Psychopathology in pathological gamblers seeking treatment

High rates of psychiatric symptoms have been reported in pathological gamblers. This study of psychiatric comorbidity in pathological gamblers is the first to use structured psychiatric interviews assessing DSM-III-R Axis I and II disorders. The Structured Clinical Interview for DSM III-R (SCID-P, SCID-II) was administered to 40 (25 male, 15 male) pathological gamblers seeking outpatient treatment in Minnesota for gambling, and 64 (41 male, 23 female) controls. High lifetime rates of Axis I (92%) but not Axis II (25%) psychopathology were found in pathological gamblers as compared to controls. No differences between male and female gamblers were found in rates of affective, substance use or personality disorders. Females had higher rates of anxiety disorders and histories of physical/sexual abuse. Possible associations between psychiatric disorders and pathological gambling are discussed along with gambler typologies and implications for future research.The authors wish to gratefully acknowledge the assistance of: Gary Christenson, M.D., Carol Peterson, Ph.D., William Meller, M.D., Thomas Mackenzie, M.D.     

Couple Therapy as a Method for Treating Male Exhibitionism: "Flashing"

The exhibiting of the genitals by males has previously been defined as symptomatic of narcissism and infantile sexuality. Viewed as a developmental anomaly of emotional life, treatment has been focused upon stimulating personal development by working out the problems which have inhibited maturation. Results have been discouraging. As an alternative, defining the problem as symptomatic of disturbances in basic relationships and treating the current central relationships as the focus offers a strong opportunity for inducing satisfactory changes.     

Risk Comparisons, Conflict, and Risk Acceptability Claims

Despite many claims for and against the use of risk comparisons in risk communication, few empirical studies have explored their effect. Even fewer have examined the public's relative preferences among different kinds of risk comparisons. Two studies, published in this journal in 1990 and 2003, used seven measures of "acceptability" to examine public reaction to 14 examples of risk comparisons, as used by a hypothetical factory manager to explain risks of his ethylene oxide plant. This study examined the effect on preferences of scenarios involving low or high conflict between the factory manager and residents of the hypothetical town (as had the 2003 study), and inclusion of a claim that the comparison demonstrated the risks' acceptability. It also tested the Finucane et al. (2000) affect hypothesis that information emphasizing low risks-as in these risk comparisons-would raise benefits estimates without changing risk estimates. Using similar but revised scenarios, risk comparison examples (10 instead of 14), and evaluation measures, an opportunity sample of 303 New Jersey residents rated the comparisons, and the risks and benefits of the factory. On average, all comparisons received positive ratings on all evaluation measures in all conditions. Direct and indirect measures showed that the conflict manipulation worked; overall, No-Conflict and Conflict scenarios evoked scores that were not significantly different. The attachment to each risk comparison of a risk acceptability claim ("So our factory's risks should be acceptable to you.") did not worsen ratings relative to conditions lacking this claim. Readers who did or did not see this claim were equally likely to infer an attempt to persuade them to accept the risk from the comparison. As in the 2003 article, there was great individual variability in inferred rankings of the risk comparisons. However, exposure to the risk comparisons did not reduce risk estimates significantly (while raising benefit estimates), and Conflict-Claim respondents found the risk of the hypothetical factory less acceptable than No-Conflict respondents. Results suggest that neither risk comparisons nor risk acceptability claims are automatically anathema to audiences, but they may have tiny or unintended effects on audience judgments about risky situations.     

THE THERAPEUTIC ALLIANCE IN HOME‐BASED FAMILY THERAPY: IS IT PREDICTIVE OF OUTCOME?

This study examined the association between the therapeutic alliance in family therapy and changes in symptom distress, interpersonal relationships, and family coping. The participants (N = 81) were members of low socioeconomic status families referred to a university clinic for in-home family therapy. Participants completed the Outcome Questionnaire, Family Crisis Oriented Personal Evaluation, and the Family Therapy Alliance questionnaires. Regression analyses revealed that the therapeutic alliance explained 19% of the variance in symptom distress changes for mother, 55% for fathers, and 39% for adolescents. The implications of these findings for practicing and researching family therapy are presented.     

Sexual health education group for adolescents with mental problems

1. Providing sexual health education for adolescents with mental health problems presents a difficult but important clinical task. 2. Using a group format for this task is an effective way to provide information about sexual health and promote positive coping strategies related to relationships and sexual issues. 3. Group leaders need to be aware of their own values related to sexual issues and have the ability to be frank and nonjudgmental.     

Are Some Risk Comparisons More Effective Under Conflict?: A Replication and Extension of Roth et al.

Despite many claims for and against the use of risk comparisons in risk communication, few empirical studies have explored their effect. Only one study, published by Roth et al. in this journal in 1990, has tested the 1988 predictions by Covello et al. as to the public's relative preferences for 14 kinds of risk comparisons as they might be used by a factory manager to explain risks of his ethylene oxide plant. That study found no correlations between the Covello predictions and seven different measures of "acceptability" of Covello's examples of each type of comparison. However, two critics of the Roth study, as well as its own authors, suggested that a scenario involving local risks, a conflict-ridden situation, and a plant manager unknown to the townspeople might better evoke Covello-like preferences than the distant, calm, friends-involving scenario used by Roth. The research reported here replicated the Roth study using the same scenario, risk comparison examples, and evaluation measures, and added a second scenario intended to replicate the conditions suggested by critics. Over 200 New Jersey residents answered the study questionnaire. The replication scenario reproduced Roth's results, and the conflict scenario also evoked no rankings correlated with Covello's predictions. Furthermore, neither agreement nor disagreement with five statements representing "conflict"--respondents' reports that the industrial-plant scenario made them angry, they lived near industry, they were concerned about industrial risks, people in their home town were angry about industrial pollution, and they worried "frequently" about long-term effects of pollution--correlated with Covello's predictions. Over half of all ratings ascribed to the comparisons in aggregate were positive, and most detailed comments offered by respondents also were positive, despite many criticisms and suggestions for their improvement. The wide variability in individuals' rankings also undermines the notion of any single ranking of preferred comparisons. These findings have implications for use of risk comparisons, but also reveal the inaccuracy of the field's assumptions about public reaction to industrial risk information, including risk comparison.     

Do Reports on Drinking Water Quality Affect Customers' Concerns? Experiments in Report Content

The Safe Drinking Water Act Amendments of 1996 required U.S. utilities to report on drinking water quality to their customers annually, beginning in fall 1999, on the assumption that such reports would alert them to quality problems and perhaps mobilize pressure for improvement. A random sample of New Jersey customers read alternative versions of a water quality report, in an experiment on reactions to water quality information under U.S. Environmental Protection Agency (USEPA) rules. Experiment design was 2 x 3 + 1: two versions each--one with, one without, a violation of a health standard--of a report that was (1) Qualitative (without water quality numbers, thus not meeting USEPA rules); (2) Basic, with minimal information meeting the rules; or (3) Extended, adding reading aids and utility performance information; plus a control instrument without any hypothetical report. Results of ANOVA suggest the reports will have less effect than hoped or feared. These manipulations were successful: people reading the Qualitative versions were less likely to say that the report gave the amounts of substances found in the water, and those reading Violation versions were more likely to report a violation of a health standard. The main differences in responses to the report involved the judged adequacy of the information, and to a lesser extent responses on a Concern scale (constructed from measures of concern, judged risk, clean-up intentions, distrust of utility information, and doubt that the utility was doing all it could to improve water quality). Overall judgments of water quality and utility performance did not change, either relative to the controls or in before versus after responses. Qualitative reports performed worse than others, confirming the decision to have utilities report actual contaminant levels. Extended reports did only slightly better than the Basic versions on these measures. Many respondents had trouble identifying the presence or absence of substance amounts or violations, despite their seeming obviousness (e.g., in a "bottom line" summary on the front page of each report), suggesting many were not processing this information carefully. However, the pattern of responses for those who accurately identified the presence or absence of substance amounts or violations did not differ substantially from that for the group as a whole. Generic risk beliefs (serious local environmental problems; lack of control over risks to one's health) dominated demographic variables, attitudes toward utility water quality or trustworthiness, and the content and format of water quality reports in influencing concern about drinking water quality. Previous empirical and theoretical evidence for lack of change in public risk attitudes due to one-time or infrequent communications--e.g., role of personal experience, perseverance of prior trust or distrust--seems to be confirmed for annual water quality reports.     

Communicating Worst-Case Scenarios: Neighbors'' Views of Industrial Accident Management

The prospect of industrial accidents motivated the U.S. Congress to require in the Clean Air Act of 1990 that manufacturing facilities develop Risk Management Plans (RMP) to submit to the U.S. Environmental Protection Agency (USEPA) by July 1999. Industry worried that the requirement to communicate to the public a "worst-case scenario" would arouse unnecessary and counterproductive fears among industry neighbors. We report here the results of focus groups and surveys with such neighbors, focusing particularly upon their reactions to messages about a hypothetical worst-case scenario and management of these risks by industry, government, and other parties. Our findings confirmed our hypotheses that citizens would be skeptical of the competence and trustworthiness of these managers and that this stance would color their views of industrial-facility accident risks. People with job ties to industry or who saw industrial benefits to the community as exceeding its risks had more positive views of industrial risks, but still expressed great concern about the risk and doubt about accident management. Notwithstanding these reactions, overall respondents welcomed this and other related information, which they wanted their local industries to supply. Respondents were not more reassured by additional text describing management of accidents by government and industry. However, respondents did react very positively to the concept of community oversight to review plant safety. Claims about the firm's moral obligation or financial self-interest in preventing accidents were also received positively. Further research on innovative communication and management of accident risks is warranted by these results, even before recent terrorist attacks made this topic more salient.