Mardi J. Horowitz

impact of Event Scale: A Measure of Subjective Stress

&NA; Clinical, field, and experimental studies of response to potentially stressful life events give concordant findings: there is a general human tendency to undergo episodes of intrusive thinking and periods of avoidance. A scale of current subjective distress, related to a specific event, was based on a list of items composed of commonly reported experiences of intrusion and avoidance. Responses of 66 persons admitted to an outpatient clinic for the treatment of stress response syndromes indicated that the scale had a useful degree of significance and homogeneity. Empirical clusters supported the concept of subscores for intrusions and avoidance responses.

Prolonged Grief Disorder: Psychometric Validation of Criteria Proposed for DSM-V and ICD-11

Holly Prigerson and colleagues tested the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and care of bereaved individuals at heightened risk of persistent distress and dysfunction.

Impact of Event Scale: A Cross-Validation Study and Some Empirical Evidence Supporting a Conceptual Model of Stress Response Syndromes.

Conducted a cross-validational study on the Impact of Event Scale (IES), a self-report instrument assessing the essential characteristics associated with stress disorders. 35 bereaved outpatients completed the IES before entering time-limited dynamic psychotherapy and at 4 and 12 mo following termination. A further 28 Ss, not participating in therapy, completed the measure at similar intervals. Results confirm the scales relevance, internal consistency, and sensitivity. In addition, data are interpreted as consistent with a clinically derived theoretical model of the pattern of response to serious life events. As predicted by the theory, the syndromatic group showed greater intensity of intrusive and avoidance states; the relevant salience of reported experience was similar across groups; and the syndromatic group before intervention was characterized by an absence of a movement toward completion of processing the meaning of the event. (11 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)

When avoiding unpleasant emotions might not be such a bad thing: verbal-autonomic response dissociation and midlife conjugal bereavement.

It has been widely assumed that emotional avoidance during bereavement leads to either prolonged grief, delayed grief, or delayed somatic symptoms. To test this view, as well as a contrasting adaptive hypothesis, emotional avoidance was measured 6 months after a conjugal loss as negative verbal-autonomic response dissociation (low self-rated negative emotion coupled with heightened cardiovascular activity) and compared with grief measured at 6 and 14 months. The negative dissociation score evidenced reliability and validity but did not evidence the assumed link to severe grief. Rather, consistent with the adaptive hypothesis, negative dissociation at 6 months was associated with minimal grief symptoms across 14 months. Negative dissociation scores were also linked to initially high levels of somatic symptoms, which dropped to a low level by 14 months. Possible explanations for the initial cost and long-term adaptive quality of emotional avoidance during bereavement, as well as implications and limitations of the findings, are discussed.

Horowitz's impact of event scale evaluation of 20 years of use

Objective The main objective of this meta-analysis was to model the relations between a set of independent variables (age and gender of the trauma group, country where the study was performed, year of publication, type of event, time elapsed between event and measurement) and stress symptoms. Methods Data from 66 studies that used Horowitz’s IES to examine the psychological impact of a major life event were subjected to meta-analysis. Results Results from hierarchical regression analysis indicated that type of event (episodes of illness and injury, natural and technological disaster, bereavement and loss, violence, sexual abuse, and war exposure) is a strong predictor of levels of intrusive and avoidant symptoms after a traumatic event. Intrusive and avoidant reactions reported by trauma victims tended to decrease linearly over time after the trauma. This finding was supported by the results reported by 20 different studies of stress reactions at two different time points after various events. Gender and cultural difference were relatively insignificant, whereas type of event induced different levels of stress reactions as measured with the IES. Conclusion These data provide evidence for the value of the IES as a measure of stress reactions in a number of different populations. Data summarized here will be useful as a comparison resource in future studies of stress response syndromes.

Life Event Questionnaires for Measuring Presumptive Stress

&NA; Cumulative stress from the impact of life events has become an important variable in psychosomatic and psychological research. This article provides both short and long life events questionnaires that add to incidence information the remoteness or recency in time of a given experience. In the weight assignment system that leads to a single presumptive stress score, events remote in time have less influence than recent events. The reliability of weight assignment was checked in subject groups that differed by sex, age, and status. Women weighted life events as more stressful than did men; other differences in groups were less important. In spite of the sex differential, review of these data suggests use of the same weight assignments for all subgroups rather than differential weighting by sex and age. Reliability was also checked by test and retest methods in contrast to common sense expectation, a disappointingly low level of reliability was found. The implications for investigative use of life events questionnaires are discussed.

Pathological grief: diagnosis and explanation.

&NA; Pathological grief deserves a place in the diagnostic nomenclature. Because posttraumatic stress disorder requires an event beyond the range of usual experience and bereavement is virtually a universal experience, a new diagnosis of signs and symptoms precipitated by a loss event is needed. Many varieties of pathological grief have been noted in clinical research studies, and multiple diagnoses of pathological grief would make research difficult. The authors advance a solution in a personality‐based explanation of abnormal responses to loss events; this allows for a single diagnosis of pathological grief. The authors also present a predictive model to partially explain pathological grief by antecedent trait combinations. The hypothesis is that persons with a preloss combination of both contradictions in relational schemas about the deceased and tendencies toward excessive control to stifle unwanted affect will tend to have unsuccessful processes of mourning. Types of contradictions and overcontrol may vary, yielding personality‐based varieties of response within a single diagnostic category.

A scale for measuring the occurrence of positive states of mind: a preliminary report.

&NA; It may be as important to measure a failure to achieve desirable states of mind as it is to measure negative moods. The proposed measure of positive states of mind was found to be internally consistent, sensitive to degrees of life stress, well accepted, quick to administer, and amenable to use as a repeated measure in longitudinal studies. Data from 187 men and women in a college student sample are reported.

A Model of Mourning: Change in Schemas of Self and Other

The mourning process may serve an evolutionary purpose, one that has allowed maximum survival characteristics. By passage through the phases of grief, the bereaved person prepares to make new commitments to others and to accept new personal roles. This passage involves an unconscious change in mental structures of meanings about the self and other people. This paper examines mourning in terms of such person schemas.

Reactions to the death of a parent. Results from patients and field subjects.

The authors studied two groups of persons who had experienced either the death of a mother or father. One group consisted of patients who had sought treatment because of pathological aspects of bereavement. The other group consisted of volunteers selected from a review of hospital death records, which indicated the recent death of their parent. The study used a nonequivalent groups design, where both groups were followed over time. The field subjects were initially seen much sooner after the death than the patients. The patient group received a time-limited dynamic therapy focused on the stress response syndrome induced by the death. At the pretherapy evaluation point, the patient sample had significantly higher levels of symptomatic distress than did the nonpatient sample. The distress declined over a 13-month period, so that patients had comparable levels of distress to that of the field subjects. After adjusting for initial values, the main difference was that patients reduced their avoidant operations more than did the field subjects. Intervening variables were assessed for the prediction of change in symptoms over time as related to the parental death. The variables that showed significant correlations to symptomatic change were cumulative negative life events from varied sources, occupation, social class, developmental level of the self-concept, identity of the deceased parent, and attribution of blame for the death. Social support did not relate to change in symptoms over time.