Bernard L. Bloom

Prevention of mental disorders: Recent advances in theory and practice

This paper begins by reviewing the current status of primary prevention. Basic concepts and definitions are introduced, and the existing knowledge base is examined. Recent advances in how primary prevention is viewed are described, and some general issues not yet resolved are identified. In particular, the importance of the growing shift of interest from predisposing factors in emotional disorders to precipitating factors, and the shift from the search for disorder-specific causes to the search for general, nonspecific causes is underlined.

Whose Decision Was It? The Effects of Initiator Status on Adjustment to Marital Disruption.

The role of initiator status was examined in terms of its mediating effect on adjustment to marital disruption. It was hypothesized that initiators (persons who indicated taking major or exclusive responsibility for deciding to end their marriages), in contrast to noninitiators, would have been more aware of marital dissatisfaction and preseparation stress-related symptoms, would have been more in favor of the decision to separate, and would report fewer postseparation symptoms and more postseparation life satisfaction. Findings, based on a sample of 144 persons interviewed on three occasions following their separations, suggested that there were not overwhelming differences in marital dissatisfaction or preseparation discomfort between initiators and noninitiators but that initiators consistently perceived more benefits to the separation. In most cases in which being the initiator appeared to play a mediating role in postseparation adjustment, its effects were more pronounced in the case of women than of men.

A PREVENTIVE INTERVENTION PROGRAM FOR THE NEWLY SEPARATED: Final Evaluations

Results of 30-month and four-year follow-ups of a six-month preventive program for people recently separated were even more favorable than the positive follow-ups at six and 18 months. At 30 months, intervention group members scored significantly higher than control group members on dependent measures of adjustment, had significantly fewer separation-related problems, and reported significantly greater separation-related benefits. At four years, intervention group members continued to report significantly more satisfactory levels of adjustment and life quality, although the differences were not as great. Benefits did not all appear at the same time, or equally in men and women, and some benefits did not appear until well after the program ended. Data on marital status transitions during the four-year follow-up period are analyzed, and suggestions are offered for further enhancing program effectiveness.

A preventive program for the newly separated: Initial evaluation

A 6-month long preventive intervention program for newly separated persons was designed on the basis of an analysis of the literature that identified the major stressful elements in the separation experience. Following the implementation of the program, its impact was assessed by contrasting persons who were assigned to the program (n = 100) with newly separated persons who were randomly selected to serve as a no-treatment control group (n = 50). Of the nine dependent measures of adjustment used in this evaluation, five significant posttreatment differences were found, in each case favoring the intervention group. The nature of these significant differences is particularly encouraging in light of the preventively oriented objectives of the intervention program. Detailed analysis of program characteristics resulted in the identification of desirable program modifications that could be implemented when the program is reinstituted.

Computer-assisted psychological intervention: A review and commentary

Abstract This paper reviews the 25-year history of computer-assisted psychological intervention, with particular emphasis on the current status of the computer in psychotherapy. The computer is playing an increasingly important role in personality and behavioral assessment, diagnostic interviewing and history taking, health education, mental health consultation, and clinical training. In these areas, the reliability, validity, and utility of the computer compares very favorably with that of the clinician. Evaluations of the use of the computer with psychiatric patients conclude that even those who are quite disturbed interact very successfully with computers, including many patients who are unable to interact with mental health personnel. Computer-assisted psychotherapy programs have been most successfully implemented in the areas of cognitive and behavioral psychotherapy. In the case of psychodynamic psychotherapy, computer programs appear to be limited by our failure to make fully explicit the rules governing therapist behavior and by the continuing inability of computers to comprehend natural language.

Sex Differences in Adjustment during the Process of Marital Separation.

Four different studies are reported in which the differential adjustment of men and women during the process of marital separation was investigated. In these studies consistent sex by time period findings were obtained. Prior to separation, women reported significantly more severe psychological symptoms than did men. During the early postseparation period, men reported significantly more severe symptoms than did women. The development ofa briefself-report measure ofpsychopathology used in all four studies is described.

The predicament of the newly separated

This study examines early adjustment to marital separation as a function of sex and parent status in a sample of 153 persons separated an average of eight weeks from their spouses because of marital discord. Men were much more satisfied with the quality of their marriages prior to separation and much more opposed to its ending than were women. Women consistently reported more gains than men as a consequence of their separations and a greater readiness to divorce. Social support systems were stronger in the case of women than men and in the case of parents than nonparents. Formal and informal helpseeking was very common. There was considerable difficulty in the areas of job performance and career planning, and the presence of children appeared to add to the difficulties faced by divorcing parents. In general, while the preseparation period appeared to be more stressful for women, the early postseparation period was far more difficult for men.

The “medical model,” miasma theory, and community mental health

Current practices in the field of community mental health are examined to determine the extent to which the so-called “medical model” is actually being utilized. In many respects it is shown that the time-honored miasma theory model is more appropriate in understanding these practices. Miasma theory is described and contrasted as a model with the medicobiological model as regards its pertinence for understanding present ideas of the taxonomy of emotional disorders, principles of diagnosis and treatment, and theories of primary prevention. Some implications of miasma theory as a community mental health model are suggested.Current practices in the field of community mental health are examined to determine the extent to which the so-called “medical model” is actually being utilized. In many respects it is shown that the time-honored miasma theory model is more appropriate in understanding these practices. Miasma theory is described and contrasted as a model with the medicobiological model as regards its pertinence for understanding present ideas of the taxonomy of emotional disorders, principles of diagnosis and treatment, and theories of primary prevention. Some implications of miasma theory as a community mental health model are suggested.

Social support: Its structure and impact on marital disruption

Availability of social support has been hypothesized to play a role in influencing adjustment to marital disruption either directly or by moderating the debilitating effects of stress. Yet previous research has not adequately conceptualized or measured the nature and availability of social support. In an effort to learn more about the structure and impact of social support as it relates to marital disruption, 50 newly separated men and women were interviewed at 2 months and again at 8 months after their separations. The structure of social support was found to include (a) several important sources of support, including family, friends, and the larger community; (b) an index of social activity; and (c) a sense of satisfaction with present marital status. Although the stress associated with separation was positively related to poorer adjustment, certain aspects of social support were found to moderate this relationship.

Factors Related to the Adjustment of Divorcing Men.

In order to examine the effects of marital disruption upon divorcing men a sample of 40 men separated between one and six months and involved in a divorce petition was interviewed. All but three were reinterviewed between three and four months later. There was relatively little improvement during the time interval. Factors associated with poor adjustment to marital separation were found to include preseparation help seeking weak or nonexistent social networks outside the marital relationship a variety of difficulties in the work setting and a continuing relatively intense relationship with the spouse and children. Successful adjustment to marital disruption in the case of some men may require a set of distancing behaviors relative to the spouse and adjustments in ways of meeting the needs of children. (authors)