Self-esteem stability and depressive symptoms in acute stroke rehabilitation: Methodological and conceptual expansion.

Objectives: Explore the relationship of self-esteem level, self-esteem stability, and other moderating variables with depressive symptoms in acute stroke rehabilitation. Measures: One hundred twenty participants completed measures of state self-esteem, perceived recovery, hospitalization-based hassles, impairment-related distress, and tendency to overgeneralize negative self-connotations of bad events. Self-report of depressive symptoms was collected at admission and on discharge. Four regression analyses explored the relationship of self-esteem level and stability and each of 4 moderating variables (perceived recovery, hassles, impairment-related distress, and overgeneralization) with depressive symptoms at discharge. Results: Analyses indicated significant 3-way interactions in the 4 regression models. In general, individuals with unstable high self-esteem endorsed greater depressive symptoms under conditions of vulnerability (e.g., lower perceived recovery) than did individuals with stable high self-esteem. Under conditions of vulnerability, participants with stable low self-esteem indicated the highest levels of depressive symptoms. Implications: Self-esteem level and stability interact with psychological, environmental, and stroke-specific variables to predict depressive symptoms at discharge from stroke rehabilitation. This suggests the viability of self-esteem stability in exploring depressive symptoms in this setting and the complexity of emotional adjustment early after stroke. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pain, depression, and physical functioning following burn injury.

Objective: Little is known about how pain and depression after burn injury may influence long-term outcomes such as physical functioning. This prospective study examined associations between pain, depression, and physical functioning in a sample of burn injury survivors. Design and Participants: Questionnaires assessing pain, depression, and physical functioning were completed by 64 (52% of original sample) adult burn survivors shortly after discharge from burn care and at 1- and 2-year follow-ups. Results: Pain and physical functioning improved over the 2 years of the study, whereas depression levels were stable. Pain and depression were associated with poorer physical functioning over time, but associations varied according to the time span under consideration. Also, the association between pain and physical functioning was strongest among persons with higher depression scores. Conclusions: Pain and depression may contribute independently to compromises in physical functioning. The co-occurrence of pain and depression represents even greater risk for reduced physical functioning over time among burn survivors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Similarities and differences in four views of David.

In this article, each author gives a brief comment on similarities he or she sees throughout the case formulations captured in the articles by Watson (2010a), Silberschatz (2010), Goldfried (2010), and Caspar (2010). A systematic comparison is added. Overall, the impression is confirmed and maintained that if authors are ready to renounce the use of the jargon of their specific approach, many similarities can be found. There are nevertheless differences that would lead us to expect a different course of therapy and different effects beyond the main effect of recovery in the case of David, pursuing the conceptualization and interventions proposed by Watson (2010b). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of family and community violence on children’s depression trajectories: Examining the interactions of violence exposure, family social support, and gender.

This longitudinal study used multilevel modeling to examine the relationships between witnessing intimate partner violence (IPV), community and school violence exposure (CSVE), family social support, gender, and depression over 2 years within a sample of 100 school-aged children. We found significant between-child differences in both the initial levels of depression and the trajectories of depression; depression over time was positively associated with change in witnessing IPV and CSVE and negatively associated with change in support. Two significant 3-way interactions were found: Gender and initial support, as well as gender and initial witnessing IPV, both significantly moderated the effect of change in witnessing IPV on the children’s depression over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Optimal levels of emotional arousal in experiential therapy of depression.

Objective: To determine the relationship between length of time spent expressing highly aroused emotion and therapeutic outcome. Method: Thirty-eight clients (14 male, 24 female) between the ages of 22 and 60 years (M = 39.5, SD = 9.71), treated for depression with experiential therapy, were rated on working alliance and expressed emotional arousal (with the Client Expressed Emotional Arousal Scale) in their three highest arousal sessions. Among the clients, 34 were of European ethnicity, 2 were of Asian ethnicity, 1 was of Latino ethnicity, and 1 was of Caribbean–Canadian ethnicity. Clients were administered the short form of the Working Alliance Inventory following their 4th therapy session and also completed, pre- and posttherapy, the Beck Depression Inventory (BDI), the Global Severity Index (GSI) of the Symptom Checklist–90–Revised (SCL-90-R), the Inventory of Interpersonal Problems, and the Rosenberg Self-Esteem Scale. Results: Hierarchical regressions showed that a nonlinear pattern of expressed emotional arousal predicted outcome significantly above the alliance. This combination predicted 30% of outcome variance on the BDI and 24% on the GSI (p     

Interpersonal psychotherapy for co-occurring depression and chronic pain.

Up to 37% of individuals experience chronic pain during their lifetimes. Approximately one fourth of primary care patients with chronic pain also meet criteria for major depression. Many of these individuals fail to receive psychotherapy or other treatment for their depression; moreover, when they do, physical pain is often not addressed directly. Women, socioeconomically disadvantaged individuals, African Americans, and Latinos all report higher rates of pain and depression compared with other groups. This article describes a version of interpersonal psychotherapy tailored for patients with comorbid depression and chronic pain, interpersonal psychotherapy for depression and pain (IPT-P). IPT-P potentially could be delivered to many patient populations in a range of clinical settings, but this article focuses on its delivery within primary care settings for socioeconomically disadvantaged women. Adaptations include a brief 8-session protocol that incorporates strategies for anticipating barriers to psychotherapy, accepting patients' conceptualization of their difficulties, encouraging patients to consider the impact of their pain on their roles and relationships, emphasizing self-care, incorporating pain management techniques, and flexible scheduling. In addition, IPT-P is designed as an adjunct to usual medical pain treatment, and seeks to engage non–treatment-seeking patients in psychotherapy by focusing on accessibility and relevance of the intervention to concerns common among patients with pain. Identifying patients with comorbid depression and chronic pain and offering IPT-P as a treatment option have the potential to improve clinical outcomes for individuals with depression and chronic pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Main, mediating, and moderating effects of social support on the well-being of survivors of intimate partner violence across 2 years.

Intimate partner violence is a serious and pervasive social problem with deleterious consequences for survivors’ well-being. The current study involved interviewing 160 survivors 6 times over 2 years to examine the role of social support in explaining or buffering these negative psychological consequences. The authors examined both between- and within-persons variability to explore women’s trajectories regarding their experiences of abuse, social support, depression, and quality of life (QOL). Findings revealed the complex role of social support on women’s well-being. Evidence was found for main, mediating, and moderating effects of social support on women’s well-being. First, social support was positively related to QOL and negatively related to depression. Social support also partially explained the effect of baseline level and subsequent change in physical abuse on QOL and depression over time, partially mediated the effects of change in psychological abuse, and moderated the impact of abuse on QOL. The buffering effects of social support were strongest at lower levels of abuse. Implications for future research and intervention are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Case formulation in EFT.

A case formulation, for a client with depression, based on emotion-focused therapy treatment principles will be presented. The client was seen for 16 sessions in emotion-focused therapy. Based on information provided in the first interview, the therapist discusses how the client’s issues can be formulated in an emotion-focused treatment by attending to different process markers, including markers of characteristic styles of being or ways of treating the self and emotional experience; modes of engagement or ways that emotional experience is processed in terms of whether it is overregulated or underregulated; specific in-session tasks like focusing, two-chair or empty chair work; and micromarkers of nonverbal behaviors including vocal quality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing mediators of intervention effects in randomized controlled trials: An evaluation of three depression prevention programs.

Objective: Evaluate a new 5-step method for testing mediators hypothesized to account for the effects of depression prevention programs. Method: In this indicated prevention trial, at-risk teens with elevated depressive symptoms were randomized to a group cognitive–behavioral (CB) intervention, group supportive expressive intervention, CB bibliotherapy, or assessment-only control condition. Results: The group CB intervention reduced depressive symptoms and negative cognitions and increased pleasant activities. Change in these mediators predicted change in depression, and intervention effects became weaker controlling for change in the mediators; yet, change in depression appeared typically to occur before change in the mediators. The supportive expressive intervention reduced depressive symptoms but affected only 1 of 2 mediators (emotional expression but not loneliness). Change in emotional expression did not correlate with change in depression, and change in depression usually occurred before change in the mediators. Bibliotherapy did not significantly affect depressive symptoms or the ostensive mediators (negative cognitions and pleasant activities), and change in depression usually occurred before change in the mediators. Conclusion: Results imply that this procedure provides a sensitive test of mediation but yielded limited support for the hypothesized mediators, suggesting that nonspecific factors may play an important mediational role. (PsycINFO Database Record (c) 2010 APA, all rights reserved)