The relationship between dimensional personality traits and treatment outcomes in clinical and forensic settings

Aims: The present thesis portfolio sought to contribute to understanding the mechanisms of change in mental health treatment, by exploring the association between the idiosyncratic client-specific factor of personality traits and outcomes of treatment. Specifically, it sought to understand whether (a) client personality traits predict the outcomes of psychological intervention, and (b) there is a significant relationship between personality traits and treatment outcomes in forensic mental health services (FMHS). Design: Two pieces of research were undertaken. A systematic review synthesised the available literature to understand whether five-factor model (FFM; Costa & McCrae, 1990) traits have been shown to predict clinical and psychosocial outcomes of empirically supported psychological interventions. An empirical research project measured the amount of change patients in FMHS showed in clinical and risk factors, after a considerable period of treatment (18 months), and correlated this with patients’ scores on a measure of their personality traits. Results: The systematic review identified few studies that explored the predictive role of personality traits for outcomes of psychological interventions. Within these, few significant predictive relationships were found. Conscientiousness showed the most predictive value for treatment outcomes. The empirical project found little significant change in clinical and risk outcomes following long-term inpatient treatment and it was therefore not possible to determine whether there was a significant relationship with personality traits. Conclusions: Both studies identified challenges to investigating the impact of client personality traits on the course and outcomes of treatment. These include the complexity of the possible interaction of numerous variables in the course of treatment, and the heterogeneity in the research designs and methods used to investigate them. Further research is needed to understand the impact personality traits have on treatment, both as predictors, and moderators for other idiosyncratic variables. Further research is also needed into the effectiveness of treatment in FMHS

Late-life depression : a systematic review of meta-analyses and a meta-analysis of the effect of cognitive behavioural therapy in older adults with co-morbid physical illness

Aims: To examine the efficacy of CBT for late-life depression in older adults with co-morbid physical illness and to review what has been revealed by meta-analytic studies with regards moderators of treatment in psychological approaches for late-life depression. Method: Systematic literature search and meta-analysis of randomised controlled trials (RCT) evaluating CBT for depression in older adults with co-morbid physical illness and systematic review of meta-analyses examining psychological therapies for late-life depression. Results: Nine papers met inclusion criteria for meta-analysis. CBT was superior to waiting list and treatment as usual control conditions, showing a statistically significant pooled standardised mean difference (SMD) of 0.63 (95 per cent CI, 0.29 to 0.97, p = 0.0003). This was largely maintained at follow up (SMD 0.5, 95 per cent CI, 0.08 to 0.92). Sensitivity analysis showed individual CBT yielded a large, statistically significant summary effect size of 0.80 (95 per cent CI, 0.45 to 1.16), but that group CBT did not show statistical superiority over controls. Clinician-rated measures of depression yielded larger effect sizes, with a SMD of 1.57 (95 per cent CI, 0.56 to 2.59, p = 0.002) as compared with patientrated measures: 1.03 (95 per cent CI, 0.75 to 1.31, p = 0.0001). Fourteen meta-analyses met inclusion criteria for systematic review. More recent publication was significantly correlated with increased reporting quality and reduced analysis of moderating factors. Duration of treatment, treatment setting and gender of participants showed no moderating impact on outcome. Depression severity, participant age, treatment modality, and study quality showed no consistent relationship with outcomes. Active or placebo controls were associated with reduced effect sizes when compared with no treatment or waiting list controls. Patient-rated outcome measures were associated with reduced effect sizes as compared with clinician-rated measures. Conclusions: When compared with treatment as usual and waiting list controls Individual CBT is effective in reducing depressive symptoms for depressed older adults with an underlying physical illness. Meta-analytic studies of late-life depression show variable results regarding moderators of treatment efficacy. More high quality studies examining the effectiveness of psychological therapies are needed with clinically representative older populations, particularly, the older-old and those with co-morbid physical illnesses

An Examination of Cognitive Biases and Imagery in Perfectionism

This present research explores the relationship between perfectionism and the tendency for individuals to focus their attention towards, and interpret ambiguous information as, stimuli that signals failure. The relationship between perfectionism, repetitive negative thinking, imagery and psychological distress was also explored. Perfectionism was associated with an increased likelihood to focus on failure, interpret ambiguous information in way that indicated failure, and were more likely to experience distress due to intrusive images about the future

The association between life adversity and depression in older adult life

This in-depth investigation into the nature and prevalence of adversity within late life involved a two phased study, employing questionnaire and interview measures with a mixed methods analysis. The larger (n=960) PHQ-9 and LTE-Q study showed depression prevalence of 12% in older adults, who most commonly experienced adversity involving health and bereavement. Depressed participants reported significantly more recent adversity, a finding observed particularly in the early stages of older adult life and amongst women. Logistic regression showed adversity to be a significant predictor of depression, accounting for 1.8% of the variance in depression. The smaller (n=19) LEDS study showed a significant prevalence of low threat difficulties across the sample, who also reported health, relationships and bereavement to be the most commonly experienced. Depressed participants were shown to report higher rates of marked difficulties and lower social emotional support than non-depressed participants, which may play a key role in the maintenance of late-life depression. Although the LTE-Q was shown to be a crude measure, only capturing a portion of LEDS measured adversity, the general pattern of life event characteristics maps well onto the LEDS data. This was mirrored in the qualitative accounts of older adults who preferred the LEDS and considered it to capture adversity in depth. Thematic analysis revealed themes around ‘self-redefinition,’ ‘being immortal,’ and ‘leaving in peace’ were pertinent to both adversity and coping in late life, which were experienced differently by depressed participants as ‘powerless in the face of reality,’ ‘threats to immortality’ and ‘leaving in disharmony.’ Further investigations are required to determine how adversity contributes to depressive experience in the elderly, in particular examining the roles of marked difficulties and social emotional support. Suggestions are made for psychological interventions to consider the social contexts of older adults, while facilitating the coping processes highlighted in the qualitative analysis

Self-esteem and emotion-control in physical and emotional well-being.

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An examination of regret as expressed in the life reflections of older adults : predictors of regret intensity and frequency, and association with well-being

This study focused on the experience of regret in older adults as expressed within the context of a life history framework, using quantitative and qualitative methods. The goals were to explore the differential impact of demographic, personality, dispositional and other relevant variables on frequency and intensity of lifespan regret, the impact of both intensity and frequency of regret on psychological and physical well-being of older adults, to examine regret themes and dimensions of regret as derived from an in-depth life history interview and on the basis of qualitative data, to arrive at high- and low-regret profiles that may indicate proneness to regret. This study was the first to use a lifespan-interview measure of regret with older adults as well as the Big Five and several dispositional variables, autobiographical memory and values as predictors of intensity and frequency of regret, and to control these variables in examining the impact of regret on well-being. In Phase 1 of the study, 111 older adults participated in a Life Reflection Interview that yielded measures of intensity and frequency of regret, emergent values, quality of experience of aging and physical well-being. They also completed a battery of self-report questionnaires assessing personality, dispositional optimism, intolerance of uncertainty, depression and happiness. In Phase 2, a subsample of 71 participants completed measures assessing dispositional coping, perceived control and perceived autobiographical memory. The findings show that relatively healthy, educated older adults do not have high levels of regret, that predictors of intensity and frequency differ, that more variance in intensity compared to frequency of lifespan regrets is explained by the variables, and that regret does predict indicators of psychological but not physical well-being. The results suggest that the methodology used facilitates the measurement of self-defined regret by evoking a spontaneous expression of feelings. Future research should examine if the interview process may contribute to the working through of negative life experiences by providing an opportunity for the sharing and discussion of regrets with an interested and involved listener. Research should also focus on the identification of older adults who may be at risk

Stress and its impact on the mental health of elite athletes - an analytical overview

In elite sports various stressors (non-sport-specific and sport-specific), such as the permanent pressure to achieve maximum performance, continuous high risk of injury, pressure from the coach, sponsors or organizers, expectations of the media or society exist. Very often these stressors are associated with negative consequences for physical and mental health (e.g., loss of self-control or identity crises). Staying healthy and maintaining (mental) health is given the highest priority in the athletic context. To date, however in elite sports publications regarding stress and its impact on mental health are still rare. This paper aims to analyse the impact of stress on mental health in the context of elite sports. The intention is furthermore to illustrate based on current literature coping strategies as resources to promote mental health of elite athletes. Additionally, risk factors pertaining to mental disorders will be analysed, as they potentially entail impairments of mental health in the target group. This information should facilitate to gain further insight in mechanisms and relationships of variables, which may on the one hand provoke mental health impairments in elite athletes and otherwise protect their mental health. Against this background the following central research questions arise: • Which impact does stress have on the mental health of elite athletes? • Which strategies could be employed to promote mental health in elite sports? To answer these questions and to describe stress and mental health in the context of elite sports various terms such as "stress", "stressor", "mental health", "coping" and "risk factor" will be explained. Three systematic reviews will form the "core" of the paper. In a conclusion part implications for future research designs referring to the above-mentioned questions and considering current study findings will be discussed