This study examines whether alexithymia relates to specific interpersonal problems, based on data collected in a sample of mental health outpatients (N = 404) and a student sample (N = 157). Linear regression analysis, in which the effects of group, gender, and age were controlled, indicated that two interpersonal problems were significantly and reliably related to alexithymia: cold/distant and nonassertive social functioning. The theoretical relevance of the results for attachment and psychoanalytic theory is indicated, as well as implications of the findings for clinical practice.

The most widely used instrument to measure alexithymia is the 20-item Toronto Alexithymia Scale (TAS-20). However, different factor structures have been found in different languages. This study tests six published factor models and metric invariance across clinical and nonclinical samples. It also investigated whether there is a method effect of the negatively keyed items. Second-order models with alexithymia as a higher order factor are tested. Confirmatory factor analyses showed that the original factor model with three factors—difficulty identifying feelings (DIF); difficulty describing feelings (DDF) and externally oriented thinking (EOT)—is the best fitting model. Partial measurement invariance across samples was illustrated but requires further study. A weakness of the model is the low internal consistency of the third factor. Because models with a method factor had a better fit, future reconsideration of the negatively formulated items seems necessary. No evidence was found for the second-order models.

The 32-item version of the EDMCQ might enrich the EDM climate measurement, clinicians' behaviour and the performance of healthcare organisations. This instrument offers opportunities to develop tailored ICU team interventions.

This study explored the meaning of “good outcome” within and beyond the much-used statistical indices of clinical significance in standard outcome research as developed by Jacobson and Truax (1991). Specifically, we examined the experiences of patients marked as “recovered” and “improved” following cognitive–behavioral therapy and psychodynamic therapy for major depression. A mixed-methods study was conducted using data gathered in an RCT, including patients’ pre–post outcome scores on the Beck Depression Inventory–II and posttreatment client change interviews. We selected 28 patients who showed recovery and 19 patients who showed improvement in self-reported depression symptoms. A grounded theory analysis was performed on patients’ interviews, ultimately resulting in a conceptual model of “good outcome.” From patients’ perspectives, good outcome can be understood as feeling empowered, finding personal balance and encountering ongoing struggle, indicating an ongoing process and variation in experience. The Jacobson–Truax classification of “good outcome” could not account for the (more pessimistic) nuances in outcome experiences, especially for “improved” patients, and did not grasp the multidimensional nature of outcome as experienced by patients. It is recommended that statistical indications of clinical meaningfulness are interpreted warily and ideally contextualized within personal narratives. Further research on the phenomenon of change and good outcome is required, aiming at integrating multiple perspectives and methods accordingly the multidimensional phenomenon under study.

In this study, the authors compared the respective contribution of an individual's subjective response and the frequency of exposure to critical incidents to the development of symptoms of posttraumatic stress disorder (PTSD) in a sample of 136 nurses and ambulance personnel working in military facilities. They found no relationship between the frequency of encountered critical incidents and the occurrence of PTSD symptoms. The subjective response to a stressor contributed to the development of PTSD symptoms and was most strongly associated with intrusion, partial eta squared =.23, and hyperarousal symptoms, partial eta squared =.16. Stressors that elicited the most intense affects within this population were those involving children and those where workers encountered limitations in supplies and resources.

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IntroductionResearch indicates that subjective tinnitus severity varies among tinnitus patients. One of the variables held responsible for these differences is depression. However the relationship between depression and tinnitus severity was never investigated more in depth.ObjectivesIf depression is responsible for differences in subjective tinnitus severity two conditions need to be fulfilled. First, there should be evidence for the presence of moderate to severe depressive symptomatology in a substantial group, and second, there should be evidence for a substantial relationship between depressive symptoms and tinnitus severity which can not be explained due to method and content overlap.AimsIn this study we investigated whether tinnitus severity is a depression related problem.Methods136 consecutive help-seeking tinnitus patients were seen by a psychologist and an audiologist. All patients filled in the Beck Depression Inventory (BDI-II), the Tinnitus Handicap Inventory (THI), and underwent psychoacoustic measurement (pitch and loudness).ResultsMean scores indicate the presence of no or minimal depressive symptoms. There was only a positive correlation (p < .01) between the BDI-II and the THI. No correlations were found between psychoacoustic measures and the self-report questionnaires. Linear regression analysis revealed that only the somatic depression subscale significantly predicted tinnitus severity.ConclusionsTinnitus does not seem to be a depression-like problem. There is no substantial group of tinnitus patients with moderate to severe depressive symptoms. The relation between depressive symptoms and tinnitus severity seems to be an artefact due to content overlap between de THI and the somatic subscale of the BDI-II.

This study investigated the psychometric properties of the 20-item Toronto Alexithymia Scale (TAS-20) in an adolescent sample (N = 406, ages 12 to 17). This is rarely done even though the TAS-20 is used in adolescent research. Five published factor models were tested. For good fitting models, a second-order model with alexithymia as a higher-order factor and metric invariance across sex and age groups was tested. Confirmatory factor analyses showed that the original three-factor model and a four-factor model provided acceptable fit. Both models were invariant across sex, but not across age. Second-order models did not provide good fit. Reliability was good for the "Difficulty identifying feelings" subscale and acceptable for the "Difficulty describing feelings" subscale, but not for the "Externally oriented thinking" subscale. Measuring alexithymia with the TAS-20 in adolescents thus seems problematic, especially in younger age groups.