Assessment of cognitive coping styles: a closer look at situation-response inventories.

Cognitive coping style approaches establish two concepts central to the understanding of people's responses to a stressful situation: "attention" and "avoidance". Theoretical frameworks corresponding to these conceptions are Sensitization-Repression (Byrne, 1961), Monitoring-Blunting (Miller, 1980), and Vigilance-Cognitive Avoidance (Krohne, 1986). Such types of cognitive coping styles are usually measured by means of situation-response inventories. In the present article, we take a closer look at this kind of coping assessment by considering the scenarios, the coping options and response formats, the dimensionality of the constructs, and published data on the reliability and the validity of seven situation-response inventories. Three important points deserve to be highlighted: (a) it probably makes little sense to assess coping style using scenarios that diverge maximally with respect to controllability and predictability since coping is not assumed to show such complete cross-situational stability; (b) similarly named inventories rely on largely different operationalizations and can hardly be considered as measuring similar constructs; and (c) monitoring/vigilance and blunting/avoidance generally emerge as independent constructs, which argues against use of summary scores.

Etiopathogenesis of reflex sympathetic dystrophy: a review and biopsychosocial hypothesis.

Reflex sympathetic dystrophy (RSD) is an enigmatic condition. Many clinicians, however, believe that psychological factors could contribute to the onset and persistence of the syndrome. In this article we critically review the evidence from psychometric and psychodynamic/biographical studies that suggests a role for such factors. An etiopathogenetic hypothesis based on the authors' clinical experience and the foregoing literature also encompasses elements of stress-coping theory, cognitive-behavioral views on chronic pain, and the psychobiological approach to sympathetic nervous system dysfunction. Implications of this model for future psychological research and the therapeutic treatment of RSD are discussed.

Premorbid "overactive" lifestyle in chronic fatigue syndrome and fibromyalgia. An etiological factor or proof of good citizenship?

OBJECTIVE: In a former study, we have shown that patients suffering from chronic fatigue syndrome (CFS) or chronic pain, when questioned about their premorbid lifestyle, reported a high level of "action-proneness" as compared to control groups. The aim of the present study was to control for the patients' possible idealisation of their previous attitude towards action. METHODS: A validated Dutch self-report questionnaire measuring "action-proneness" (the HAB) was completed by 62 randomly selected tertiary care CFS and fibromyalgia (FM) patients, as well as by their significant others (SOs). RESULTS: HAB scores of the patients and those of the SOs were very similar and significantly higher than the norm values. Whether or not the SO showed sympathy for the patient's illness did not influence the results to a great extent. SOs with a negative attitude towards the illness even characterized the patients as more "action-prone." CONCLUSIONS: These results provide further support for the hypothesis that a high level of "action-proneness" may play a predisposing, initiating and/or perpetuating role in CFS and FM.

Marital intimacy in patients with an eating disorder: a controlled self-report study.

The clinical literature on married patients with anorexia nervosa or bulimia nervosa suggests a lack of intimacy in these couples. This assumption was tested by comparing the scores on the Marital Intimacy Questionnaire of 21 eating-disordered (ED) couples with those of two matched control groups of 21 maritally distressed (MD) and 21 non-distressed (ND) couples. The overall level of intimacy attained by ED couples is lower than that of ND couples but higher than that of MD couples. Whereas this quantitative difference may reflect the couples' differences in marital satisfaction (as assessed by the Maudsley Marital Questionnaire), an additional qualitative discrimination can be made between ED couples and the two control groups on account of the former group's relatively low level of openness and high level of intimacy problems.

Reliability and validity of the Critical Care Family Needs Inventory in a Dutch-speaking Belgian sample.

OBJECTIVE: The purpose of the study was to provide psychometric evaluation of the Dutch version of the Critical Care Family Needs Inventory. SETTING: The study took place in an intensive care unit of a university hospital. PARTICIPANTS: The participant group included 200 adult family members visiting a patient within the 72-hour interval after admission to the intensive care unit. RESULTS: Principal factor analysis with varimax rotation resulted in a 5-factor solution distinguishing 5 need types: need for information, need for comfort, need for support, need for assurance and anxiety reduction, and need for proximity and accessibility. The internal consistency of the resulting subscales ranged from 0.80 to 0.62, and all factors were significantly related to each other. The Critical Care Family Needs Inventory subscales were found to be clearly related to the demographic variables age, sex, and education level. CONCLUSION: The reliability and validity of the Dutch-language Critical Care Family Needs Inventory as a diagnostic tool in family needs assessment are supported.

The Impact of Previous Experience on Children's Reactions to Venepunctures.

The relationship between children's previous experience with venepunctures and their responses to a subsequent blood test was studied in 47 children hospitalized for a surgical intervention. We replicated the results of earlier studies, revealing no effect of the amount of experience but a significant effect of the quality of previous experience. Children with a history of negative medical experiences were found to show higher levels of state anxiety prior to the procedure and to be more distressed and less cooperative during the procedure than children with previous positive or neutral experiences. A comparison of both groups of experienced children with inexperienced children revealed that negative past experiences are likely to sensitize the child, whereas positive or neutral past experiences do not have a significant impact on subsequent reactions. This effect occurs independently of the coping style of the child (sensitizing versus repression).

Self-injurious behaviors in eating-disordered patients.

High rates of self-injurious behaviors (SIBs) have been described in eating-disordered patients. The present study in 134 female inpatients suffering from an eating disorder (ED) confirmed this: 44% of the total group reported at least one form of SIB (mostly hair pulling, scratching, cutting, or bruising) with a mean age at onset of 17.5 years. No major differences have been found between the subgroups (anorexics, bulimics). The considerable number of patients who did not feel any pain during SIB showed more tendency towards dissociative experiences. Those who admitted SIB reported higher levels of psychological dysfunctioning, dissociative experiences, and impulsiveness.

Coping with peer arguments in school-age children with bully/victim problems.

BACKGROUND AND AIMS: This paper reports data on the relationship between bully/victim problems and the coping strategies used when confronted with a peer argument. Specifically, we examine the extent to which bully/victim problems are related to five types of coping strategies (Social Support Seeking, Problem-Solving, Distancing, Internalising and Externalising). SAMPLE: The sample consists of 329 children (168 boys, 161 girls), drawn from the fourth- through sixth-grade classrooms of three Flemish elementary schools. RESULTS AND CONCLUSION: In the correlational analyses, both victimisation and social neglect are shown to be related to internalising coping, whereas bullying is associated with externalising coping and with a lack of problem-solving. Moreover, a positive relationship between victimisation and social support seeking was found. Separate analyses for boys and girls and a consecutive categorical approach provide a more precise picture of the link between social coping strategies and bully/victim problems.

Psychological distress in husbands of eating disorder patients.

Psychological distress scores of 21 eating-disordered (ED) women and their husbands were compared with those of two matched groups of 21 maritally distressed (MD) and 21 maritally nondistressed (ND) control groups. In contrast to previous clinical reports, ED husbands in the present group did not report significantly more psychological distress than did ND husbands, and actually reported less interpersonal sensitivity and hostility than did MD husbands.

Antecedents, concomitants, and consequences of pediatric headache: confirmatory construct validation of two parent-report scales.

The aim of the study presented is to examine the psychometric properties of two parent-report scales for the assessment of environmental factors in pediatric headache, namely, the Children's Headache Assessment Scale (CHAS) and the Illness Behavior Encouragement Scale (IBES). Data were gathered in a sample of 160 parents of children suffering from headaches regularly. The internal structure of both scales is investigated by means of confirmatory factor analysis. The internal consistency of the resulting subscales is explored and data on the convergent validity and on the relationship with demographics are presented. Both the CHAS and the IBES appear to be promising assessment tools in a behavioral approach to pediatric headache.

Minuchin's psychosomatic family model revised: a concept-validation study using a multitrait-multimethod approach.

The convergent and discriminant validity of three operationalizations of the psychosomatic family features--enmeshment, rigidity, overprotectiveness, and lack of conflict resolution, as described by Minuchin and colleagues--are tested in families that include patients with eating disorders, especially anorexia nervosa and bulimia. We redefined the family features as dimensions and measured them with two behavioral methods (direct observation and behavioral product) and a self-report method. The two behavioral methods showed convergent as well as discriminant validity for the intensity of intrafamilial boundaries, the degree of the family's adaptability, and the family's way of handling conflicts. The self-report method showed only convergent validity for the latter dimension and discriminant validity for none of them. Besides intrafamilial conflict, the self-report method seemed to measure other constructs. A factor analysis of the family questionnaire indeed yielded three more evaluative constructs: conflict, cohesion, and disorganization. We interpreted these findings according to two usually interwoven mechanisms: the different research context (insider/outsider evaluation) in self-report and behavioral observation, and the different level of specification (micro/global evaluation) of certain operationalizations. We draw some conclusions about the psychosomatic family model and discuss the clinical implications of our findings.

Marital communication in eating disorder patients: a controlled observational study.

In order to investigate the communication between 21 eating disorder (ED) patients and their husbands, an observational study was carried out using two matched control groups of 21 maritally distressed (MD) and 21 nondistressed (ND) couples. During some discussion tasks the interaction was videotaped and the (verbal and nonverbal) communication skills were rated afterwards according to the Kategoriensystem für Partnerschaftliche Interaktion (KPI) coding system. Unexpectedly, compared with the control groups ED couples do not show a greater disequilibrium (between patient and husband) in the emission rate of positive and negative messages. Also striking is the generally higher degree of self-disclosure in ED couples than in ND couples, but this may reflect their experience of distress. Overall and most importantly, ED couples appear to lack some of the ND couples' skills of constructive communication, but manage to avoid the destructive communication style of MD couples.

Visual analogue scale for the perceived influence of exertion and movements/positions on low back problems in surveys of adolescents.

UNLABELLED: The test-retest reproducibility of visual analogue scales for the perceived influence of exertion and movements/positions on low back problems in adolescents was investigated. The study was performed on 61 adolescents with low back problems. Item completion, median score, interquartile range and weighted kappa were calculated. Results showed that visual analogue scales produce repeatable information for all items tested (weighted kappa: 0.59-0.83), except for the influence of pulling materials on back problems (0.45). CONCLUSION: The results of this study suggest that adolescents, aged 16-18 y, can reproduce their visual analogue scores.

Low back pain in Flemish adolescents and the role of perceived social support and effect on the perception of back pain.

AIM: To document the prevalence of low back pain (LBP) in Flemish adolescents and to recognize the association between perceived social support and affect and medical consultation and reduction of activities. METHODS: The study comprised 620 adolescents. A questionnaire was used to elicit the characteristics of LBP. Perceived social support and affect were investigated using the Personal Resource Questionnaire (PRQ) and the Positive Affect Negative Affect Scale (PANAS), respectively. Comparisons were made between adolescents with LBP and adolescents without LBP. Within the LBP group, answers from adolescents appealing for medical advice were compared with those who did not seek advice. Another comparison was done between adolescents who reduced their activities and those who did not. Descriptive statistics, the median test for two samples, a chi2 test or Fisher's exact probability test and logistic regression analysis were used for data analysis. RESULTS: Month prevalence of LBP was 24.7%. Thirteen adolescents visited a physician or received treatment, pain severity being the sole factor associated with the decision. Fifteen adolescents reduced their sports activities and 11 reduced or stopped other leisure activities. Pain severity and negative affect were the main associated factors. CONCLUSION: The results of the present study encourage further research on the role of pain perception and the influence of psychosocial factors on back pain in adolescents.

Dissociative experiences and trauma in eating disorders.

This study explores the relationship between traumatic experiences and dissociative phenomena in a large group of eating disorder patients (N = 98). Traumatic experiences were assessed by means of a self-report questionnaire and a clinical interview; dissociative experiences were assessed with the newly developed self-reporting Dissociation Questionnaire (DIS-Q). About 25% of the patients reported to have experienced traumatic events in their personal life and this subgroup had significantly higher scores on the DIS-Q, compared with normal control subjects. About 12% of our patient sample mentioned dissociative experiences to a degree as high as in a group of patients with dissociative disorders. Amnesia turned out to be the most specific characteristic in trauma-induced dissociation. These data suggest that trauma-induced dissociative experiences may play an important role in the development of a subgroup of patients with an eating disorder.

Psychometric Properties of the Psychotherapy Expectancy Inventory-Revised (PEI-R).

The Psychotherapy Expectancy Inventory-Revised (PEI-R) was developed to measure clients' expectations of behavior in counseling. An exploratory factor analysis of the original PEI-R (Rickers-Ovsiankina, Berzins, Geller, & Rogers, 1971) on a sample of clients yielded four factors: approval, advice, audience and relationship (Berzins, 1971). The aim of the study presented in this paper is to examine the internal construct validity of the PEI-R by means of a confirmatory factor analysis on data gathered in a sample of 159 clients. The analysis revealed an adequate model fit for the four-dimensional oblique model. However, detailed inspection of model fit suggest the possibility of a fifth factor. Data concerning the reliability and the relationship with demographics are also provided.

Self-report assessment of the DSM-IV personality disorders. Measurement of trait and distress characteristics: the ADP-IV.

BACKGROUND: Self-report instruments assessing the DSM personality disorders are characterized by overdiagnosis due to their emphasis on the measurement of personality traits rather than the impairment and distress associated with the criteria. METHODS: The ADP-IV, a Dutch questionnaire, introduces an alternative assessment method: each test item assesses 'Trait' as well as 'Distress/impairment' characteristics of a DSM-IV criterion. This item format allows dimensional as well as categorical diagnostic evaluations. The present study explores the validity of the ADP-IV in a sample of 659 subjects of the Flemish population. RESULTS: The dimensional personality disorder subscales, measuring Trait characteristics, are internally consistent and display a good concurrent validity with the Wisconsin Personality Disorders Inventory. Factor analysis at the item-level resulted in 11 orthogonal factors, describing personality dimensions such as psychopathy, social anxiety and avoidance, negative affect and self-image. Factor analysis at the subscale-level identified two basic dimensions, reflecting hostile (DSM-IV Cluster B) and anxious (DSM-IV Cluster C) interpersonal attitudes. Categorical ADP-IV diagnoses are obtained using scoring algorithms, which emphasize the Trait or the Distress concepts in the diagnostic evaluation. Prevalences of ADP-IV diagnoses of any personality disorder according to these algorithms vary between 2.28 and 20.64%. CONCLUSIONS: Although further research in clinical samples is required, the present results support the validity of the ADP-IV and the potential of the measurement of trait and distress characteristics as a method for assessing personality pathology.

Attributions in chronic fatigue syndrome and fibromyalgia syndrome in tertiary care.

OBJECTIVE: To evaluate the attributions of patients with chronic fatigue syndrome (CFS) and fibromyalgia (FM) consulting at a university fatigue and pain clinic. METHODS: Consecutive attenders (n = 192) who met the CFS criteria (n = 95) or FM criteria (n = 56) or who had medically unexplained chronic pain and/or fatigue without meeting both criteria (CPF) (n = 41) were evaluated. All subjects completed an extended form of the Cause of Illness Inventory. Descriptive statistics, frequency analyses, chi-square tests, one-way analysis of variance, and sequential Fisher least significant difference tests were performed. RESULTS: In total, 48 patients reported physical causes only and 10 patients psychosocial causes only; the majority (70%) mentioned both types of causes. With regard to the contents, "a chemical imbalance in my body" (61%), "a virus" (51%), "stress" (61%), and "emotional confusion" (40%) were reported most frequently. The diagnostic label did not have a significant influence on number and type of attributions. Small to moderate effect sizes were registered concerning the association of specific attributions and diagnosis, sex, duration of the symptoms, contact with a self-help group, and premorbid depression. CONCLUSION: The majority of patients with CFS, FM, and CPF reported a great diversity of attributions open to a preferably personalized cognitive behavioral approach. Special attention should be paid to patients with symptoms existing for more than one year and those who had previous contacts with a self-help group. They particularly show external, stable, and global attributions that may compromise feelings of self-efficacy in dealing with the illness.