Weight-Based Emotional Abuse: Self Psychological Implications for Treatment

The aim of this paper is to provide evidence that overweight individuals are at increased risk for emotional abuse compared to their normal weight counterparts. Studies examining weight-based discrimination and bullying demonstrate examples of emotional abuse aimed at overweight individuals. The psychological difficulties associated with emotional abuse, such as symptoms of anxiety, depression and social difficulties, are reviewed. It is hypothesized that similar psychological difficulties are experienced when obese persons experience weight based emotional abuse. A self psychological conceptualization is applied to understand the effect emotional abuse has on one's sense of self. A treatment proposal, which aims to utilize self-object transferences to strengthen the self, is offered. Future research for the application of self psychology in a group therapy format is discussed.

Clinical Implications for Working with Gay Men A Self Psychological Treatment Approach.

Specific training for conducting psychotherapy with gay men is limited for psychologists, particularly when using a Self Psychology theoretical orientation (Robertson, 1996). In fact, psychologists often are faced with conflicting and contradictory points of view that mirror society's condemnation of homosexuality (Robertson, 1996). This paper is written from a self-psychological perspective to address the lack of a constructive body of literature that explains the unique treatment needs which impact gay men. Estimates of the prevalence of male homosexuality have generated considerable debate. A common assumption is that there are homosexual and non-homosexual men. However, scientists have long been aware that sexual responsiveness to others of the same sex, like most human traits, is continuously distributed in the population (Michaels, 1996). Still the presumption exists that such traits are stable within each man over time (Michaels, 1996). Conflating same-sex sexual experiences with a categorization of the man as homosexual is problematic, in that defining sexuality solely on the basis of experience excludes people who fantasize about sex with others of the same sex but never have sexual contact. Thus, most modern conceptions of sexual orientation consider personal identification, sexual behavior, and sexual fantasy (McWhirter, Sanders & Reinisch, 1990). Gay men's mental health can only be understood in the context of homosexuality throughout history, since religious and moral objections to sexual attraction between men have existed for centuries. Men who desired other men were regarded as sinful and depraved if not ill or abnormal, and same sex contacts were not distinguished from lewd behaviors (Weeks, 1989). Although most people, regardless of sexual orientation, have experienced some feelings of personal rejection, rarely do heterosexuals become targets for disapproval based on the nature of their attractions and behaviors relative to the same and to the other sex. For lesbians, bisexuals, and gay men, however, homosexuality becomes the focus of aspects of themselves that make them feel hated and hateful (Isay, 1989). While gay men and lesbians are often considered together because of the same-sex nature of their relationships and the similar issues that they may experience in their treatment within society, there are many issues where they might be best studied separately. Issues involving with health, parenthood, sexuality and perceived roles and status in society, for example, are often related more to gender than to any shared concept of a 'gay and lesbian community'. Many issues surrounding lesbians and lesbian culture will have more to do with women's issues, and some issues involving with gay men will have more to do with the gay male subculture and with masculinity. The author of this paper has limited experience in working with lesbian and bisexual individuals, and although it is likely that some of the concepts articulated in this paper could translate to working with lesbian and bisexual individuals, further research is indicated to examine the beneficence of utilizing a Self Psychological orientation in psychotherapy with lesbian women and bisexual individuals. This paper presents an overview of the literature including historical treatments of homosexuality, the history of Self Psychology, key principles in Self Psychology, research on Self Psychology, identity development models for gay men, and Self Psychological perspectives on identity development related to gay men. The literature review is followed by a section on treatment implications for psychologists seeking to treat gay men, including case vignettes based on work from my own practice. I have preserved the anonymity of clients by changing demographics, and rearranging and combining presenting issues and historical backgrounds among the case examples.

Self-regulatory behaviors in children with Down syndrome and typically developing children measured using the Goodman Lock Box

Self-regulation has been identified as an area of difficulty for those with mental retardation. The Goodman Lock Box provides measures of two critical aspects of self-regulation-planfulness and maintenance of goal-directed behavior. In this study, the Lock Box performance of 25 children with Down syndrome was compared with that of 43 typically developing children, matched for mental age (24-36 months). Children in both groups showed similar levels of competence, planfulness and distractibility. However, children with Down syndrome displayed more task-avoidant behavior. Some issues related to the measurements obtained from the Lock Box are raised. (C) 2003 Elsevier Science Ltd. All rights reserved.

Development of a controlled drinking self-efficacy scale and appraising its relation to alcohol dependence

There is no specific self-efficacy measure that has been developed primarily for problem drinkers seeking a moderation drinking goal. In this article, we report the factor structure of a 20-item Controlled Drinking Self-Efficacy Scale (CDSES Sitharthan et al., 1996; Sitharthan et al., 1997). The results indicate that the CDSES is highly reliable, and the factor analysis using the full sample identified four factors: negative affect, positive mood/social context, frequency of drinking, and consumption quantity. A similar factor structure was obtained for the subsample of men. In contrast, only three factors emerged in the analysis of data on female participants. Compared to women, men had low self-efficacy to control their drinking in situations relating to positive mood/social context, and subjects with high alcohol dependence had low self-efficacy for situations relating to negative affect, social situations, and drinking less frequently. The CDSES can be a useful measure in treatment programs providing a moderation drinking goal. (C) 2003 Wiley Periodicals, Inc.

Irja' ila Nafsika: Suhraward's apperception of the self in light of Avicenna

Shihāb al-Dīn Suhrawardī (d.687/1191) proposed a theory of apperception that constitutes the core of his “illuminative” epistemology. His theory of apperception purports to account for the soul’s immediate, reflexive, and unmediated knowledge of its own essence. Apperception may be defined as the direct experience the soul has of its essence. A closer examination of the Avicennan tradition (Avicenna died in 420/1037) reveals the existence of a number of arguments for the demonstration of an apperception of the self/soul similar to the arguments Suhrawardī later proposes. Contrary to admitted views, Avicenna had tackled issues related to the soul’s apperception, a type of perception distinct from the soul’s intellection of its essence. Avicenna alluded to the existence of a mode of perception specific to the soul that would guarantee both the soul’s unity and its personal identity. This apperception is defined as an unmediated presence of the soul to itself. These elements recur in Suhrawardī’s theory of apperception and numerous versions of Avicenna’s arguments for the demonstration of the presential nature of apperception

Pretend play, mirror self-recognition and imitation: A longitudinal investigation through the second year

The aim in the current study was to investigate the emergence of pretend play, mirror self-recognition, synchronic imitation and deferred imitation in normally developing human infants. A longitudinal study was conducted with 98 infants seen at three-monthly intervals from 12 through to 24 months of age. At each session the infants were tested on a range of tasks assessing the four target skills. Deferred imitation was found to emerge prior to synchronic imitation, pretend play and mirror self-recognition. In contrast, the latter three skills emerged between 18 and 21 months and followed similar developmental trajectories. Deferred imitation was found to hold a prerequisite relation with these three skills. Synchronic imitation, pretend play and mirror self-recognition were not closely associated and no prerequisite relations were found between these skills. These findings are discussed in the context of current theories regarding the development of pretend play, mirror self-recognition, synchronic imitation and deferred imitation in the second year. (C) 2004 Elsevier Inc. All rights reserved.

Comparison of the R-70 self-heating rate of New Zealand and Australian coals to Suggate rank parameter

Samples from New Zealand and Australia have been tested in an adiabatic oven to assess the effect of rank on the R-70 selfheating rate of coal. A non-linear relationship can be defined for coals from both countries using the revised Suggate rank (S-r) parameter. Subbituminous coals have the highest R-70 self-heating rate values, which are 20 times that of high volatile A bituminous coals on a dry mineral matter free basis (similar to 1 cf. 20 degrees C h(-1)). However, the moderating effects of moisture and mineral matter can reduce this difference to only 2-3 times for coal in-situ. (c) 2005 Elsevier B.V All rights reserved.

Differences in mail and telephone responses to self-rated health: use of multiple imputation in correcting for response bias

Objectives: To estimate differences in self-rated health by mode of administration and to assess the value of multiple imputation to make self-rated health comparable for telephone and mail. Methods: In 1996, Survey 1 of the Australian Longitudinal Study on Women's Health was answered by mail. In 1998, 706 and 11,595 mid-age women answered Survey 2 by telephone and mail respectively. Self-rated health was measured by the physical and mental health scores of the SF-36. Mean change in SF-36 scores between Surveys 1 and 2 were compared for telephone and mail respondents to Survey 2, before and after adjustment for socio-demographic and health characteristics. Missing values and SF-36 scores for telephone respondents at Survey 2 were imputed from SF-36 mail responses and telephone and mail responses to socio-demographic and health questions. Results: At Survey 2, self-rated health improved for telephone respondents but not mail respondents. After adjustment, mean changes in physical health and mental health scores remained higher (0.4 and 1.6 respectively) for telephone respondents compared with mail respondents (-1.2 and 0.1 respectively). Multiple imputation yielded adjusted changes in SF-36 scores that were similar for telephone and mail respondents. Conclusions and Implications: The effect of mode of administration on the change in mental health is important given that a difference of two points in SF-36 scores is accepted as clinically meaningful. Health evaluators should be aware of and adjust for the effects of mode of administration on self-rated health. Multiple imputation is one method that may be used to adjust SF-36 scores for mode of administration bias.

Symptom reporting and associations with compensation status, self-awareness, causal attributions, and emotional wellbeing following traumatic brain injury

Individuals seeking compensation following traumatic brain injury (TBI) are often found to report a disproportionately high level of symptoms relative to objective indicators of impairment. Previous studies highlight that level of symptom reporting is also related to self-awareness, causal attribution, and emotional wellbeing. Therefore, the reasons for high symptom reporting in the context of compensation are generally unclear. This study aimed to identify whether self-awareness, causal attribution, and emotional wellbeing are significantly associated with level of symptom reporting after controlling for compensation status. A sample of 54 participants with TBI comprised two groups, namely, claimants (n = 27) and non-claimants (n = 27), who were similar in terms of demographic and neuro-cognitive variables. Participants completed the Symptom Expectancy Checklist, Hospital Anxiety Depression Scale, Awareness Questionnaire and a causal attribution scale. A series of independent t tests and Pearson's correlations identified that a higher level of symptom reporting was associated with the following: seeking compensation, less severe TBI, increased age, greater self-awareness, increased post-injury changes reported by relatives, a higher level of mood symptoms, and a tendency to blame other people. Multivariate analysis identified that after controlling for demographic, injury, and compensation status variables, level of mood symptoms and self-awareness were significantly associated with level of symptom reporting. The findings suggest that mood symptoms and heightened self-awareness are significantly related to high symptom reporting independent of compensation status, thus supporting the need for clinicians to interpret symptom reporting within a biopsychosocial context.

Bias, precision and heritability of self-reported and clinically measured height in Australian twins

Many studies of quantitative and disease traits in human genetics rely upon self-reported measures. Such measures are based on questionnaires or interviews and are often cheaper and more readily available than alternatives. However, the precision and potential bias cannot usually be assessed. Here we report a detailed quantitative genetic analysis of stature. We characterise the degree of measurement error by utilising a large sample of Australian twin pairs (857 MZ, 815 DZ) with both clinical and self-reported measures of height. Self-report height measurements are shown to be more variable than clinical measures. This has led to lowered estimates of heritability in many previous studies of stature. In our twin sample the heritability estimate for clinical height exceeded 90%. Repeated measures analysis shows that 2-3 times as many self-report measures are required to recover heritability estimates similar to those obtained from clinical measures. Bivariate genetic repeated measures analysis of self-report and clinical height measures showed an additive genetic correlation > 0.98. We show that the accuracy of self-report height is upwardly biased in older individuals and in individuals of short stature. By comparing clinical and self-report measures we also showed that there was a genetic component to females systematically reporting their height incorrectly; this phenomenon appeared to not be present in males. The results from the measurement error analysis were subsequently used to assess the effects of error on the power to detect linkage in a genome scan. Moderate reduction in error (through the use of accurate clinical or multiple self-report measures) increased the effective sample size by 22%; elimination of measurement error led to increases in effective sample size of 41%.

'They cooperate with us, so they are like me': perceived intergroup relationship moderates projection from self to outgroups

Whereas projection of self-attributes to ingroups is ubiquitous, projection of self-attributes to outgroups (outgroup projection) is an elusive phenomenon. Two experiments examined the moderating effect of perceived intergroup relationship on outgroup projection and explored underlying mechanisms. Perceived cooperation versus competition between ingroup and outgroup was manipulated using fictitious (Experiment 1) or natural groups (Experiment 2). In both experiments, participants judged the outgroup as more similar to the self in the cooperation condition than in the competition condition. This effect was independent of recategorization, perceived intergroup similarity, and ingroup-to-outgroup projection. These studies demonstrate the very existence of outgroup projection and extend previous work on moderators of projection from self to groups.

Use of complementary and alternative medicine and self-tests by coronary heart disease patients

Background: Coronary heart disease patients have to learn to manage their condition to maximise quality of life and prevent recurrence or deterioration. They may develop their own informal methods of self-management in addition to the advice they receive as part of formal cardiac rehabilitation programmes. This study aimed to explore the use of complementary and alternative medicines and therapies (CAM), self-test kits and attitudes towards health of UK patients one year after referral to cardiac rehabilitation. Method: Questionnaire given to 463 patients attending an assessment clinic for 12 month follow up in four West Midlands hospitals. Results: 91.1% completed a questionnaire. 29.1% of patients used CAM and/or self-test kits for self-management but few (8.9%) used both methods. CAM was more often used for treating other illnesses than for CHD management. Self-test kit use (77.2%,) was more common than CAM (31.7%,) with BP monitors being the most prevalent (80.0%). Patients obtained self-test kits from a wide range of sources, for the most part (89.5%) purchased entirely on their own initiative. Predictors of self-management were post revascularisation status and higher scores on 'holism', 'rejection of authority' and 'individual responsibility'. Predictors of self-test kit use were higher `holism' and 'individual responsibility' scores. Conclusion: Patients are independently using new technologies to monitor their cardiovascular health, a role formerly carried out only by healthcare practitioners. Post-rehabilitation patients reported using CAM for self-management less frequently than they reported using self-test kits. Reports of CAM use were less frequent than in previous surveys of similar patient groups. Automatic assumptions cannot be made by clinicians about which CHD patients are most likely to self-manage. In order to increase trust and compliance it is important for doctors to encourage all CHD patients to disclose their self-management practices and to continue to address this in follow up consultations.

Anger rumination and self-reported aggression amongst British and Hong Kong Chinese athletes: a cross cultural comparison

Previous work has determined relationships between provocation, anger rumination, and aggression in British athletes (Maxwell, 2004); however, the reliability of these findings and their generality across diverse cultures has not been examined. Therefore, a comparison of British and Hong Kong (HK) Chinese athletes’ propensity for rumination and aggression was undertaken. Provocation and thoughts of revenge were significantly associated with the self-reported aggression of both British and HK Chinese athletes. Frequency of aggression was similar across cultures except for a tendency for British male contact sport athletes to report greater frequency of aggressive behaviour. HK Chinese athletes tended to report higher frequencies of thoughts relating to understanding the causes of anger and higher incidence of perceived provocation. It was concluded that the pattern of aggressive behaviour was similar across the two cultures when opportunities for aggression are infrequent, but that HK Chinese athletes may inhibit aggressive responding even when opportunities are frequent.

Targets and self monitoring in hypertension: randomised controlled trial and cost effectiveness analysis

OBJECTIVES: To assess whether blood pressure control in primary care could be improved with the use of patient held targets and self monitoring in a practice setting, and to assess the impact of these on health behaviours, anxiety, prescribed antihypertensive drugs, patients' preferences, and costs. DESIGN: Randomised controlled trial. SETTING: Eight general practices in south Birmingham. PARTICIPANTS: 441 people receiving treatment in primary care for hypertension but not controlled below the target of < 140/85 mm Hg. INTERVENTIONS: Patients in the intervention group received treatment targets along with facilities to measure their own blood pressure at their general practice; they were also asked to visit their general practitioner or practice nurse if their blood pressure was repeatedly above the target level. Patients in the control group received usual care (blood pressure monitoring by their practice). MAIN OUTCOME MEASURES: Primary outcome: change in systolic blood pressure at six months and one year in both intervention and control groups. Secondary outcomes: change in health behaviours, anxiety, prescribed antihypertensive drugs, patients' preferences of method of blood pressure monitoring, and costs. RESULTS: 400 (91%) patients attended follow up at one year. Systolic blood pressure in the intervention group had significantly reduced after six months (mean difference 4.3 mm Hg (95% confidence interval 0.8 mm Hg to 7.9 mm Hg)) but not after one year (mean difference 2.7 mm Hg (- 1.2 mm Hg to 6.6 mm Hg)). No overall difference was found in diastolic blood pressure, anxiety, health behaviours, or number of prescribed drugs. Patients who self monitored lost more weight than controls (as evidenced by a drop in body mass index), rated self monitoring above monitoring by a doctor or nurse, and consulted less often. Overall, self monitoring did not cost significantly more than usual care (251 pounds sterling (437 dollars; 364 euros) (95% confidence interval 233 pounds sterling to 275 pounds sterling) versus 240 pounds sterling (217 pounds sterling to 263 pounds sterling). CONCLUSIONS: Practice based self monitoring resulted in small but significant improvements of blood pressure at six months, which were not sustained after a year. Self monitoring was well received by patients, anxiety did not increase, and there was no appreciable additional cost. Practice based self monitoring is feasible and results in blood pressure control that is similar to that in usual care.

Self-attentional processes in anxiety:an experimental study

Self-attention research has demonstrated a relationship between dispositional self-focus, anxiety proneness and fear arousal. In addition, the effect of self-focus manipulations on approach-avoidance tasks involving a feared stimulus are strikingly similar to the effects obtained from manipulation of other cognitive factors such as perceived self-efficacy. A number of experiments were designed to explore the relationship between self-focused attention and ffilxiety. Data from the experiments demonstrate that self-attention influences a variety of cognitive variables which have been considered as central factors in anxiety. Concomitants of self-focus are increased awareness of physiological arousal and overestimation of such arousal, the identification of self-discrepancies, cognitive failures and performance deficits and the activation of physical threat concepts in memory. These factors are conceptualised as central in the negative evaluation of physiological arousal and coping resources in anxiety. Clinically anxious individuals typically have high scores in dispositional self-consciousness and body-consciousness. In patients suffering from generalised anxiety or panic disorders maladaptive self-focusing tendencies can be related to specific life stressors which render aspects of the self salient. An analysis of the ideational component of anxiety revealed three subcomponents; negative social ideation (worry about other people's reaction to the self), negative somatic ideation (worry about physical symptoms and health) and obsessional ideation (the experience of uncontrollable and repetitive thoughts) which were differentially associated with measures of dispositional self-focus. The frequency and content of an.xious w-orry is associated with specific self-focusing tendencies. It is proposed that the 'attentional style' of the individual is an important determinant of the nature and intensity of their affective response in a threatening situation. A self-attentional model of anxiety is proposed and the complex interaction between self-focus and other cognitive factors in anxiety such as appraisal of arousal and coping resources and perceived levels of self-efficacy is discussed. The model presents new directions for research and therapeutic intervention in anxiety.