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This longitudinal study explored the relations between fear-enhancing parenting behaviors (modeling and threat information transmission) and children's cognitive biases and anxiety symptoms on three subsequent time points over a one-year period. Participants were 216 children aged 7-12 years (114 boys and 102 girls), and their mothers (n = 199) and/or fathers (n = 117). On each time point, children and parents completed the Parental Enhancement of Anxious Cognitions scale, which measures parental modeling and threat information transmission. Furthermore, children filled in a measure of anxiety disorder symptoms. In addition, confirmation bias and interpretation bias were measured by means of a number of computerized tasks. The results yielded support for a circular model in which cognitive biases enhanced anxiety symptoms, which in turn promoted cognitive biases on each of the three time points. However, no evidence was found for longitudinal effects of cognitive biases on anxiety or vice versa. In contrast to what we expected, cognitive biases and anxiety appeared to promote parental modeling and threat information rather than the other way around. These findings extend research on the relations between parenting behaviors, cognitive biases, and childhood anxiety symptoms, and suggest valuable leads for assessment and intervention.

Integrating a screening possibility for Autism Spectrum Disorder (ASD) within the widely applied Achenbach System of Empirically Based Assessment (ASEBA) scales could be of great value for daily clinical practice. The present study explored the ability of the school-aged Child Behavior Checklist (CBCL) and the Teacher’s Report Form (TRF) to screen for ASD in children and adolescents (aged 6 to 18 years) within a mixed clinically referred sample. Different screening variants were compared for the CBCL, TRF, and the combination of CBCL and TRF: the separate withdrawn/depressed, social problems, and thought problems syndrome scales; combinations of these syndrome scales; and special ASD scales composed of relevant individual items. Analyses were performed for: youth with a DSM-IV-based clinical diagnosis; youth for which the clinical DSM-IV diagnosis was confirmed by a standardized assessment (the Autism Diagnostic Interview-Revised); and youth with a DSM-IV- based clinical diagnosis of ASD that also met the DSM-5 criteria. The results clearly demonstrated that the special ASEBA-based scales – in particular when completed by the parents – were most predictive of ASD. The results also indicate that following the initial screen with these ASEBA scales, further thorough diagnostic assessment is necessary to definitively establish whether young people really suffer from ASD.

Eye movement desensitization and reprocessing (EMDR) is a widely used treatment for posttraumatic stress disorder. The idea behind EMDR is that lateral eye movements may mitigate the emotional impact of traumatic memories. Given the focus on changing patients' memories, it is important that EMDR practitioners have detailed knowledge about human memory. We explored beliefs and ideas about memory in samples of EMDR practitioners (Study 1: n = 12; Study 2: n = 41), students (Study 1: n = 35; Study 2: n = 24), and researchers (Study 2: n = 30). All groups seemed to be aware of the fallibility of memory. However, a majority of the surveyed EMDR practitioners (70-90%), students (around 90%), and researchers (66.7%) endorsed the controversial idea of repressed memories. Skepticism and endorsement of problematic ideas about memory-related topics may coexist within the same group. In clinical settings, this might be problematic, because a strong belief in repressed memories might lead therapists to suggestively seek for such memories in patients.

Performing eye movements during memory retrieval is considered to be important for the therapeutic effect of eye movement desensitization and reprocessing (EMDR). We conducted a meta-analysis of laboratory studies that compared the effects of eye movements and/or alternative dual tasks (e.g., counting) on the vividness and emotionality of negative autobiographical memories with recall only (control) conditions. The databases PsycINFO and Web of Science were queried. Fifteen studies that involved 942 participants were included. Eye movements and alternative dual tasks produced similar vividness and emotionality decreases, with the impact on vividness being strong than that on emotionality. However, eye movements yielded a stronger overall vividness reduction than alternative dual tasks, although the associated effect size was small (Cohen’s d = .29). Because eye movements and alternative dual tasks produced comparable effects, one might conclude that both tasks are therapeutic equivalents. However, it should be acknowledged that only a limited number of laboratory studies were included in our meta-analysis, and the degree to which both procedures tax working memory was not independently established. Although our conclusion cannot be generalized to clinical practice, it does raise questions about the mode of action of EMDR.

Eye Movement Desensitization and Reprocessing (EMDR) is an effective treatment for post-traumatic stress disorder. However, literature on possible adverse memory effects of EMDR is scarce. Using the Deese/Roediger-McDermott (DRM) false memory paradigm, we examined the susceptibility to spontaneous false memories after performing eye movements, as used in EMDR. In Experiment 1, 72 undergraduates received word lists containing negative and neutral associated words and immediately after this they were given a free recall and recognition test. In Experiment 2, 68 undergraduates underwent the free recall and recognition test 48 h later. During the free recall phase in both experiments, participants either performed eye movements or not (control condition). In Experiment 1, the two conditions did not differ statistically with regard to correct and false recall/recognition. In Experiment 2, correct memory rates were higher in the eye movement than in the control condition and this was accompanied by an increase in spontaneous false memories on both free recall and recognition. Although our experimental approach is far removed from clinical practice, our findings suggest that eye movements as used in EMDR might amplify both correct and false memory rates.

Contains fulltext : 219065.pdf (Publisher’s version ) (Open Access) Background and objectives: This study aimed to unravel the relationship between socially anxious individuals' expectation of being (dis)liked and actual likeability by looking at the mediating role of both strategic and automatic social behavior: Self-disclosure as well as mimicry were examined. Method: Female participants (N = 91) with various levels of social anxiety participated in a social task with a confederate. Before the task, participants indicated their expectation of being liked by the confederate. Afterwards, objective video-observers rated the likeability of the participants before and after the social task as well as their level of self-disclosure and mimicry. Results: Social anxiety correlated negatively with the expectation to be liked but was not related to observer ratings of likeability, self-disclosure or mimicry. However, degree of social anxiety moderated the relation between expectations and self-disclosure. As expected, participants with low levels of social anxiety disclosed more if they expected to be liked. A reversed pattern was found for the high socially anxious participants: Here, higher expectations of being liked were related to less self-disclosure. Limitations: The study used an analogue female sample. Our social interaction task was highly structured and does not reflect informal day-to-day conversations. Conclusion: Socially anxious individuals function rather well in highly structured social tasks. No support was found for declined likeability or disrupted mimicry. Nevertheless, high socially anxious individuals did have a cognitive bias and show a self-protective strategy: when expecting a neutral judgment they reduce their level of self-disclosure. This pattern probably adds to their feelings of social disconnectedness. 9 p.

This study investigated whether the schema therapy constructs of schema coping and schema modes have val dity in adolescents. We examined the validity and reliability of the Schema Coping Inventory (SCI) and an 80-item version of the Schema Mode Inventory (SMI) in a mixed sample of adolescents. Confirmatory factor analyse showed that the first-order factor structures of the SCI and SMI were replicated, but that the hypothesized higher-order models of the SMI were not confirmed. Instead, we proposed an alternative higher-order model of Internalizing, Externalizing, Overachieving, and Healthy modes. In general, the SCI and SMI scales were able o distinguish the clinical sample from the community sample, and meaningful relationships were found between oping styles, schema modes, and behavior problems. In conclusion, our study supports the theorized relations ips between schema coping styles, schema modes, and behavior, problems in adolescents, and provides initial validation for the SCI and the, 80-item SMI in adolescent populations.

This multiple case study examined the feasibility and effectiveness of an innovative residential treatment, based on Schema Therapy (ST), for adolescents with disruptive behaviors and Personality Disorder (PD) traits. We reported case narratives as well as quantitative changes in behavior problems, early maladaptive schemas, and schema modes of four patients. In terms of feasibility, the therapist was able to use the full range of ST techniques (working in the here and now, experiential techniques, and cognitive-behavioral techniques) with all four patients. We trained and coached treatment teams in ST theory and practice, and were partially successful in involving patients' parents in the ST treatment. Qualitative and quantitative findings showed that patients improved in their behavior problems, early maladaptive schemas, and schema modes. These results support the feasibility of ST for adolescents with disruptive behaviors and PD traits in residential treatment, and provide preliminary evidence of its effectiveness.

Personality disorders are complex mental health problems, associated with chronic dysfunction in several life domains. Adolescents suffer from these disorders as well. The present study is a naturalistic case study, investigating whether group schematherapy (GST) can be applied to adolescents with personality disorders or personality disorder traits. Four clinically referred patients were included and completed questionnaires on quality of life, symptoms of psychopathology, schema modes, early maladaptive schemas, and schema coping styles. Patients participated in weekly GST sessions complemented by weekly or 2-weekly individual sessions. The parents of the adolescents participated in a separate parent group. From pre- to post-treatment, results demonstrated improvements for some patients in quality of life and symptoms of psychopathology. Changes in a number of modes and schemas were observed in all patients from pre- to post-therapy. In addition to assessing changes from pre- to post-treatment, the current study investigated the temporal changes in modes during therapy as well. Results demonstrated that maladaptive modes decreased, whereas healthy modes increased for all patients across the course of therapy. The present study provides preliminary support for the applicability of GST for adolescents as well as the effectiveness of GST. It is a starting point for further research on this intervention.

Eye movement desensitization and reprocessing (EMDR) is a popular treatment for posttraumatic stress disorder. However, little is known about the memory effects of EMDR. Using a misinformation paradigm, we examined whether lateral eye movements, as used in EMDR, enhance susceptibility to false memories. Undergraduates ( N = 82) saw a video depicting a car crash. Subsequently, participants either performed eye movements or held their eyes stationary. Afterward, all participants received misinformation in the form of an eyewitness narrative. The results indicate that eye movement participants were less accurate and were more susceptible to the misinformation effect than controls. Our finding suggests EMDR may have risky drawbacks in an eyewitness context and therefore urgently needs follow-up research.

ispartof: CLINICAL PSYCHOLOGICAL SCIENCE vol:7 issue:3 pages:405-406 status: published

The Structured Clinical Interview for DSM-IV Childhood Disorders (Kid-SCID) is a semi-structured interview for the classification of psychiatric disorders in children and adolescents. This study presents a first evaluation of the psychometric properties of the Kid-SCID in a Dutch sample of children and adolescents who had been referred to an outpatient treatment centre for mental health problems. Results indicated that the inter-rater reliability of the Kid-SCID classifications and the internal consistency of various (dimensional) criteria of the diagnoses were moderate to good. Further, for most Kid-SCID diagnoses, reasonable agreement between children and parents was found. Finally, the correspondence between the Kid-SCID and the final clinical diagnosis as established after the full intake procedure, which included the information as provided by the Kid-SCID, ranged from poor to good. Results are discussed in the light of methodological issues pertaining to the assessment of psychiatric disorders in youths. The Kid-SCID can generally be seen as a reliable and useful tool that can assist clinicians in carrying out clinical evaluations of children and adolescents.

BackgroundSubthreshold psychotic and bipolar experiences are common in major depressive disorder (MDD). However, it is unknown if effectiveness of psychotherapy is altered in depressed patients who display such features compared with those without. The current paper aimed to investigate the impact of the co-presence of subclinical psychotic experiences and subclinical bipolar symptoms on the effectiveness of psychological treatment, alone or in combination with pharmacotherapy.MethodIn a naturalistic study, patients with MDD (n = 116) received psychological treatment (cognitive behavioural therapy or interpersonal psychotherapy) alone or in combination with pharmacotherapy. Depression and functioning were assessed six times over 2 years. Lifetime psychotic experiences and bipolar symptoms were assessed at the second time point.ResultsSubclinical psychotic experiences predicted more depression over time (β = 0.20, p p p p ConclusionsIn general, subclinical psychotic experiences have a negative impact on the course and outcome of psychotherapy in MDD. Effects of subclinical bipolar experiences were less prominent.

Background: Controversy persists about how effectively empirically-supported treatments for major depression work in actual clinical practice as well as how patients choose among them. We examined the acute phase effectiveness of cognitive therapy (CT), interpersonal psychotherapy (IPT), and combined psychotherapy-pharmacotherapy (PHT) in a naturalistic setting, allowing patients their choice of treatment. Methods: The study compared CT (n=63), IPT (n=56), CT-PHT (n=34), and IPT-PHT (n=21) for 174 subjects with major depression in a secondary care mood disorders clinic. Patient preference, rather than randomization, determined treatment selection. The Beck Depression Inventory-II (BDI) was the primary outcome variable. Exclusion criteria were minimal. Results: All treatments were associated with a reduction in depressive symptoms, with a 35% remission rate by week 26. Overall improvement was well within ranges reported in efficacy trials. On average, treatment effects of the different interventions straddled the same range, but moderation analyses revealed that BDI scores dropped faster in the first 16 weeks in patients who received CT alone than patients who received CT and pharmacotherapy, a pattern not found in patients who received IPT (with or without pharmacotherapy). Limitations: Limitations consist of a modest sample size, choice of treatment was made by participants which may have been influenced by many sources, and the absence of a non-active control group. Conclusions: This study supports the effectiveness of empirically-supported antidepressant treatments selected by patients in routine settings, and provides an indication that speed of therapeutic response may vary amongst treatments. (c) 2012 Elsevier B.V. All rights reserved.

The Beck Depression Inventory (BDI-II) is a widely used instrument that provides information about the presence and severity of depressive symptoms. Although the BDI-II is a psychometrically sound instrument, relatively little is known about norm scores. This study aimed to develop reliable norms for the BDI-II in a Dutch community sample. Gender, age, and education were hypothesized to predict BDI-II scores. A total of 7,500 respondents from a community sample in The Netherlands completed the BDI-II. It was investigated by means of multiple regression analysis whether distinct norms for genders, education levels, and age group are appropriate. BDI-II scores depended on gender and education level, but not on age. BDI-II norms were computed based on the final regression model. These BDI-II norms can be used for diagnostic purposes, clinical decision making, or the evaluation of treatment effects. © 2012 Springer Science+Business Media, LLC.

A social skills training (SST) for high-functioning children with autism spectrum disorders (ASD) was evaluated in an outpatient setting using a combined between- and within-subject design in which SST and a waiting list condition were compared. According to parents and teachers, the SST produced greater improvement of social skills than the waiting list, and these effects were maintained at 3 months follow-up. No between-group effects were found for loneliness, although in general scores on this outcome measure decreased from pre- to follow-up. The effects of SST were unaffected by social anxiety, ADHD symptoms, Theory of Mind, or desire for social interaction. Altogether, SST seems an effective intervention for high-functioning children with ASD that can be applied in daily clinical practice.

Schema modes are strong, predominant, momentary (state-like) emotional and cognitive states, and maladaptive coping responses that occur when underlying personality schemas are activated by emotional events. The current study employed the Schema Mode Inventory for Adolescents (SMI-A) to assess such schema modes in a sample of non-clinical adolescents (n = 530). Confirmatory factor analysis revealed that the hypothesized model of the SMI-A with 14 separate schema modes provided a good fit for the data. Reliability coefficients for the various schema modes were all in the adequate to good range. Finally, the validity of the SMI-A was supported by significant and meaningful relations between schema modes on the one hand and early maladaptive schema domains, symptoms of psychopathology, and quality of life on the other. Taken together, the psychometric properties of the SMI-A are promising, and the SMI-A can be considered a viable instrument to assess schema modes in adolescents.

In chronic low back pain (CLBP) research, the self-discrepancy model has been applied to explain dysfunctional avoidance and persistence behaviour. The main aim of this study was to evaluate whether specific self-discrepancies in patients with CLBP are associated with the abovementioned types of activity-related behaviour and whether changes in self-discrepancies over time are associated with changes in activity-related behaviour. Furthermore, the aim was to evaluate whether avoidance and persistence behaviour are associated with a higher level of disability and a diminished quality of life and whether changes over time in avoidance and persistence behaviour result in changes in disability and quality of life. A longitudinal cohort study in a sample of patients with CLBP (N = 116), in which self-discrepancies, disability, quality of life, and objectively registered characteristics of activity-related behaviour were measured, was performed to evaluate the pathways in the aforementioned self-discrepancy model. Results indicate that patients with CLBP who feel closer to their ideal-other show more characteristics of persistence behaviour. Patients who move further away from their ideal-own also show more characteristics of persistence behaviour. Furthermore, in patients characterized as avoider, a decrease in a patient's daily uptime was associated with a decrease of mental health-related quality of life. (C) 2011 International Association for the Study of Pain. Published by Elsevier B. V. All rights reserved.

This study examined associations between indices of the quality of attachment relationships of adolescents with parents and peers, rumination, and symptoms of depression. More specifically, a mediation model was investigated in which rumination was hypothesized to mediate the relation between quality of attachment relations and symptoms of depression. A total of 455 high school students completed a battery of questionnaires, including quality of attachment relations, rumination, and depression. Results showed that most indices of quality of attachment relations were significantly associated with rumination and symptoms of depression. When examining the relative contribution of these variables in explaining variance in depression symptoms, trust in parents, communication with peers, and alienation from peers accounted for a significant portion of the variance in depression scores. Finally, the relation between communication with peers and depressive symptoms was fully mediated by rumination, whereas partial mediation was found for the relations between parental trust and depressive symptoms, and between alienation from peers and depressive symptoms. Implications of the findings may be that the treatment of depression in adolescence should consist of both cognitive interventions aimed at targeting ruminative thinking as well as a focus on interpersonal relationships of the adolescent with parents and peers.

Background:Quality of attachment relations between adolescents and their parents and peers may be related to early maladaptive schemas as well as to symptoms of depression.Aims:The aim of the current study was to assess whether schema domains and maladaptive schemas mediate the relation between indices of quality of attachment relationships with parents and peers and symptoms of depression in non-clinical adolescents (N= 222).Method:A battery of questionnaires was completed, including measures of quality of attachment relations, maladaptive schemas, and depression.Results:The schema domains of disconnection and rejection and other-directedness mediated the relation between quality of attachment relationships and symptoms of depression. More precisely, the schemas’ mistrust/abuse and social isolation mediated the relation between trust in parents and depressive symptoms, whereas the schemas’ social isolation and self-sacrifice mediated the relation between alienation from peers and symptoms of depression.Conclusions:The mediation analyses suggest that treatment of adolescent depression could be focused on both attachment bonds and on changing maladaptive schemas.

Chronic pain not only interferes with daily activities, it may also have a negative impact on the perceived integrity of one's self through self-discrepancies. Self-discrepancies are experienced distances between the actual self and self-guides that can exist from 2 perspectives (ie, own and other). Self-discrepancies are associated with negative mood states and incite self-regulatory behavior in order to reduce these discrepancies. The present study was aimed at replicating the emotional consequences of self-discrepancies in patients with chronic low back pain, and extending current knowledge of the behavioral consequences of self-discrepancies (ie, behavioral activity patterns such as avoidance and persistence). A cross-sectional design was employed with 83 patients who completed a number of self-report measures. We hypothesized that ideal and ought discrepancies, as well as feared congruencies were associated with depressed and anxious mood. On the behavioral level, a U-shaped relationship was hypothesized between ideal and ought self-discrepancies and persistence behavior, whereas feared self-discrepancies were hypothesized to be related to avoidance behavior. Results were partially in line with the hypotheses. With respect to the emotional consequences, feared (own and other) self-discrepancies were predictive of depressive and anxious mood. With regard to activity patterns, results showed a U-shaped relationship between ideal-other self-discrepancies and persistence behavior and a positive relationship between feared-own self-discrepancies and avoidance behavior. In contrast to expectations, none of the other self-discrepancies was related to activity patterns. Of interest was that avoidance, but not persistence behavior, was predictive of higher levels of disability and lower levels of quality of life. Support is provided for the role of self-discrepancies in the emotional well-being and behavioural patterns of patients with chronic low back pain.

Prior research has shown that depressive symptoms are associated with an enhanced attention toward negative stimuli and difficulty of disengaging attention from negative stimuli. The current study was an extension of a 2005 study by Koster and colleagues. A different stimulus presentation time and word set were used. The whole range of depressive symptoms was included in this sample instead of creating dichotomized groups. The Exogenous Cueing Task with negative, positive, and neutral cues was administered to 85 female undergraduate university students. Participants completed the Beck's Depression Inventory-II-NL questionnaire to measure self-reported depression. Contrary to previous findings, depressive symptoms were related to a facilitated rather than impaired attentional disengagement from negative stimuli. An explanation for the discrepancy with findings from Koster, et al. may be the different stimulus presentation time (1,000 msec, instead of 500 or 1,500 msec). (PsycINFO Database Record (c) 2011 APA, all rights reserved) (journal abstract)

This study aimed to (a) assess relationships between the Children's Depression Inventory (CDI) and DSM-oriented depression and anxiety scales of the Youth Self Report, (b) develop reliable norms for the CDI, and (c) determine CDI cutoff scores for selecting youngsters at risk for depression and anxiety. A total of 3,073 nonclinical and 511 clinically referred children and adolescents from The Netherlands and Belgium were included. Results showed that CDI scores were significantly related to DSM-oriented symptoms of both depression and anxiety. CDI scores correlated highly with depression symptoms and moderately with anxiety symptoms. Norms for the CDI were determined by means of multiple regression analysis and depended on sex, age, and country. CDI cutoff scores for selecting individuals at risk for depression and anxiety as measured by the DSM-oriented depression and anxiety scales of the Youth Self Report were determined by means of multiple regression analysis and receiver operating characteristic analysis. A CDI score of 16 was found to have the most optimal balance between sensitivity and specificity for depression, whereas a score of 21 provided the best sensitivity and specificity for anxiety in a subsample of children. We conclude that the CDI is an effective instrument for screening depression and to a lesser extent anxiety in primary and secondary care centers, before applying further assessment of high-risk individuals.

Patients with chronic pain are not only faced with disabilities but are also challenged to maintain a valued sense of self. This sense of self is in part determined by the extent to which patients can accomplish their identity-related goals. The present study explores the content of three domains of the self, namely the ideal, ought and feared self and examines how the content relates to disability and depression. The ideal, ought and feared attributes of 80 chronic low back pain patients were analyzed and categorized in eight general goal-domains: interpersonal attributes, personal abilities, physical, emotional and psychological well-being, close interpersonal relationships, self-expression abilities, achievement-related attributes, physical appearance, and religion. Results showed that most of the attributes that patients generated involved interpersonal attributes. Comparisons between the self-guides revealed that ideal attributes were more intrapersonally focused while ought and feared attributes were interpersonally focused. The content appeared to be related to disability but not to depression. More specifically, the more disabled patients were, the more they listed well-being related attributes as part of their ought self. None of the other goal-domains was related to disability or depression. The present study provides additional insight into the goals of patients with chronic pain at the level of identity and has shown that these are, at least in part, related to the level of functional disability. These results might be useful for future studies incorporating the role of identity in chronic pain, such as psychological interventions. ispartof: European Journal of Pain vol:14 issue:6 pages:648-653 ispartof: location:England status: published

The present study sought to investigate psychometric properties of the Positive Beliefs about Rumination Scale (PBRS) and the Negative Beliefs about Rumination Scale (NBRS), two self-report measures of metacognitive beliefs of depressive rumination, in patients with major depressive disorder (N = 179). Confirmatory factor analysis of the PBRS showed good fit of the hypothesized one-factor model. The previously proposed two-factor model of the NBRS was supported after implementation of some modifications. The scales showed adequate to good internal consistency and validity was supported on some indices. Finally, the metacognitive model of rumination and depression was tested by means of structural equation modeling. After implementation of some theoretically consistent modifications, the model provided a good fit to the data. Clinical implications of the findings, including the implementation of a metacognitive-focused cognitive therapy of depression, and suggestions for future research are discussed.

The Dysfunctional Attitude Scale (DAS) was designed to measure the intensity of dysfunctional attitudes, a hallmark feature of depression. Various exploratory factor analytic studies of the DAS form A (DAS-A) yielded mixed results. The current study was set up to compare the fit of various factor models. We used a large community sample (N = 8,960) to test the previously proposed factor models of the DAS-A using confirmatory factor analysis. The retained model of the DAS-A was subjected to reliability and validity analyses. All models showed good fit to the data. Finally, a two-factor solution of the DAS-A was retained, consisting of 17 items. The factors demonstrated good reliability and convergent construct validity. Significant associations were found with depression. Norm-scores were presented. We advocate the use of a 17-item DAS-A, which proved to be useful in measuring dysfunctional beliefs. On the basis of previous psychometric studies, our study provides solid evidence for a two-factor model of the DAS-A, consisting of 'dependency' and 'perfectionism/performance evaluation'.

This review examined evidence for some core predictions of the response styles theory (RST) concerning the relation between response styles and symptoms of depression and gender differences in the use of response styles in non-clinical children and adolescents. In summarizing the literature, effect sizes (pooled correlation coefficients) were calculated for cross-sectional and longitudinal studies. Stability of the obtained effect sizes was evaluated by means of a fail-safe N analysis. Results indicated that stable and significant effect sizes were found for rumination being associated with concurrent and future levels of depression. When controlling for baseline levels of depression, effect sizes for rumination and distraction were not stable, indicating that these findings should be interpreted with considerable caution. Finally, significant and stable effect sizes for gender differences in response styles were found only for rumination among adolescents. Taken together, the findings partly support the predictions of the response styles theory examined in this meta-analysis and may implicate that rumination is a cognitive vulnerability factor for depressive symptoms among adolescents.

Objectives Patients with social anxiety disorder (SAD) not only fear social rejection, but accumulating evidence also shows that they are indeed less liked than their non-anxious counterparts. Three factors are hypothesized to play a role in this social anxiety–social rejection relationship: (1) social performance; (2) elicited negative emotions, and (3) perceived similarity. Method Patients with SAD (N = 63) and control participants (N = 27) were observed during a 5 minutes ‘getting acquainted’ conversation with a male and female confederate who rated their social performance. Video-observers rated their own negative emotions and perceived similarity with the patients, while other video-observers rated their wish to engage in future contact with them (a measure of social rejection). Results Analysed by way of structural equation modelling (SEM), the results supported the social anxiety–social rejection relationship. More specifically, poor social performance was associated with perceived dissimilarity ratings and mediated by evoked negative emotions, both of which were in turn associated with social rejection. Conclusion These results suggest that a sequence of events links social anxiety to social rejection. Treatment should aim to improve social performance and perceived similarity to reverse SAD's vicious, negative interpersonal cycle.

Rumination and worrying are considered possible mediating variables that may explain the relation between neuroticism and symptoms of depression and anxiety. The Current study Sought to examine the mediational effects of rumination and worry in the relationships between neuroticism and symptoms of depression and anxiety in a sample of clinically depressed individuals (N = 198). All patients completed a battery Of questionnaires including measures of neuroticism, rumination, worrying, depression, and anxiety. Results showed that in subsequent analyses, rumination and worrying both mediated the relation between neuroticism and depression and anxiety. When rumination and worrying were simultaneously entered in the mediation analysis, only rumination Was found to mediate the relation between neuroticism and symptoms of anxiety and depression. Two Components of rumination (i.e., brooding and reflection) were also analyzed in the mediational analysis. Both reflection and brooding were significant mediators with respect to depressive symptoms, whereas brooding was the only significant mediator in relation to anxiety symptoms. The results are discussed in the light of current theories, previous research, and recent treatment developments. Clinical implications and Suggestions for future research are provided.

Neuroticism, is considered a vulnerability factor for depression and anxiety but the mechanism by which this vulnerability is increased is unknown. Rumination is considered a psychological vulnerability for depression and anxiety. The current study sought to examine the mediational effects of different components of rumination (i.e., rumination on sadness, symptom-based rumination, rumination on causes of sadness) in the relationships between neuroticism and symptoms of depression and anxiety in a sample of non-clinical undergraduates (N = 192). In line with the expectations, rumination on sadness was associated with more symptoms of depression and anxiety, while rumination on causes of sadness was related to fewer symptoms of depression but not anxiety. However, symptom-based rumination was not associated with depression or anxiety scores when controlling for the other two rumination factors. Furthermore, rumination on sadness partially mediated the relation between neuroticism and symptoms of depression and anxiety. Rumination on causes of sadness was found to partially mediate the relationship between neuroticism and symptoms of depression but not anxiety, indicating that this component of rumination might be characteristic for depressive symptomatology. The results are discussed in the light of current theories, previous research, and recent treatment developments. Clinical implications and suggestions for future research are provided.

Worry and rumination both refer to unproductive, repetitive thought processes. Few studies have addressed the relationship between these two constructs, with most researchers exclusively relating rumination to depression and worry to anxiety. The present study examined relationships between self-reported rumination as assessed by the Children's Response Style Scale (CRSS), worry as measured by the Penn State Worry Questionnaire for Children (PSWQ-C), and anxiety and depression symptoms as indexed by respectively the Screen for Child Anxiety Related Emotional Disorders (SCARED) and the Children's Depression Inventory (CDI) in a sample of 337 nonclinical adolescents aged 12–17 years. Results showed that rumination and worry were substantially correlated. Further, a factor analysis showed that both constructs were nevertheless distinct as rumination and worry items loaded on separate factors. Interestingly, both rumination and worry correlated more substantially with anxiety symptoms than with depression symptoms. Finally, worry emerged as a unique predictor of anxiety symptoms, even when controlling for rumination. In contrast, when controlling for worry, rumination no longer accounted for a significant proportion of the variance in depression symptoms.

The present study assessed, by means of a modified Stroop paradigm, whether highly fearful patients with chronic low back pain pay selective attention to words related to movement and injury. Two groups of patients (High Fear and Low Fear) were included based on their scores on the Tampa Scale of Kinesiophobia (TSK), a measure of fear of movement or (re)injury. A control group was recruited by means of advertisement in a local newspaper. Repeated-measures analysis of variance was conducted to examine whether highly fearful pain patients pay more selective attention to movement and injury words, compared to patients with low pain-related fear and controls. The results from the present study do not support the proposition that highly fearful patients with chronic low back pain selectively pay attention to words related to injury and movement. Limitations of the modified Stroop paradigm are discussed as well as the need for the application of alternative methods such as the dot-probe paradigm.

In chronic pain patients, preoccupation with or attention to pain is associated with pain-related fear and perceived pain severity. The current study investigated psychometric properties of the pain vigilance and awareness questionnaire (PVAQ). An exploratory factor analysis on Dutch fibromyalgia patients indicated that a two-factor solution was most suitable. The first factor could be referred to as attention to pain and the second factor was interpreted as attention to changes in pain. A confirmatory factor analysis, testing three different factor structures in two independent samples (Dutch fibromyalgia patients and American pain patients with various diagnoses) showed that the goodness-of-fit indicators for all models were satisfactory. The existence of the previously reported intrusion subscale of the PVAQ as a unique construct within the PVAQ was discussed. This subscale should be further extended by non-reverse-keyed items. With regard to the convergent validity, the PVAQ was highly correlated with related constructs such as the pain catastrophizing scale (PCS), pain anxiety symptoms scale (PASS), and Tampa scale of kinesiophobia (TSK). The attention to pain subscale was significantly stronger associated with these pain-related measures than the attention to changes in pain subscale, indicating that attention to changes in pain is a distinctive construct. The uniqueness of the attention to changes in pain subscale was also supported by an exploratory factor analysis on all items of the PVAQ, PCS, PASS, and TSK which showed that all items from that scale loaded on one separate factor. Overall, the PVAQ showed good internal consistency. Implications for future research and treatment interventions are discussed.

Department of Medical, Clinical and Experimental Psychology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. J.Roelofs@dep.unimaas.nlAlthough the modified Stroop paradigm is considered to be a prominent paradigm for investigating selective attention in emotional disorders, relatively few studies have applied this paradigm to examine selective attention in chronic pain patients. Moreover, the results from these studies are not robust. The purpose of this article is to review the evidence for attentional bias in chronic pain patients, by means of a meta-analysis. Data from five studies were pooled and summarized into a mean difference (MD). Significant MD estimations (in milliseconds) were found for both sensory pain words (MD=26.7; 95% confidence interval (CI) 10.0-42.9) and affective pain words (MD=28.1; 95% CI 0.4-55.8). Meta-regression analysis indicated that methodological quality did not significantly affect the pooled MD estimation for both sensory pain words and affective pain words. Thus, the results from the present meta-analysis on studies applying the modified Stroop paradigm suggest that chronic pain patients selectively attend to both pain sensory and pain affective stimuli. Furthermore, the MD estimation did not depend on the methodological quality, tentatively indicating that even though studies differed in methodology, the results were rather consistent. Implications of the results are discussed. Copyright 2002 European Federation of chapters of the International Association for the Study of Pain. Published by Elsevier Science Ltd.

The extent to which rumination mediates the relation between mindfulness skills and depressive symptoms in nonclinical undergraduates (N=254) was examined. Measures of mindfulness (Kentucky Inventory of Mindfulness Skills), ruminative brooding and reflective pondering (Ruminative Response Scale), and depressive symptomatology (Quick Inventory of Depressive Symptomatology) were administered. The contribution of mindfulness and rumination subscales was investigated in mediation analyses using the bootstrapping methodology. The relations among the mindfulness scales and rumination and depressive symptomatology were investigated. The results suggest that brooding partially mediated the relation from awareness to depressive symptomatology and from depressive symptomatology to awareness (higher levels of awareness result in lower levels of brooding and, as a result, lower levels of depressive symptomatology and vice versa). Brooding fully mediated the relation from accepting without judgment to depressive symptomatology (higher levels of accepting without judgment result in lower levels of brooding, which results in lower levels of depressive symptomatology). Brooding partially mediated the relation from depressive symptomatology to accepting without judgment (higher levels of depressive symptomatology result in higher levels of brooding and thus in lower levels of accepting without judgment). Reflective pondering fully mediated the relation from depressive symptomatology to observing (higher levels of depressive symptomatology result in higher levels of reflective pondering and thus in higher levels of observing). Mindful observing was negatively correlated with awareness and accepting without judgment. Mindful describing was unrelated to rumination. The current study helps clarify the relations between mindfulness and depression, as influenced by rumination. A necessary step will be to investigate these relations in a clinical population.

In this experimental clinical study, a first attempt was made to examine the desire for social interaction in children with autism spectrum disorders (ASD). Children with ASD and typically developing (TD) children completed both an explicit measure (self-report) and an implicit measure (Face Turn Approach-Avoidance Task) of the desire for social interaction. On the explicit assessment, children with ASD clearly displayed lower scores reflecting less desire for social interaction than TO children. On the implicit assessment, children with ASD showed a stronger tendency to pull both social and non-social stimuli towards them, which indicates a general automatic tendency towards approach, as compared to the TO children. Possible reasons for this dissociation between the explicit and implicit desire for social interaction are discussed and directions for future research are provided. (C) 2014 Elsevier Ltd. All rights reserved.

The present study examined the psychometric properties of the Short Form of the Fear Survey Schedule for Children-Revised (FSSC-R-SF) in non-clinical and clinically referred children and adolescents from the Netherlands and the United States. Exploratory as well as confirmatory factor analyses of the FSSC-R-SF yielded support for the hypothesized five-factor structure representing fears in the domains of (1) failure and criticism, (2) the unknown, (3) animals, (4) danger and death, and (5) medical affairs. The FSSC-R-SF showed satisfactory reliability and was capable of assessing gender and age differences in youths' fears and fearfulness that have been documented in previous research. Further, the convergent validity of the scale was good as shown by substantial and meaningful correlations with the full-length FSSC-R and alternative childhood anxiety measures. Finally, support was found for the discriminant validity of the scale. That is, clinically referred children and adolescents exhibited higher scores on the FSSC-R-SF total scale and most subscales as compared to their non-clinical counterparts. Moreover, within the clinical sample, children and adolescents with a major anxiety disorder generally displayed higher FSSC-R-SF scores than youths without such a diagnosis. Altogether, these findings indicate that the FSSC-R-SF is a brief, reliable, and valid scale for assessing fear sensitivities in children and adolescents.

Introduction. In order to set up an effective early-detection of depressive symptoms in youngsters, the current study aims to investigate whether two measure moments of the Children's Depression Inventory (CDI) improve screening and whether a multi-informant procedure is superior compared to a single-informant procedure thereby controlling for comorbid. symptoms. Method. Youngsters (10-15 years) filled in the CDI and an Anxiety Scale at Time 1 and the CDI and Youth Self Report one week later. Next, a structured clinical interview was administered. The Child Behaviour CheckList was filled in by the parents. Results. Two measure moments of the CDI are not more accurate in capturing disordered mood changes. Furthermore, parent reports were no significant contributor to the variance over and above the CDI. Discussion. A second moment does not increase screening accuracy. Further research on setting up an effective multistage screening procedure for depressive symptoms for youngsters is however necessary.

Patients with social anxiety disorder (SAD) not only fear negative evaluation but are indeed less likeable than people without SAD. Previous research shows social performance to mediate this social anxiety-social rejection relationship. This study studied two pathways hypothesized to lead to poor social performance in social anxiety: increased self-focused attention and negative beliefs. State social anxiety was experimentally manipulated in high and low-blushing-fearful individuals by letting half of the participants believe that they blushed intensely during a 5 min getting-acquainted interaction with two confederates. Participants rated their state social anxiety, self-focused attention, and level of negative beliefs. Two confederates and two video-observers rated subsequently likeability (i.e., social rejection) and social performance of the participants. In both groups, the social anxiety-social rejection relationship was present. Although state social anxiety was related to heightened self-focused attention and negative beliefs, only negative beliefs were associated with relatively poor social performance. In contrast to current SAD models, self-focused attention did not play a key-role in poor social performance but seemed to function as a by-product of state social anxiety. Beliefs of being negatively evaluated seem to elicit changes in behavioral repertoire resulting in a poor social performance and subsequent rejection. (c) 2010 Elsevier Ltd. All rights reserved.

Objective: Little is known about depressed individuals' illness attributions and how these influence treatment assignment in clinical practice. The aim of the present study was to examine whether illness attribution across the domains of intraindividual, interpersonal and biological reasons was associated with treatment assignment in a naturalistic treatment setting.Method: Illness attribution was assessed with the Reasons for Depression Questionnaire in 221 depressed individuals. Participants were assigned to either cognitive-behavioural therapy (CBT), interpersonal therapy (IPT) or psychopharmacological treatment (PHT).Results: Depressed individuals who strongly attributed their illness to intraindividual factors were more likely to be assigned to CBT, and depressed individuals attributing their depression to biological reasons were more likely to receive in PHT. In contrast, interpersonal illness attribution was not associated with treatment assignment.Conclusions: Illness attribution influences treatment assignment to CBT and PHT. However, factors other than illness attribution for depression affect a treatment choice of IPT. Copyright (C) 2009 John Wiley & Sons, Ltd.Key Practitioner Message:Intraindividual and biological illness attributions affected depressed individuals' treatment assignment, making these individuals more likely to receive CBT and PHT, respectively.Interpersonal illness attribution was not found to be associated with treatment assignment.There were significant gender differences in illness attribution. Men were more likely to endorse in achievement-related causes, and women attributed their depressive illnesses to more interpersonal reasons (i.e., relationship, childhood and intimacy).

We investigated the influence of self-reported parental romantic attachment status and rearing behaviors on children's self-reported attachment (in) security towards father and mother in a sample of 237 non-clinical children aged 9-12. All children and their parents completed a single-item measure of attachment style. The parents further completed an index of their authoritative, authoritarian, and permissive rearing behaviors. Results showed that the attachment status of the father was significantly related to the child's attachment style to the father. Further, children who portray themselves as insecurely attached to their fathers have fathers with lower average authoritative scores compared to children who are securely attached to their fathers. In examining the relative contribution of attachment style and rearing behaviors of the parents, insecure attachment status of the father was still significantly related to insecure attachment style of the child but the effect of authoritative rearing behaviors of the father on attachment (in) security of children was not statistically significant anymore. Altogether, these results support the notion that attachment status of the father was most substantially associated with self-reported insecure attachment of children.

The present study aimed to test the central components of Papageorgiou and Wells' (2003) non-clinical metacognitive model of rumination and depression that is grounded on the Self-Regulatory Executive Function (S-REF) model of emotional disorders [Wells, A., & Matthews, G. (1994). Attention and emotion: A clinical perspective. Hove, UK: Lawrence Erlbauin.]. A second aim of this study was to extend the non-clinical model with the concept of self-discrepancy in line with the S-REF model. Data of the current study were collected in a large sample of non-clinical Dutch undergraduates (N = 196), who completed a battery of questionnaires including measures of rumination, positive and negative metacognitions, depressive symptoms, and self-discrepancy (i.e., actual-ideal, actual-ought, and actual-feared discrepancies). Hypothesized relationships among these variables were tested by means of structural equation modelling. Following some theoretically consistent modifications, the model was an adequate fit to the data. With respect to the second aim of the study, self-discrepancies were directly linked to symptoms of depression as well as indirectly via the cognitive processes involved in the metacognitive model of rumination and depression. Evidence was found for positive beliefs, about rumination to partially mediate the relation between self-discrepancy and rumination. Clinical implications of the findings, including implementation of a metacognitive-focused cognitive therapy of depression, and suggestions for future research are discussed.

We sought to investigate the relationships between negative family factors such as insecure attachment and adverse parental rearing, and internalizing and externalizing symptoms in a large sample of non-clinical children (N = 237) aged 9 to 12 years. All children completed a set of self-report questionnaires including a single-item measure of attachment style towards the mother and the father as well as an index of perceived parental rearing behaviors. Further, measures of internalizing symptoms (e.g., anxiety and depression) and externalizing symptoms (e.g., aggression) were completed. Results showed that perceived rearing behaviors of both mother and father (in particular rejection and anxious rearing) consistently accounted for a significant proportion of the variance in internalizing and externalizing symptoms. Attachment style was found to play a less prominent role. Some support for gender-specific relationships was found, indicating that the presence of negative family factors in fathers had more impact on symptoms in boys, whereas the presence of such factors in the mothers had more influence on symptoms in girls. Altogether, these results suggest that in addition to common pathways by which both parents promote psychopathological symptoms in children, there may also be separate pathways by which the father or the mother may have a unique impact on the development of such symptoms in boys or girls respectively.

Rumination is considered a specific cognitive vulnerability factor that is thought to play a prominent role in the maintenance of depressive symptoms. The present study investigated the psychometric properties of two measures of rumination, the ruminative response scale (RRS) and the rumination on sadness scale (RSS) in undergraduates (N = 331). A joint factor analysis yielded three factors, 'rumination on causes of sadness', 'symptom-based rumination', and 'rumination on sadness'. The internal consistency of the rumination factors was good and the test-retest stability over a 6-month period of time was moderate. Support was also found for the construct validity of the rumination factors. Finally, the 'rumination on the causes of sadness' factor was found to moderate the relation between depression measured at baseline and at 6-month follow-up. More specifically, baseline depression was a strong predictor of future depression but this was particularly true for high ruminating individuals. Implications of the results and directions for future research are provided.

Three fundamental fears - anxiety sensitivity (AS), injury/illness sensitivity (IS) and fear of negative evaluation (FNE) - have been proposed to underlie common fears and psychopathological conditions. In pain research, the relation between AS and (chronic) pain processes was the subject of several studies, whereas the possible role of IS has been ignored. The current research examines the role of IS with respect to various pain-related variables in two studies. In the first study, 192 healthy college students completed the Sensitivity Index (SI; a composite measure assessing the three fundamental fears) and various pain-related questionnaires. In a second study, 60 students out of the original sample took part in a pain induction procedure and completed the SI as well. We first examined the properties of the SI. Factor analysis on the SI replicated the proposed factor structure [Taylor S. The structure of fundamental fears, J Behav Ther Exp, Psychiat 1993;24:289-99]. However, some items of the ASI did show problematic loadings and were therefore excluded in subsequent analyses. The main hypothesis of the current study states that IS is a stronger predictor than AS of pain catastrophizing and fear of pain as assessed by self-report measures, and of pain tolerance and anticipatory fear of pain as assessed in a pain induction study. This hypothesis could be confirmed for all variables, except for pain tolerance, which was not predicted by any of the three fundamental fears. The current study can be considered as an impetus for devoting attention to IS in future pain research.

Psychometric properties of the Dutch version of the Maslach Burnout Inventory General Survey, the MBI-DV, were examined in individuals with and without clinical burnout. The factor structure, the utility of the MBI-DV as a screening instrument in addition to a clinical interview for diagnosing clinical burnout, as well as construct validity and reliability (internal consistency) were investigated. Individuals underwent a clinical interview and completed the MBI-D V as well as the Symptom Checklist (SCL-90). Confirmatory factor analysis, correlational analyses, and Cronbach alphas were computed and used to examine the objectives of the present study. A three-factor model of the MBI-DV best fitted the data in both individuals with and without clinical burnout. The Emotional Exhaustion subscale was highly associated with clinical diagnosis of burnout even when controlling for depression and general psychopathology. Construct validity of the MBI-DV was supported by modest correlations with the SCL-90 and subscales of the MBI-DV showed good internal consistency in individuals with and without clinical burnout. The MBI-DV is a valid and reliable multidimensional construct of which the Emotional Exhaustion subscale may be particularly useful as a screening tool in addition to a clinical interview for determining the presence of clinical burnout.

The present study sought to examine psychometric properties of the Fear of Pain Questionnaire (FPQ), a measure of pain-related fear, in a sample of undergraduates. Confirmatory factor analysis confirmed the previously reported three-factor model of the FPQ (e.g. severe pain, minor pain, medical pain), but some items may be redundant. With respect to the reliability of the FPQ, both the FPQ and the subscales showed good internal consistency and test-retest stability was moderate to good. Convergent and predictive validity of the FPQ (and the subscales) were partly supported by moderate correlations with related constructs and with self-reported fear associated with three experimental pain tests. Discriminant validity of the FPQ (and the subscales) was partly supported by low correlations with unrelated self-report measures. Moreover, modest correlation coefficients were found between the FPQ and other pain-related measures. Finally, the minor pain subscale of the FPQ accounted for pain intensity scores on the ischemic pain test and the remaining subscales and the FPQ total scores accounted for pain tolerance on the electrical stimulation test and the thermal pain test. Results are discussed and directions for future research are provided.

Although the modified Stroop paradigm is considered to be a prominent paradigm for investigating selective attention in emotional disorders, relatively few studies have applied this paradigm to examine selective attention in chronic pain patients. Moreover, the results from these studies are not robust. The purpose of this article is to review the evidence for attentional bias in chronic pain patients, by means of a meta-analysis. Data from five studies were pooled and summarized into a mean difference (MD). Significant MD estimations (in milliseconds) were found for both sensory pain words (MD = 26.7; 95% CI 10.0-42.9) and affective pain words (MD = 28.1; 95% CI 0.4-55.8). Meta regression analysis indicated that methodological quality did not significantly affect the pooled MD estimation for both sensory pain words and affective pain words. Thus, the results from the present meta-analysis on studies applying the modified Stroop paradigm, suggest that chronic pain patients selectively attend to both pain sensory and pain affective stimuli. Furthermore, the MD estimation did not depend upon the methodological quality tentatively indicating that even though studies differed in methodology, the results were rather consistent. Implications of the results are discussed. * Roelofs, J., Peters, M. L., Zeegers, M. P. A., Vlaeyen, J. W. S. (2002). The modified Stroop paradigm as a measure of selective attention towards pain-related stimuli among chronic pain patients: a metaanalysis. European Journal of Pain, 6, 273-281. 24 CHAPTER 2 – PAIN-RELATED FEAR AND SELECTIVE ATTENTIONAL PROCESSING

The current study examined validity and reliability of the Pain Vigilance and Awareness Questionnaire (PVAQ) in two samples of healthy college students. Exploratory and confirmatory factor analysis showed that a two-factor model of the PVAQ was most suitable in the present study. The first factor could be referred to as attention to pain whereas the second factor could be specified as attention to changes in pain. With regard to the convergent and divergent validity, the PVAQ was found to correlate highly with related constructs like catastrophising (PCS) and general body vigilance (BVQ). The correlation between PVAQ and pain-related fear (FPQ) was moderate, whereas correlations with unrelated constructs like trait anxiety (STAI-T) and fear of spiders (FSQ) were low. Furthermore, the PVAQ showed good internal consistency and fair test-retest reliability. Altogether, these findings suggest that the PVAQ is a valid and reliable measure of pain vigilance in healthy individuals. The results of this study can be regarded as a starting point for further validation of the PVAQ in clinical pain populations. Implications for future research and treatment interventions are discussed.