bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive Case Conceptualization and Treatment of Anxiety Disorders: Implications of the Looming Vulnerability Model
Authors: Riskind John H. , Williams Nathan L.
Published: September 2018

This article describes an approach to cognitive case conceptualization and treatment that is based on the “looming vulnerability” model of anxiety. The model assumes that much of what produces anxiety for people in everyday life, as well as in cases of pathological anxiety, is “looming” from their point of reference, or changing dynamically and step-by-step in time to become increasingly risky. That is, they have a “sense of looming vulnerability” to threat—perceptions of threat as moving toward an endpoint or rapidly rising in risk. Anxious individuals manifest biases in their primary cognitive appraisals (a painful sense that perceived threats are rapidly approaching, changing, or escalating in risk), and in consequence, feel “pressed” to urgently cope with or neutralize the looming threat. The net result of their sense of urgency is that they often select maladaptive, rigid coping strategies (e.g., avoidance and escape) and underestimate their personal efficacy to effectively deal with the oncoming dynamic threats (i.e., biased secondary appraisal). We suggest that anxiety is often based on dynamic, story-like scripts, called progressive threat scripts. The present article identifies several ways that cognitive therapists can conceptualize, identify, and modify features of patients’ mental simulations of present or developing threat (i.e., distance, motion, speed, and perspective). The article also addresses several features of anxious patients’ response to threat that are relevant to cognitive case conceptualization and treatment (i.e., generating alternative simulations, time structuring, proactive coping, and the enhancement of dynamic personal efficacy for dealing with rapidly rising risk).
Ward, I’m Worried About the Beaver: Issues in Early Identification and Intervention With Children Experiencing Depression and Anxiety
Authors: Friedberg Robert D. , Crosby Lori E. , Friedberg Barbara A.
Published: September 2018

Childhood anxiety and depression are commonplace yet often neglected problems. This article briefly summarizes information on the prevalence and developmental chronology of these disorders. Innovative intervention methods are presented and described. Finally, a section alerting readers to salient issues germane to working with children of color who experience depression and anxiety is included.
Systemic and Clinical Strategies for Preventing School Refusal Behavior in Youth
Authors: Kearney Christopher A. , Hugelshofer Daniela S.
Published: September 2018

This article summarizes clinical aspects of school refusal behavior and school dropout as well as community, school, parent/family, social, personal, and academic success predictors of these problems. In addition, systemic strategies to prevent school refusal behavior and dropout are discussed. These include community-, school-, and parent/family-based strategies that emphasize professional collaboration and support to reduce absenteeism. Furthermore, clinical strategies to prevent school refusal behavior and dropout in individual cases are described. These clinical strategies include photographs, videotaping, structured activities outside the home, booster sessions, and introduction to a new school. Suggestions are also made for youth with chronic school refusal behavior and for addressing full-blown relapse.
A Partial Component Analysis of Beck’s Cognitive Therapy for the Treatment of General Anger
Authors: Dahlen Eric R. , Deffenbacher Jerry L.
Published: September 2018

Eighty-six high-anger undergraduates were assigned to eight group sessions of Beck’s full cognitive therapy (FCT) focusing on both cognitive and behavioral change, cognitive restructuring only (CRO) focusing only on cognitive change, or a no-treatment control. Analyses suggested treatments were delivered in an equivalent, high-quality manner and that therapists adhered to treatment protocols. By 5-week follow-up, treatment groups, while not differing from each other, showed reductions in trait anger, cognitive, emotional, and behavioral components of anger, the individual’s greatest ongoing source of anger, and anger-related physiological arousal. Treatments lowered anger suppression and outward negative expression and enhanced controlled expression. Compared to controls, CRO also reduced trait anxiety and depression. Treatment effect sizes were medium (η2 = .06 to .13) to large (η2 > .13), and more treatment participants met a clinically reliable change index on trait anger. Findings support FCT and CRO for general anger reduction.
Update in Cognitive Therapy for Depression
Authors: Blackburn Ivy-Marie , Moorhead Steve
Published: September 2018

In this review article, the evolution of the cognitive theory of depression is described and new theories, inspired by cognitive science, are examined. The results of major meta-analyses of controlled outcome studies of cognitive therapy (CT) in depression, as well as of recent outcome and follow-up studies, are reported. Current controversies regarding the efficacy of CT in depression and the role of process variables in outcome are evaluated. Finally, a short case study is reported to illustrate the model, structure, and process of therapy with a depressed patient who also demonstrates two syndromes of personality disorder.
The Relationship Between Patient Pretreatment Interpersonal Schemas and Therapeutic Alliance in Short-Term Cognitive Therapy
Authors: Soygüt Gonca , Nelson Liane , Safran Jeremy D.
Published: September 2018

This pilot study examined the relationship between interpersonal schemas (as measured by the Interpersonal Schema Questionnaire) and the therapeutic alliance (as measured early in treatment by a patient self-report version of the Working Alliance Inventory) in short-term cognitive therapy. Twenty-six (15 men, 11 women) patients participated in this study. Findings revealed that the complementarity of expected responses in submissive situations was positively associated with therapeutic alliance, whereas the complementarity of expected responses in dominant situations and the desirability of these responses were negatively related to therapeutic alliance.
Are the Short and Long Forms of the Young Schema Questionnaire Comparable and How Well Does Each Version Predict Psychopathology Scores?
Authors: Stopa Lusia , Thorne Peter , Waters Anne , Preston Jackie
Published: September 2018

Young’s Schema Questionnaire (YSQ; Young & Brown, 1994) was developed to measure schemas that may need to be modified during therapy. This study examines whether the long and short forms of the YSQ produce comparable scores in a heterogenous group of psychiatric outpatients. The study also looks at how well each version predicts psychopathology measured by the SCL-90 -R (Derogatis, 1977). The results of this study show that the two versions of the YSQ have similar levels of internal consistency, parallel forms reliability and concurrent validity, and indicate that the short from can be used with reasonable confidence by the clinician and researcher. Both versions of the YSQ were modest predictors of psychopathology scores and each version produced slightly different patterns of predictions although there was overlap between the predicted schemas in each version.
Cognitive-Behavioral Therapy With Couples: Empirical Status
Authors: Epstein Norman
Published: September 2018

This article briefly summarizes the behavioral, cognitive, and affective factors that have been implicated in couples’ relationship problems, describes representative interventions for those factors, and reviews the current status of outcome research on cognitive-behavioral therapy for couples. Although the initial studies have provided encouraging findings concerning the effectiveness of cognitive-behavioral treatment for distressed couples, limitations in the number and scope of the studies leave many unanswered questions. In particular, studies have not assessed the impact of cognitive-behavioral couple therapy as it is conducted in clinical practice. Additional research is needed to address issues such as the relative efficacy of different cognitive restructuring interventions and the impact of integrating interventions targeting cognitive, affective, and behavioral aspects of relationship problems.
Schema Theory: A Framework for Research and Practice in Psychotherapy
Authors: Pace Terry M.
Published: September 2018

Both the nature of human problems and the process of behavioral change are increasingly being viewed from a cognitive-structural perspective. The concept of a cognitive schema seems to be the major theoretical construct used by researchers studying how cognitive structures influence human behavior. Schemas are fundamental cognitive structures, derived from past experience. Schemas operate by selectively organizing the on-going experience of each person into subjectively meaningful patterns. Through the operation of schemas, people are active constructors of their own psychological realities. This article presents an overview of the philosophical, historical, and theoretical foundations of schema theory. The relevance of schema theory for psychotherapy is presented through a discussion of schema oriented cognitive-behavioral theorists. A specific application of a schema framework in psychotherapy is illustrated by research on depressive self-schemas. It is hoped this article will serve as a stimulus to the continued application of schema oriented cognitive-structural approaches to research and practice in psychotherapy.
Does Mood Affect Reasons for Living? Yes
Authors: Ellis Jon B. , Range Lillian M.
Published: September 2018

Adaptive life-maintaining characteristics, which may be present in non-suicidal people and absent in suicidal people, have received little attention. This study examined the relationship between these adaptive characteristics and mood by giving the Reasons for Living Inventory (RFL) to 199 college students, a group that has recently been shown to be at high risk for suicidal behavior. Subjects completed the RFL, experienced a mood induction or served as a control, and then completed the RFL a second time. Analyses of variance of RFL change scores indicated that elated subjects differed from all others in overall RFL and responsibility to family scores, which improved while others remained about the same. Also, depressed subjects differed from all others in their survival and coping beliefs, which dropped while others remained about the same. These results suggest that a brief intervention such as a mood manipulation technique may positively or negatively affect reasons that people have for not committing suicide.
Patterns of Addiction: A Rational-Emotive Perspective
Authors: DiGiuseppe Raymond , Mclnerney John
Published: September 2018

While Rational-Emotive Therapy (RET) has enjoyed continued popularity as a treatment for addictive disorders, it is rather vague in specifying the relationships between irrational beliefs, emotions, and addictive behavior. This article attempts to correct this by presenting four possible relationships between activating events, irrational beliefs, and emotions which could lead to addictive behavior. Clinical strategies are presented for treating each pattern.
The Adult Problem Solver as Person Scientist
Authors: Strohmer Douglas C. , Blustein David L.
Published: September 2018

In this paper, we take the position that viewing the adult problem solver as a lay or person scientist provides a useful model for understanding the types of difficulty adults have in problem solving, and suggests a number of useful interventions for dealing with these difficulties. Problems and interventions are reviewed in three areas: making observations, generating tentative solutions (inferences), and testing the utility of these tentative solutions (hypothesis testing).

Let us then, instead of occupying ourselves with man, the biological organism, or man, the lucky guy, have a look at man the scientist. Might not the individual man, each in his own personal way, assume more of the stature of a scientist, ever seeking to predict and control the course of events with which he is involved? Would not he have his theories, test his hypotheses, and weigh his experimental evidence? (Kelly, 1955, pp. 5-6).
Irrational Belief Tests: New Insights, New Directions
Authors: Robb Harold B. , Warren Ricks
Published: September 2018

Critical appraisals of the RET model have been accompanied by closer scrutiny of measures designed to assess irrational beliefs. Problems with content and discriminant validity (Smith, 1982), and inclusion of items which describe feelings or behaviors rather than beliefs (Ramanaiah, Heerboth, & Schill, 1987) compromise previous research testing the RET model. The present study further examines six measures of irrational beliefs: The Idea Inventory, Irrational Beliefs Test, Rational Behavior Inventory, Belief Scale, the Dysfunctional Attitude Scale, and the Attitudes and Belief Scale-II. Our findings support and extend previous criticisms of irrational belief inventories and suggest recommendations for improvement.
Patterns of Attachments and the Assessment of Interpersonal Schemata: Understanding and Changing Difficult Patient-Therapist Relationships in Cognitive Psychotherapy
Authors: Liotti Giovanni
Published: September 2018

The results of empirical studies of attachment behavior in children provide the cognitive psychotherapist with powerful conceptual tools that may be profitably used in some puzzling instances of patient’s behavior within the therapeutic relationship. Some patients ask energetically for the therapist’s reassurance and at the same time resist the therapist’s comforting responses. Others seem compelled to avoid any expression of personal vulnerability as soon as they perceive the therapist’s empathic availability to listen to their painful emotional experiences. Other patients utter their requests for help in a most confused, mutable and contradictory way. When the therapist deals with such kinds of therapeutic relationship, the knowledge of the representational models of self and the attachment figure that may be inferred from abnormal patterns of attachment (anxious-resistant, avoidant and disorganized/disoriented attachments) guides the assessment and change of the patient’s interpersonal schemata in a most profitable way.
Defusing Conceptual Fusions: The “Just Because” Technique
Authors: Elliott James E.
Published: September 2018

The author discusses a technique that can be taught to clients to help them challenge dysfunctional or irrational beliefs. The technique is useful for—“conceptual fusions”—beliefs consisting of two ideas that are not necessary entailments of each other but which are fused together in the client’s mind as if they were.
Narrative in Views of Humanity, Science, and Action: Lessons for Cognitive Therapy
Authors: Russell Robert L.
Published: September 2018

The role of narrative constructs in philosophical views of humanity, science, and action is presented and contrasted with more familiar constructs that influence cognitive therapy. In terms of philosophical views of humanity, the view of human beings as rational animals is contrasted with a novel view emphasizing humanity’s unique storytelling nature. In terms of the philosophy of science, a positivistic, somewhat realist view is contrasted with a constructivist view in which narrative plays an essential role in explaining how theory succession takes place. In terms of the philosophy of action, partitive, ahistorical accounts of action are contrasted with a more holistic, historical view, one which necessitates narrative to account for actions intentionally oriented to the realization of an agent’s desires. The turn toward narrative in each of these areas also provides lessons concerning innovative ways to conduct cognitive therapy. In concluding, it is suggested that further investigation of narrative processes in cognitive therapy can broaden and deepen our understanding of the representational process undergirding adaptation and change.
Scripts in Cognitive Therapy: The Systemic Perspective
Authors: Leahy Robert L.
Published: September 2018

Scripts are identified as role patterns which provide self-consistency and consistency in the behavior of others. Script holders construct an interpersonal reality which reaffirms their automatic thoughts and self-other schemas. Consequently, scripts are difficult to modify using traditional cognitive therapy techniques. Two scripts—the Victim and the Acquisitor Narcissist--are described and cognitive-systemic interventions suggested. The implications of scripts for transference interpretations and interventions are indicated. Finally, developmental analysis of these scripts is advanced as a therapeutic strategy.
Participants’ Memories for Therapeutic Events and Ratings of Session Effectiveness
Authors: Cummings Anne L. , Hallberg Ernest T. , Slemon Alan , Martin Jack
Published: September 2018

We investigated various relationships between therapists’ and clients’ memories for important therapeutic events and their assessments of the effectiveness of therapy sessions in 11 therapy dyads. Results showed that clients had greater accuracy of recall of important events for sessions they rated as more effective. There was also a greater match between therapists and clients in their choice of important events for more effective sessions. Finally, therapists displayed greater overall accuracy of recall than did clients. Implications of these results for therapeutic work are explored.
Use of Anthetic Dialogue In Eliciting and Challenging Dysfunctional Beliefs
Authors: Elliott James E.
Published: September 2018

The author discusses a technique for eliciting and challenging dysfunctional beliefs, based on the idea that such beliefs seem to have their source in an inferred internal agency known as the inner critic. Various conceptions of the inner critic are listed. An adaptation of the empty chair technique is described, which the clinician can use to elicit the inner critic’s voice as a phenomenological reality that issues dysfunctional messages, which, when accepted by the person, become dysfunctional beliefs. Once the messages are verbally expressed, they can be disputed and countered using cognitive-behavioral methods.
Developmental Constructivism: An Integrative Framework for Psychotherapy Practice
Authors: Lyddon William J.
Published: September 2018

This article (a) describes the role of feedback mechanisms in developmental constructivist conceptions of new learning and change and (b) suggests that such mechanisms may function as a common change factor in psychotherapy. Salient sources of feedback identified with diverse psychotherapy approaches are described and conceptualized in constructivist terms. It is concluded that developmental constructivist epistemology may serve as a viable integrative framework for psychotherapy practice.
Assessing the Intensity of “Appropriate” and “Inappropriate” Emotions in Rational-Emotive Therapy
Authors: Kassinove Howard , Eckhardt Christopher , Endes Russell
Published: September 2018

We examined the perceived intensity of common emotion words. 369 undergraduates rated the intensity of verbal stimuli which represented hypothesized inappropriate/appropriate negative affect tokens (depressed/sad, anxious/concerned, angry/annoyed, and guilty/regretful) and positive affect tokens. Each stimulus was presented with the modifiers “very” and “mildly,” and without a modifier. As expected, for each of the four negative emotion categories the hypothesized inappropriate emotion token was rated as more intense. However, the intensity level accounted for by the modifiers was six to seven times greater than the intensity level accounted for by the emotion words themselves. These data lead us to question Ellis’ recent view wherein he decided that the appropriateness of an emotion refers to quality, rather than intensity. We believe it is wise for clinicians to pay close attention to the modifiers used by their clients when emotions are expressed.
Using Releasing Statements to Challenge Shoulds
Authors: Elliott James E.
Published: September 2018

This article presents a new method for challenging internal imperative shoulds based on the idea that such shoulds have their origin in an internal voice called the inner critic, and constitute attempts to deprive the individual of her or his rights. The method consists of taking back one’s rights by making releasing statements — statements which release the person from the oppression of the inner critic.
Cognitive Therapy for Generalized Anxiety Disorder: Significance of Comorbid Personality Disorders
Authors: Sanderson William C. , Beck Aaron T. , McGinn Lata K.
Published: September 2018

Thirty-two patients diagnosed with generalized anxiety disorder were treated with cognitive therapy. Patients attended weekly one-hour sessions and there was no predetermined duration of treatment. Prior to treatment, each patient was evaluated for a comorbid personality disorder (PD) using the Structured Clinical Interview for the DSM-ffi-R Personality Disorders (SCID-II). Patients completed the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) at the intake evaluation and at their final session. Sixteen of the 32 patients were diagnosed with a comorbid PD at the intake evaluation. A total of 22 patients completed a minimum course of cognitive therapy, which was defined as six sessions. Overall, there was a significant reduction of BAI and BDI scores for patients with and without a PD. There was no significant difference between the two groups. However, patients with a comorbid PD were more likely to drop out of treatment Seven of the 10 dropouts had a comorbid PD as compared to only 9 out of the 22 completers.
Cognitive Narrative Psychotherapy: The Hermeneutic Construction of Alternative Meanings
Authors: Gonçalves Oscar F.
Published: September 2018

Cognitive psychotherapies are experiencing dramatic conceptual changes. An increasing constructivist orientation along with a narrative model of the knowing processes is apparent in the most recent developments in cognitive theory. These changes demonstrate the need to develop new therapeutic methodologies able to effect deep changes in the knowing processes. This article tries to address these issues by presenting an illustration of a new therapeutic methodology hereafter referred to as cognitive narrative psychotherapy.
Cultural Relativism in Cognitive Therapy with Disadvantaged African American Women
Authors: Randall Elizabeth J.
Published: September 2018

Cognitive therapy is considered by many the treatment of choice for unipolar depression. Yet a number of the proven techniques of cognitive therapy depend on cultural assumptions which derive from the Western European tradition and may not be shared by ethnically diverse clients. In particular, concepts of time, and of personhood or the self, may differ considerably among minority clients. Modifications to the technique of cognitive therapy are discussed which may create a better fit between the world view of disadvantaged African American women and the cognitive model. Three case vignettes are presented including data on the use of these modifications in a practice situation using single subject design.
Cognitive—Behavioral Interventions with Avoidant Personality: A Single Case Study
Authors: Coon David W.
Published: September 2018

Studies of the outcome of cognitive-behavioral treatment of clients diagnosed with personality disorders are few and need further replication. This case study examines how Beck’s (Beck, Freeman, & Associates, 1990) and Young’s (Young, 1990; Young & Lindemann, 1992) schema-focused approach offers a helpful framework to use with an Avoidant Personality Disorder (APD) client. The findings point to the value of cognitive/behavioral strategies in restructuring Early Maladaptive Schema (Young, 1990) historically associated with APD, and in modifying many of the behavior patterns characteristic of APD.
Cognitive Hypnotherapy With Sexual Disorders
Authors: Burte Jan M. , Araoz Daniel L.
Published: September 2018

Research has found that in psychogenic sexual disorders, cognitive processes are more important than physiological ones. Negativistic “thinking” about one’s sexual activity aggravates the symptom and perpetuates it. Therefore, as vital as a differential diagnosis of sexual dysfunction is, the uncovering of Negative Self-Hypnosis (NSH) becomes essential for the successful resolution of the sexual problem. NSH constitutes the “hidden symptom” in all psychogenic sexual dysfunctions. After explicating NSH, the paper offers specific hypnotic techniques for different sexual disorders.
Imagery Rescripting: A New Treatment for Survivors of Childhood Sexual Abuse Suffering From Posttraumatic Stress
Authors: Smucker Mervin R. , Dancu Constance , Foa Edna B. , Niederee Jan L.
Published: September 2018

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.
Treatment of Clinical Depression in Caregivers of Spouses With Dementia
Authors: Kaplan Candia P. , Gallagher-Thompson Dolores
Published: September 2018

Anticipatory grief and clinical depression are common reactions in spousal caregivers of demented individuals. A novel method of treatment is offered in which grief counseling is combined with more traditional cognitive behavioral therapy based on the theoretical and clinical work of both Beck and Lewinsohn. This combined therapeutic approach is discussed in light of a prospective individual case study. Significant clinical improvement was noted in objective measures of depression across 17 sessions of individual therapy and at termination. The specific techniques used to promote change are identified along with the conceptual framework integrating cognitive behavioral therapy and grief counseling. This method may be particularly useful in light of the current need to maximize clinical improvement within the constraints of cost containment.
Are All Psychotherapies Cognitive?
Authors: Persons Jacqueline B.
Published: September 2018

The well-known failure to find differential mechanisms and outcomes of psychotherapies has led to the suggestion that all therapies share a common mechanism—perhaps even a cognitive mechanism. I suggest that all therapies can be seen as cognitive—but all therapies can also be seen as behavioral, biological, emotional, and interpersonal. In fact, cognitive therapy itself has many noncognitive components, including behavioral, biological, emotional, and interpersonal elements. I argue that one of these vantage points is not more “correct” than the others, but that different approaches to the study of psychotherapeutic change may be useful to test different hypotheses. Rather than reflecting the action of a single common mechanism that cuts across therapies, the commonality of elements across therapies and the failure to find mode-specific actions of therapies may reflect the crudity of the measurement approaches currently available for detecting therapeutic change.
Cognitive Therapy With the Core Beliefs of a Distressed, Lonely Caregiver
Authors: Dick Leah P. , Gallagher-Thompson Dolores
Published: September 2018

The purpose of this case study is to describe, in detail, a systematic approach that was used to modify a long-standing dysfunctional schema in a depressed female outpatient over the age of 60. In our opinion, this paper addresses a gap in the current cognitive therapy literature which contains very little description of methods for schema change. The client, Mrs. A., was depressed as a result of caring for her elderly mother who was suffering from advanced Alzheimer’s disease. She first received a 20-session course of treatment for her depression which focused on goals such as reducing guilt, setting limits, and making some time for her personal needs. After attaining these goals, she was given the opportunity to participate in an intense program of 18 additional individual sessions to evaluate and revise a key core belief, using an adaptation of Young’s (1990) method of the Historical Test of Schemas. This core belief was stated as follows: “In order to alleviate my feelings of inferiority, I must be all things to everyone.” Mrs. A was able to discuss the origin and the maintenance of this schema throughout her life, and she also was able to revise it in a way that allowed her to be more accepting of herself and her abilities.
An Analysis of Risk Assessment Questions Based on Loss-Averse Preferences
Authors: Guillemette Michael A. , Yao Rui , James Russell N.
Published: September 2018

A variety of risk assessment questionnaires are used within the financial planning profession to assess client risk preferences. Evidence indicates that the average person overweighs losses relative to an arbitrary reference point. This paper evaluated risk assessment questions on how well they correlate with monetary loss aversion. Twenty-nine Western Texas residents between the ages of 27 and 56 participated in experimental research and filled out several risk assessment questionnaires. Two weeks later their levels of loss aversion were measured using monetary gain and loss scenarios. The individual risk assessment questions were placed into three categories: expected utility theory, prospect theory and self-assessment. Composite measures were created for within-group and between-group comparisons. Statistically significant correlations were found between monetary loss aversion and different composite measures. The results provide financial planners with a group of risk assessment questions that capture loss-averse preferences.
The Social Security Statement: Its Contribution to Retirement Planning
Authors: Smith Barbara A.
Published: September 2018

The Social Security Statement is one of the most important outreach efforts of the Social Security Administration (SSA). In October 1999, SSA began sending out the Statement to inform Americans aged 25 or older about their estimated benefits and their earnings records. This article reviews the Statement's history, discusses how the public uses the Statement in retirement planning, and highlights how the Statement has increased the public's knowledge of Social Security. The article describes SSA tools and publications that the public can use in retirement planning. It concludes with suggestions for how financial educators, counselors, planners, and researchers might use the Statement and related survey data to inform the public about Social Security programs, benefits, and services.
Financial Stress and Financial Counseling: Helping College Students
Authors: Britt Sonya L. , Canale Anthony , Fernatt Fred , Stutz Kristen , Tibbetts Racquel
Published: September 2018

This study had two distinct purposes. First, to determine the predictors of financial stress among college students who sought free peer-based financial counseling from a large Midwestern university (N = 675). Secondly, to determine the effectiveness of the particular financial counseling center from a subsample of those who sought help (N = 97). Results of the regression analysis indicate that students more likely to experience financial stress include freshmen, those with low perceived mastery and net worth, and those with median student loan debt as compared to those with no student loan debt. Results of t-test analyses suggest that financial counseling had positive effects on subjective financial knowledge and financial attitudes and mixed effects on financial behaviors.
Resource Column: Information for Working Mothers
Authors: Montgomery Kristen S.
Published: September 2018

Women are entering, staying, or returning to the workforce following childbirth in increasing numbers. They report various amounts of success in the workplace after they become mothers. This column presents a review of five Web sites that provide useful resources to working Moms.
Deb’s Page: What If…?
Authors: Gauldin Deb
Published: September 2018

In this column, a childbirth educator wonders how to impress upon parents the importance of accepting their children for who they are, just as they are.
Focus Groups to Reveal Parents’ Needs for Prenatal Education
Authors: Dumas Louise
Published: September 2018

Focus group interviews are a useful qualitative research technique to obtain data from small groups about their opinions, attitudes, and/or feelings on a given subject. This particular technique has been used in Western Quebec in order to reveal the opinions, needs, and feelings of health professionals and future parents concerning prenatal education. As part of the region’s priorities for 2002, all future parents in this part of the province were to be offered prenatal, government-paid, community health education. Consequently, the Ministry of Health at the regional level sought a customized program for all community centers, based on identified regional needs and recent research. This program had to prove to be innovative, user-friendly, effective, and efficient. After reviewing the literature and conducting discussions with representatives from all regional health agencies throughout the province, the author of this article designed and conducted focus groups with perinatal health professionals from all community centers and hospitals of the Outaouais region. Later, focus groups were also conducted with parents. Following the analysis of the data and comparisons with existing resources, the author of this paper designed and proposed a specific program aimed at the empowerment of future parents. This paper reports the original problem and its context, the research methodology, and the proposed program (underlying philosophy, objectives, content, and educational techniques).
Smoking Hygiene: An Educational Intervention to Reduce Respiratory Symptoms in Breastfeeding Infants Exposed to Tobacco
Authors: Pulley Keri R. , Flanders-Stepans Mary Beth
Published: September 2018

The American Academy of Pediatrics recently removed nicotine from the category of drugs contraindicated during breastfeeding. Little evidence demonstrates that infants exposed to nicotine through breastfeeding experience increased health risks beyond the airborne risks associated with passive smoking. The purpose of this longitudinal, five-week, quasi-experimental pilot study was to determine whether “smoking hygiene,” an educational intervention, reduces the frequency of respiratory symptoms experienced by infants whose mothers both smoke and breastfeed. Twenty-nine mother-infant pairs entered the study with 28% dropping out. Of the 21 mother-infant pairs who completed the study, 66% of the nine infants in the control group experienced respiratory illness, compared to 42% of the 12 infants in the intervention group (x2 = .814; p mt .05). Thus, the difference was statistically nonsignificant in this small sample, but the trend worsened the anticipated direction. The study demonstrates some of the difficulties of intervening with this group of mothers.
Ask a Lawyer: Are LCCEs Exempt from Income Taxes?
Authors: Philipsen Nayna Campbell
Published: September 2018

Lamaze International Certified Childbirth Educators (LCCEs) may incorporate as tax-exempt organizations under the federal tax law if they meet all of the outlined requirements. They may then be considered exempt from income taxes for the purpose of any law that refers to tax-exempt organizations.
Selling Out Mothers and Babies by Marsha Walker
Authors: Gossler Sandra M.
Published: September 2018

The monitoring project reported in Marsha Walker’s book, Selling Out Mothers and Babies, offers a qualitative assessment of formula companies’ unethical marketing practices in the United States. The book presents extensive documentation on the questionable strategies of formula companies and how they avoid and circumvent recommendations of the International Code of Marketing of Breast Milk Substitutes.
Post-Ecstatic Birth Syndrome
Authors: Humenick Sharron S.
Published: September 2018

In this column, the author suggests the use of positive terminology as a way to influence the dominant viewpoint of childbirth towards the midwifery model of care.
Current Studies on Two Separate Topics: Breastfeeding Postpartum Length of Hospital Stay
Authors: Moore Mary Lou
Published: September 2018

In this column, the author examines recent research on two separate topics: 1) breastfeeding; 2) postpartum length of hospital stay. Recent studies suggest long-term effects of breastfeeding that benefit both mother and infant. Benefits include a reduced risk of breast cancer in breastfeeding mothers and a reduced level of total and LDH cholesterol in adults who were breastfed as infants. Infants of mothers with maternal asthma had lower rates of asthma if the mother breastfed. In a study of women in the United States who planned to breastfeed, those mothers who breastfed exclusively and planned to breastfeed more than three months were more likely to achieve their goals than mothers who planned to combine breast and human-milk substitute feeds and to breastfeed less than three months.

In a Canadian study, shortened postpartum stays led to increased re-admission to hospital for mothers with cesarean births. In contrast, in a Massachusetts study, shortened postpartum stays did not lead to an increase in infant visits for urgent care. However, the Massachusetts study did not reflect a decrease in maternity-related costs associated with shortened length of postpartum stay.
Breastfeeding Attitudes of WIC Staff: A Descriptive Study
Authors: Reifsnider Elizabeth , Gill Sara , Villarreal Patty , Tinkle Mindy B.
Published: September 2018

A sample of staff members from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC program) were interviewed about breastfeeding and their perceptions of WIC recipients’ views on breastfeeding. WIC staff members universally supported breastfeeding and expressed desires for more linkages between WIC agencies and perinatal education specialists in childbirth education classes, as well as with mothers during their postpartum hospital stay. The WIC staff members in this study reported on a variety of beliefs about breastfeeding held by their WIC clients, including cultural beliefs, the importance of family support, and experiences of pain during breastfeeding.
Childbearing Women’s Fears: At the Heart of “Choice”
Authors: Lothian Judith A.
Published: September 2018

In this column, the author examines how the promotion of medical birth feeds into women’s natural concerns about pregnancy and birth and, consequently, negatively influences their childbirth choices.
Overcoming Isolation of the New Mother
Authors: Humenick Sharron S.
Published: September 2018

Isolation is a frequently mentioned and long-remembered issue for new mothers in a North American culture. Perinatal educators can play a role in helping new parents build support systems that are designed to diminish the experience of postpartum and new-parent isolation.
Service Evaluation of Relaxation Workshops for Pregnant Women
Authors: Tabib Mo , Crowther Susan
Published: September 2018

This article reports a service evaluation of “antenatal education on physiology of childbirth and relaxation.” A service evaluation was carried out during group class discussion, immediately after the workshops, and following birth. Identified themes in the collected data were (a) my own relaxation, (b) confident, and not afraid, (c) proud of myself, (d) unexpected and feeling in control, and (e) support. Overall, women creatively customized the learned skills and reported feelings of pride and confidence. They reported feeling able to apply relaxation techniques when unexpected situations arise. Support and encouragement from partners and midwives were also valued by women. The evaluation demonstrates the efficacy of designing antenatal education that includes education on physiology of normal birth and relaxation training.
Birth Photos: #No Filter!
Authors: Budin Wendy C.
Published: September 2018

In this column, the editor of The Journal of Perinatal Education (JPE) shares a letter to the editor from a reader commenting on photos selected for the cover of JPE. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.
Letter From the Editor: Exploring Women’s Ways of Healing
Authors: Humenick Sharron S.
Published: September 2018

The juxtaposition of medical science and Old Wives’ Tales is explored. Examples are given in which both sources of knowledge have been helpful, useless, or even harmful. A culture in which the health care consumer feels free to question and selectively use or reject elements from both sources of knowledge is essential in order for the “trust your body” message of perinatal education to be heard.
Childbirth and the Measurement of Fatigue
Authors: Pugh Linda C.
Published: September 2018

Fatigue during labor concerns women and nurses alike, yet few studies have directly measured fatigue during childbirth. Many issues and difficulties with the conceptualization and measurement of fatigue have been raised because of the multidimensionality of the concept. Fatigue was conceptualized as including subjective, cognitive, and physical dimensions, and was therefore operationalized using multiple methods. In the two studies described, fatigue was measured using the Modified Fatigue Symptom Checklist (MFSC), the Pearson-Byars Feeling Checklist (PBFC), Visual Analogue Scales (VAS), the Digit Span Subtest of the Wechsler Intelligence Test (revised R), and a hand held bulb dynamometer. These studies support the reliability and validity of the measures used to quantify fatigue during labor. These findings support the operationalization of fatigue as a multidimensional concept.
Cognitive Assessment in the Acute Care Setting: Reliability and Validity of the Levels of Cognitive Functioning Assessment Scale (LOCFAS)
Authors: Flannery Jeanne
Published: September 2018

Nurses have responsibility for accurate assessment of cognitive functioning for traumatic brain injured (TBI) patients early in the posttrauma period to enhance rehabilitation with appropriate care planning. To meet this need the Levels of Cognitive Functioning Assessment Scale (LOCFAS) was adapted from the Rancho Los Amigo Levels of Cognitive Functioning instrument. One validity and three reliability studies were conducted using videotapes of five TBI patients at different levels of cognitive functioning. Interrater and intrarater reliability was assessed using coefficient kappa. With raters experienced in assessing cognitive functioning, agreement among cognitive levels was 1.00 with a mean agreement of .997 (5D=.006) for individual items. With inexperienced raters in cognitive assessment, mean agreement for levels was .839 (SD = .120) and for individual items, .830 (SD = .052) Intrarater reliability, after a two-week interval, yielded a mean agreement of .860 (SD = .088) for levels. Criterion-related validity of the LOCFAS was demonstrated by correlating it with the Rancho Los Amigos Levels of Cognitive Functioning scale. The resultant Pearson r correlation was .929. Implications for nursing practice and nursing education are discussed.
Reliability and Validity of a New Preadmission Acuity Tool for Long-Term Care
Authors: Swanson Elizabeth A. , Click Orpha J.
Published: September 2018

The purpose of this project was to develop a new tool designed to assess the acuity of applicants to long-term facilities. Using a known groups method, residents of long-term care facilities were categorized as independent (n=68), assist (n=71), and dependent (n=65) and assessed using the Preadmission Acuity Inquiry Tool (PAI) to generate the data base for examining its psychometric properties. The progression of the mean scores from independent to assist to dependent demonstrates the ability of the tool to differentiate across varying levels of functional independence. Using discriminant analysis, the degree of accuracy in predicting group membership for the independent group was 88%, for the dependent group 75%, and for the assist group 17% with the overall agreement between PAI scores and a priori classifications at 60%. Kappa coefficients for interrater reliability ranged from .54 to 1.0 with a mean of .90. The Cronbach’s alpha coefficient was .81. The PAI has demonstrated sufficient reliability and validity to warrant further refinement and testing. This new instrument may enable health care professionals to provide the appropriate level of care in a cost-effective manner.
Measurement of Body Fat and Fat Distribution
Authors: Keller Colleen , Thomas Katherine T.
Published: September 2018

Overweight and obesity are increasing in prevalent and thus an important area for intervention and investigation. Researchers and clinicians have a variety of measurement techniques to assess body fatness and regional fat. These techniques are chosen for their accuracy and precision in light of their cost, convenience, and safety. This article introduces techniques for the measurement of body fatness and regional fat, their advantages and disadvantages and accuracy. Recommended measurement techniques for investigators and clinicians are provided.
The Postpartum Support Questionnaire: Reliability and Validity
Authors: Logsdon Mimia C. , Usui Wayne , Birkimer John Charles , McBride Angela Barron
Published: September 2018

Support has been found to be related to perinatal health, resulting in the development of the Postpartum Support Questionnaire based on the four categories of support (informational, material, emotional and comparison) identified by House (1981) and Cronenwett (1985). Data from four studies (N=207) provided evidence of the psychometric properties of the instrument. Internal consistency reliability was demonstrated (alpha = .90 to .94 for total instrument). Test-retest reliability ranged from .69 to .79 for total scores and .30 to .79 for categories of support. Measures of concurrent validity with the Personal Resource Questionnaire 85 were .42 and .48 at 6 and 8 weeks postpartum. Confirmatory factor analysis using LISREL 7 supported the four categories of support, but the use of these factors separately remains to be demonstrated.