Journal of Projective Psychology and Mental Health: Volume 31, Number 2, July 2024 Editorial |
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| 1. Editorial: Nightmares: What are the Major Topical Areas of Scholarly Research? Chris Piotrowski, pages 61-64. In a recent bibliometric analysis on dreams, Piotrowski (2023) found that the topic of nightmares receives extensive investigatory attention. In fact, the current issue of this journal includes a study on the nightmares-suicide link (see Ellis, 2024). Yet, to date, no studies have examined the scope and breadth of research focus regarding nightmares within this voluminous body of research. To that end, a bibliometric review of published studies, over the past 25 years, on the subject matter of nightmares was undertaken in the database of PsycINFO. In order to target primary studies where the topic of nightmares was a major focus of investigation, the online search was designed to select references where the terms nightmare or nightmares were in the Title of each reference. This strategy produced 547 journal article references (June 1998-June 2023). Based on a review of each individual study, a sole topical descriptor that best represented the main focus of each article was determined. A frequency tally, across individual subject categories, was maintained and then summed for each topical descriptor. Table 1 presents the rank-order of investigatory topical areas, based on the procedure noted above. Interestingly, a sizable number of articles (9% of dataset) had a specific focus on pharmacological treatments (mostly Prazosin) for nightmares or for medication adverse effects that can prompt nightmares (Geldenhuys et al., 2022; Mamelak, 2020; Zhang et al., 2022). The issue of trauma-induced nightmares was also a prominent area of study with an emphasis of the PTSD-nightmare nexus (Moraczewski & McCall, 2019; Possemato et al., 2022). Several domains dealing with psychological treatment or intervention (cognitive-behavioral therapy, imagery rehearsal, and rescripting) represented, in aggregate, 71 studies (Hansen et al., 2013; Krippner & Taitz, 2017; Meador et al, 2022; Rousseau & Belleville, 2018; Spangler & Sim, 2023). Other interventional approaches receiving sparse attention were hypnosis, EMDR, and self-help. Interestingly, there was a dearth of studies which concentrated on psychoanalytic or cathartic approaches regarding treatment. Measurement issues appear to be a major area of investigatory interest regarding nightmares (Schredl, 2002). First, there seems to be lively discussion on what constitutes a nightmare, and thus, definitional concerns challenge conceptual and research designs (see Blagrove & Haywood, 2006). Related to this issue is the wide breadth of prevalence and frequency statistics reported by many researchers (Schredl, 2009; Schredl & Reinhard, 2011; Schredl et al., 2019), which has contributed to inconsistent or contradictory results in published studies. Second, dreams recall parameters, and awakening criteria can vary based on sample characteristics and research design. Third, the lack of consensus with regard to measurement is evidenced by the myriads of self-report measures which purport to evaluate or assess nightmares (24 studies focused on individual tests). Most prominent is the Nightmare Distress Questionnaire and the Nightmare Experience Scale. Of interest, projective techniques were rarely relied upon by researchers. Perhaps reflecting the methodological concerns noted above, there has been a wide spectrum of theoretical approaches that strive to understand the nature and dynamics of the nightmare phenomenon (Ellis, 2023; Flockhart & Gackenbach, 2017). Prominent are sensory and affective conceptual frameworks (Buckingham et al., 2022; Carr & Nielsen, 2017; Carr et al., 2021), in addition to neuro-cognitive models (e.g., Paxton-Willing, 2022). Hence, this domain was highly ranked. Not surprisingly, nightmares are associated with a wide host of psychopathological disorders (Sheaves et al., 2023). Most noteworthy in the current analysis were suicide and anxiety states (Andrews & Hanna, 2020; Hedstrom et al., 2021; Rufino et al., 2020). Previous research has explored the association of personality factors on both the frequency and severity of nightmares (Brekke et al., 2023; Gessert & Schredl, 2023; Schredl, 2021). There has been particular interest in the 5-Factor theory. Carr et al. (2022) found that neuroticism and sensory-processing sensitivity were significantly related to nightmare distress and frequency. As listed in lower half of Table 1, several areas of investigation represented less than 3% of the dataset; most noteworthy has been an active stream of studies on nightmares related to the COVID-19 pandemic (e.g., Scarpelli et al., 2021), as well as research on the link between insomnia and nightmares (Kelly, 2022). In addition, the current analysis identified several salient topical areas that received sparse research attention (i.e., sleep deprivation, fear of sleep, circadian rhythms, Sleep apnea, substance abuse, genetics). These salient issues often appear as secondary investigatory factors across studies but were not the main focus of study in the current analysis. In addition, exploratory research on nightmare content (e.g., symbols, characters, color) is in need of further investigation. The analysis identified 4 main domains, i.e., the emphasis on pharmaceutical treatments, neurophysiology, psychological interventions, and post-traumatic states. Moreover, it is apparent that researchers study nightmares based on a myriad of systematized theories and conceptual models which reflect the wide breadth of methodological approaches in the data collection and analysis stage of investigations (see Schredl, 2002; Zadra, 2019).These findings provide a) an overview on the scope of the scientific landscape regarding investigatory trends over time, and b) a framework for further research efforts on this troubling parasomnia (Germain, 2012). 2. The Journal Review Process: A Cautionary Note on the Rorschach / Psychopathy Literature. Carl B. Gacono & Jason M. Smith, pages 65-75. In Orwellian fashion, Wright and Cumming’s (2005) described disturbing trends that detract from the credibility of psychological research. Writers of their time looked to an informed, ethical, and competent journal review process to balance these trends. A review of the current Rorschach/ psychopathy literature makes one realize that a plethora of largely unchallenged biases, unsound methodology, and faulty conclusions pervade the literature (Cunliffe et al., 2021; Gacono, 2016; Smith et al., 2021). Have journal editors failed to ensure that only sound, ethical, unbiased, useful research is published? Sadly, they have. Practicing clinicians must be wary, rather than trusting that editors and reviewers are informed about key issues, that reviewers offer only opinions within their areas of expertise, and that researchers have an adequate experiential knowledge base for understanding the populations or assessment instruments they study (Cunliffe et al., 2021; Gacono, 2021). In this article, we review 5 articles that illustrate these issues. 3. Use of Projective Techniques with Children: A Review of Contemporary Research Studies, Chris Piotrowski, pages 76-84. A review of the mental health literature clearly indicates that both clinicians and researchers have, for many decades, considered various projective measures as suitable and pragmatic assessment instruments in the mental health evaluation of children. The aim of the current study is to present a brief overview of recent scholarship reflected in this body of literature on projective assessment with child samples, based on a bibliographic analysis. To that end, a comprehensive search of the database PsycINFO identified 250 peer-reviewed articles with a focus on projective tests and children. Of these, the author selected 38 studies or key references cited in these publications. Based on an aggregated analysis of this contemporary bibliographic dataset (2000-2022, inclusive), the author contends that projective techniques have been found to have empirical support for critical clinical issues such as the ability to reveal latent psychodynamics, identify cognitive deficits, and differentiate select diagnostic groups in children and pediatric populations. These attributes of projective measures are a key feature in the assessment of children, where issues such as developmental milestones, social adaptations, emotion regulation, and verbal expression are central clinical challenges. A select historical bibliography of key studies and books is provided. 4. The Alarming Nightmare-Suicide Link: Evidence, Theories, and Implications for Treatment, Leslie Ellis, pages 85-93. A robust link has been established between frequent nightmares and increased risk of suicide, both in adult and adolescent populations. Yet nightmares remain vastly undertreated for a confluence of reasons: patients rarely talk about their nightmares, clinicians rarely ask about them, and too few clinicians are trained to treat disturbing dreams. Current clinical research shows that nightmares are not only associated with posttraumatic stress disorder (PTSD), but also are more prevalent in most psychiatric disorders. There are myriad reasons for clinicians to inquire about and treat nightmares: Patterns of disturbed dreaming, and content of nightmares can provide warning signs of suicide; dream content can aid in diagnosis, treatment, and assessment of response to treatment; and there are established, evidence-based treatments for nightmares that appear to reduce nightmare frequency and distress, as well as other symptoms of post-traumatic stress. Mechanisms of action remain unclear, and the range of treatment options could be expanded, so further research is needed. In the meantime, viable nightmare screening and treatment options currently exist that have the potential to mitigate suicide risk. This review summarizes the extant body of research in this clinical area. 5. A Commentary on Color Red and the Assessment Process: Implications for the Rorschach, Sanae Aoki, pages 94-95. This paper comments on the role of the color Red in the assessment process with specific applications to the Rorschach, as outlined by Piotrowski (2023). Based on prior research findings, the central importance of the impact of color Red on cognitive and perceptual processes is noted. Future research should stress experimental findings as well as applications for clinical assessment. 6. Commentary: Could we have a new look on projective methods? Piero Porcelli, pages 96-98. About 20 years ago, Meyer and Kurtz (2006) and Bornstein (2007) argued that the labels of ‘objective’ and ‘projective’ for psychological tests have low construct validity and clinical utility. Whereas it seems that the label ‘objective’ carries with it a positive connotation of unbiased and evidence-based prediction, ‘projection’ has generally the worse reputation of a subjectively biased and theoretically laden prediction. As claimed in those two seminal papers, criteria for identifying a personality assessment method rely on two factors: the kind of stimulus used in the test and the kind of the underlying process that the task requires. Classical test classification implies that objective methods use stimuli that are not equivocal, typically an adjective, sentence, or question. The respondent is required to indicate the extent to which measure accurately describes themselves by using a limited set of established response options (e.g., true/false, yes/no, never/sometimes/often/always, or other Likert-type scales). The process underlying the objective methods is thought to rely on the small, if any, burden of subjective inferences from the assessor on the scoring interpretation (see Piotrowski & Keller, 1984). Nowadays we do know this is not true since the subjective interpretation of the examinee may affect deliberately or involuntarily the results of the test. In contrast, the classical test classification defines as ‘projective’ those methods that use ambiguous or not defined stimuli. The person is required to deliver a free response with minimal or no external guidance or anchorage. Thanks to the poorly defined perceived object, the examinee makes a subjective sense of the reality of the stimulus by wrapping it with something that lives only in their inner world but not in the stimulus. Once again, nowadays we do know this is not true because any stimulus, ambiguous as it can be, is a double-faced coin: one side is what is there in the stimulus (implying perception) and the reverse side is what is there in the subject (implying projection). Hence, the suggested change as ‘performance-based’ (Meyer & Kurtz, 2006) when the measure focuses on the performance for completing the task (e.g., completing the block design test or accomplishing the cognitive-perceptual problem-solving task by delivering a Rorschach response) and ‘stimulus-attribution’ (Bornstein, 2007) when the person is required to attribute a meaning to a stimulus based in part on its formal characteristics and in part on the person’s cognitive style, motives, emotions, and need states. Briefly, as outstanding classic authors stated, a personality assessment measure involves a “dialectic tension” (Schafer, 1954, p.109), an “apperceptive distortion” (Abt & Bellak, 1950, p.12), a balance between the inner world and the external reality that parallels the “transference reactions among psychotherapy patients to the extent to which their therapists present themselves as ambiguous figures rather than real objects” (Weiner, 2003, p.10). 7 Projective Indicators of Substance Use Disorders on Somatic Imagery Test, Titiksha Paul & Anand P. Singh, Pages 99-105. Substance use disorder (SUD) is characterized by long-term exposure to substances leading to mental and physical dependence, often resulting in social, academic, and occupational impairment. Understanding the projective indicators of substance use disorders is important for targeted interventions and treatment. Thus, the aim of this study is to examine the projective indicators of substance use disorders on the SIT. The data was collected from patients with clinical diagnosis of SUDs belonging to the age group of 18-35 years old from De-Addiction Centres Delhi/NCR region. A descriptive analysis was performed, and it was found that the patients with SUDs had low human, sex, movement, most typical and typical responses as compared to normal controls. In addition, they displayed high animal, anatomical, other responses, total number of responses and rejection of cards, pathological anatomical and hostility aggression scale as compared to the normal group. The results suggested that interventions targeting emotional regulation and adjustment may be valuable in the treatment of SUDs. 8. Psychological Resources and Stress Tolerance Capacity on Rorschach in Patients with Schizophrenia and Bipolar Affective Disorder, Kriti Jain, Deapti Mishra & Ranjeet Kumar, Pages 106-112. It is evident that psychological recourses and stress tolerance capacity are found poor in various psychiatric conditions that have significant impact on their treatment outcome but are less studied. This study caters to the need to assess and compare the presence of psychological resources, stress tolerance abilities, and capacity to control, as well as coping ability in patients with BPAD and schizophrenia. A sample of 30 patients with Schizophrenia and 30 patients with BPAD, diagnosed clinically by a consultant psychiatrist based on ICD-10 were selected for the study from Gwalior Mansik Arogyashala. (Gwalior Mental Hospital) Patients of both genders, ranging from 18-50 years, having more than 16 responses on Rorschach were included in the study. The findings of the study reveal that patients with BPAD have significant differences in various Rorschach variables such as psychological resources, though poor in both groups, but were extremely limited in patients with schizophrenia compared to the patients with BPAD. Minimal stress tolerance was seen in patients with schizophrenia in comparison to BPAD. Situational stress is seen more in BPAD, with poor capacity of control in both groups. 9. Psychogenic diplopia in an adolescent: Blind analysis through Somatic Inkblot Test, L. S. S. Manickam & B.L. Dubey, Pages 113-118. There are not many reports on psychogenic diplopia in children and adolescents which is diagnosed as ‘Dissociate neurological symptom disorder, with visual disturbance’ (DNSD) as per ICD-11 guidelines. Here we present a 12-year-old adolescent’s case report along with his responses on Somatic Inkblot Series (SIS-II) projective test along with the interpretation of the responses. The blind analysis of the report validates the known history and indicated the need for further exploration to aid the therapeutic process. The images revealed the client’s poor interpersonal relationships with his mother, father and peers, with a low self and aggressive attitude with desire to have power and authority. Clients who undergo these experiences need personal therapy to address their negative attitude and aggressive behavior. More research of SIS-II with children and adolescents may help the clinicians to unravel the ‘inner cry’ and help them to process the unresolved issues during psychotherapy. 10. Family Conflict in Dysthymia and preoccupation with unusual bodily sensations: A case study with the help of Somatic Inkblot Test and Sack’s Sentence Completion Test, Swati Agarwal & Satyadhar Dwivedi, Pages 119-122. Dysthymia, a persistent depressive disorder, manifests as a chronic state of depressed mood. Its prevalence in the general population is estimated to be around 1% to 2%, with a higher incidence in women compared to men. The utilisation of innovative psychological assessment tools like the Sentence Completion Test and Somatic Inkblot Test provides a nuanced understanding of an individual's perceptual and cognitive processes related to bodily sensations and emotional experiences. By integrating familial lens into the exploration of dysthymia and heightened fixation on unusual bodily sensations, this study endeavours to unravel the potential role and impact of family dynamics in shaping the experiences of individuals grappling with this intricate intersection. Mr. Y.C. is a 33 year old male, Graduate Engineer (B.tech) and currently unemployed. His chief complaints were of sad mood, feelings of loneliness, lack of concentration, loss of pleasure in things he previously enjoyed, indecisiveness and uncomfortable body sensations such as stiffness in body and sensation of heat in certain parts of body. He reported having sexual relationships with several partners but not able to build an emotional attachment with anyone. The findings on assessments reveal parental conflict that contributes to his symptoms of dysthymia and heightened preoccupation with bodily sensations. Furthermore, his conflicted relationship with mother also reflects internalized aggression and frustration, which impacts his ability to maintain a healthy romantic relationship with any woman. The weekly therapy sessions spread over a period of 4 months have led to improvement in socio-occupational functioning as the patient is now working as an IIT coach in a coaching center. Future interventions will focus on developing conflict resolution strategies and promote constructive ways to address and resolve family conflicts. |
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