Mervin R. Smucker

Factor analysis of the Children's Depression Inventory in a community sample

The factor structure of the Childrens Depression Inventory (CDI; M. Kovacs, 1992) was evaluated in a large community sample of 1,777 children and 924 adolescents. There were 5 first-order factors (Externalizing, Dysphoria, Self-Deprecation, School Problems, and Social Problems) for the child group; the adolescent group yielded the same 5 factors plus a 6th factor (Biological Dysregulation). Confirmatory factor analyses supported the stability and replicability of the obtained factor structures. Both samples yielded 2 higher order factors-Internalizing and Externalizing. The factors were compared with previous CDI factors identified for clinical (B. Weiss et al., 1991) and community (M. Kovacs, 1992) samples. Other notable findings included more boys reporting high scores (17 and above) on the CDI among the child sample, whereas, among adolescents more girls reported high scores (17 and above) on the total CDI as well as higher scores on the biological dysregulation factor.

Imagery rescripting: A new treatment for survivors of childhood sexual abuse suffering from posttraumatic stress.

Imagery rescripting is presented as a new treatment of posttraumatic stress disorder (PTSD) for adult survivors of childhood sexual abuse. A theoretical discussion illustrates the model’s consistency with schema theory and information processing models of PTSD, and suggests that the rescripting process may effect change in pathological schemas associated with interpretation of the traumatic event(s). It is proposed that this combination of imaginal exposure, mastery imagery, and cognitive restructuring goes beyond extinction models to alter recurring images of the trauma and create more adaptive schemas. Hypothesized mechanisms for PTSD symptom reduction are presented, implications for cognitive restructuring are noted, and the model’s potential for facilitating personal empowerment and self-nurturance are discussed. Preliminary outcome research data are summarized that support the efficacy of imagery rescripting in significantly reducing PTSD symptomatology with this population.

Treating incest-related PTSD and pathogenic schemas through imaginal exposure and rescripting

The prevalence of posttraumatic stress disorder (PTSD) among adult survivors of childhood sexual abuse indicates a need for the development of effective therapeutic interventions. This article presents one such treatment, Imagery Rescripting, that combines imaginal exposure with mastery imagery. Imagery Rescripting is based on an expanded information processing model that conceptualizes the recurring traumatic memories of the abuse survivor both within a PTSD framework and as part of the patients core schemata. A rationale for the model is provided by a review of relevant information processing theories of PTSD and a discussion of the effects of sexual trauma upon schema formation. The treatment procedure is briefly described, results of a pilot study supporting the efficacy of Imagery Rescripting are cited, and its application is illustrated by means of a case study. It is proposed that Imagery Rescripting facilitates adaptive processing of childhood traumas by reducing intrusive PTSD symptoms and modifying abuse-related beliefs and schemas.

When prolonged exposure fails: Adding an imagery-based cognitive restructuring component in the treatment of industrial accident victims suffering from PTSD

Prolonged exposure (PE) is a widely promulgated treatment modality for PTSD. While successful with many subjects, PE also has a significant failure rate (i.e., dropouts, nonimprovement, symptom exacerbation). To date, outcome research has not examined why PE at times appears to be the treatment of choice for PTSD and why it sometimes needs to be combined with cognitive restructuring interventions to be effective. This study presents a detailed cognitive-behavioral analysis of two industrial victims suffering from PTSD who failed to benefit from PE alone, but who subsequently made a quick and lasting recovery when an imagery-based, cognitive restructuring component was added to their exposure treatment. A comparative analysis is presented of the theoretical underpinnings and treatment components of the behavioral and cognitive treatments used with the subjects in this study—PE and imagery rescripting and reprocessing therapy (IRRT). PE is a behavioral treatment based upon theories of classical conditioning that relies on exposure, habituation, desensitization, and extinction to facilitate emotional processing of fear. By contrast, IRRT is cognitive therapy applied in the context of imagery modification. In IRRT, exposure is employed not for habituation, but for activating the trauma memory so that the distressing cognitions (i.e., the trauma-related images and beliefs) can be identified, challenged, modified, and processed.

Is type-D a stable construct? An examination of type-D personality in patients before and after cardiac surgery

OBJECTIVE Type-D personality-negative affectivity and social inhibition-are related to poor prognosis in cardiovascular diseases. At present, little is known about type-D personality and its stability before and after cardiac surgery. METHODS One hundred twenty-six patients recommended for coronary bypass and/or valve surgery were examined at pre-surgery and 6 months post-surgery to investigate the stability of type-D (14-item Type-D Scale) and its relationship to anxiety, depression (Hospital Anxiety and Depression Scale) and quality of life (Short Form 12). RESULTS Preoperatively, 26% were assessed to have type-D, while only 11% fulfilled type-D criteria both pre- and post-surgery. Patients were assessed and identified as belonging to one of the four type-D groups: Stable type-D (11%), non-type-D (61%), type-D pre (15%), and type-D post (13%). In comparison to the stable non-type D group, the stable type-D reported more symptoms of anxiety, depression, lower physical quality of life post-surgery, and lower mental quality of life both pre- and post-surgery. When compared to the population at large, stable type-D had more symptoms of depression pre-surgery, and more anxiety as well as lower physical and mental quality of life pre- and post-surgery. CONCLUSION Type-D diagnosis changed in nearly 60% of the cases post-surgery. Only those patients with stable type-D exhibited a relationship to emotional distress, such as anxiety and depression and reduced quality of life. Additional research on the critical cut-off scores and stability of type-D as it relates to critical life events would likely enhance our ability to more effectively diagnose and treat patients who are at high risk for insufficient coping.

Imagery rescripting for recurrent, distressing images

Intrusive images are a familiar aspect of daily experience that, when persistent and unwanted, may cause emotional distress. In many cases, images accompany disturbing and repetitive thoughts and ruminations. In others, images are the primary mental experience. This article describes the use of a therapy procedure—imagery rescripting (IR)—in the treatment of distressing intrusive images that occur spontaneously but are not memories of actual events or experiences (i.e., flashbacks, intrusive memories). Eleven individuals who reported recent onset of such images, and who did not benefit from brief treatment with imaginal exposure, subsequently improved significantly with one trial of IR. Subjective Units of Discomfort (SUDS) data and two case studies are presented. Results support the use of IR in the treatment of repetitive, distressing images that persisted despite previous personal efforts (distraction, reasoning) and clinical intervention with imaginal exposure.