Paulomi M. Sudhir

Dimensions of perfectionism and perfectionistic self-presentation in social phobia

In a cross sectional study we examined the dimensions of perfectionism and perfectionistic self-presentation in patients with social phobia. We also examined associations between perfectionism and self-report of anxiety and depression with fear of negative evaluation. Thirty patients with a diagnosis of social phobia and 30 community volunteers completed two measures of trait perfectionism, fear of negative evaluation and measures of anxiety and depression. The clinical sample had overall higher levels of perfectionism and had greater fear of negative evaluation, social anxiety, trait anxiety and depression than the community sample. The clinical sample had significantly higher concern over mistakes, doubts over actions, parental criticism (F-MPS, Frost et al., 1990) and scored higher for non-display of imperfection on the Perfectionistic Self Presentation Scale (PSPS; Hewitt et al., 2003). The two groups did not differ on other dimensions of perfectionism, or on both measures of perfectionism. The two measures of perfectionism were positively correlated. There was a significant correlation between trait perfectionism and Brief Fear of Negative Evaluation scale (BFNE). The paper discusses the importance of examining perfectionism in social phobia.

Interpersonal sensitivity and dysfunctional cognitions in social anxiety and depression

This exploratory study assessed interpersonal sensitivity and dysfunctional cognitions in patients with social phobia and depression. Thirty patients with social phobia/depression were compared with community sample of 30 participants on measures of interpersonal sensitivity and dependency. The clinical sample also responded to measures of dysfunctional cognitions, anxiety and depression. Test retest reliability for the IPSM was established. Results indicated higher interpersonal sensitivity and dependency in clinical sample and positive correlations between interpersonal sensitivity, dependency and dysfunctional attitudes. Anxiety was associated with both interpersonal measures. The paper discusses implications of interpersonal sensitivity for psychological interventions and cultural differences.

Comprehensive management of psychogenic dysphonia: A case illustration

UNLABELLED Psychogenic dysphonia refers to the loss of voice, in the absence of apparent structural or neurological pathology. It is a disorder seen more often in women and is usually associated with significant life events and emotional difficulties that may lead to conflict over speaking. Therapeutic interventions in voice disorders recommend the adoption of a multidisciplinary approach to treatment. The following is a case illustration of a 50-year-old married lady with dysphonia and significant marital difficulties. LEARNING OUTCOMES The case demonstrates the psychological issues in the onset and maintenance of psychogenic voice disorders. It also emphasizes the use of a multidisciplinary approach consisting of cognitive behavioural strategies, pharmacological inputs and voice therapy. The case illustration will also help the reader to focus on cultural issues relevant in the development of problems and the need to address these in psychotherapeutic interventions, as well as difficulties that are likely to be encountered in therapeutic interventions.

Clinical Psychology in India

Scientific Psychology in India has seen steady development since its inception in the early 1900s. With clinical psychology developing as an independent profession, clinical psychologists have been functioning in various roles, offering a wide range of services in consultation, training, research, and private practice on multidisciplinary teams as well as in independent practice. This paper focuses on the historical roots of clinical psychology in India and highlights the role of clinical psychologists in the general mental health care and the contributions made by the profession in a wide range of public and private health care settings. Ancient Indian systems of Medicine, mental health care and psychotherapy in India, and training-related and organizational issues are discussed. This paper reflects on the growth and development of clinical psychology that has occurred in India in spite of current difficulties and the challenges that lie ahead.

Mindfulness-based cognitive behavior therapy in patients with anxiety disorders: A case series

The present study is aimed at evaluating the effectiveness of a Mindfulness-Based Cognitive Behavior Therapy (MBCBT) for reducing cognitive and somatic anxiety and modifying dysfunctional cognitions in patients with anxiety disorders. A single case design with pre- and post-assessment was adopted. Four patients meeting the specified inclusion and exclusion criteria were recruited for the study. Three patients received a primary diagnosis of generalized anxiety disorder (GAD), while the fourth patient was diagnosed with Panic Disorder. Patients were assessed on the Cognitive and Somatic Anxiety Questionnaire (CSAQ), Penn State Worry Questionnaire (PSWQ), Hamiltons Anxiety Inventory (HAM-A), and Dysfunctional Attitudes Scale. The therapeutic program consisted of education regarding nature of anxiety, training in different versions of mindfulness meditation, cognitive restructuring, and strategies to handle worry, such as, worry postponement, worry exposure, and problem solving. A total of 23 sessions over four to six weeks were conducted for each patient. The findings of the study are discussed in light of the available research, and implications and limitations are highlighted along with suggestions for future research.

Quality of life in anxiety disorders: Its relation to work and social functioning and dysfunctional cognitions: An exploratory study from India

The aim of the study was to examine quality of life, functioning, disability, work and social adjustment, depression, anxiety and dysfunctional cognitions in patients with anxiety disorders. One hundred patients with anxiety disorders and 98 non-clinical participants were recruited for the study. A cross sectional design was adopted. The participants were assessed on the WHOQoL-BREF, Global Assessment of Functioning (GAF), Sheehan Disability Scale (SDS), the Work and Social Adjustment Scale (WSAS) and Dysfunctional Attitudes Scale (DAS). Data was analyzed using descriptive statistics, Mann-Whitney test, Spearmans Rho and regression analysis. Patients with anxiety disorders reported significantly lower quality of life than the community sample (df=98, p<.001). A shorter duration of illness was associated with lower quality of life. QoL was significantly correlated with severity of anxiety, depression and stress as well as with measures of disability and adjustment. Partial correlations indicated that depression did not significantly impact the relationship between work and social adjustment and QoL. Work and social adjustment, depression and dysfunctional cognitions emerged as significant predictors of QoL. The findings of the study are discussed in the light of existing research and the implications for future interventions are highlighted.

Feasibility and effectiveness of the Integrated Psychological Therapy (IPT) in patients with schizophrenia: a preliminary investigation from India

Functional outcome is an important index of recovery in patients with Schizophrenia (SZ). Several factors impact social functioning, including neurocognition. The Integrated Psychological Therapy (IPT) has been effective in improving social-functioning in SZ patients, but needs to be evaluated for its feasibility and impact in the Indian subcontinent. The study examined the effectiveness of the IPT on neurocognition and social functioning in patients with SZ. An open label design with baseline, post-intervention and 3-month follow-up assessments was adopted. Twenty nine clinically stable out-patients with schizophrenia/schizo-affective disorder (DSM IV-TR) providing written informed consent were recruited, of whom 23 completed the intervention. Patients were assessed on tests of neurocognition, social functioning and symptomatology. Following baseline assessment, patients received 16-20, 1h individual sessions of the IPT over 2.5-3 months. The structure and content of the IPT was modified to make it culturally appropriate for the Indian subcontinent. Therapy comprised of psycho education and the first four modules of the IPT. Repeated measures analysis of variance (RMANOVA) for the completers sample (N=23) indicated significant improvement in social-functioning, symptom severity and certain domains of neurocognition following the intervention. Large effect sizes of 1.21 and 1.01 were obtained for scores on Social and Occupational Functioning Scale (SOFS) and Groningen Social Disabilities Schedule (GSDS) respectively at 3-month follow-up. The IPT was effective in improving social-functioning and neurocognition in Indian patients with SZ. The study demonstrated the durability of these improvements.

Perfectionism, emotion regulation and their relationship to negative affect in patients with social phobia.

Context: Research on the perfectionism and emotion regulation strategies in anxiety disorders has gained increased attention. These have an important implication for formulation of therapies. Aims: We examined perfectionism, emotion regulation were examined in 30 patients with social phobia (SP) and 30 community participants. Settings and Design: A cross-sectional design using a clinical and a community control sample was adopted in this exploratory study. Materials and Methods: Participants were assessed on The Mini-International Neuropsychiatric Interview, Frosts-Multidimensional Perfectionism Scale, Ruminative Response Scale of the response style questionnaire, cognitive emotion regulation questionnaire, Social Interaction Anxiety Scale and the Becks Depression Inventory. Statistical Analysis: Data was analyzed using independents samples t-test and Pearsons Product moment correlations and step-wise linear regression. Results: Individuals with SP had higher perfectionism (mean = 100.30, SD = ±17.73, t = 7.29, P < 0.001), rumination (mean = 61.47, SD = ±11.96, t = 6.71, P < 0.001) and lower levels of positive reappraisal (mean = 11.53, SD = ±3.85, t = 4.90, P < 0.001). Perfectionism was correlated with social anxiety (r = 0.44, P < 0.05) and rumination (r = 0.43, P < 0.05), but not with depression. Rumination was positively correlated with both social anxiety (r = 0.513, P < 0.01) and depression (r = 0.485, P < 0.01). Positive reappraisal was negatively correlated with depression (r = -0.396, P < 0.05) and anxiety (r = -0.335, P < 0.05). Acceptance was found to be significantly correlated only to the reflective pondering subscale of rumination. Parental criticism was a significant predictor of social anxiety (F = 11.11, P < 0.01) and brooding predicted depression (F = 10.49, P < 0.01). Conclusions: This study highlights the role of perfectionism as a maintaining factor in SP and the importance of adaptive forms of emotion regulation that need to be addressed in psychological interventions.

Effectiveness of metacognitive therapy in patients with social anxiety disorder: A pilot investigation

Metacognitive therapy (MCT) is a recent psychological intervention for emotional disorders. Its efficacy in social anxiety disorder (SAD) is yet to be established. Aims: We examined the effectiveness of an MCT in patients with SAD. A two group case–control design with baseline, post, and 3 months follow-up was adopted. The control group received training in applied relaxation (AR). Four patients with Diagnostic and Statistical Manual-IV diagnosis of social anxiety were sequentially allotted to receive either MCT or AR. Patients were assessed on postevent processing (PEP), social anxiety, depression, and fear on negative evaluation. Clinical significance was calculated. MCT was more effective than AR in reducing social avoidance, PEP, and self-consciousness. While overall both interventions were effective in reducing social anxiety, MCT was marginally more effective. MCT may be a promising therapeutic approach in the management of SAD.

Inclination to speeding and its correlates among two-wheeler riding Indian youth.

Context: Concerns about road safety have been increasingly associated with two-wheeler riding and especially with young commuters in India. Aims: The study was designed to explore inclination to speeding and to profile the driving behaviors in two-wheeler riding young men and women who reported a tendency to ride faster than their peers. Design: A cross-sectional survey design was used. Materials and Methods: On the basis of three focus group discussions and review of literature, a survey was prepared to tap domains such as affect states associated with riding/speeding, factors contributing to speeding, inclination for competing, perceived speed and safety, etc. The study sample comprised of 961 two-wheeler riding college-going young men and women in Bangalore. Statistical Analysis: Descriptive and inferential statistical procedures were used including Chi-square, Spearman′s rank correlation, and independent sample t-test. Results: The sample was divided into two subgroups on the basis of self-report of greater speeding than one′s peers. A subgroup of 349 participants endorsed the item regarding inclination to ride faster than one′s peers, whereas, the remaining 612 participants did not endorse it. The profiles of these two subgroups were obtained in terms of sociodemographic variables, riding behaviors, and associated domains. Significant differences between the subgroups emerged on domains such as motives for riding fast, tendency for competing, perceived safety and frequency of minor accidents while riding. Conclusions: Several correlates of the tendency to speeding among young two-wheeler riders emerged that have implications for enhancing safe riding.