Psychological factors predicting self-reported and observed aggression in male forensic psychiatric inpatients

The present study examined the psychological determinants of self-reported and observed aggression in male violent forensic psychiatric inpatients. Baseline data came from 232 inpatients referred to a cognitive–behavioral treatment program. Linear regression models were used to assess the relationship between the patients’ psychological characteristics and aggressive behavior. Self-reported aggression was studied with cross-sectional data, while the inpatients’ observed aggression in the ward was investigated with prospective data. The main factors contributing to the prediction of self-reported aggression were state anger, antisocial lifestyle and agreeableness, while the main factors contributing to the prediction of observed aggression were trait anger and agreeableness. The findings support the focus of treatment programs for forensic psychiatric inpatients on anger management.</p

Experimental stress in inflammatory rheumatic diseases: a review of psychophysiological stress responses

Contains fulltext : 88668.pdf (publisher's version ) (Open Access)INTRODUCTION: Stressful events are thought to contribute to the aetiology, maintenance and exacerbation of rheumatic diseases. Given the growing interest in acute stress responses and disease, this review investigates the impact of real-life experimental psychosocial, cognitive, exercise and sensory stressors on autonomic, neuroendocrine and immune function in patients with inflammatory rheumatic diseases. METHODS: Databases Medline, PsychINFO, Embase, Cinahl and Pubmed were screened for studies (1985 to 2009) investigating physiological stress responses in inflammatory rheumatic diseases. Eighteen articles met the inclusion criteria. RESULTS: Results suggest that immune function may be altered in response to a stressor; such alterations could contribute to the maintenance or exacerbation of inflammatory rheumatic diseases during stressful events in daily life. CONCLUSIONS: This review emphasizes the need for more experimental research in rheumatic populations with controlled stress paradigms that include a follow-up with multiple evaluation points, simultaneous assessment of different physiological stress systems, and studying factors contributing to specific physiological responses, such as stress appraisal

Psychophysiological Responses to Stress after Stress Management Training in Patients with Rheumatoid Arthritis

Contains fulltext : 97274.pdf (publisher's version ) (Open Access)BACKGROUND: Stress management interventions may prove useful in preventing the detrimental effects of stress on health. This study assessed the effects of a stress management intervention on the psychophysiological response to stress in patients with rheumatoid arthritis (RA). METHODS: Seventy-four patients with RA, who were randomly assigned to either a control group or a group that received short-term stress management training, performed a standardized psychosocial stress task (Trier Social Stress Test; TSST) 1 week after the stress management training and at a 9-week follow-up. Psychological and physical functioning, and the acute psychophysiological response to the stress test were assessed. RESULTS: Patients in the intervention group showed significantly lower psychological distress levels of anxiety after the training than did the controls. While there were no between-group differences in stress-induced tension levels, and autonomic (alpha-amylase) or endocrine (cortisol) responses to the stress test 1 week after the intervention, levels of stress-induced tension and cortisol were significantly lower in the intervention group at the 9-week follow-up. Overall, the response to the intervention was particularly evident in a subgroup of patients with a psychological risk profile. CONCLUSION: A relatively short stress management intervention can improve psychological functioning and influences the psychophysiological response to stress in patients with RA, particularly those psychologically at risk. These findings might help understand how stress can affect health and the role of individual differences in stress responsiveness. TRIAL REGISTRATION: TrialRegister.nl NTR1193

Stuttering And Social Anxiety

The aim of the present study was to investigate the presence of social anxiety in adults who stutter. This was done by administering the Inventory of Interpersonal Situations (IIS) (Van Dam-Baggen & Kraaimaat, 1999), a social anxiety inventory, to a group of 89 people who stuttered and 131 people who did not stutter. Two components of social anxiety were measured by the ISS, the extent to which emotional tension or discomfort is perceived in social situations and the frequency with which social responses are executed. The people who stuttered displayed significantly higher levels of emotional tension or discomfort in social situations. They also reported a significantly lower frequency of social responses compared to their nonstuttering peers. In addition, about 50% of the scores of the people who stuttered fell within the range of a group of highly socially anxious psychiatric patients. The results of the study suggest that the measurement of social anxiety is an important element in the assessment of adults who stutter. Educational objectives: The reader will learn about and be able to describe (1) the IIS as an assessment procedure for evaluating social anxiety, (2) the level of discomfort expressed by adult stutterers in social situations, and (3) the effect of social anxiety on stutterers\u27 responsiveness in social situations. © 2002 Elsevier Science Inc. All rights reserved

Aggression Replacement Training for Violent Young Men in a Forensic Psychiatric Outpatient Clinic

Abstract The effects of Aggression Replacement Training (ART) were explored in a group of Dutch violent young men aged 16 to 21 years, who were obliged by the court to follow a treatment program in a forensic psychiatric outpatient clinic. To evaluate the training, patients completed a set of selfreport questionnaires at three moments in time: at intake/before a waiting period, after the waiting period/before the training, and after the training. During the waiting period, the patients did not change on most measures, although they displayed a significant increase in anger. The patients who completed the therapy scored significantly lower on psychopathy than the patients who dropped out. The training produced significant decreases in physical aggression and social anxiety and showed trends toward a decline in self-reported hostility, general aggression, and anger. After the training, the patients scored comparably with a reference group on measures of hostility Aggression Replacement Training (ART) is a multimodal intervention originally developed to promote prosocial behavior in children and adolescents who display aggressive and violent behavior. The training was designed by ART has been applied not only to juvenile but also to adult offenders. In the Netherlands, three studies in criminal youth have been devoted to the effect of EQUIP The Present Study The U.S. Department of Health and Human Services Various issues of ART were investigated in our group of violent male forensic psychiatric outpatients aged 16 to 21 years. To explore whether ART would result in any effect, we measured the patients at three moments in time: at intake/before a waiting period (intake measurement), after the waiting period/before the training (pre-training measurement), and after the training (post-training measurement). Criminogenic needs Method Participants The study was carried out in a nonrandom group of 123 patients of forensic psychiatric outpatient clinic &quot;het Dok&quot; at Rotterdam (Netherlands) with a at PENNSYLVANIA STATE UNIV on October 6, 2016 jiv.sagepub.com Downloaded from Hornsveld et al. 5 mean age of 17.35 years (SD = 1.82, range = 15-21 years). These patients were convicted by the court for a violent offense (e.g., assault, robbery with violence, or serious threats with violence) and ordered to follow a treatment program in a forensic psychiatric outpatient clinic. The decision of the court was based on the conclusion of a psychiatric or psychological evaluation (Pro Justitia report) that recidivism was probable because of a mental disorder The patients had conduct or oppositional defiant disorder as their main diagnosis on Axis I or, when they were 18 years or above, an antisocial personality disorder on Axis II of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994). The classifications were based not only on the psychiatric and/or psychological evaluation (Pro Justitia report) used by the court in deciding to impose a forensic psychiatric outpatient treatment but also on the evaluation of an experienced clinical psychologist during the intake interview. Almost all patients gave the impression of being unmotivated to follow the obligatory training. They claimed to have been treated unfairly by the court, which implied that their conviction was the result of a judicial flaw. Measures In this study, we used a standard set of measures for personality traits and problem behaviors for individuals aged 16 years or above; these measures were chosen because of their relation to determinants of violent behavior, such as hostility, anger, social anxiety, and social skills. This standard set of measures comprises the following instruments. Journal of Interpersonal Violence consists of 20 items that have to be rated on a 3-point scale, with 0 = does not apply, 1 = applies to some extent, and 2 = applies. The NEO Five-Factor Inventory (NEO-FFI; The Trait Anger subscale of the Spielberger (1980) State-Trait Anger Scale (STAS; An adapted version of Rosenzweig&apos;s (1978) Picture-Frustration Study (PFS-AV; Hornsveld, Nijman, Hollin, &amp; Kraaimaat, 2007) was used to measure hostility. This test asks participants to write down their reactions to 12 cartoon-like pictures. The subjects are instructed to examine the situations shown in the pictures (e.g., to a shopkeeper: &quot;This is the third time that this watch has stopped.&quot;) and to write in the blank text box the first appropriate reply that enters their mind. The answers are scored by an experienced and independent research assistant (psychologist) on a 7-point scale, ranging from 1 = not hostile at all to 7 = extremely hostile. In a sample of 231 Dutch at PENNSYLVANIA STATE UNIV on October 6, 2016 jiv.sagepub.com Downloaded from Hornsveld et al. 7 violent forensic psychiatric patients (all males), the internal consistency (Cronbach&apos;s α) turned out to be .76, the inter-rater reliability .77, and the testretest reliability .67 The Aggression Questionnaire (AQ; The NAS part of the Novaco Anger Scale-Provocation Inventory (NAS-PI; Novaco, 1994; Dutch version: Hornsveld, Muris, &amp; Kraaimaat, 2011) was used to study the self-reported responses of the participants to 48 anger-eliciting situations (e.g., &quot;When someone yells at me, I yell back at them.&quot;). The items are scored on a 3-point Likert-type scale: 1 = never true, 2 = sometimes true, and 3 = always true. In a sample of 194 Dutch violent forensic psychiatric outpatients (all males), for the NAS total score, the internal consistency (Cronbach&apos;s α) was found to be .95 and the test-retest reliability in a subgroup of 90 outpatients was .80 The Inventory of Interpersonal Situations (IIS; Van Dam-Baggen &amp; Kraaimaat, 1999) assesses how much anxiety people experience during social interactions (e.g., &quot;Refusing a request to lend out money&quot;) and how often they are able to actually perform the appropriate behavior in such situations. For social anxiety, the scores range from 1 = &quot;no tension at all&quot; to 5 = &quot;very tense&quot;; the frequency scores range from 1 = &quot;never&quot; to 5 = &quot;always.&quot; The internal consistency (Cronbach&apos;s α) and test-retest reliability of the IIS can be qualified as good (i.e., αs &gt; .80 and test-retest correlations &gt; .70; Procedure In the Netherlands, the supervision of convicted offenders has to be carried out by an after-care and resettlement organization. Such an organization usually at PENNSYLVANIA STATE UNIV on October 6, 2016 jiv.sagepub.com Downloaded from 8 Journal of Interpersonal Violence &quot;delegates&quot; the execution of an obligatory treatment to a forensic psychiatric outpatient clinic. It is the duty of the probation officer to motivate the patient, his girlfriend, or his parent(s) to contribute to the success of the training. Depending on the age and living conditions of the patient, the probation officer maintains relations with the school, employer, and social or welfare services. The intake interview was carried out for late adolescents, together with their youth probation officer and preferably with at least one of the parents. However, most of these adolescents lived with their mother, who, according to the probation officer, was often not able or not motivated to attend the interview. Young men aged 18 to 21 years who lived on their own were interviewed in the presence of their probation officer only. The participation of the probation officer during the intake interview was important for the provision of additional information about the current situation of the patient, in addition to the Pro Justitia report. The presence of the probation officer also considerably enlarged the chance that the patient would attend the interview. During the training, there was occasionally contact between one of the two trainers and the probation officer, especially when a patient did not show up. When a patient failed to attend for two sessions or did not show up at the start of the training, he could no longer follow the training except when there were valid reasons for his absence. The policy was that non-completers were sent to prison, but in reality this punishment was rarely imposed. Young men who were referred to the outpatient clinic for obligatory treatment because of a violent crime were interviewed within a week and put on the waiting list when indicated for ART. When the waiting list group reached six to eight patients, a new training group was formed. In practice, this meant that the first patient had to wait about 8 weeks and the last one about 2 weeks until the start of the training. To explore whether ART would have any effect, sets of questionnaires were administered, particularly for the effect study; these questionnaires were to be completed individually. Participation in the study (but not in the training) was voluntary and was rewarded with a fee of €7 for each measurement. The assessment of the PCL-R scores and the ART were done by experienced clinical psychologists who completed additional education of 6 years after their 4-year university study of psychology. The trainers had a training scenario at their disposal, whereas the patients could do their homework assignments in a workbook Aggression Replacement Training The outpatient version of the ART consists of 15 weekly sessions lasting 1½ hours each and three 5-weekly follow-up meetings for 6 to 8 patients: (a) at PENNSYLVANIA STATE UNIV on October 6, 2016 jiv.sagepub.com Downloaded from Hornsveld et al. 9 anger management, sessions 1 to 5; (b) social skills, sessions 6 to 10; (c) moral reasoning, sessions 11 to 15; and follow-up and evaluation, sessions 16 to 18. Role-playing was an essential part of the sessions. Participants had to complete homework assignments for the generalization of learned skills to new situations. Altogether, the training meant an investment of approximately 40 hr for the patient, which is often a requirement of the court for juvenile offenders. Design and Statistics The study was approved by the Dutch Review Committee for Patient-Linked Research in Arnhem, the Netherlands, and by the Scientific Research and Documentation Center of the Dutch Ministry of Security and Justice. Data sets were analyzed through the statistical program IBM SPSS Statistics 20.0. The problem behaviors of the patients at the intake (intake measurement) were compared with those at the start of the training (pretraining measurement) through a two-tailed paired samples t test (p &lt; .05). The behaviors at the start of the training (pre-training measurement) were also compared with those after the training (post-training measurement) through a one-tailed paired samples t test (p &lt; .05). Differences between dropouts and completers were evaluated with a two-tailed t test (p &lt; .05). To determine the factors that predicted dropout, a stepwise binary logistic regression analysis was applied. Multiple ANCOVAs (two-tailed; p &lt; .05) were used to compare the intake measurement and the posttreatment measurement with a reference group. Because comparable norm groups for the used measurement instruments were lacking, a group of secondary vocational students functioned as a reference group. These students were measured once only as part due to another study. Age was used as a covariate because the mean age of the reference group (M = 18.14 years, SD = 1.81) was significantly higher (t (396) = −4.03, p &lt; .001) than the mean age of the patients (M = 17.35 years, SD = 1.76). Results Criminogenic Needs To assess the criminogenic needs of the patients, we compared the personality traits and problem behaviors of the patients with those of the reference group, consisting of 275 secondary vocational students (all men). The patients scored significantly higher than the students on trait anger (STAS), F(2, 395) = 2.52, p = .041; hostility (PFS-AV), F(2, 280) = 18.90, p &lt; .001; and at PENNSYLVANIA STATE UNIV on October 6, 2016 jiv.sagepub.com Downloaded from 10 Journal of Interpersonal Violence aggression (AQ), F(2, 395) = 2.74, p = .033; and significantly lower on agreeableness (NEO-FFI), F(2, 395) = 2.39, p = .047, and social anxiety (IIS), F(2, 395) = 10.19, p &lt; .001. The patients who withdrew prematurely (nonstarters plus non-completers) seemed to score significantly higher on psychopathy (PCL-R Total), t(121) = −2.57, p = .006, than did the completers, in particular on the factor antisocial behavior, t(121) = −3.36, p &lt; .001. No differences were found on the other measures. To determine which intake measures could differentiate completers from dropouts, a stepwise binary logistic regression analysis was done with each individual measure. Only the PCL-R Total could independently differentiate completers from dropouts, B (SE) = 0.09 (0.037), odds ratio = 1.094, p = .014. More specifically, completers and dropouts were differentiated by Factor 2 of the PCL-R, B (SE) = 0.214 (0.069), odds ratio = 1.239, p = .002, and not by Factor 1 of the PCL-R, B (SE) = 0.063 (0.058), odds ratio = 1.065, p = .281

Multidisciplinary allocation of chronic pain treatment: effects and cognitive-behavioural predictors of outcome.

Item does not contain fulltextOBJECTIVES: Multidisciplinary treatment approaches have been found to be effective for chronic pain patients although there are large individual differences in outcomes. To increase overall treatment effects, tools are needed to identify patients most likely to benefit from tailored, comprehensive modular treatment schemes. DESIGN: The present study evaluates the effects of a multidisciplinary pain treatment allocation protocol in chronic pain patients and seeks to identify cognitive-behavioural predictors of outcome. Pain intensity, functional disability, depression, and use of medication in an intervention group of 110 chronic pain patients were compared to the outcomes of a 110 strong control group. RESULTS: Paired pre- and post-treatment t tests showed that all primary outcomes had significantly decreased in the intervention group with ANCOVAs revealing a main group effect for post-treatment pain intensity levels and functional disability. Paired t tests demonstrated both variables to have significantly reduced after treatment relative to the levels reported by the control group. Predictor analyses further showed higher levels of acceptance to significantly predict larger reductions in pain intensity in the intervention but not in the control group. CONCLUSION: The tested multidisciplinary allocation scheme for out-patient treatment of chronic pain complaints was effective in reducing pain intensity and functional disability. Findings also showed that especially those patients that are able to accept their condition are likely to profit most from the treatment in terms of pain reduction