Abigail K. Mansfield

Measurement of Men's Help Seeking: Development and Evaluation of the Barriers to Help Seeking Scale

This article describes the development and psychometric evaluation of the Barriers to Help Seeking Scale (BHSS). The measure was designed to assess reasons men identify for not seeking professional help for mental and physical health problems. Exploratory factor analyses in a sample of 537 undergraduate men revealed a 5-factor solution of internally consistent subscales, including Need for Control and Self-Reliance, Minimizing Problem and Resignation, Concrete Barriers and Distrust of Caregivers, Privacy, and Emotional Control. A separate study of 58 undergraduate men confirmed the reliability of the scale and provided evidence of convergent and criterion validity between the BHSS and measures of masculine gender-role conflict and attitudes toward seeking professional help.

Posttraumatic Stress Disorder Symptoms and Functional Impairment Among OEF and OIF National Guard and Reserve Veterans

The aims of the present investigation were (a) to examine associations between posttraumatic stress disorder (PTSD; diagnosis and symptoms) and different aspects of functioning, severity, and subjective distress among Operation Iraqi Freedom and Operation Enduring Freedom National Guard and Reserve veterans, and (b) to examine the unique contribution of PTSD symptom clusters to different aspects of functioning and distress. Participants were 124 veterans who had returned from war-zone deployment. A PTSD diagnosis and PTSD symptoms were significantly associated with nearly all of the psychosocial functioning and distress measures, controlling for Axis I disorders and other covariates. Of the PTSD symptom clusters, numbing/avoidance symptoms were the strongest predictors of interpersonal and social functioning, and hyperarousal symptoms were the strongest predictors of overall severity and distress.

Effectiveness of cognitive--behavioral treatment for panic disorder versus treatment as usual in a managed care setting.

Eighty clients enrolled in a managed care health plan who identified panic disorder as their primary presenting problem were randomly assigned to treatment by a therapist recently trained in a manual-based empirically supported psychotherapy or a therapist conducting treatment as usual (TAU). Participants in both conditions showed significant change from pre- to posttreatment on a number of measures. Those receiving panic control therapy (PCT) showed greater levels of change than those receiving TAU. Among treatment completers, an average of 42.9% of those in PCT and 18.8% in TAU achieved clinically significant change across measures. The results are discussed with reference to the dissemination of PCT and other evidence-based psychotherapies to clinical practice settings.

Management of Treatment-Resistant Depression

Given the limitations of evidence for treatment options that are consistently effective for TRD and the possibility that TRD is in fact a form of depression that has a low probability of resolving, how can clinicians help patients with TRD? Perhaps the most important conceptual shift that needs to take place before treatment can be helpful is to accept TRD as a chronic illness, an illness similar to many others, one that can be effectively managed but that is not, at our present level of knowledge, likely to be cured. An undue focus on remission or even a 50% diminution of symptoms sets unrealistic goals for both patients and therapists and may lead to overtreatment and demoralization. The focus should be less on eliminating depressive symptoms and more on making sense of and learning to function better in spite of them. It is important to acknowledge the difficult nature of the depressive illness, to remove blame from the patient and clinician for not achieving remission, to set realistic expectations, and to help promote better psychosocial functioning even in the face of persisting symptoms. The critical element when implementing such an approach is a judicious balance between maintaining hope for improvement without setting unrealistic expectations. It is important to reemphasize that following a disease management model with acceptance of the reality of a chronic illness is not nihilistic and does not mean the abandonment of hope for improvement. The first step in treating a patient with TRD is to perform a comprehensive assessment of the patient’s past and current treatment history to ensure that evidence-based treatment trials have in fact been undertaken, and if not, such treatment trials should be implemented. If the patient continues to have significant residual symptoms, it is important to determine the impact is of these symptoms on the patient’s quality of life and ability to function. It is also important to evaluate the factors that may be contributing to the persistence of depressive symptoms such as comorbid personality disorders, somatic disorders, substance abuse, and work and interpersonal conflicts. The treatment of patients with TRD needs to move beyond attempts to modify symptoms without taking into consideration and attempting to modify the patient’s personality, coping skills, and social system. Further somatic treatment trials can be undertaken, if desired by the patient and therapist, as a small (5%–15%) percentage of patients may respond and further treatment trials, and this may engender hope. The risk with this approach is that patients and therapists may not work at disease management skills if they believe there may be a resolution of the depression if they could just find the right medication or intervention. Therapists may also feel pressured by patients, families, insurance companies, as well as their own sense of helplessness to escalate treatment in a more and more aggressive manner in an attempt to achieve an elusive remission. A disease management program can provide the therapist and patient with sufficient structure, skills, and goals to encourage ongoing treatment without resorting to unproven measures that may create more side effects and problems. It is particularly important to include the patient’s significant others in the reformulation of the patient’s problem and thereby learn how to manage the illness more effectively. Significant others and family members can be invaluable in providing support for dealing with the difficult process of acquiring a new skill set. Indeed, they spend significantly more time with the patient than does any therapist. Family members are likely to provide this kind of support only if they have been part of the assessment and treatment process. Patients with a wide range of chronic medical illnesses can and do learn to function effectively and to achieve a satisfying quality of life in spite of their illness. There is no reason to think that patients with TRD should not be able to achieve a similar level of illness management, functioning, and quality of life.

Effectiveness of cognitive-behavioral treatment for panic disorder versus treatment as usual in a managed care setting : 2-year follow-up

Eighty clients meeting criteria for panic disorder and receiving either panic control therapy (PCT; M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or treatment as usual (TAU) in a managed care setting were assessed 1 and 2 years following acute treatment. PCT was provided by therapists with little or no previous exposure to cognitive-behavioral therapies. Analyses of the full intent-to-treat sample revealed no significant differences between the treatments across the follow-up period. However, when treatment completer status was added as a moderator, those receiving PCT showed lower levels of panic severity and phobic avoidance and a greater likelihood of achieving and maintaining clinically significant change. Benzodiazepine use during follow-up was associated with greater panic severity for those clients who received PCT, but no such relationship was found for TAU clients. Results are discussed in relation to the dissemination and effectiveness of PCT as well as evidence-based psychotherapies more generally.

The family assessment device: an update.

The current study set out to describe family functioning scores of a contemporary community sample, using the Family Assessment Device (FAD), and to compare this to a currently help-seeking sample. The community sample consisted of 151 families who completed the FAD. The help-seeking sample consisted of 46 families who completed the FAD at their first family therapy appointment as part of their standard care at an outpatient family therapy clinic at an urban hospital. Findings suggest that FAD means from the contemporary community sample indicate satisfaction with family functioning, while FAD scores from the help-seeking sample indicate dissatisfaction with family functioning. In addition, the General Functioning scale of the FAD continues to correlate highly with all other FAD scales, except Behavior Control. The cut-off scores for the FAD indicating satisfaction or dissatisfaction by family members with their family functioning continue to be relevant and the FAD continues to be a useful tool to assess family functioning in both clinical and research contexts.

Family functioning in depressed and non-clinical control families

Background: Existing studies of depression and family functioning have used western samples to examine how depression and impaired family functioning are related, and to explore levels of discrepancy between depressed patients and their family members. The purpose of the current study is to explore these questions in a Chinese sample. Method: This study examined the association between family functioning and depression in a Chinese sample of 60 depressed patients and their family members and 60 non-clinical controls and their family members. The study evaluated levels of agreement between family members on a self-report measure of family functioning (Family Assessment Device) using reliability statistics. It also compared families’ self-reported family functioning to that of a trained observer using an observational rating scale (McMaster Clinical Rating Scale). Results: Results indicate poorer family functioning among Chinese families with a depressed family member, high to moderate agreement between patients and family members, moderate to low agreement between non-clinical participants and their family members, and moderate correlations between subjective and objective ratings of family functioning in a mainland Chinese sample. Conclusions: As in other cultures, depression is associated with impaired family functioning in Chinese families. There is good agreement between family members and a trained evaluator about the family impairments. The Family Assessment Device and the McMaster Clinical Rating Scale are useful for assessing family functioning in Chinese families.

Family Functioning and Income Does Low-Income Status Impact Family Functioning?

This study explored the impact of income status (low-income vs. non-low-income) on family functioning, social support, and quality of life in a community sample of 125 families. The sample identified themselves as 17% Black or African American, 7% Latino, 4% Asian, and 66% White. The mean age of participants was 37 years. The study used a self-report measure of perceived family functioning, the Family Assessment Device (FAD). Results demonstrated that low-income status was associated with less satisfaction with several areas of family functioning, and that the effect of having a family member with a psychiatric disorder on family functioning depended on income status, with low-income families with a psychiatric disorder endorsing much greater dissatisfaction with family functioning than non-low-income families with a psychiatric disorder. Low-income families also had significantly lower social support and quality of life scores than non-low-income families. Low-income status appears to put stress on families in general and to compound the effects of having a psychiatric disorder on family functioning. Non-low-income status, by contrast, appears to offer a buffer from the effects of having a psychiatric disorder on family functioning. These findings suggest the importance of providing family-based interventions to low-income families in which one or more members has an identified psychiatric disorder.

Emotional Skillfulness as a Key Mediator of Aggression

Psychological research has documented several predictors of aggression, including adherence to hegemonic masculinity, trauma symptoms, and insecure attachment. However, at present, little is known about why these variables predict aggression. This study used acceptance theory to introduce the concept of emotional skillfulness as a counterpoint to emotion dysregulation. In an effort to better understand the pathways through which these variables predict aggression, this study used a clinical sample to test three mediational models which hold that emotional skillfulness functions as a common link between the aforementioned predictors and aggression in both men and women. Results indicated that emotional skillfulness is a mediator of aggression for both men and women, but that the predictors of aggression differed by gender.

Manual-based psychotherapies in clinical practice Part 1: assets, liabilities, and obstacles to dissemination.

Treatment manuals evolved in comparative psychotherapy outcome studies but are rapidly becoming a major medium for disseminating empirically supported treatments. Currently, the role of manual-based psychotherapies in clinical practice is a source of considerable debate among mental health practitioners and clinical researchers. In this editorial, we address why translating manual-based treatments from research to practice may be both difficult and worthwhile. We begin with an outline of the arguments for and against manuals and then explore some of the concrete difficulties involved in translating manuals into practice. Finally, we briefly address how these difficulties might be handled. Perhaps the most often articulated criticism of manual-based treatments is that they lead to a bland, rule governed, and emotionally detached form of therapy. Some therapists fear that practising therapy under these conditions may feel more like following a recipe than the intuitive and creative process that drew therapists to the field. Another criticism leveled against manual-based treatments is that clinical situations rarely mirror the tightly controlled conditions of a clinical research study.1 Criteria for participation in psychotherapy research often require accurate and differential diagnosis, which can be time consuming and costly. In addition, people with multiple diagnoses (eg, panic, depression, and substance dependence) are often deemed ineligible for participation in research. Yet another criticism lies in the impracticality of having a separate treatment manual for every diagnosis. A separate treatment manual for each diagnosis makes acquiring training and achieving competence in empirically supported treatments all but impossible because there is simply too much to learn. This trend toward differential treatment based on diagnosis is puzzling since few data support the use of alternative forms of psychotherapy based on diagnosis.2 Although some psychologists oppose manual-based treatments, others strongly favour them. The arguments in favour of manual-based treatment rest on its ability …