Journal of Psychosomatic Research

Aims and Scope

2010-03-01

The two views of emotion in psychosomatic research

Mark A. Lumley — 2010-03-01

Emotions have been central to psychosomatic medicine since the field's inception, and emotions have been seen as the driver of disease-relevant physiological changes and symptoms. How emotions have been conceptualized in psychosomatic research, however, has shifted over the years. In the early decades, a psychodynamic framework was influential, and investigators were particularly interested in the “how and why” of emotions—what I refer to as “emotional processes.” Research sought to understand how patients' awareness, experience, and expression of their emotions were related to health, and why patients differed in these emotional processes. Guided by conceptual models of conflict and defense, early investigators believed that what patients said about their emotional processes was of questionable validity. People are motivated to avoid awareness and experiencing of aversive or conflictual emotions, so early researchers eschewed simple patient self-report assessments in favor of clinical judgments from interviews and observations as well as the measurement of psychophysiological processes.

Evaluation of the structure of Brazilian State-Trait Anxiety Inventory using a Rasch psychometric approach

2009-12-10

Abstract: Objective: This study evaluates the State-Trait Anxiety Inventory (STAI) structure using a Rasch psychometric approach, and a refined and shorter STAI version is proposed.Methods: A cross-sectional study was performed with 900 inpatients scheduled for elective surgery. Age varied from 18 to 60 years (American Society of Anesthesiologists physical status I–III). Demographic information was collected using a structured questionnaire. The measuring instrument (the STAI) was applied to all patients in the afternoon before the surgery and prior to the patients receiving preoperative sedatives.Results: Rasch analysis of the state and trait anxiety scales was performed separately. This analysis demonstrated that the original format of state and trait scales fails to show invariance across the trait-state anxiety level, which results in the unstable performance of items. The refined scale was retested in two subsequent random samples of 300 subjects each, and the results were confirmed. The performance was adequate regardless of gender. In the analysis, some items of the state scale (items 3,4,9,10,12,15, and 20) were deleted due to poor fit statistics. The remaining 13 items showed unidimensionality, local independence, and adequate index of internal consistency. Also, the original trait scale displayed several weaknesses. First, the four-point Likert response scale proved to be inadequate, and threshold disorders were found in all 20 items. Also, the original trait scale showed insufficient item-trait interaction and several individual item misfits. Following the rescoring process, and retesting in a second random sample, items were excluded (namely Items 3, 4, 11, 13, 14, 15, 18, and 19). The refined version showed local independence, unidimensionality, and adequate fit statistics.Discussion: The results indicate that the application of the Rasch model led to the refinement of the classic STAI state and trait scales. In addition, they suggest that these shorter versions have a more suitable psychometric performance and are free of threshold disorders and differential item functioning problems.

Social phobia and depression: Prevalence and comorbidity

Maurice M. Ohayon, Alan F. Schatzberg — 2010-03-01

Abstract: Background: Social phobia may seriously impair the functioning of affected individuals. It is frequently associated with other mental disorders.Aims: To estimate the co-occurrence of social phobia with major depressive disorder (MDD) and to analyze their interaction.Method: Subjects were 18,980 individuals, aged 15 years or older, representative of the general population of the United Kingdom, Germany, Italy, Spain and Portugal, who were interviewed by telephone. DSM-IV diagnoses were made with the Sleep-EVAL system.Results: The point prevalence for social phobia was 4.4% (95% confidence interval: 4.1–4.7%) of the sample. It was higher in women (odds ratio: 1.6) and decreased with age. MDDs were found in 19.5% of participants with social phobia. Co-occurrence of another anxiety disorder was high and increased when a MDD was present (65.2%). The odds of developing a major depressive episode 2 years after the appearance of the social phobia was of 5.74.Conclusions: Social phobia is highly prevalent in the general population. It increases the risk of developing a MDD and has a high comorbidity with other mental disorders. Social phobia is often present in the course of depression, more obviously during remission period of MDD. Physicians must explore and treat more systematically this frequent pathology.

The effectiveness of bibliotherapy in alleviating tinnitus-related distress

John M. Malouff, William Noble, Nicola S. Schutte, Navjot Bhullar — 2009-11-04

Abstract: Objective: The present study examined the efficacy of bibliotherapy in assisting individuals experiencing distress related to tinnitus.Methods: One hundred sixty-two tinnitus sufferers from Australia participated in a study designed to examine the effectiveness of a cognitive–behaviorally based self-help book in reducing distress.To maximize the ecological validity of the findings, we excluded no individuals interested in treatment for tinnitus-related distress.Results: The experimental condition lost 35% of participants at postassessment, compared to 10% in the control group. In an analysis of participants who completed postintervention assessment, those assigned to the intervention condition, who received a tinnitus self-help book, showed significantly less tinnitus-related distress and general distress 2 months later compared to those assigned to the waiting list control condition. The intervention group's reduction in tinnitus-related distress and general distress from preintervention to postintervention 2 months later was significant, and these participants maintained a significant reduction in distress on follow-up 4 months after they received the tinnitus self-help book. A long-term follow-up of all participants, who at that time had received the book at least a year previously, showed a significant reduction in tinnitus distress. Although these group differences and pre–post changes were significant, effect sizes were small. Intention-to-treat analyses showed no significant effect for between-groups analyses, but did show a significant effect for the 1-year follow-up pre–post analysis.Conclusion: Information on the effectiveness of using a self-help book, without therapist assistance, in alleviating distress is important, as bibliotherapy can provide inexpensive treatment that is not bound by time or place.

Patients with medically unexplained symptoms and their significant others: Illness attributions and behaviors as predictors of patient functioning over time

Anja Hilbert, Alexandra Martin, Thomas Zech, Elisabeth Rauh, Winfried Rief — 2009-12-10

Abstract: Objective: Previous research suggests that medically unexplained symptoms (MUS) are maintained in an interpersonal context. The current study examined MUS concurrently and prospectively by measuring specific interpersonal predictors of symptom severity and health care use.Methods: A total of 127 patients with MUS and their significant others were recruited through primary care offices and assessed with self-report questionnaires and structured interviews about illness attributions, illness behavior and responses, relationship quality, symptom severity, and health care use at baseline and 6-month follow-up.Results: Illness attributions and interpersonal illness behaviors of patients with MUS were cross-sectionally associated with illness attributions and responses of the patients' significant others. Relationship quality was related to specific illness behaviors and responses. Symptom severity at baseline was predicted by patients' somatic illness attributions. Symptom severity at 6-month follow-up was predicted by somatic illness attributions of patients and withdrawal of patients' significant others at baseline, but these predictors became insignificant when correcting for baseline symptomatology. Health care use at baseline was predicted by a greater amount of coping behavior and higher anxiety scores of patients, and health care use at 6-month follow-up was predicted by more attention-seeking behaviors and health care use of patients at baseline.Conclusion: The results document the interpersonal influences on the maintenance of MUS. The perspective of significant others should be considered for enhancement of psychological approaches to the treatment of patients with MUS.

The psychological impact of accidents on recreational divers: A prospective study

Andrew Trevett, David Peck, Robert Forbes — 2009-07-21

Abstract: Objective: The present study aimed to examine the medium and long term psychological impact of diving accidents on the victims (n=52), compared with the impact on two control groups: the victim's diving “buddy” (n=40) who simply witnessed the accident, and a second control from the same boat who did not dive with the victim (n=38).Methods: This was a prospective cohort study of the impact of an accident on the victims who attended the Hyperbaric Unit, in comparison with the two control groups. Pre-accident psychological morbidity was assessed using the General Health Questionnaire. Trauma symptoms were assessed using the Revised Impact of Events Scale at 3, 6 and 12 months post accident.Results: The accident victims endorsed more trauma symptoms and experienced them more intensely and for longer, compared with the two control groups.Conclusion: A significant minority of diving accident victims (between 25% and 50%) continued to suffer from the psychological impact of the accident, some for over a year. This has important implications for their future health care, for their safety on subsequent dives, and for dive training.

Is alexithymia a risk factor for major depression, personality disorder, or alcohol use disorders? A prospective population-based study

2009-09-24

Abstract: Objective: Disagreements concerning the stability of alexithymia and its ability to predict subsequent psychiatric disorders prevail. The aim of this 7-year follow-up study was to examine whether alexithymia predicts subsequent major depression, personality disorder, or alcohol use disorders in a population-based sample.Methods: The four-phase Kuopio Depression Study (KUDEP) was conducted in the eastern part of Central Finland. The study population (aged 25–64, n=2050) was randomly selected from the National Population Register. Data were collected in 1998, 1999, and 2001. In 2005, a subsample (n=333, 43 were excluded) of the 3-year follow-up population (1998–2001) was gathered and their diagnoses of mental disorders were confirmed by the Structure Clinical Interview for DSM-IV Axis I (SCID-I). Alexithymia was measured using the Toronto Alexithymia Scale (TAS-20) and depressive symptoms using the Beck Depression Inventory (BDI-21). For both of these measures, two groups were formed based on the median of their sum score (summing the 1998, 1999, and 2001 scores). Logistic regression analyses were performed.Results: BDI sum scores, but not those of TAS, were associated with subsequent major depressive disorder, personality disorder, and alcohol use disorders in 2005. The BDI sum scores explained 35.7% of the variation in concurrent TAS sum scores.Conclusion: Alexithymia did not predict diagnoses of major depressive disorder, personality disorder, or alcohol use disorders. Alexithymia was closely linked to concurrent depressive symptoms. Thus, depressive symptoms may act as a mediator between alexithymia and psychiatric morbidity.

Commentary on the paper “Is alexithymia a risk factor for major depression, personality disorder, or alcohol use disorders? A prospective population-based study”

Olivier Luminet — 2009-11-18

The main aim of the study conducted by Honkalampi et al was to examine whether alexithymia (and depression) scores at three different times predict major depression, personality disorder, and alcohol use disorders 7 years after the first data collection in a population-based sample. The key issue was thus to assess the ability of the two constructs to predict new cases of psychiatric disorders in the future. This data set tested whether, in a large group of healthy people, alexithymia is a predisposing or vulnerability factor that influences the onset or course of psychiatric disorders.

Health-related quality-of-life profiles in nonalexithymic and alexithymic subjects from general population

2009-12-07

Abstract: Objective: Earlier studies have shown an association between alexithymia and health-related quality of life (HRQoL). There has been some controversy as to whether this is attributable solely to psycho-social domains of HRQoL or also to physical domains. Furthermore, there are no studies on HRQoL profiles in representative general population samples controlling for sociodemographic variables, mental health and somatic health.Methods: The study forms part of the Health 2000 Study. Altogether 5090 participants from general population, aged 30-97 years, filled in the 20-item Toronto Alexithymia Scale and the 15D HRQoL scale. Depressive and anxiety disorders were assessed in a structured psychiatric interview. Physical health was examined by physicians. The 15-dimension HRQoL profiles of both alexithymic and non-alexithymic subjects were obtained by analysis of covariance, controlling for sociodemographic and health-related variables.Results: The alexithymic group had significantly (P<.001) lower mean scores on every dimension of the 15D even after controlling for confounding demographic variables, somatic diagnoses and depressive and anxiety disorders. The differences were greatest in the psycho-social domains.Conclusions: Alexithymia seems to be a personality trait with a statistically significant association to every dimension of HRQoL, not only to psychosocial domains. However, the associations between alexithymia and some somatic dimensions may be of little clinical significance.

The Beliefs about Emotions Scale: Validity, reliability and sensitivity to change

Katharine A. Rimes, Trudie Chalder — 2009-12-10

Abstract: Objective: Beliefs about the unacceptability of experiencing or expressing negative emotions have been noted in individuals with a range of problems, including chronic fatigue syndrome (CFS), irritable bowel syndrome, somatization disorder, depression, eating disorders, social phobia, posttraumatic stress disorder, and borderline personality disorder. These beliefs are likely to have implications for emotion regulation and processing, and are addressed explicitly or implicitly within many therapies including cognitive behavior therapy (CBT), mindfulness-based cognitive therapy (MBCT), and Acceptance and Commitment Therapy (ACT). This article describes the development, validation, and internal reliability of the Beliefs about Emotions Scale (BES), a self-report questionnaire to assess such beliefs.Methods: The new scale was completed by people with CFS (n=121) and healthy controls (n=73). Twenty-two individuals with CFS completed the scale before and after CBT.Results: People with CFS had significantly higher scores on this new questionnaire than healthy controls. Principal components analysis identified one factor, and the scale had high internal consistency (0.91). Scores on the BES were most highly correlated with a measure of negative perfectionism (r=0.59) and also showed significant correlations with measures of dysfunctional attitudes, self-sacrifice, depression, anxiety, and fatigue. When completed before and after CBT for CFS, the questionnaire was sufficiently sensitive to detect a significant reduction in endorsement of unhelpful beliefs about emotions.Conclusion: The new Beliefs about Emotions Scale showed good internal reliability, validity and sensitivity to change.

Cost outcomes on a medical psychiatry unit

Roger G. Kathol — 2009-10-05

Nearly 30 years ago, I was privileged to visit a medical psychiatry unit (MPU) similar to the one described by Leue et al. at Duke University. It was one of few MPUs in operation in the United States in the early 1980s and had the charge of assisting patients with psychosomatic illness . Within 2 years of my visit, the unit closed. Personal discussions with Alan Stoudemire, its medical director, suggested that lengths of stay had been considered too long and that the treatments being given could have been provided less expensively in the outpatient setting. Other than improved access to psychiatric care, there were no data showing change in patient outcomes; thus the unit closed.

Managing complex patients on a medical psychiatric unit: An observational study of university hospital costs associated with medical service use, length of stay, and psychiatric intervention

2009-10-05

Abstract: Objective: Although there is a suggestion that the medical psychiatric unit (MPU) may reduce length of hospital stay (LOS), little is known about costs in terms of medical service use and psychiatric interventions in MPU care.Method: A record linkage study was conducted, linking cost data of hospital medical service use, LOS, and hospital psychiatric interventions to patients admitted to the MPU of the Maastricht University Medical Centre (MUMC) between 1998 and 2004. The data set was analyzed to enable comparison between cost changes of the same complex patient population following either MPU index admission or index admissions to reference MUMC medical wards.Results: Comparisons revealed lower costs of medical service use in favor of the MPU (−€104; 95% CI −€174 to −€35; P<.01). However, cost of psychiatric intervention and cost of LOS were higher after MPU admission (respectively, +€165; 95% CI +€25 to +€305; P<.05; and +€202; 95% CI +€170 to +€235; P<.001). Total costs were higher after MPU admission compared to medical ward admission (+€263; 95% CI +€68 to +€458; P<.05). These differences were not moderated by somatic diagnosis or previous pattern of admissions.Conclusion: The findings suggest that patients at the interface of psychiatric and somatic morbidity are diagnosed and treated adequately at the MPU, leading to a decrease in medical service use and an appropriate increase in exposure to psychiatric interventions. These results are specifically generalizable to MPUs with a focus on psychosomatic conditions, for instance, somatoform disorders or affective disorders with comorbid somatic diseases. However, failure to show cost savings in terms of LOS compared to medical wards outweighs cost–benefit derived from lower medical service use, suggesting that MPU activities may gain in cost-effectiveness if shifted more to outpatient psychosomatic care solutions.

Can we increase adherence to treatment recommendations of the consultation psychiatrist working in a general hospital? A systematic review

Albert F.G. Leentjens, Annette D. Boenink, Christina M. van der Feltz-Cornelis — 2009-11-20

Abstract: Background: Adherence to advice given by the consultation–liaison (CL) psychiatrist is a prerequisite for the effectiveness and success of psychiatric consultation. It is unknown which factors are associated with better adherence to advice.Aim: To review the adherence of consultees with advice given by the psychiatrist during inpatient consultation.Method: Systematic literature review.Results: Eighteen studies reported on the level of adherence with recommendations given by the consultation psychiatrist in a hospital setting. All were retrospective cohort studies conducted before 1998. Thirteen of these reported on the association between clinical variables and the level of adherence.The median level of adherence with diagnostic advice was 56% (range 29–75%), with medication advice 79% (range 68–98%), and with discharge advice 91% (range 85–95%). Patient-related variables were not associated with adherence, nor were consultee-related variables. Consultant-related variables associated with adherence were level of professional expertise, organizing liaison activities, following up on patients after initial consultation, and prescription of medication by the consultant during the consultation.Conclusion: This review provides evidence for a role of consultant characteristics and an active approach of the consultant in terms of CL activities as well as consultation procedures, in attaining adherence to advice. Prospective qualitative research is needed to identify consultation methods that may further enhance adherence.

Expectations in rheumatoid arthritis

Robert Ferrari, Anthony S. Russell — 2010-01-11

We read with interest the findings of Graves et al. , that rheumatoid arthritis patients' beliefs about their illness are associated with disability and quality of life irrespective of disease status. Graves et al. underpin the importance of illness beliefs and expectations in a variety of illnesses, even when the pathology is significant and demonstrable, and would normally be expected to be the chief determinant of disability and quality of life. Chronic pain and disability should perhaps always be approached from the biopsychosocial model, something we have proposed for more controversial disorders such as whiplash and spinal pain , but which should not be overlooked in our arthritis patients.

Embodied effects of mindfulness-based cognitive therapy

Johannes Michalak, Nikolaus F. Troje, Thomas Heidenreich — 2010-03-01

Mindfulness-based cognitive therapy (MBCT) was developed as an intervention for relapse prevention in depression, and its effectiveness has been demonstrated in three randomized controlled trials . One fundamental characteristic of MBCT is that patients practice mindfulness exercises that intensively train bodily awareness. But what could be the benefits of developing a heightened awareness of the body? MBCT proposes that the self-perpetuating patterns of ruminative, negative modes of mind that often lead to relapse are not solely cognitive in nature. Instead, they are characterized by complex configurations of negative mood, thoughts, and body sensations [, p. 67]. This notion is supported by recent research emphasizing the close and reciprocal relationships between bodily and emotional processes. This research converges in the idea of the embodied nature of emotion .

The HSCL-20: One questionnaire, two versions

Jane Walker, Michael Sharpe, Kurt Kroenke, Gordon Murray — 2009-12-07

The Hopkins Symptom Checklist Depression Scale (HSCL-20) is a widely used 20-item self-rated measure of depression severity, often assumed to be a subscale of the HSCL-90 . Patients complete the HSCL-20 by reporting how distressed they have been by each of the listed symptoms over the preceding 2 weeks, using a five-point scale that ranges from “not at all” to “extremely.” Its ease of administration and face validity have made the HSCL-20 a popular choice for researchers, and it has been used as a measure of depression severity in a number of major clinical trials of depression management, particularly those carried out in primary care and in nonpsychiatric settings .

2010-03-01

Title page

2010-03-01

Copyright page

2010-03-01

Instructions for Authors

2010-03-01

Journal of Psychosomatic Research

Aims and Scope

The two views of emotion in psychosomatic research

Evaluation of the structure of Brazilian State-Trait Anxiety Inventory using a Rasch psychometric approach

Social phobia and depression: Prevalence and comorbidity

The effectiveness of bibliotherapy in alleviating tinnitus-related distress

Patients with medically unexplained symptoms and their significant others: Illness attributions and behaviors as predictors of patient functioning over time

The psychological impact of accidents on recreational divers: A prospective study

Is alexithymia a risk factor for major depression, personality disorder, or alcohol use disorders? A prospective population-based study

Commentary on the paper “Is alexithymia a risk factor for major depression, personality disorder, or alcohol use disorders? A prospective population-based study”

Health-related quality-of-life profiles in nonalexithymic and alexithymic subjects from general population

The Beliefs about Emotions Scale: Validity, reliability and sensitivity to change

Cost outcomes on a medical psychiatry unit

Managing complex patients on a medical psychiatric unit: An observational study of university hospital costs associated with medical service use, length of stay, and psychiatric intervention

Can we increase adherence to treatment recommendations of the consultation psychiatrist working in a general hospital? A systematic review

Expectations in rheumatoid arthritis

Embodied effects of mindfulness-based cognitive therapy

The HSCL-20: One questionnaire, two versions

Contents

Title page

Copyright page

Instructions for Authors