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Is Self-Criticism Uniquely Associated with Health Anxiety among Jewish and Arab Israeli Young Adults?
Abstract
Self-criticism constitutes an important risk factor to psychopathology. However, it has never been investigated in the context of health anxiety. The authors examined the role of self-criticism in health anxiety in Arab and Israeli young adults, while controlling for known predictors of health anxiety -- anxiety sensitivity, depression, major and minor stressful events, and alexithymia -- and related outcomes (e.g., reassurance seeking, avoidance). Both main effects and stress-diathesis patterns involving self-criticism were hypothesized. Measures of the above variables were administered to 111 Arabs and 194 Jews (age range: 29-33) via the online Qualtrics system, and General Linear Modeling analyses were conducted to test our hypotheses. A main, but not stress-diathesis, effect of self-criticism on symptoms of health anxiety was found. The findings highlight the potential involvement of self-criticism in health anxiety, but caution against stress-diathesis explanations of this involvement.
... Moreover, recent research has already attested to the adverse effect of self-criticism on physical symptoms such as fatigue, pain, and insomnia (Kempke et al. 2013(Kempke et al. , 2016(Kempke et al. , 2014Lerman et al. 2012;Luyten et al. 2011;Teixeira et al. 2016). Several mechanisms could account for this effect, including the tendency to ruminate over physical changes and over unpleasant-to-painful sensation, and even to develop health anxiety (Akariya et al. 2022). ...
... Self-criticism is-by definition-a psychologically inflexible stance. Relatedly, the link between selfcriticism and maladaptive cognitive processes such as ruminative brooding, anxiety sensitivity, and health anxiety (Akariya et al. 2022) increases the likelihood that self-critical patients with breast cancer react strongly and adversely to bodily changes emanating from systemic cancer therapy. Second, the effect of self-criticism on systemic therapy side effects has important implications for oncological practice. ...
Dependency and self‐criticism are two dimensions of personality vulnerability to depression, whereas efficacy is a dimension of personality resilience. The aim of this study was to examine the unique role of these personality dimensions in adaptation following a diagnosis of breast cancer, while controlling for the potentially confounding role of symptoms of depression and anxiety. Three adaptation outcomes were examined: Functioning, symptomatic load, and fatigue. Patients residing in Germany, diagnosed with breast cancer and comorbid depression, participated in a Randomized Clinical Trial (RCT) testing Supportive‐Expressive Psychodynamic Psychotherapy (SEP; N = 78)) versus Treatment as Usual (TAU; N = 79). Assessments were made pre‐treatment, at termination, and at 6‐month follow‐up. Analyses were conducted via General Linear Modelling (GLM). Pretreatment self‐criticism prospectively predicted a rank‐order decrease in functioning and a rank order increase in symptomatic load and fatigue. Dependency predicted an increase in breast symptoms. No effects were found for efficacy. Self‐criticism may complicate adaptation to breast cancer. Implications for early detection and illness management are discussed.
... Indeed, self-criticism has been studied as a cognitive regulation strategy that individuals can use to prevent or reduce their emotional distress in emotionally activating situations (Kamholz et al., 2006). Several studies have found an association between alexithymia and self-criticism (Speranza et al., 2005;Akariya et al., 2022), suggesting that individuals who have a poor ability to explore emotions lack compassion and kindness towards themselves (Gilbert et al., 2011). Indeed, individuals with better emotional awareness use complex and specific strategies to regulate their emotions, leading to a lower likelihood of developing depressive self-criticism than those who use simple and general strategies (Pascual-Leone et al., 2016). ...
... From their findings, the authors inferred that individuals with greater selfcriticism and shame may feel a greater sense of responsibility and a greater fear of harm. In doing so, in the light of the relationship between self-criticism and alexithymia (Speranza et al., 2005;Akariya et al., 2022), we want to test the contribution of alexithymia in determining the specific selfcritical modalities, considering the forms of alexithymia most associated with the symptoms assessed. Several studies indicate an association between obsessive-compulsive functioning and externally-oriented thinking, which would result in poor insight and symbolic capacity (Berardis et al., 2008), suggesting that this cognitive style characterized by the constriction of imaginative activity could be a relevant aspect in obsessive-compulsive disorder that the individual uses to cope with emotional stress. ...
Self-criticism is a transdiagnostic factor of significant clinical relevance. Research has studied its detrimental role on mental health without discriminating how this differs based on individual psychological functioning. Furthermore, little research has considered the lack of emotional awareness as an essential competence that contributes to dysfunctional self-critical processes and, consequently, to psychopathological outcomes. The objective of the study was to investigate how different forms of self-criticism are associated with specific symptoms, considering social anxiety, obsessive-compulsive, and eating disorder symptoms. Furthermore, we wanted to explore the role of alexithymia in this relationship. The sample comprised 564 subjects (M = 35.12, SD = 12.8), 389 females and 175 males. Participants completed online questionnaires to investigate levels of self-criticism, alexithymia, and specific symptoms. Hierarchical regression and path analyses showed that aspects of self-criticism have different importance in psychopathological features. Furthermore, the subscales of alexithymia differently mediate the relationship between self-criticism and symptomatological features, depending on the type of feature considered (social anxiety, eating or obsessive-compulsive). In light of the results, since self-criticism is a contributing factor to the onset and maintenance of many mental disorders, it becomes important to distinguish its specific characteristics and how they are linked to the disorders. A better understanding of these processes would help to prepare more targeted interventions.
... A timidez é um traço de personalidade definido como tensão e inibição diante de outras pessoas, e tem relação com o desconforto gerado por situações sociais . O conceito abrange o comportamento de evitação de interações sociais, falhas relacionadas à participação social e autocrítica excessiva sobre a competência social (Akariya et al., 2022;Henderson & Zimbardo, 2010;Pilkonis, 2006). O transtorno de ansiedade social, também denominado como fobia social, é identificado a partir do medo intenso e persistente de situações socais, acompanhado pelo medo de julgamento, com respostas de ansiedade com desconforto físico e prejuízos consistentes na vida do indivíduo, em termos sociais, acadêmicos e laborais (American Psychiatry Association [APA], 2014). ...
... Isso implica em dúvidas quanto ao construto efetivamente mensurado, o que desaconselha o uso das escalas com base nas estruturas propostas ao se tratar de casos de diagnósticos que impliquem análise diferencial entre traços de timidez e níveis de fobia social. A literatura indica que a sobreposição entre timidez e fobia social pode ter desfechos negativos ao dificultar o manejo adequado para identificação de traços regulares de personalidade (timidez) ou quadros clínicos (fobia social; Akariya et al., 2022;Heiser et al., 2009;Poole et al., 2017;Weeks et al., 2015). Também indica que a linguagem utilizada para descrever os construtos são quase indistinguíveis (Brook & Willoughby, 2017), o que incitou neste estudo a investigação da estrutura fatorial conjunta dos instrumentos para desambiguação teórico-prática. ...
O presente estudo objetivou realizar a adaptação cultural e proporcionar evidências psicométricas das Escalas Revisada de Timidez Cheek & Buss (RCBS) e Inventário de Fobia Social (SPIN) para avaliação da timidez e fobia social entre crianças e adolescentes brasileiros. Participaram do estudo 142 adolescentes, com média de idade de 14,22 anos (DP = 1,76; Min = 10,00; Máx = 17,50), sendo 64,08% do gênero feminino. As escalas avaliadas apresentaram elevada consistência interna, com Alfa de Cronbach e Ômega de McDonald superiores a 0,80 para todos os fatores dos instrumentos. A RCBS obteve índices de ajustes adequados para o modelo de um fator, e o inventário SPIN apresentou melhores índices de ajustes para o modelo testado de dois fatores. A evidência de validade para critério concorrente demonstrou correlação positiva e significativa com fatores relativos à vitimização por bullying. Identificou-se a sobreposição dos fatores das escalas RCBS e SPIN, o que respaldou a proposta de uma escala unificada (MU-TFS) de avaliação dos dois construtos, abrangendo 35 itens e estrutura fatorial de três fatores. O principal impacto do estudo consiste na otimização das condições de avaliação e rastreio da timidez e fobia social entre crianças e adolescentes brasileiro.
... Whether there are bodily symptoms or not, the critical point in both hypochondria and somatization is the relationship one establishes with one's body, both unconsciously and consciously (e.g., Akariya et al., 2021). For this reason, it is possible to draw a general conclusion about somatization from the discussions on hypochondria and the body. ...
... This may lead to PPD (Posmontier & Waite, 2010). There are positive correlations between alexithymia and self-criticism in literature (Akariya et al., 2021;Gilbert, et al., 2011;Speranza, et al., 2005), suggesting that people with a low ability to explore their own feelings lack compassion and kindness towards themselves (Gilbert et al., 2011). Negative and significant correlations between emotional regulation and awareness, and self-criticism suggest that people with functional, complex and specific strategies to regulate emotions are less likely to report depressogenic self-critical symptoms in comparison to those who enact maladaptive, more general strategies for emotional regulation (Pascual-Leone et al., 2015). ...
Postpartum depression (PPD) is common after birth and can have a profound effect on women and their families. It is therefore important to understand the conditions and factors that lead to the occurrence and maintenance of PPD. The first aim of the current study was to identify whether there is a relationship between alexithymia and postpartum depressive symptoms (PPDS) in a sample of Romanian mothers. The second aim was to explore whether self-criticism and self-compassion mediate the relationship between alexithymia and PPDS. The current cross-sectional study included 307 mothers with babies aged between four weeks and one year. The results show that alexithymia, self-compassion, self-criticism, PPDS all correlated with one another, and self-criticism, self-compassion and alexithymia are significant predictors of PPDS. Moreover, self-criticism and self-compassion mediated the relationship between alexithymia and PPDS. A psychological therapy that increases self-compassion and reduces alexithymia and self-criticism may be beneficial for preventing symptoms of PPD.
... A meta-analysis by Barbek et al. (2021) found a higher risk of health anxiety in low socio-economic individuals, indicating social inequalities in health anxiety on a vertical level. Still, social inequalities in health anxiety according to migration background are not well studied and remain inconclusive (Mölsä et al., 2014;Weck et al., 2014;Akariya et al., 2021). Therefore, we examine differences in health anxiety between migrants and ethnic minorities compared to the majority population in the respective countries in a systematic review and meta-analysis. ...
Background
Health anxiety exists on a continuum ranging from the absence of health awareness to the obsessive fear of having a serious illness despite reassurance. Its pathological manifestation can be diagnosed as hypochondriacal or illness anxiety or somatic symptom disorder. Health anxiety is associated with psychological distress and adverse life events, among others, and leads to considerable economic burden. Compared to the majority population, migrants, and ethnic minorities often face major health inequalities. Several mental illnesses and psychosomatic complaints are more common among these groups. To date, potential ethnic and migration-related inequalities in health anxiety have not been clearly described. However, they are of high relevance for the provision of adequate health care of this diverse and potentially vulnerable group. Thus, we conducted a systematic review and meta-analysis of health anxiety in migrants and ethnic minorities.
Methods
A systematic literature search of PubMED, Web of Science, PsycINFO, and PSYNDEX was conducted, covering all studies published until 1 st of December 2021. Studies were selected if they employed validated measurement tools of health anxiety and examined migrants and/or ethnic minorities in comparison with the majority population. Meta-analytic methods were applied by using a random-effect model. The study quality was assessed with the Effective Public Health Practice Project Quality Assessment Tool (EPHPP).
Results
We identified 18 studies from 445 studies initially screened. Of these, 14 studies conducted in North America with a total number of 5,082 study participants were included in the meta-analysis. The pooled effect size indicated a higher risk of health anxiety in migrants and ethnic minorities compared to the majority population (OR 1.39, 95%-CI 1.01–1.92). The results proved not to be robust according to publication bias (adjusted OR 1.18, 95%-CI 0.83–1.69) and fail-safe N (2/3 < benchmark N = 75) and are limited due to heterogeneity ( I ² = 57%), small sample sizes and an overall low quality of included studies.
Conclusion
To address the diversity of migrants and ethnic minorities, inter-sectional approaches across different countries are needed in research to shed further light on social inequalities in health anxiety linked to migration.
Systematic review registration
PROSPERO, registration number CRD42022298458.
... There were several characteristics in both groups of respondents that might appear as self-criticism: Russians consider themselves passive, sad and heavy drinkers, while Vietnamese see themselves as naïve and indomitable. It is well established that self-criticism constitutes an important risk factor to psychopathology (Werner et al., 2019) that leads to symptoms of health anxiety in representatives of different nations (Akariya et al., 2021). However, it also serves an important cultural function, at least in collectivist cultures, where self-criticism may have both adaptive and maladaptive purposes (Aruta et al., 2021). ...
This paper investigates Russian-Vietnamese mutual perceptions based on the empirical, questionnaire-based approach. As the preliminary stage of a large-scale study devoted to revealing mutual representations of the Russian and Vietnamese people, ethnic portraits and self-portraits were compiled based on the linguistic data collected. The authors consider the study and its results as the further development of the theoretical and experimental approaches to the investigation of ethnic identification and self-identification processes. The survey participants were Russian and Vietnamese university students. The comparative analysis of the results demonstrated similarities and differences in the characteristic and personified (anthroponymic) self-portraits and portraits of the two peoples. Among the ten most frequently mentioned qualities to describe each other, kindness emerged as the only common feature. Regarding ethnic portraits, the most frequently mentioned characteristics of the Russians were hospitality, friendliness, and intelligence; while the Vietnamese portrait included such traits as hard-working, kind, and gay. The most frequent self-identification characteristics mentioned by the Russians were patience and courage, while the Vietnamese described themselves as united, hard-working and patriotic. The conclusion is made that ethnic portraits and self-portraits may differ considerably, as demonstrated above. Data obtained were systemised and analysed based of the Schwartz Theory of Basic Human Values, which resulted in noteworthy cross-cultural differences in the perception of openness to change and conservation. Data on the personified portraits and self-portraits of Russian and Vietnamese people are of interest. The collection of names of important or just famous persons as typical representatives of the people has been collected and analysed. The combined application of the international theories and the Russian ethnic conflictology approaches may contribute to gaining a clearer picture of Russian and Vietnamese mutual and self-perceptions, which in its turn will lead to a more effective intercultural dialogue.
Reviews the 6 approaches to etiology that now preempt the field––ecological, developmental, learning, genetic, internal environment, and neurophysiological models––and proposes a 2nd-order model, vulnerability, as the common denominator. Methods are suggested for finding markers of vulnerability in the hope of revitalizing the field. It is assumed that exogenous and/or endogenous challengers elicit a crisis in all humans, but depending on the intensity of the elicited stress and the threshold for tolerating it (i.e., one's vulnerability), the crisis will either be contained homeostatically or lead to an episode of disorder. Vulnerability and episode stand in a trait–state relation, and markers for each must be provided to distinguish between them. (83 ref)
Addressing shortcomings of the self-report Toronto Alexithymia Scale (TAS), two studies were conducted to reconstruct the item domain of the scale. The first study resulted in the development of a new twenty-item version of the scale—the TAS-20. The TAS-20 demonstrated good internal consistency and test-retest reliability, and a three-factor structure theoretically congruent with the alexithymia construct. The stability and replicability of this three-factor structure were demonstrated in the second study with both clinical and nonclinical populations by the use of confirmatory factor analysis.
Investigated depression as a normal affect state that could have continuity with types of clinical depression. A 66-item Depressive Experiences Questionnaire (DEQ) was constructed to assess a wide range of experiences that, though not direct symptoms of depression, are frequently associated with it. The DEQ, the Wessman-Ricks Mood Scale, a version of the semantic differential, and the Death-Concern Questionnaire were administered to 500 female and 160 male college students. In another sample, 128 college students were given the DEQ and the Zung Self-Rating Depression Scale. Three highly stable factors emerged from the DEQ: Dependency, Self-Criticism, and Efficacy. These factors had significant differential correlations with other measures, which support the interpretation of the factors derived from the items. These data indicate the need to consider dependency and self-criticism as 2 primary dimensions of depression and the value of investigating the continuity between normal mood states and the clinical phenomena of depressions. (38 ref)
Research on the construct of self-criticism has been gaining attention in the psychopathology and psychotherapy literature. The aims of this review are to provide an integrated theoretical and empirical understanding of client self-criticism and its implications for psychopathology and processes of self-critical change. Cognitive, emotion-focused, and psychodynamic therapy approaches are reviewed to highlight the ways in which self-criticism is addressed across different psychotherapies. Implications for treatment are put forward based upon the strengths of the different approaches in developing a self-protective and self-compassionate stance toward self-criticism. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Emerging research has begun to examine cognitive and interpersonal predictors of stress and subsequent depression in adolescents. This research is critical as cognitive and interpersonal vulnerability factors likely shape expectations, perspectives, and interpretations of a given situation prior to the onset of a stressor. In the current study, adolescents (n = 157; boys=64, girls=93), ages 12 to 18, participated in a 6-month, multi-wave longitudinal study examining the impact of negative cognitive style, self-criticism, and dependency on stress and depression. Results of time-lagged, idiographic multilevel analyses indicate that depressogenic attributional styles (i.e., composite score and weakest link approach) and self-criticism predict dependent interpersonal, but not noninterpersonal stress. Moreover, the occurrence of stress mediates the relationship between cognitive vulnerability and depressive symptoms over time. At the same time, self-criticism predicts above and beyond depressogenic attributional styles (i.e., composite and weakest link approach). In contrast to our hypotheses, dependency does not contribute to the occurrence of stress, and additionally, no gender differences emerge. Taken together, the findings suggest that self-criticism may be a particularly damaging vulnerability factor in adolescence, and moreover, it may warrant greater attention in the context of psychotherapeutic interventions.
This article presents the factors on which I focus as an integrative psychotherapist when treating self-critical patients. I first describe my personal version of psychotherapy integration. Drawing principally from Wachtel’s cyclical psychodynamic model, I also incorporate existential and neurocognitive elements highlighting patients’ future-oriented thinking and goal-directed action. I then relate this integrative model to the vexing clinical problem of self-criticism. Finally, I outline three types of interventions I attempt to implement in each session: (1) Multiple-Selves Analysis (MSA); (2) Behavioral Activation (BA), conceptualized integratively; and (3) use of therapist’s presence.
The current study investigated the Dependency and Self-critical personality vulnerabilities to depression among Bedouin and Jewish university students. Culture was expected to play a moderating role in the association between self-criticism and Depression. Ninety-six Bedouin students and ninety-six Jewish students completed the Depressive Experiences Questionnaire (DEQ) the Center for Epidemiological Studies Depression (CES-D), and Demographics. An Arabic-language version of the DEQ was created and found to be a reliable and valid instrument for assessing Dependency and Self-criticism. Bedouin students were found to present high levels of Self-criticism and Depression. The moderating role of culture was demonstrated. The contribution of the study of vulnerabilities to Depression in different cultures to the understanding of the complex interplay of personality traits and environmental conditions is discussed.
Generalized anxiety disorder (GAD) is associated with substantial personal and societal cost yet is the least successfully treated of the anxiety disorders. In this review, research on clinical features, boundary issues, and naturalistic course, as well as risk factors and maintaining mechanisms (cognitive, biological, neural, interpersonal, and developmental), are presented. A synthesis of these data points to a central role of emotional hyperreactivity, sensitivity to contrasting emotions, and dysfunctional attempts to cope with strong emotional shifts via worry. Consistent with the Contrast Avoidance model, evidence shows that worry evokes and sustains negative affect, thereby precluding sharp increases in negative emotion. We also review current treatment paradigms and suggest how the Contrast Avoidance model may help to target key fears and avoidance tendencies that serve to maintain pathology in GAD.
To determine the prevalence of psychological disorders and somatization among primary care patients from a semi-urban area of the Kingdom of Saudi Arabia.
Screening of consecutive patients with the 12-item and 28-item versions of the General Health Questionnaires and assessments of physical symptoms associated with somatization, using the HSCL-12. Eight primary care health centres in Assir, Saudi Arabia.
About half of the sample had one or more psychological disorders. The prevalence of somatization detected by the GHQ-28 was 16%. The prevalence of somatization indicated by GPs' identification of medically unexplained symptoms was 14%. Women displayed higher levels of somatization than men.
This study reported prevalence of psychological disorders that was as high as found in the more modern areas of Saudi Arabia such as Riyadh. The view that individuals in less open areas are protected from psychological disorders associated with stress and lifestyle pressure seems to be unsubstantiated. The results highlight the potential value of screening for psychological disorders using such simple instruments as the GHQ.
Background: Many older adults have at least one chronic disease and experience greater health problems than young adults. However, little is known about factors other than health that account for health anxiety (HA) among older adults. The overall objective of the present study was to develop a better understanding of HA among older and young adults.
Methods: We examined how anxiety-related constructs (anxiety sensitivity, intolerance of uncertainty, anxiety control, and emotion regulation) predict two core components of HA described in the cognitive–behavioral model of HA (illness likelihood and negative consequences) in older and young adults. We also examined the extent to which the predictor variables differentially account for HA in both age groups. Older and young adult participants completed several self-report surveys.
Results: Young adults reported higher levels of HA than older adults. Anxiety sensitivity and reappraisal predicted illness likelihood for older and young adults. Intolerance of uncertainty predicted negative consequences in both age groups. Anxiety sensitivity predicted negative consequences for older adults only. Anxiety control did not predict illness likelihood or negative consequences for either age group.
Conclusions: Results suggest that anxiety sensitivity and intolerance of uncertainty may predispose older and young adults to HA, which is influenced by reappraisal. Implications for the cognitive–behavioral model of HA in both age groups are discussed.
353 Hypochondriasis is presently classified as a somatoform disorder. However, in terms of phenomenology and cognitive processes, it is probably best considered as a form of severe and persistent anxiety focused on health. This reconceptualization allows the application of Beck's general cognitive theory of anxiety (1985) to the understanding and treatment of hypochondriasis. In this paper, the classification and phenomenology of health anxiety is explained in terms of a specific cognitive-behavioral conceptualization. The way this conceptualization has been successfully applied to the treatment of health anxiety and hypochodriasis is described. The all-important task of engagement is accomplished as part of the cognitive assessment, which helps the patient develop and evaluate an alternative understanding of their problems. This understanding focuses on how misinterpretations of health-related information (mainly bodily variations and medical information) leads to a pattern of responses including anxiety, distorted patterns of attention, safety-seeking behaviors, and physiological arousal. These responses in turn account for the patient's pattern of symptoms and functional impairment. Treatment progresses by helping the patient actively explore the validity of the alternative account of their problems arising from the shared understanding. This objective is accomplished through two avenues: one, discussion, which has the purpose of making sense of the person's experience; and two, active evaluation of the mechanisms involved, through collaboratively designed and implemented behavioral experiments. Evidence from randomized controlled trials strongly suggests that cognitive treatments are effective and that the effects are specific to the treatment techniques used. Development of this work will likely branch into medical problems, where a prominent component of health anxiety exists. [Brief Treatment and Crisis Intervention 3:353–367 (2003)] KEY WORDS: hypochondriasis, somatoform disorders, cognitive behavioral therapy. Until relatively recently, the treatment of hy-pochondriasis was not considered to be an im-portant issue, as this condition was regarded as invariably being secondary to depression or anxiety. Kenyon's (1964) influential study of pa-tients with hypochondriacal beliefs suggested that hypochondriasis is always secondary to an-other primary disorder, usually depression. It was subsequently suggested that hypochondri-acal beliefs occurring in the absence of affective symptoms were due to "masked depression." More recently, studies have convincingly identi-fied a primary disorder in which false concerns about health are the central problem, to which affective symptoms are secondary (Bianchi, 1971). The paper by Barsky and Klerman (1983) marked the reestablishment of hypochondriasis not only as a recognizable clinical condition but also as an important research topic (e.g., As-mundsen & Cox, 2001). Primary hypochondri-asis is now included in both ICD 10 (World Health Organization) and DSM-IV (APA, 1994). Although hypochondriasis is now accepted as a primary problem, its taxonomy remains controversial. Debate continues as to whether it is best seen as a somatoform disorder (as presently classified) or as an anxiety disorder (Salkovskis & Warwick, 1986; Warwick & Sal-kovskis, 1990). To place this debate in con-text, let us examine the diagnostic criteria presently used. According to DSM-IV, hypo-chondriasis is characterized by preoccupa-tion with fears of having, or the idea that one has, a serious disease, based on the person's misinterpretation of bodily symptoms. Thus, the problem is characterized as a cognitive one, involving erroneous appraisals. Note that this definition bears a strong resemblance to the cognitive theory of panic disorder (Clark, 1986; Salkovskis, 1989). The definition requires that the preoccupation persist despite appropriate medical evaluation and reassurance, meaning that the failure of a psychological intervention (reassurance) by a doctor is required for the di-agnosis to be made. In addition, formal diagno-sis dictates that the preoccupation has to cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Despite the considerable health care resources utilized by people with hypochondriasis, nei-ther physical medicine nor psychiatry has pre-viously established an effective treatment. Hypochondriasis has long been regarded as an intractable disorder, with supportive therapy and reassurance the best that can be offered. To some extent it has at times also been seen as a nuisance, with some considering it to be akin to factitious problems and malingering. Recently, well-defined cognitive-behavioral theories of hypochondriasis have been de-scribed, and treatment strategies derived from them have been empirically tested in random-ized controlled trials. The evidence from this re-search strongly suggests that this approach is effective both in engaging these patients in treatment and ameliorating the clinical symp-toms. The cognitive-behavioral theory of hypochondriasis provides a comprehensive ac-count of the psychological processes involved in the disorder, including etiological and main-taining factors. Modification of the important psychological factors involved in the mainte-nance of each case should lead to a resolution of the central problem—that is, a false belief that the patient is physically ill, based on the misin-terpretation of innocuous physical symptoms or signs, and based on health-related information from professionals, the media, and the Internet.
Objective:
According to cognitive-behavioral models of hypochondriasis (HYP), biased attentional and memory processes related to health threat stimuli are crucial for the development and maintenance of severe health anxiety. Little is known about the specificity, temporal stability, and modifiability of these biases via psychotherapy.
Method:
In an emotional Stroop and subsequent recognition task, the authors compared attention and memory processes for health-related words (illnesses, bodily complaints, and panic-related words) in patients with HYP (n = 32), other somatoform disorders (SFD; n = 27), and panic disorder (PD; n = 25). A control group consisted of 31 healthy participants (CG). All patients were reexamined after 4 months of cognitive-behavioral therapy (CBT).
Results:
Patients with HYP showed a significant attentional bias toward all 3 target word categories. Evidence for a specific bias was found only for the PD group. General recognition performance for health threat and neutral words was best in the HYP group. After therapy, attentional bias had clearly decreased in the HYP and SFD patients.
Conclusions:
Patients with HYP can be characterized by attentional bias and more elaborate verbal processing. These irregularities tend to disappear after psychotherapy.
Hypochondriasis remains controversial, despite its 2000-year history. Although it is considered a mental disorder, hypochondriasis is often regarded as a defence mechanism, peculiar cognitive/perceptual style, means of nonverbal communication, response to stress, abnormal illness behaviour, personality trait, distinct personality disturbance, and part of other mental disorders. Disagreements about etiology and pathogenesis of hypochondriasis go hand in hand with disagreements about its treatment. This book fills the need for a modern, balanced, in-depth, and integrative overview of hypochondriasis as a mental disorder with diverse manifestations. Written by world experts and from different perspectives, it aims to be a state-of-the-art text, demonstrating how the current concepts of hypochondriasis are linked with its rich history, critically examining diagnostic and nosologic issues and suggesting ways of overcoming the conceptual obstacles, describing current views on the etiology, pathogenesis and psychopathology, presenting main treatment approaches, and providing treatment guidelines. This book is intended for both practising clinicians and researchers. An important resource for all psychiatrists, primary care physicians, clinical psychologists, and other mental health professionals, it will also be of interest for psychiatry residents, medical students, graduate students in clinical psychology, and lay public.
Cognitive behaviour therapy (CBT) is efficacious for severe health anxiety, but little is known about mechanisms. We analysed putative mediators of change based on 13 weekly assessments in a randomised controlled trial (N = 132) of exposure-based minimal-contact CBT (guided Internet-delivered CBT, unguided Internet-delivered CBT and bibliotherapy) vs. a waitlist control for severe health anxiety. We hypothesised that the effect of CBT on health anxiety would be mediated by non-reactivity to inner experiences, health anxiety behaviours and perceived competence. We also explored somatosensory amplification. In parallel process growth models, non-reactivity, health anxiety behaviours and perceived competence - but not somatosensory amplification - were influenced by CBT and associated with health anxiety. Random intercepts cross-lagged panel models were used to study within-individual ordering of change. None of the putative mediators systematically predicted subsequent changes in health anxiety. Rather, changes in health anxiety predicted subsequent changes in all putative mediators. In summary, CBT influenced health anxiety behaviours, non-reactivity to inner experiences and perceived competence, and these variables were associated with the outcome. However, their role as mediators was not corroborated because we found no evidence that changes in these variables predicted subsequent changes in health anxiety. We encourage further research into mediators of CBT for health anxiety.
Background: Self-criticism represents a central phenomenon in a variety of mental disorders. The review looks at the recent body of literature (2012–2018) to summarize the relation of self-criticism and psychopathology beyond depression and aims at detecting how different conceptualizations of self-criticism with psychoanalytical, psychodynamic, or cognitive-evolutionary background are related to psychopathology. Furthermore, latest treatment approaches for dysfunctional forms of self-criticism are reviewed. Methods: The literature research of five databases (PsycINFO, PSYNDEX, PubMed, Medline, and Cochrane Library) took place in August 2018. Inclusion criteria for studies to enter the review narrative were an adult sample, non-clinical samples as well as clinical samples, and an empirical approach, which resulted in quantitative data. Results: 48 studies entered the review. Besides depressive symptoms, self-criticism showed positive relations to symptoms of eating disorders, social anxiety disorder, and personality disorders as well as to psychotic symptoms or interpersonal problems through different conceptualizations of self-criticism. Regarding the treatment of self-criticism, compassion- or emotion-focused therapy interventions were investigated in most of the reviewed studies and both reduced self-criticism in clinical and non-clinical samples. However, harsh forms of self-criticism were more persistent and difficult to change. Limitations: The review focused only on the latest empirical findings regarding self-criticism and psychopathology. Conclusion: Potentially functional forms and functions of self-criticism need further consideration, as they represent a possible goal of psychotherapeutic treatment. Future research should address specific questions regarding antecedents and consequences of self-criticism.
There is an ongoing debate about the specificity of dysfunctional beliefs in patients with obsessive-compulsive disorder (OCD) as some of these beliefs seem to be relevant in depressed patients as well. The present study aimed to elucidate the specificity of dysfunctional beliefs using the newly developed Beliefs Questionnaire (BQ). A combination of an online assessment and clinical interviews was carried out. One hundred thirty OCD patients (M = 38.7 years; 68% women) were compared to 85 patients with depression (M = 36.6 years; 75% women) and 220 nonclinical controls (M = 38.9 years; 71% women) on the BQ, which contains 13 items tapping cognitive beliefs. The BQ was validated against the Obsessive Beliefs Questionnaire (OBQ). Patients with OCD and depression scored higher on the BQ compared to nonclinical controls. OCD patients displayed higher values on overestimation of threat and the fear of becoming insane. Correlation between BQ and OBQ total scores was high (r = 0.751), supporting the validity of the new scale. Our results show that two beliefs are OCD-specific. However, the BQ covers mainly transdiagnostic features and should be replicated with the inclusion of an anxiety disorder sample.
Three aspects of heroic self-representations have recently been identified: self-as-savior, self-as-conqueror, and heroic-identification (i.e., linking oneself with heroes). In Israeli-Jewish society, heroism represents a convergence of the cultural myth of the Tzabar (the tough New Jew) with manic-narcissistic defenses that replace helplessness with exhilaration. We expected Heroic identification to epitomize the myth of the Tzabar, and thus to confer the greatest stress-related vulnerability. Israeli adults (N = 812) were assessed pre-and-post a prolonged exposure to missile attacks. Heroic identification prospectively predicted increased anxious mood, both as a main effect and under major stressful life events. Self-as-savior predicted an increased anxious mood under high levels of perceived-stress related to the missile attacks. Possible mechanisms of these effects are discussed.
Exposure-based cognitive behavior therapy (CBT) has been shown to be effective in the treatment of severe health anxiety, but little is known about mediators of treatment effect. The aim of the present study was to investigate mindful non-reactivity as a putative mediator of health anxiety outcome using data from a large scale randomized controlled trial. We assessed mindful non-reactivity using the Five Facets Mindfulness Questionnaire-Non-Reactivity scale (FFMQ-NR) and health anxiety with the Short Health Anxiety Inventory (SHAI). Participants with severe health anxiety (N = 158) were randomized to internet-delivered exposure-based CBT or behavioral stress management (BSM) and throughout the treatment, both the mediator and outcome were measured weekly. As previously reported, exposure-based CBT was more effective than BSM in reducing health anxiety. In the present study, latent process growth modeling showed that treatment condition had a significant effect on the FFMQ-NR growth trajectory (α-path), estimate = 0.18, 95% CI [0.04, 0.32], p = .015, indicating a larger increase in mindful non-reactivity among participants receiving exposure-based CBT compared to the BSM group. The FFMQ-NR growth trajectory was significantly correlated with the SHAI trajectory (β-path estimate = -1.82, 95% CI [-2.15, -1.48], p < .001. Test of the indirect effect, i.e. the estimated mediation effect (αβ) revealed a significant cross product of -0.32, which was statistically significant different from zero based on the asymmetric confidence interval method, 95% CI [-0.59, -0.06]. We conclude that increasing mindful non-reactivity may be of importance for achieving successful treatment outcomes in exposure-based CBT for severe health anxiety.
Background:
The aim of this study was to explore whether certain aspects of emotion dysregulation (i.e., facets of alexithymia and rumination) are more closely linked to hypochondriasis than to depression and vice versa.
Methods:
Nineteen patients with hypochondriasis (HYP), 33 patients with depression, and 52 healthy control participants completed the Toronto Alexithymia Scale, the Response Styles Questionnaire, and additional symptom and illness behaviour scales. A clinical interview was used to establish DSM-IV diagnoses and to exclude all cases with more than one axis I diagnosis.
Results:
Depression patients reported more difficulties describing feelings and more symptom- and self-focused rumination than both HYP patients and healthy individuals, whereas HYP patients differed only from healthy individuals in regard to more difficulties in identifying feelings and more symptom-focused rumination. Multiple regression analyses, including all assessed facets of emotion dysregulation, showed that the degree of somatoform features (somatic symptoms, health anxiety, and illness behaviour) was specifically predicted by higher difficulties in identifying feelings scores, whereas depressive symptom levels were specifically predicted by higher rumination scores.
Conclusions:
Specific associations were found between difficulties in identifying feelings and key features of HYP, whereas depression was linked to a more generalized pattern of emotion regulation deficits.
Key practitioner message:
Emotion dysregulation can be found in hypochondriasis and depression Difficulties in identifying own feelings are specifically linked to somatic symptoms, health anxiety, and illness behaviour, whereas a more generalized pattern of emotion dysregulation is found in relation to depression Further research is needed to investigate whether the effectiveness of current treatments for depression, hypochondriasis, health anxiety, and related disorders could be improved by additional emotion regulation interventions.
The Toronto Alexithymia Scale (TAS-20) is a 20-itemself-report scale assessingemotional and social competency impairments like difficulty identifying feelings (DIF), difficulty describing feelings (DDF) and externally-oriented thinking (EOT). Despite strong validity and predictive utility in North American and European samples, its validity
in Non-Western cultures is still in need of verification. An Arabic version of the TAS-20 was given to a sample (n=2221) of young adults from3 Arabic-speaking countries (Algeria, Gaza andOman), aswell as English speaking young adults fromCanada (n=2220).Confirmatory factory analysis indicated good fit of the data from both samples, suggesting that the alexithymia construct can be extended to Arabic populations. The Arabic sample scored significantly higher on the total TAS-20 as well as all subscales and in total TAS-20 scores. This trend
was consistent for both men andwomen and suggests important cultural differences exist in the communication
of emotional information.
An integrative-psychodynamic theory of criticism in self and relationships is presented (Shahar, 2015). My theoretical starting point is the tension between Authenticity (A; our inherited potential, tantamount to Winnicott's True Self) and Self-Knowledge (SK; what we [think] we know about ourselves). Self-criticism, a formidable dimension of vulnerability to a wide array of psychopathologies, is construed as a distorted form of self-knowledge, reducing internal confusion at the expense of widening the gap between A and SK. Amalgamated by a genetic and neuroanatomic makeup, criticism of the self quickly translates into criticism-based interpersonal exchanges across the life span, culminating in an Axis of Criticism (ACRIM). A psychodynamic-integrative psychotherapy of malignant criticism in self and relationships is described. The article is concluded with some broad reflections on the implication of this work to the theory development and therapeutic action. © 2016 The American Academy of Psychoanalysis and Dynamic Psychiatry.
This paper deals with the impact of modernization on kinship structure in developing societies. The data are based on a synthesis of secondary sources and a field study conducted among the Arab population in Israel. Our analysis shows that the kinship structure has survived and, in some aspects, has even been reinforced in the wake of modernization. However, processes connected with individual modernization have changed the nature of kinship organization and the dynamics of the interaction between individuals and their kinship group. They have led to the emergence of 'instrumentalized kinship', based on pragmatic needs rather than traditional ideological commitments.
Self-criticism is a personality trait that has been implicated in a wide range of psychopathologies and developmental arrests. Defined as the tendency to set unrealistically high standards for one's self and to adopt a punitive stance towards the self once these standards are not met, self-criticism is both active and cyclical. Self-critics actively create the social-interpersonal conditions that generate their distress, and their distress itself exacerbates self-criticism. Erosion offers a comprehensive treatment of self-criticism based in philosophy, developmental science, personality and clinical psychology, social theories, and cognitive-affective neuroscience. Professor Golan Shahar expertly summarizes the most recent research on the topic and synthesizes theory, empirical research, and clinical practice guidelines for assessment, prevention, and treatment. The book rests upon three elements that, as Shahar argues, are central to the maintenance of self-critical vulnerability: the importance of a concept of an authentic self or the need to "feel real"; the importance of intentionality and goal-directedness; and the power of interpersonal relationships and cultural context. Shahar argues that exploring these elements requires an integrated clinical approach that incorporates multidimensional assessment and interventions which reconcile science, practice, and policy. The result is a broad and scholarly volume that is useful to practitioners, researchers, and theorists interested in self-criticism.
Objective:
To explore the contribution of health anxiety to disability and use of mental health and medical services, independently of co-occurring mental and physical conditions.
Methods:
Data from the Australian National Survey of Mental Health and Wellbeing 2007 were analyzed (n = 8841). Participants were aged 16 to 85 years (mean [standard deviation] = 46.3 [19.0] years) and 54% were women.
Results:
Health anxiety accounted independently for high disability and service use. People with health anxiety were more likely to use both mental health (for psychiatrists: odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.2-3.5; for psychologists: OR = 1.9, 95% CI = 1.2-3.3) and specialist medical services (OR = 1.7, 95% CI = 1.2-2.3) than people without health anxiety. However, they were not high-frequency attenders to specialist mental health services (OR = 1.6 [95% CI = 0.9-3.0] and OR = 1.3 [95% CI = 0.6-2.9]) compared with people with other mental disorders (OR = 11.7 [95% CI = 4.3-31.8] and OR = 29.5 [95% CI = 13.5-64.6] for psychiatrists and psychologists, respectively). People with health anxiety were likely to be high-frequency attenders to general practice (OR = 2.0, 95% CI = 1.4-2.8) and specialist medical services (OR = 2.4, 95% CI = 1.7-3.6).
Conclusions:
It is important to recognize and treat health anxiety, even when coexisting with other conditions, to prevent high disability burden and excessive service use. The cross-sectional design and self-reported outcomes may have resulted in overestimation of the associations. Future work is needed on actual service use using reviews of medical records.
• We attempted to integrate the DSM-III criteria for hypochondriasis with the clinical literature and derived six positive and two negative diagnostic criteria. Seven of these were assessed in a random sample of 92 medical outpatients by means of a self-report questionnaire, structured interview, and medical record audit. The results are in accord with previous work: there appears to be considerable internal validity and consistency in the syndrome in that disease conviction, disease fear, bodily preoccupation, and somatic symptoms are significantly intercorrelated. The three hypochondriacal attitudes (conviction, fear, and preoccupation) were not statistically related to the number of medical diagnoses in the patients' medical records. Depressive symptoms, as measured by the Beck Depression Inventory, were highly correlated with the other hypochondriacal symptoms. The hypochondriacal syndrome in these patients appears to be consistent with the clinical disorder described in DSM-III.
Unlabelled:
Self-criticism is a vulnerability risk factor for a number of psychological disorders, and it predicts poor response to psychological and pharmacological treatments. In the current study, we evaluated the efficacy of a loving-kindness meditation (LKM) programme designed to increase self-compassion in a sample of self-critical individuals. Thirty-eight individuals with high scores on the self-critical perfectionism subscale of the Dysfunctional Attitude Scale were randomized to an LKM condition (n = 19) or a wait-list (WL) condition (n = 19). Measures of self-criticism, self-compassion and psychological distress were administered before and immediately following the intervention (LKM or WL). WL participants received the intervention immediately after the waiting period. Both groups were assessed 3 months post-intervention. Intent-to-treat (n = 38) and per-protocol analyses (n = 32) showed significant reductions in self-criticism and depressive symptoms as well as significant increases in self-compassion and positive emotions in the LKM condition compared with the WL condition. A follow-up per-protocol analysis in both groups together (n = 20) showed that these gains were maintained 3 months after the intervention. These preliminary results suggest that LKM may be efficacious in alleviating self-criticism, increasing self-compassion and improving depressive symptoms among self-critical individuals. Copyright © 2014 John Wiley & Sons, Ltd.
Key practitioner message:
Self-criticism plays a major role in many psychological disorders and predicts poor response to brief psychological and pharmacological treatments for depression. The current study shows that loving-kindness meditation, designed to foster self-compassion, is efficacious in helping self-critical individuals become less self-critical and more self-compassionate. The study also suggests that practising loving-kindness may reduce depressive symptoms and increase positive emotions.
Past research and national survey data on Canadians' perceived need for mental health care (MHC) have focused on unmet needs overall, and have not considered specific types of MHC needs or the extent to which needs are met.
Using data from the 2012 Canadian Community Health Survey-Mental Health, this article describes the prevalence of perceived MHC needs for information, medication, counselling and other services. The degree to which each type of need was met is explored. Associations between risk factors for having MHC needs and the extent to which needs were met are investigated.
In 2012, an estimated 17% of the population aged 15 or older reported having had an MHC need in the past 12 months. Two-thirds (67%) reported that their need was met; for another 21%, the need was partially met; and for 12%, the need was unmet. The most commonly reported need was for counselling, which was also the least likely to be met. Distress was identified as a predictor of perceived MHC need status.
Many Canadians are estimated to have MHC needs, particularly for counselling. People with elevated levels of distress are significantly more likely to have unmet and partially met MHC needs than to have fully met MHC needs, regardless of the presence of mental or substance disorders.
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
No previous study has examined the initial stages of the depressive interpersonal spiral described by J. C. Coyne (1976). The authors' purpose was to elucidate predictions regarding the formative stages of the spiral and to put them to empirical test in a prospective study of 177 college undergraduates. The authors predicted and found that (a) negative life events predicted increases in anxiety, decreases in self-esteem, and increases in reassurance-seeking; (b) negative life events predicted changes in reassurance seeking via their influence on anxiety and self-esteem; and (c) this mediational role was relatively specific to anxiety and self-esteem and did not apply to depression. Understanding the groundwork of the depressive interpersonal spiral may point to its prevention. (PsycINFO Database Record (c) 2010 APA )
Studied the under-use of professional psychological services by the Arabs of Jaffa, a mixed Arab–Jewish section of Tel Aviv. Specifically, this study examined 2 possible reasons why Jaffa's Arab do not seek professional help for their family and personal problems: (1) the possibility that the under-use of professional services is associated with both negative attitudes towards psychological help-seeking, and (2) the availability of alternative sources of assistance in the community. 242 Arab female residents of Jaffa were interviewed, 20 of which were currently using the Jaffa Marital and Family Counseling Service. Findings suggest that neither negative attitudes nor positive attitudes towards seeking help through culturally approved channels account for the under-use of professional help by Jaffa's Arabs. The majority of Ss favored dealing with family problems within the nuclear family itself. Results show a substantial discrepancy between Ss' attitudes and actual help seeking behavior. That is, the percentage of Ss that actually used psychotherapeutic services was much lower than the percentage expressing a positive attitude toward seeking help. Other reasons for the under-utilization of services, such as cultural factors, are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Unlabelled:
The current study tests a model based on social rank mentality investigating whether women who feel inferior and believe others see them negatively, and feel under pressure to compete to avoid social inferiority, present increased body dissatisfaction and drive for thinness and whether these associations are mediated by distinct emotional regulation processes. The predictions from the model proposed were examined through path analyses, in a sample of 125 women from the general population and 102 patients with eating disorders. Results showed that the path model explained 51% of body dissatisfaction variance and 61% of drive for thinness and allowed us to confirm that social ranking variables increased drive for thinness through higher levels of self-criticism and lower levels of self-compassion. The findings suggest that the nuclear eating disorders' features arise as a result of a more self-critical and less compassionate attitude with the self, in the context of a mentality focused on social ranking and competition.
Key practitioner message:
The current study explores an innovative comprehensive model based on social rank theory to understand eating disorders' symptoms in women. A mentality focused on ranking, shame and competition predicts body image dissatisfaction. This ranking-focused mentality, along with body image dissatisfaction, leads to drive for thinness through increased self-criticism and decreased self-compassion. These findings support the emergent psychotherapeutic approaches for eating disorders that target self-criticism and self-compassion.
To evaluate various psychological constructs used in formulations of anorexia and bulimia nervosa, we compared 76 eating-disordered, 20 psychiatric, and 24 normal women on measures of irrational cognitions, object-relations disturbances, and defense styles. The eating-disordered groups exhibited more disturbance on all measures than normals and many pathological elevations relative to psychiatric controls. Despite these differences, common qualitative features were identified in all patient groups, suggesting that formulations based on the factors examined alone, while useful in providing an understanding of patients' issues, will be inadequate to account for eating-disorder development.
This study examined socioculturel and gender group differences in perceptions of major sources of academic stress in first year college students, in addition to the relationship between reported academic stress and college achievement. Data were collected via a self-administered student stress inventory given to a sample of 184 Jewish and 209 Arab college undergraduates studying in a major Israel university. They evaluated the personal stressfulness of each of 53 potential sources of academic stress along a 6-point Likert-type scale covering a wide range of potential academic Stressors (academic curriculum and course requirements, course evaluation procedures, college instruction, social milieu and cultural factors on campus, college administration and bureaucracy, physical conditions and accommodations, economic factors, organismic and interpersonal factors, student expectations, daily hassles and constraints). Arab, lower-status, and female students were hypothesized and found to be more stressed than their respective Jewish, upper-class and male counterparts, respectively. Cultural group background was found to be the most salient background predictor of student stress, followed by social class and gender, with each exerting independent (noninteractive) effects. Although group differences were observed in mean ratings, there proved to be a strong correspondence in the hierarchy of perceived Stressors across sociocultural and gender subgroups. As a whole, students appeared to be most stressed by pressures originating from course overload and academic evaluation procedures and least stressed by a variety of personal, familial, and social factors. Furthermore, student stress and achievement factors were found to be inversely correlated, with little evidence for the contention that stress differentially debilitates the academic performance of students as a function of gender or sociocultural group membership. The findings also lend some evidence to the cross-cultural generalizability of major stressors in academia.
The purposes of this article are to summarize the author's expectancy model of fear, review the recent studies evaluating this model, and suggest directions for future research. Reiss' expectancy model holds that there are three fundamental fears (called sensitivities): the fear of injury, the fear of anxiety, and the fear of negative evaluation. Thus far, research on this model has focused on the fear of anxiety (anxiety sensitivity). The major research findings are as follows: simple phobias sometimes are motivated by expectations of panic attacks; the Anxiety Sensitivity Index (ASI) is a valid and unique measure of individual differences in the fear of anxiety sensations; the ASI is superior to measures of trait anxiety in the assessment of panic disorder; anxiety sensitivity is associated with agoraphobia, simple phobia, panic disorder, and substance abuse; and anxiety sensitivity is strongly associated with fearfulness. There is some preliminary support for the hypothesis that anxiety sensitivity is a risk factor for panic disorder. It is suggested that future researchers evaluate the hypotheses that anxiety and fear are distinct phenomena; that panic attacks are intense states of fear (not intense states of anxiety); and that anxiety sensitivity is a risk factor for both fearfulness and panic disorder.
Moderating and mediating models of the depressogenic effect of personality (dependency and self-criticism), interpersonal behavior (excessive reassurance-seeking), and specific life stressors were examined. The moderating model posits that these factors augment each others' depressogenic effects. The mediating model postulates that personality and interpersonal behavior generate life stress, resulting in depression. Support for both models was found in a two-wave longitudinal study of undergraduates (N=198). Family and friends-related stress moderated the effect of dependency, and a wide range of life events mediated the effect of self-criticism on depression. Reassurance-seeking behavior predicted only spouse-related stress. Results illuminate the need to assess specific, rather than general, life stress domains, and suggest that the vulnerability of dependency is reactive, whereas that of self-criticism is proactive.
Unlabelled:
Self-criticism plays a key role in many psychological disorders and predicts poor outcome in psychotherapy. Yet, psychotherapy research directly targeting self-critical processes is limited. In this pilot study, we examined the efficacy of an emotion-focused intervention, the two-chair dialogue task, on self-criticism, self-compassion and the ability to self-reassure in times of stress, as well as on depressive and anxiety symptoms among nine self-critical clients. Results showed that the intervention was associated with significant increases in self-compassion and self-reassuring, and significant reductions in self-criticism, depressive symptoms and anxiety symptoms. Effect sizes were medium to large, with most clients exhibiting low and non-clinical levels of symptomatology at the end of therapy, and maintaining gains over a 6-month follow-up period. Although preliminary, these finding suggest that emotion-focused chair work might be a promising intervention addressing self-criticism.
Key practitioner message:
Self-criticism is an important process in a variety of clinical disorders and predicts poor outcome in brief therapy for depression. Yet, little is known about how self-criticism can be effectively addressed in psychological treatment. Practitioners can benefit from increasing their awareness of self-critical processes in their clinical work, and from directly working with emotions in addressing self-criticisim. Emotion-focused two-chair dialogue intervention can be effective in reducing self-criticism, increasing self-compassion, and decreasing depressive and anxiety symptoms, and these improvements are largely maintained six months after therapy.
Medically unexplained symptoms are the defining feature of somatoform disorders (SFD) as currently included in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the International Classification of Diseases, Tenth Edition. Cognitive, behavioral, biological, and social variables are important to our understanding of SFD. Research in the past decade has highlighted the central role of (a) prolonged attention allocation to bodily sensations, (b) the dysfunctional role of catastrophizing symptoms as signs of severe illness, (c) neuroendocrine alterations, and (d) the influence of illness behavior (e.g., the avoidance of physical activity) on the maintenance and chronicity of SFD. Additionally, conditioning approaches have demonstrated that perceiving somatic discomfort can easily be learned. In addition to current models of etiology and pathogenesis, the existing evidence on the efficacy and effectiveness of psychotherapy for SFD is reviewed. Finally, future directions and some current blind spots in research on SFD are outlined.
This study explored the relationship of forms and functions of self-criticism, shame, and social rank variables to self-harm, depression, and anxiety.
The study used a questionnaire design.
In-patients and day-patients (N=73) completed a series of questionnaires measuring self-harm, mood, self-criticism, shame, and social comparison.
Self-harm was significantly associated with forms and functions of self-criticism, shame, and feelings of inferiority (low social rank). The self-persecuting function of self-criticism was especially linked to self-harm, depression, and anxiety.
This study adds to a growing literature on the importance of recognizing the pathogenic effects of negative self-critical thoughts and feelings about the self and the value of distinguishing different types of self-criticism.
We investigated the factor structure, reliability estimates, and correlates of the Anxiety Sensitivity Index-3 (ASI-3; Taylor et al., 2007) in 2 studies. We established a bifactor model in Study 1 as an alternative representation of the structure of the ASI-3. Analyses of gender differences on the total ASI-3 and subscale scores were not statistically significant (Study 1, N = 462). In Study 2 (N = 293), results of a series of confirmatory factor analyses provided stronger support for the fit of the bifactor model compared with 2 alternative models. Estimates of scale reliability were adequate (all rho values > or = .80) and not "p" (as in italic p for significance). in the 2 studies. In addition, using simultaneous regression analyses, we found anxiety-specific correlates for the total ASI-3 and subscale scores to include responses on self-report measures of interpersonal sensitivity, obsessive-compulsive anxiety, paranoid ideation, and phobic anxiety.
In this study, we attempted to disentangle the extent to which older age vs physical health problems contribute to health anxiety. Thus, we compared the levels of health anxiety among younger adults and seniors, with either low or high levels of frailty. Predictors of health anxiety in seniors were explored.
Forty-nine seniors with high levels of frailty were compared with 63 seniors with low levels of frailty and 130 younger adults. Comparisons were made on the Illness Attitudes Scale (IAS) and on a Medically Adjusted Illness Attitudes Scale, an adapted version ensuring scores reflect health anxiety, and not greater illness. Seniors also completed measures of frailty, pain, depression, trait anxiety and coping.
Results varied depending on the health anxiety measure. Using the traditional IAS, seniors with high frailty experienced greater levels of health anxiety than seniors with low-frailty and younger adults. Using the medically adjusted version, seniors with high frailty experienced similar levels of heath anxiety compared with younger adults; seniors with low frailty had the lowest levels of health anxiety. Using multiple regression analysis, emotional preoccupation and trait anxiety uniquely predicted health anxiety among seniors. CONCLUSIONs: Researchers and clinicians should ensure that health anxiety measures actually assess health anxiety and not physical illness. Using an appropriate health anxiety measure, the results suggest seniors with relatively fewer health problems may experience reduced health anxiety compared with other older adults and younger adults. The results are considered in the context of research on aging and anxiety. Implications for clinical practice and future research are discussed.
Reviews the 6 approaches to etiology that now preempt the field—ecological, developmental, learning, genetic, internal environment, and neurophysiological models—and proposes a 2nd-order model, vulnerability, as the common denominator. Methods are suggested for finding markers of vulnerability in the hope of revitalizing the field. It is assumed that exogenous and/or endogenous challengers elicit a crisis in all humans, but depending on the intensity of the elicited stress and the threshold for tolerating it (i.e., one's vulnerability), the crisis will either be contained homeostatically or lead to an episode of disorder. Vulnerability and episode stand in a trait–state relation, and markers for each must be provided to distinguish between them. (83 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Investigated depression as a normal affect state that could have continuity with types of clinical depression. A 66-item Depressive Experiences Questionnaire (DEQ) was constructed to assess a wide range of experiences that, though not direct symptoms of depression, are frequently associated with it. The DEQ, the Wessman-Ricks Mood Scale, a version of the semantic differential, and the Death-Concern Questionnaire were administered to 500 female and 160 male college students. In another sample, 128 college students were given the DEQ and the Zung Self-Rating Depression Scale. Three highly stable factors emerged from the DEQ: Dependency, Self-Criticism, and Efficacy. These factors had significant differential correlations with other measures, which support the interpretation of the factors derived from the items. These data indicate the need to consider dependency and self-criticism as 2 primary dimensions of depression and the value of investigating the continuity between normal mood states and the clinical phenomena of depressions. (38 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Primary hypochondriasis is a poorly understood condition for which there is no accepted effective treatment. A cognitive-behavioural formulation is described which identifies the psychological processes and factors involved in the aetiology and maintenance of the condition. Using this formulation, it is also possible to account for the development and course of health concerns in non-hypochondriacal individuals. Modification of the aetiological and maintaining factors identified by the cognitive-behavioural formulation should provide an effective treatment for primary hypochondriasis. Cognitive-behavioural treatment strategies derived directly from the formulation have been used successfully in case-studies and require further systematic evaluation.
The authors administered the Illness Attitude Scales, which identify hypochondriacal patients, to 20 nonpsychotic inpatients with DSM-III diagnosis of melancholia before and after 4 weeks of treatment with amitriptyline, and to a matched group of normals. Before treatment characteristic hypochondriacal responses occurred in over one-third of melancholics whereas after treatment the number was the same as in normals. The findings are in accord with the clinical observation that melancholia is one of the causes of hypochondriacal fears and beliefs and these tend to remit with recovery from depression.
