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Journal of Projective Psychology and Mental Health: Volume 28, Number 2, July 2021 Editorial

1.Editorial: The Assessment of ‘Health Anxiety’ in the Context of COVID-19: Select Tests and Measures, Chris Piotrowski, Pages 63-66.

Copious research studies have called attention to the onerous impact of the COVID-19 pandemic on instilling high levels of stress in the general population (Taylor et al., 2020). More specifically, such deleterious, chronic stress during COVID-19 has been linked to anxiety reactions in both the general (Xiong et al., 2020) and patient population (Dozois, 2020; Fu et al., 2021; Hawes et al., 2021; Smith et al., 2020). Concerns regarding overall health or specific physical symptomatology is commonly referred to as Health Anxiety and is a major component of the biopsychosocial model of clinical health psychology (see chapters in Andrasik et al., 2015). Indeed, clinicians have expressed research interest in this specific type of anxiety in recent decades (Asmundson et al., 2010; Kosic et al., 2020). While vigilance to symptomatology can reflect concerns over threats to health and well-being, excessive levels of anxiety in response to potential disease can be counterproductive and lead to chronic stress and dysfunctional coping (Folkman & Moskowitz, 2004; Taylor & Asmundson, 2004).

Thus, from a conceptual framework, Health Anxiety has been viewed as the fear, apprehension, and avoidance behaviors due to the potential of threat to physical health or well-being. Researchers have argued that Health Anxiety largely stems from dysfunctional beliefs and cognitive over-sensitivities (Bardeen & Fergus, 2020; Fergus, 2014; Olatunji et al., 2009; Salkovskis et al., 2002). Yet many clinicians are challenged regarding which measures/tests best encompass or evaluate Health Anxiety states or symptomatology. Indeed, this issue is most pertinent in the current context of COVID-19.

To that end, I performed an online search of PsycINFO on the keyword term ‘Health Anxiety’ (on March 10, 2021). A total of 798 references (i.e., journal articles) were identified, where this term was noted in the Abstract of articles. The Tab-down option listed the most frequently noted tests/measures mentioned in Abstracts. Table 1 presents, in rank order, the listing of the tests/measures most relied upon by researchers in studies related to the topic of Health Anxiety. Several of these measures have remained popular in mental health practice and research over the past 3 decades (Piotrowski 1999, 2018; Piotrowski & Gallant, 2009; Piotrowski & Lubin, 1990).

In addition, based on the scholarly literature in this area, I note several adjunctive measures/tests commonly used, as part of the methodology, in studies about Health Anxiety. These assessment instruments are noted in Table 2. In conclusion, these bibliometric findings should fortify the assessment toolkit of mental health professionals (and researchers) when engaged in the clinical evaluation of patients presenting with Health Anxiety issues, particularly in the era of the COVID-19 pandemic.

2. Some Comments on the Importance of Comparative Group Data for Interpreting Rorschach Findings, Carl B. Gacono & Jason M. Smith, pages 67-73.

The Rorschach (RIM) provides information beyond what one gathers from self-report measures. In addition to CS data, psychoanalytic theory has led to several valid and reliable supplemental Rorschach scoring systems. When integrated, CS and supplemental RIM data increases the conceptual understanding of a patient or group, allowing for highly nuanced insights into personality functioning. In order to interpret Rorschach data one must understand that, for the most part 1) Rorschach variables measure traits (dimensions) not diagnosis (categories), that 2) the degree of pathology or health represented by a variable is determined in relationship to comparative group data, such as non-patients, and assessed within the context of the entire protocol or protocols (for group data), and, 3), confirming the presence or absence of a trait within a given sample necessitates a comparison to other relevant groups both those that contain threshold quantities of the identified trait, and those ―absence‖ the trait. Throughout this article we underscore the essential contribution of a nomothetic context (using comparative CS data) for anchoring Rorschach interpretation.

3. The Case for Projective Measures in Bariatric Psychological Evaluations: A Review of the Scientific Literature Chris Piotrowski, pages 74-82.

Bariatric psychological evaluation, over the past 20 years, has emerged as a clinical specialty, and recommended revisions to the standard assessment protocol have been recently published (Rutledge et al., 2020). Yet despite reliance on a host of clinical assessment measures across several mental health domains, projective techniques are rather shunned by professionals in this specialty area. Based on an extensive review of the extant literature, this article: a) provides supporting evidence that based on a myriad of clinical features central to the evaluation of bariatric surgery candidates (i.e., body image, self-esteem, self-representation, motivation, emotion regulation, interpersonal functioning, psychopathology), projective tests are ideally suited to tap these psychological domains; b) cites studies that make the case for the utility of projective assessment in the treatment of eating disorders, and for bariatrics specifically; and c) presents key findings, based on clinical data derived from projective tests, on studies of bariatric patients. Overall, this review supports the clinical utility of projective measures (i.e., the Draw-A-Person test, the Baum Test, Rorschach, Thematic Apperception Test, Sentence Completion tests, Somatic Inkblot Series), as part of a comprehensive evaluation of both candidates and patients facing bariatric surgery, in addition to assessment of post-surgery outcomes. Interestingly, most of the studies cited in this review were conducted by researchers outside the U.S.A., mainly Europe and Japan. Perhaps, the disuse of projective techniques by clinicians is more an artifact on lack of professional training in these methods (see Piotrowski, 2015), as opposed to the lack of applied utility of these assessment measures per se.

4. Manual of Somatic Imagery Test (SIT-30 Image Online Test) Bankey L. Dubey and Anand Dubey, pages 83-112.

The Somatic Imagery Test (SIT) is a “cloud based” semi-structured projective diagnostic instrument and an adjunct to psychotherapy. The SIT can be administered in an “individual” and “group” setting. The SIT is fully automated including reports, case management, billing etc. The SIT puts particular emphasis on content analysis, psychoanalytic interpretation, and symbolic interpretation while providing a quantitative analysis framework as well. The SIT helps therapists in "hearing" the "inner cry" that is not only hidden from others, but often hidden from one's own conscious awareness as well (Cassell & Dubey, 1990, Dubey et al, 2019).

5. Mental Health and Psychosocial Impact of Type 1 Diabetes in adolescents of Low-Socio Economic Strata- A Qualitative Study, Sabornee Karmakar, Prasanta K. Roy and Amit K. Bhattacharya, pages 98-104.

Juvenile or Type 1 Diabetes being a lifestyle disease is associated with a lot of complications in terms of lifestyle changes, treatment adherence and disease associated complications. In India, the increasing numbers of adolescents are getting affected with this disease. Considering this context and owing to a limited number of studies in this area, it is important to understand the psychological impact of the disease on affected individuals. The sample comprised of 6 adolescents, 3 males and 3 females, diagnosed with Type 1 diabetes mellitus, the age range being 12-18 years, minimum age of diagnosis being 10 years. A qualitative method was adopted. A semi-structured interview was conducted comprising of questions related to trauma reaction to the diagnosis, changes in perception and attitude towards life along with cognitive appraisal of medical management of diabetes. The method of content analysis was used, unit of analysis being themes, to arrive at prominent themes and subthemes. Analysis of the subjective responses indicated psychopathology of helplessness and hopelessness, shame and associated stigma, low self-esteem, loss of future goals and aspirations along with interpersonal difficulties. Belief related to difficulties in living with the disease was also reported across several domains. The above factors may be taken into consideration in developing psychological treatment guidelines as an adjunct approach for affected adolescents to enhance adherence to diabetic treatment, especially in developing countries like India.

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