sub-processes of assimilation.

Fibromyalgia characterization in a psychosocial approach.

This study aimed to characterize a group of women diagnosed with fibromyalgia, evaluating the relationship between personality and psychopathology, health status (disability, physical health, mental health, and pain), and potentially traumatic life events (PTLE) before the onset of the syndrome. The disability caused by fibromyalgia, physical and mental health status, pain, PTLE in childhood and in the course of life, and personality were assessed in a sample of 50 women with fibromyalgia, age 25-70 years (M = 46.96; SD = 10.96). A multiple correspondence analysis with all the variables identified two types of profiles and a K-Means cluster analysis confirmed two groups of patients: cluster 1 (n = 36), with better health and less psychopathological problems, named "Better adjustment" and cluster 2 (n = 14), with less health and more personality problems, named "Disorder and disability." Pertaining to personality only, a K-Means cluster analysis replicated the three classic personality profiles (normal, neurotic, and psychopathological) identified in chronic pain patients; and the normal profile was the more prevalent (n = 22). The results enhance the importance of recognizing the heterogeneity of fibromyalgia population and the great closeness between personality and physical health, with the PTLE having a less important role than expected.

Fibromyalgia: antecedent life events, disability, and causal attribution.

This study aimed to evaluate the relation of disability and physical and mental health status with potentially traumatic life events (PTLE) before the onset of fibromyalgia in women diagnosed with this syndrome. We also investigated causal attribution of fibromyalgia to a triggering event, physical or psychological in nature, and its relation with the health measures and the adverse life events. The impact of fibromyalgia, physical and mental health status, pain, PTLE in childhood and not in childhood, and causal attribution were assessed in a sample of 50 women with fibromyalgia, aged 25-70 (M = 46.96; SD = 10.96). There were no statistically significant relations between the health measures (disability, physical and mental health, and pain) and the PTLE. The predominant attribution was to a physical event. There were no significant differences neither in the health measures across causal attribution status (Pillai's Trace = 0.193; F(8,90) = 1.200; p = .308; η2 par = .096) nor in the PTLE not in childhood (F(2,47) = 1.063; p = .354; η2 par = .043). There were significant differences across causal attribution status in the PTLE in childhood (F(2,47) = 3.590; p = .035; η2 par = .133), specifically between the group that made a psychological attribution and the group that made no attribution (C.I. 95%) 0.1805; 14.0468; (p = .043), with the former having a higher score of PTLE in childhood. The results raise questions about the importance of psychological aspects in the appraisal of the adverse events and its possible relation to the psychological functioning in women with fibromyalgia.