Narrative innovations predict symptom improvement: Studying innovative moments in narrative therapy of depression

Objective:Innovative moments (IMs) are moments in the therapeutic dialog that constitute exceptions toward the client's problems. These narrative markers of meaning transformation are associated with change in different models of therapy and diverse diagnoses. Our goal is to test if IMs precede symptoms change, or, on the contrary, are a mere consequence of symptomatic 15 change. Method: For this purpose, IMs and symptomatology (Outcome Questionnaire-10.2) were assessed at every session in a sample of 10 cases of narrative therapy for depression. Hierarchical linear modeling was conducted to explore whether (i) IMs in a given session predict patients' symptoms in the following session and/or (ii) symptoms in a given session predict IMs in the next session. Results: Results suggested that IMs are better predictors of symptoms than the reverse. Conclusions: These results are discussed considering the contribution of meanings and narrative processes' changes to symptomatic improvement.

Attachment to parents: the mediating role of inhibition of exploration and individuality on health behaviors

This study’s goal was to analyze whether the quality of university students’ relationship with their parents mediated the association between mental health and physical symptoms and health behavior. Participants were 250 university students (66% female and 34% male), aged between 17 and 29 years old (M = 20.88, SD = 2.03) that answered the Father/Mother Attachment Questionnaire (FMAQ), the Physical Symptoms Scale from the Rotterdam Symptom Checklist (RSCL), the Health Behavior Questionnaire (HBQ), and the Hospital Anxiety and Depression Scale (HADS). The results showed that the indirect effect of physical symptoms on health behavior was significantly mediated by the father’s and mother’s inhibition of exploration and individuality (IEI). Also the indirect effect of psychological distress on health behavior was significantly mediated by the father’s and mother’s IEI. These results suggest that young adults who had more restrictions to their individuality show worse health behaviors. Separation Anxiety and Dependence (SAD) and Quality of Emotional Bond (QEB), the other 2 attachment scales, were not mediators of the relationship between physical symptoms/ psychological distress and health behavior. This study shows the importance of promoting positive parenting practices that contribute to healthier behavior choices and less risky behaviors, as well as the need for more studies that clearly identify these practices in young adult populations.

The alarm distress baby scale in a longitudinal Portuguese study reanalyzed with attachment data

Article first published online: 13 NOV 2013

Estudo de validação da versão portuguesa da Alarm Distress Baby Scale (ADBB)

Contexto. O comportamento de retraimento social prolongado da criança é um importante sinal de alarme, quer tenha origem orgânica, psicológica e/ou social. A. Guédeney construiu a Alarm Distress Baby Scale (ADBB), para identificar este comportamento no contexto da consulta pediátrica ou da observação psicológica. Objectivos. Validação da versão portuguesa da ADBB destinada a avaliar o comportamento de retraimento social de crianças com idades compreendidas entre 2 e 24 meses. Metodologia A ADBB e as Bayley Scales of Infant Development (BSID) foram administradas a uma amostra de 130 lactentes com 3 meses de idade, cujas mães preencheram a versão portuguesa da Edinburgh Postnatal Depression Scale (EPDS); 51 bebés foram novamente avaliados aos 12 meses de idade. Resultados. Os itens da ADBB organizam-se satisfatoriamente em duas sub-escalas. A consistência interna do instrumento é razoável (alpha de Cronbach = .587). A validade externa é elevada: a correlação entre os resultados na ADBB e nas BSID é muito significativa - os bebés que aos 3 meses apresentam um resultado igual ou superior a 5 na ADBB evidenciam menor desenvolvimento nas BSID. Os resultados testemunham ainda que bebés de mães deprimidas (EPDS ≥ 12) mostram mais sinais de retraimento social do que os bebés das mães não deprimidas. Conclusão. A escala permite detectar crianças a necessitar de ajuda no sentido de contrariar o retraimento social que encetaram em relação ao meio. Desenhada para sinalizar tão precocemente quanto possível o retraimento social do lactente, e na medida em que este é um comprovado sinal da perturbação do desenvolvimento, a ADBB pode estimular os clínicos na procura das suas causas e na intervenção junto das mesmas. Estudos em amostras de crianças com mais idade são necessários. No entanto, os resultados obtidos apontam que a Versão portuguesa da ADBB é robusta e válida.

Bone turnover markers for early detection of fracture healing disturbances: A review of the scientific literature

Imaging techniques are the standard method for assessment of fracture healing processes. However, these methods are perhaps not entirely reliable for early detection of complications, the most frequent of these being delayed union and non-union. A prompt diagnosis of such disorders could prevent prolonged patient distress and disability. Efforts should be directed towards the development of new technologies for improving accuracy in diagnosing complications following bone fractures. The variation in the levels of bone turnover markers (BTMs) have been assessed with regard to there ability to predict impaired fracture healing at an early stage, nevertheless the conclusions of some studies are not consensual. In this article the authors have revised the potential of BTMs as early predictors of prognosis in adult patients presenting traumatic bone fractures but who did not suffer from osteopenia or postmenopausal osteoporosis. The available information from the different studies performed in this field was systematized in order to highlight the most promising BTMs for the assessment of fracture healing outcome.

Empatia no desenvolvimento típico: relação entre autorrelatos e comportamentos empáticos

Dissertação de mestrado integrado em Psicologia

Self-narrative reconstruction after dilemma-focused therapy for depression: a comparison of good and poor outcome cases

Objective: The aim of this study is to improve the understanding of self-changes after an intervention for depression focused on implicative dilemmas, a type of cognitive conflict related to identity. As recent research has highlighted the relevance of identity-related dilemmas in clients with depression, we sought to assess the way in which clients resolve such inner conflicts after a tailored dilemma-focused intervention and how this is reflected in the clients’ self-narratives. Method: We used three instruments to observe differences between good (n = 5) and poor (n = 5) outcome cases: (i) the Repertory Grid Technique to track the resolution of dilemmas, (ii) the Change Interview to compile clients’ accounts of changes at posttreatment, and (iii) the Innovative Moments Coding System to examine the emergence of clients’ novelties at the Change Interview. Results: Groups did not differ in terms of the number and relevance of client-identified significantly helpful events. However, between-group differences were found for the resolution of dilemmas and for the proportion of high-level innovative moment (IM) types. Furthermore, a greater self-narrative reconstruction was associated with higher levels of symptom improvement. Conclusions: Good outcome cases seem to be associated with the resolution of conflicts and high-level IMs.

Attachment, infidelity, and loneliness in college students involved in a romantic relationship: the role of relationship satisfaction, morbidity and prayer for partner

This study examined the mediating effects of relationship satisfaction, prayer for a partner, and morbidity in the relationship between attachment and loneliness, infidelity and loneliness, and psychological morbidity and loneliness, in college students involved in a romantic relationship. Participants were students in an introductory course on family development. This study examined only students (n = 345) who were involved in a romantic relationship. The average age of participants was 19.46 (SD = 1.92) and 25 % were males. Short-form UCLA Loneliness Scale (ULS-8), (Hays and DiMatteo in J Pers Assess 51:69–81, doi:10.1207/s15327752jpa5101_6, 1987); Relationship Satisfaction Scale (Funk and Rogge in J Fam Psychol 21:572–583, doi:10.1037/0893-3200.21.4.572, 2007); Rotterdam Symptom Checklist (De Haes et al. in Measuring the quality of life of cancer patients with the Rotterdam Symptom Checklist (RSCL): a manual, Northern Centre for Healthcare Research, Groningen, 1996); Prayer for Partner Scale, (Fincham et al. in J Pers Soc Psychol 99:649–659, doi:10.1037/a0019628, 2010); Infidelity Scale, (Drigotas et al. in J Pers Soc Psychol 77:509–524, doi:10.1037/0022-3514.77.3.509, 1999); and the Experiences in Close Relationship Scale-short form (Wei et al. in J Couns Psychol 52(4):602–614, doi:10.1037/0022-0167.52.4.602, 2005). Results showed that relationship satisfaction mediated the relationship between avoidance attachment and loneliness and between infidelity and loneliness. Physical morbidity mediated the relationship between anxious attachment and psychological morbidity. Psychological morbidity mediated the relationship between anxious attachment and physical morbidity. The present results expand the literature on attachment by presenting evidence that anxious and avoidant partners experience loneliness differently. Implications for couple’s therapy are addressed. Future research should replicate these results with older samples and married couples.

Suporte social em cuidadores informais de dependentes de substâncias.

Os cuidadores informais têm de lidar com situações potencialmente causadoras de stress e Sobrecarga. Uma amostra com 120 cuidadores de Dependentes de Substâncias, residentes em Portugal, completou uma bateria de questionários que incluía o BDI (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961; McIntyre & Araújo-Soares, 1999), BSI (Canavarro, 1999; Derogatis, 1975, 1993), CRA (Given, et al., 1992), WHOQOL – Bref (Fleck, 2000; Vaz Serra, et al., 2006) e o IESSS (Ensel & Woelfel, 1986; Faria, 1999). De seguida, os participantes foram distribuídos por três grupos (G1, G2 e G3), dependendo do tempo de abstinência do familiar a quem prestavam cuidados. O estudo explorou a relação entre diversas variáveis clínicas e psicológicas e o suporte social nesses cuidadores. Os resultados revelaram que a coabitação com o paciente, o distress psicológico, a qualidade de vida (relações sociais e psicológica) e a sobrecarga são preditores, do suporte social explicando 48% da variância observada. O modelo de mediação demonstrou que o suporte social é um mediador parcial da relação entre o distress e a sobrecarga, explicando 60% da variância observada. Deste modo, verifica-se a importância de intervir no suporte social no sentido de diminuir o impacto do distress e sobrecarga nos cuidadores.

Hemispheric dorsolateral prefrontal cortex lateralization in the regulation of empathy for pain

The dorsolateral prefrontal cortex (DLPFC) is involved in the cognitive appraisal and modulation of the pain experience. In this sham-controlled study, with healthy volunteers, we used bi-hemispheric transcranial direct current stimulation (tDCS) over the DLPFC to assess emotional reactions elicited by pain observation. Left-cathodal/right-anodal tDCS decreased valence and arousal evaluations compared to other tDCS conditions. Compared to sham condition, both left-cathodal/right-anodal and left-anodal/right-cathodal tDCS decreased hostility, sadness and self-pain perception. These decreased sensations after both active tDCS suggest a common role for left and right DLPFC in personal distress modulation. However, the differences in arousal and valence evaluations point to distinct roles of lateralized DLPFC in cognitive empathy, probably through distinct emotion regulation mechanisms.

Common symptoms of Nepalese soft contact lens wearers: A pilot study

Aim: To determine the common symptoms in current soft contact lens (CL) wearers and theirassociation with other factors among Nepalese population.Methods: All the current CL wearers who started to wear soft CL in Nepal Eye Hospital between July 2007 and June 2012 were invited for the participation. Frequency of the ten most common symptoms, divided into never, occasionally, frequently and consistent were recorded. Association between degree of symptoms with other factors, e.g. age, gender, profession, cigarette smoking, ethnicity, level of education and duration and wearing modality of CL wear were analyzed.Results: Out of 129 subjects participated in this study, 67% were female; the mean age of the subjects was 23.9 ± 4.3 years. Ninety seven percent of them had at least one symptom occasionally or frequently or consistently. Discomfort was found in 88.4% of the total subjects.Other common symptoms were foreign body sensation in 73.6%, redness in 65.9%, reduced wearing time in 63.6% and dryness in 62.8%. Symptoms were found occasionally in the majority of subjects. Degree of symptoms was not associated with age, gender, profession, education status, ethnicity of subjects and duration or modality of lens wear (p > 0.05) but was positively associated with passive cigarette smoking (p < 0.001).Conclusion: Almost all of the Nepalese soft CL wearers had some types of symptoms at least occasionally. Discomfort was the most common symptom. Degree of symptoms was associated with the passive smoking but not with other factors like age, sex, profession and duration of lens wear.

Couple's willingness to donate embryos for research: a longitudinal study

Introduction. Decision-making on embryo disposition is a source of distress and is subject to change over time. This paper analyses the willingness of couples undergoing in vitro fertilization to donate cryopreserved embryos for research from 15 days after embryo transfer to 12 months later, taking into account the influence of psychosocial, demographic, and reproductive factors. Materials and methods. Prospective longitudinal study, with 74 heterosexual couples undergoing in vitro fertilization in a public fertility centre in Portugal, recruited between 2011 and 2012. Participants were evaluated twice: 15 days after embryo transfer and 12 months later. Results. A significant decrease in patients’ willingness to donate embryos for research over time was observed [86.5% to 73.6%; relative risk (RR) = 0.85; 95% CI 0.76–0.95]. A higher education level (>12 years) [adjusted RR (RRadj) = 0.79; 95% CI 0.64–0.96], considering research on human embryos to be important (vs. very important) (RRadj = 0.59; 95% CI 0.39–0.85) and practicing a religion less than once a month (vs. at least once a month) (RRadj = 0.73; 95% CI 0.53–1.00) seemed associated with unwillingness to donate embryos for research over time. Change towards non-donation happened mainly among couples who first considered that it was better to donate than wasting the embryos. Change towards donation occurred mostly among those stating that their priority at time 1 was to have a baby and who became pregnant in the meantime. Conclusions. Quality of care guided by patients’ characteristics, values, preferences, and needs calls for considering the factors and reasons underlying couples’ willingness to donate embryos for research over time as a topic in psychosocial guidelines for infertility and medically assisted reproductive care.

A cumulative risk model of child physical maltreatment potential: findings from a community-based study

"Published online before print November 20, 2015"

Parents' physical victimization in childhood and current risk of child maltreatment: the mediator role of psychosomatic symptoms

Objective: To test the potential mediation effect of psychosomatic symptoms on the relationship between parents' history of childhood physical victimization and current risk for child physical maltreatment. Methods: Data from the Portuguese National Representative Study of Psychosocial Context of Child Abuse and Neglect were used. Nine-hundred and twenty-four parents completed the Childhood History Questionnaire, the Psychosomatic Scale of the Brief Symptom Inventory, and the Child Abuse Potential Inventory. Results: Mediation analysis revealed that the total effect of the childhood physical victimization on child maltreatment risk was significant. The results showed that the direct effect from the parents' history of childhood physical victimization to their current maltreatment risk was still significant once parents' psychosomatic symptoms were added to the model, indicating that the increase in psychosomatic symptomatology mediated in part the increase of parents' current child maltreatment risk. Discussion: The mediation analysis showed parents' psychosomatic symptomatology as a causal pathway through which parents' childhood history of physical victimization exerts its effect on increased of child maltreatment risk. Somatization-related alterations in stress and emotional regulation are discussed as potential theoretical explanation of our findings. A cumulative risk perspective is also discussed in order to elucidate about the mechanisms that contribute for the intergenerational continuity of child physical maltreatment.

The Portuguese version of the Psychological Adjustment to Separation Test-Part A (PAST-A): a study with recently and non-recently divorced adults

Past research has demonstrated that divorced adults show more health problems and psychological distress than married adults. Considering the high prevalence rates of divorce among Western countries, new and robust measures should be developed to measure psychological distress after this specific transition in adulthood. The aim of this study was to adapt and validate a Portuguese version of the Psychological Adjustment to Separation Test-Part A (PAST-A; Sweeper and Halford in J Family Psychol 20(4):632–640, 2006). PAST-A is a self-report measure that assesses two key dimensions of separation adjustment problems: lonely-negativity and former partner attachment. Psychometric properties of the Portuguese version of PAST-A were assessed in terms of factor structure, internal consistency, and convergent and divergent validity, in an online convenience sample with divorced adults (N = 460). The PAST-A two-factor structure was confirmed by exploratory and confirmatory factor analyses, with each factor demonstrating very satisfactory internal consistency and good convergence. In terms of discriminant validity, the Portuguese PAST-A reveals a distinct factor from psychological growth after divorce. The results provided support for the use of the Portuguese PAST-A with divorced adults and also suggested that the explicative factors of the psychological adjustment to divorce may be cross-cultural stable. The non-existence of validated divorce-related well-being measures and its implications for divorce research are also discussed.