Leanne Andrews

Assessing positive and negative Changes in the aftermath of adversity: Psychometric evaluation of the Changes in Outlook Questionnaire

The Changes in Outlook Questionnaire (CiOQ; S. Joseph, R. Williams, & W. Yule, 1993) is a 26-item self-report measure that was designed to assess positive and negative changes in the aftermath of adversity. This article had 3 aims: 1st, to investigate the factor structure of the CiOQ; 2nd, to test for internal consistency reliability and convergent and discriminant validity; and, 3rd, to investigate the association between positive and negative changes in outlook, posttraumatic stress, and psychological distress. Three studies are reported. Study 1 provides evidence that positive and negative changes are statistically separable and that the 2-factor model is a better fit than the 1-factor model. Studies 2 and 3 provide evidence for internal consistency reliability, convergent and discriminant validity of the CiOQ, and its associations with posttraumatic stress and psychological distress. In conclusion, the CiOQ has much promise for research on responses to stressful and traumatic events.

Confirmatory Factor Analysis of the Posttraumatic Growth Inventory

With a sample of 372 participants who had experienced a range of adverse life events, we conducted a confirmatory factor analysis (CFA) of the Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996). CFA results support the original five-factor structure, as well as indicating that a single higher-order construct with five first-order latent variables provides an acceptable fit.

Multidimensionality of intrusion and avoidance: alternative factor models of the Impact of Event Scale

Previous research using exploratory factor analysis of the Impact of Event Scale (Horowitz et al., 1979) has suggested structures that are not consistent with the original two-factor model. IES data from 485 emergency service personnel who had experienced traumatic events during the course of their work were submitted to confirmatory factor analysis to test seven alternative factor models of the IES. This study is one of the most comprehensive analyses of the IES to date, investigating both theoretically and empirically derived models. The model of best fit was a four-factor model with a single second-order factor. This model comprised four first-order factors including intrusion, avoidance, numbing and sleep disturbance factors all subsumed by a second-order general distress factor. These results provide support for the multidimensionality of both intrusion and avoidance symptoms following traumatic experiences. Researchers and practitioners in the field of traumatic stress should be made aware of the assessment and treatment implications of this multidimensional structure

Social rank and symptom change in eating disorders : A 6-month longitudinal study

BACKGROUND Following previous cross-sectional research adopting an evolutionary approach to social rank and eating disorders, the present study explored the predictive value of social rank for changes in eating disorder symptoms in a 6-month longitudinal study. METHODS Seventy-three women and men with a history of eating disorders were followed up over 6 months. A broad range of measures of social rank were used to determine whether social rank at baseline predicted residual changes in eating disorder symptoms. RESULTS Low social rank (in terms of perceived external entrapment and submissive behaviour) predicted an increase in symptoms of anorexia but not symptoms of bulimia. The predictive value of low social rank was not mediated by changes in depressive symptoms. CONCLUSION Perceived low rank predicts an increase in anorexic symptoms. However, further research is required to determine the precise nature of how social rank exerts its influence on the development of eating disorder symptoms. KEY PRACTITIONER MESSAGE Self-perceived low social rank predicts an increase in anorexic symptoms but not bulimic symptoms. The effect of low social rank on changes in anorexic symptoms was not mediated by changes in depressive symptoms. Interventions for anorexia nervosa may need to incorporate techniques for increasing status and/or self-compassion.

Social Rank and Symptom Change in Eating Disorders

BACKGROUND Following previous cross-sectional research adopting an evolutionary approach to social rank and eating disorders, the present study explored the predictive value of social rank for changes in eating disorder symptoms in a 6-month longitudinal study. METHODS Seventy-three women and men with a history of eating disorders were followed up over 6 months. A broad range of measures of social rank were used to determine whether social rank at baseline predicted residual changes in eating disorder symptoms. RESULTS Low social rank (in terms of perceived external entrapment and submissive behaviour) predicted an increase in symptoms of anorexia but not symptoms of bulimia. The predictive value of low social rank was not mediated by changes in depressive symptoms. CONCLUSION Perceived low rank predicts an increase in anorexic symptoms. However, further research is required to determine the precise nature of how social rank exerts its influence on the development of eating disorder symptoms. KEY PRACTITIONER MESSAGE Self-perceived low social rank predicts an increase in anorexic symptoms but not bulimic symptoms. The effect of low social rank on changes in anorexic symptoms was not mediated by changes in depressive symptoms. Interventions for anorexia nervosa may need to incorporate techniques for increasing status and/or self-compassion.

The Role of Childhood Experiences in the Development of Sexual Compulsivity

There is a lack of evidence regarding the nature of the relationship between childhood trauma and sexual compulsivity in adulthood. Participants (n = 348) were users of support websites relating to drug, alcohol, gambling, and sexual addictions who completed an online survey including addiction questionnaires, the Sexual Compulsivity Scale, and the Early Trauma Inventory (Short Form). Multiple regression modeling indicated that gender, sexual orientation, childhood emotional abuse, childhood exposure to pornography, and parental sex addiction were associated with sexual compulsivity in adulthood (R2 = 0.23). Childhood sexual or physical abuse and addictions to other behaviors (alcohol, drugs, gambling) were not associated with adult sexual compulsivity.

Differences in patient outcomes between a 6, 7 and 8 week pulmonary rehabilitation programme: A service evaluation

OBJECTIVE To investigate changes and differences in patient outcomes over time for 6, 7 and 8 week pulmonary rehabilitation programmes in order to identify optimal duration. SETTING Community based pulmonary rehabilitation programmes in the East of England. PARTICIPANTS In total 363 participants completed one of the three pulmonary rehabilitation programmes. Patients with a chronic respiratory condition showing a commitment to the pulmonary rehabilitation programme and no contraindications to exercise were included. INTERVENTION Pulmonary rehabilitation twice a week for 6, 7 or 8 weeks. MAIN OUTCOME MEASURES St Georges Respiratory Questionnaire (SGRQ), Clinical COPD Questionnaire (CCQ), Hospital Anxiety and Depression Scale (HADS) and Incremental Shuttle Walk Test (ISWT). RESULTS All programmes showed improvements in ISWT post rehabilitation, with the 8 week programme showing the greatest improvement. CONCLUSION Findings show that greatest improvements in terms of exercise capacity may be seen from 8 week pulmonary rehabilitation programmes, but that improvement for the ISWT can be obtained from 6, 7 or 8 week programmes.

The Structure of Avoidance Following Trauma: Development and Validation of the Posttraumatic Avoidance Scale (PAS)

Avoidance is a key maintenance factor in traumatic reactions but currently no satisfactory measures of it exist. Previous factor analytic studies have demonstrated a distinction between conscious attempts to avoid trauma-related stimuli (e.g., trying not to talk or think about the event) versus nonconscious avoidance processes (e.g., emotional numbing, amnesia). Here we develop and validate a multidimensional measure of trauma-related avoidance across two samples. In Sample 1, 485 emergency service personnel completed a 44-item self-report measure of avoidance in relation to an identified occupational trauma. Principal components analysis provided evidence for a distinction between controlled and automatic avoidance. On the basis of these results a 20-item measure, the Posttraumatic Avoidance Scale (PAS), was constructed. The predictive validity of the PAS was established in a longitudinal study utilizing 6-month follow-up data from the emergency service personnel sample. Test-retest reliability was found to be very good for this 6-month period (correlations >.70) for both PAS controlled and automatic avoidance subscales. Sample 2 illustrated the transdiagnostic potential of the PAS in an eating disordered sample, all of whom reported to have experienced at least one traumatic event. Support was found for the two-factor structure of the PAS as well as for the convergent validity within this sample. The internal consistency of the PAS was assessed within both samples (Cronbachs alphas >.80) for both controlled and automatic avoidance subscales. This measure of trauma-related avoidance is the first to intentionally assess trauma-related avoidance symptoms in this bidimensional manner. Language: en

Measuring Emotional Intelligence Enhances the Psychological Evaluation of Chronic Pain

The assessment of emotional factors, in addition to other psychosocial factors, has been recommended as a means of identifying individuals with chronic pain who may not respond to certain pain treatments. Systematic reviews of the evidence regarding the prediction of responsiveness to a treatment called the spinal cord stimulator (SCS) have yielded inconclusive results. Emotional intelligence is a term which refers to the ability to identify and manage emotions in oneself and others and has been shown to be inversely associated with emotional distress and acute pain. This study aims to investigate the relationship between emotional intelligence, chronic pain, and the more established psychosocial factors usually used for SCS evaluations by clinical psychologists in medical settings. A sample of 112 patients with chronic pain on an acute hospital waiting list for SCS procedures in a pain medicine service were recruited. Psychological measures were completed including: a novel measure of emotional intelligence; usual measures of emotional distress and catastrophizing; and a numerical rating scale designed to assess pain intensity, pain-related distress, and interference. As predicted, findings revealed significant associations between most of the measures analyzed and current pain intensity. When entered into a simultaneous regression analysis, emotional intelligence scores remained the only significant predictor of current pain intensity. There are potential clinical, ethical, and organizational implications of emotional intelligence processes partially predicting pain in patients on a waiting list for a medical procedure. These results may offer new insight, understanding, and evaluation targets for clinical psychologists in the field of pain management.

Prevalence rates and risk factors for mental health difficulties in adolescents aged 16 and 17 years living in rural Ireland

OBJECTIVE This study sought to ascertain the prevalence rates and risk factors for a range of mental health difficulties, including suicidal ideation/self-harm among 16 and 17-year-old rural Irish adolescents, a vulnerable group in transition from childhood to adulthood. METHOD Adolescents (n=237) took part in this cross-sectional study. Participants completed a questionnaire compendium consisting of generic questions on demographic information, use of mental health services and four normed questionnaires: The Youth Self-Report, the Childrens Depression Inventory, the Coping Inventory for Stressful Situations-Adolescent and The Family Assessment Device. RESULTS We found that 16.9% of adolescents reported clinically significant mental health difficulties. Significant gender differences were found on internalising and externalising difficulties. There were no gender differences in suicidal ideation or self-harm. Only 3.4% of adolescents were receiving professional help for mental health difficulties. Multiple regression analyses revealed that family dysfunction, emotion-focussed coping and poor academic competence were significant predictors of poorer mental health difficulties in both genders. Family dysfunction was the strongest predictor of mental health difficulties in males. Among females, emotion-focussed coping was the strongest predictor of internalising difficulties and depression. Social diversion (social support) was predictive of less internalising difficulties and depression for females. CONCLUSION The study shows that a significant number of Irish 16 and 17 year olds have mental health difficulties, yet very few are receiving treatment. Emotion-focussed coping, family dysfunction, poor academic competence and less social support were important predictors of mental health difficulties. A new finding is the stronger association that family dysfunction has with poorer mental health in males than females, when controlling for academic competence and coping skills. The findings may have implications for psychological interventions.