Author Archives: smucker

Mervin Smucker. An examination of type-D personality in patients before and after cardiac surgery

Stephanie Dannemann, Klaus Matschke, Franziska Einslec, Mervin Smucker, Katrin Zimmermann, Peter Joraschky, Kerstin Weidner, & Volker Köllner (2010).  Is type-D a stable construct? An examination of type-D personality in patients before and after cardiac surgery. Journal of Psychosomatic Research, 69, 101-109.

Objective: Type-D personality—negative affectivity and social inhibition—are related to poor prognosis in cardiovascular diseases. At present, little is known about type-D personality and its stability before and after cardiac surgery. Methods: One hundred twenty-six patients recommended for coronary bypass and/or valve surgery were examined at pre-surgery and 6 months post-surgery to investigate the stability of type-D 14-item Type-D Scale) and its relationship to anxiety, depression (Hospital Anxiety and Depression Scale) and quality of life (Short Form 12). Results: Preoperatively, 26% were assessed to have type-D, while only 11% fulfilled type-D criteria both pre-and post-surgery. Patients were assessed and identified as belonging to one of the four type-D groups: Stable type-D (11%), non-type-D (61%), type-D pre (15%), and type-D post (13%). In comparison to the stable nontype D group, the stable type-D reported more symptoms of anxiety, depression, lower physical quality of life post-surgery, and lower mental quality of life both pre-and post-surgery. When compared to the population at large, stable type-D had more symptoms of depression pre-surgery, and more anxiety as well as lower physical and mental quality of life pre-and post-surgery. Conclusion: Type-D diagnosis changed in nearly 60% of the cases post-surgery. Only those patients with stable type-D exhibited a relationship to emotional distress, such as anxiety and depression and reduced quality of life. Additional research on the critical cutoff scores and stability of type-D as it relates to critical life events would likely enhance our ability to more effectively diagnose and treat patients who are at high risk for insufficient coping.

Mervin Smucker

Mervin Smucker. Attachment Theory and Imagery Rescripting & Reprocessing Therapy (IRRT).

In attachment theory, psychotherapy is conceptualized as a process of re-appraising and re-working inadequate, maladaptive, outdated schematic models of the self and primary attachment figures.  A core therapeutic task is thought to be the development of a “secure base”, from which individuals may begin the difficult task of examining, challenging, and modifying their internal working models.

Similarly, a primary task of the IRRT therapist’s work with individuals suffering from PTSD is to provide a “secure base” or “safety zone” that functions as a therapeutic anchor, within which the individual’s distressing traumatic material can be accessed, confronted, and processed.  This procedure may be viewed as akin to Wolpe’s systematic desensitization treatment that facilitates patient shifts from a state of relaxation to exposure to phobic stimuli, followed by a return to the relaxed state, and so on.

Mervin Smucker Ph.D.

Mervin Smucker. Using Praise as a Positive Reinforcer with Children.

Praise encompasses words, gestures, or facial expressions that lead to another person feeling pride, joy, and a general sense of well-being. When we as parents praise our children for engaging in behaviours or attempting tasks that we approve of (e.g., for sharing, showing kindness and respect for others, playing with other children cooperativey, remembering to do tasks on their own without being reminded, attempting to master difficult tasks), we increase the likelihood that these desired behaviours will be repeated and become part of a child’s behavioural repertoire. According to child experts, it is best to give a child praise related to a specific event and not necessarily the total being or character of the child.

For example, when a child makes an unsuccessful attempt to do his math homework:

Example 1 illustrates the use of constructive parental praise:

„Wow, you really worked hard at that math assignment. Doing math is sometimes really hard and not much fun. I’m impressed with how hard you worked at those problems. Perhaps we can talk to your teacher about getting some extra help with this.“

Example 2 illustrates the use of non-constructive parental praise:

„You are a wonderful son. I am really proud of you and don’t know what I would ever do without you?“

Mervin Smucker Ph.D is an international trauma consultant and author of numerous articles and books on trauma and cognitive-behavioural therapy interventions.

IRRT Homework Record

Name of Client­
Name of Therapist
Date
Imagery Session

Homework Assignment:  Listen daily to audiotape of entire imagery session (exposure and rescripting).  Record date and time of each audiotape listening session.

Record Subjective Unites of Distress: (SUDS: 0 – 100) at the beginning and end of listening to the audiotape.  Also record the peak (highest) SUDS experienced while listening to the audiotape.

Self-administer the Post-Imagery Questionnaire (PIQ-A or PIQ-B) immediately after listening to the audiotape and record the total PIQ score.

DAY                               1              2              3              4              5              6              7
Date and Time
SUDS Beginning
SUDS End
SUDS Peak

DAY                             8             9            10             11             12             13            14
Date and Time
SUDS Beginning
SUDS End
SUDS Peak
PIQ Score (A or B)

Mervin Smucker

Mervin Smucker. The Emotion of Shame

Shame is one of the most powerful, painful and potentially destructive emotions known to humans. The essence of shame is the fear of negative evaluations of others by means of exposure of one’s undesirable qualities or actions. The word shame originates from the Indo-European word „skam“ which means to hide (so as to avoid exposure). The very first human story recorded in the Bible – the account of Adam and Eve in the Garden of Eden – is a story about shame and how Adam and Eve became wrought with fear of judgment and negative consequences after eating of the „forbidden fruit“.  Researchers (e.g., Paul Gilbert) have identified two subtypes of shame: (1) Internal shame: perceived qualities of the self that the individual judges to be negative (e.g., bad, weak, inadequate, digusting or repugnant); that is, attacks on the self by the self; (2) External shame: refers to qualities of the self that others view as bad, weak, inadequate, disgusting or repugnant); that is, attacks on the self by others.

Dr. Mervin Smucker is an international trauma consultant and author of numerous articles and books on trauma and cognitive-behavioural therapy interventions.

Mervin Smucker. Agenda-setting in Cognitive Therapy

Cognitive therapy is a time-limited, structured approach that involves a high degree of active involvement from the therapist and the client. An agenda is collaboratively set with the client for each session to ensure that critical issues are identified and addressed and that enough time is allocated each agenda item. Agenda items may include a review of self-help assignments and issues explored in the previous session, therapist feedback pertaining to the previous and current session, an assessment of interventions that have been effective (or not effective) thus far, and current, here-and-now issues that need to be addressed. Agenda items are then prioritized, and the therapist and client determine collaboratively which agenda goals are realistic to accomplish in one session. Allowing time at the end of each session to briefly review what has been discussed and accomplished is also an important part of the session agenda (See Beck et. al., 1979).

Dr. Mervin Smucker is an international trauma consultant and author of numerous articles and books on trauma and cognitive-behavioural therapy interventions.

Mervin Smucker. Factor Analysis of the Children’s Depression Inventory in a Community Sample

In a study conducted by Craighead, Smucker, Craighead, & Ilardi (1998) published in Psychological Assessment, a factor analysis of the Children’s Depression Inventory (CDI; Kovacs, 1992) was conducted with a large nonclinical, community sample of 1,777 pre-adolescents and 924 adolescents. The data yielded the following five first-order factors: externalizing, dysphoria, self-deprecation, school problems, and social problems for the pre-adolescent group. The adolescent group yielded the same five factors plus a sixth factor (biological dysregulation). A confirmatory factor analysis supported the stability and replicability of the obtained factor structures. Both of these sample groups produced two higher order factors: internalizing and externalizing. In addition, more pre-adolescent boys reported higher depression scores on the total CDI (17 and above), while more adolescent girls reported higher CDI scores (17 and above) as well as relatively higher scores on the biological dysregulation factor.

Dr. Mervin Smucker

Mervin Smucker. The rural nature of the Amish and their eschewing of the modern world.

The Old Order Amish are a rural people who place a high value on farming. In spite of their refusal to adopt technological conveniences in their homes and utilize modern equipment on their farms, they have developed some of the most productive and stable agricultural communities in North America. Their rejection of trends, which have changed other rural communities, such as consolidation of schools and migration to the cities, has enabled the Amish to remain a cohesive, homogeneous group. The Amish view themselves as separate from “the world”, want to have no part of the worldly values that define the modern culture around them, and are quite content to live in isolation from the mainstream of secular society.

Mervin Smucker

Mervin Smucker. The Post-Imagery Questionnaire (PIQ).

The (PIQ) was developed as a means of obtaining immediate and direct client feedback about the imagery rescripting session just experienced. The PIQ consists of two forms: PIQ-A and PIQ-B. While some overlap exists between the two forms, specific items vary in accordance with the particular phase of rescripting which the client is in at the moment.

The PIQ is administered by the clinician immediately following the completion of an imagery session. The clinician introduces the PIQ to the client as follows:

I would like to ask you a few questions about the imagery session we just completed. I will be asking you to rate your response to each item on a 0-100 scale. Do you need a few moments to get reoriented?              

Once the client has indicated a readiness to begin, the clinician reads aloud the items of the PIQ-A beginning with Item A:

On a scale from 0-100, how vivid was the imagery you experienced during our session today? Zero would indicate that you could not develop the imagery at all, 100 would indicate that the imagery was extremely vivid.

After recording the client’s response on the line to the left of Item A, the clinician then proceeds to Items B, 1, 2, and so on, following the same procedure until all items have been administered.

When the client’s responses to all of the PIQ items have been recorded, the clinician notes the items with an asterisks [*] next to them. These are the “reversed” items and are converted to “real” scores in the following manner:

Where X equals the Client Rating Score (i.e. the actual number reported on a reversed item),100 minus X equals the Real Item Score.

The Real Item Score of each item without an asterisks is the actual number reported by the client. The total PIQ quantitative score is the sum of all individual Real Item Scores of items 1-10. (Items A and B of both PIQ forms are not tabulated in the total PIQ score.) Total scores in each PIQ form range from 0 to 1000.

The higher the total PIQ score, the more acute is the degree of abuse-related cognitive dysfunctionality and affective distress. At the completion of Imagery Rescripting treatment, a significant drop in the total PIQ scores should be noted. Although the PIQ appears to have good face validity, psychometric data are not yet available for either form.

Mervin Smucker

Mervin Smucker. Masterson’s Theory of Abandonment Depression.

Masterson (1985) conceptualizes the self-destructive, acting-out behaviours of BPD individuals as attempts to manage their feelings  of „abandonment depression“, which include rage, anxiety, fear of being alone, and depression, accompanied by a functional loss of soothing introjects and transitional objects. Accordingly, it is this individuation-separation threat (which may also be triggered by symptomatic improvement in treatment) that is thought to reactivate the „abandonment depression“ of earlier experiences. This, in turn, often invokes the primitive, defenses of projective identification, splitting, and denial leading to the following manifestations: (1) Acting-out, impulsive, self-destructive behaviours; (2) emotional dysregulation, e.g.,, inappropriate anger, lability of affect; (3) unstable, intense interpersonal relationships; and (4) identity disturbances and unstable self-boundaries predisposing to transient psychotic episodes. This triad of the separation-individuation threat leads to abandonment depression that results in the activation of destructive defenses with their associated clinical manifestations constitutes Mastern’s conceptualization of the core dynamic features of borderline phenomena.

Dr. Mervin Smucker is an international trauma consultant and author of numerous articles and books on trauma and cognitive-behavioural therapy interventions.

Mervin Smucker. Homework Assignments in Imagery Rescripting & Reprocessing Therapy (IRRT).

Homework assignments are an essential component of IRRT.  Typically, each IRRT session is audiotaped. Clients are given a copy of the just-completed IRRT session and are asked to:  (1) listen daily to the audiotape of the entire IRRT session; (2) record SUDs levels immediately before and after listening to the audiotape, as well as their highest SUDs rating while listening to the audiotape; (3) record their subjective reactions to the audiotaped session immediately after listening to it; (4) document efforts (in a journal) to self-calm and self-nurture; (5) record frequency and intensity (on a 0-100 scale) of flashbacks experienced between therapy sessions; and (6) bring homework in for review at the beginning of the next IRRT session.

Mervin Smucker

Mervin Smucker. Post-Imagery Rescripting Guidelines for Crisis Management.

If a crisis arises or serious difficulties are encountered between outpatient imagery sessions, before calling the therapist or counselor a client is instructed to first visualize, and record in a journal, an imaginary conversation with the therapist, in which the client:

  1. describes the upsetting situation,
  2. verbalizes his or her thoughts and feelings about the situation,
  3. explains to the therapist (in imagery) how s/he has already attempted to cope with the upsetting situation,
  4. then “listens” carefully to the therapist’s response and attentively writes down what s/he “hears” the therapist saying.

If, after having this imagery conversation with the therapist, the client still feels the need to call, s/he may do so. However, the client is informed that upon making such a call, the therapist’s initial response will be to ask him/her to report on (a) whether s/he was able to visualize him-/herself having a conversation with the therapist, (b) what s/he has written down from that imagery conversation, and (c) what s/he “heard” the therapist say in response.

Mervin Smucker

Mervin Smucker (2012). Who are the Old Order Amish today?

The Old Order Amish today are a German-speaking religious sect who have maintained a distinctive, consistently traditional way of life since their migration to North America in the eighteenth century. The Amish emerge as unique, not only because of their austere lifestyle but also because they have steadfastly maintained it despite the all-pervasive forces of twentieth and twenty-first century modernization. Today, there are Old Order Amish communities in some 20 states, a Canadian province, and several Latin American countries. There are an estimated several hundred thousand Old Order Amish today, with the largest settlements in Indiana, Ohio, and Pennsylvania.

Mervin Smucker

Mervin Smucker (2015). Stories under the Story

Most of us live by stories, whether or not we are aware of this. For instance, some of us believe the story that if we work hard, we will succeed. Others may believe that they’ve been cheated in life, and therefore life owes them something. Some believe that if they live a life of service and giving to others they will be rewarded in the afterlife. In cognitive therapy, such stories are called underlying assumptions, beliefs, and schemas. These stories can be adaptive or maladaptive, depending on their context and content, and lead to habitual responses to situations. For instance, a person with a “powerlessness” schema deeply believes the story that no matter what they do, they are powerless to change their situation. Effectively working with such persons requires addressing this maladaptive story and helping them to “rescript” it into a story of empowerment.

Mervin Smucker

Mervin Smucker (2015). Finding Meaning in Suffering: A Logotherapy Perspective

Viktor Frankl’s years of personal experience spent as a prisoner in the Nazi concentration camps led him to pursue the question of how to make sense of, or find larger meaning and purpose in senseless suffering.  In particular, he purported that meaning may be found in seemingly hopeless situations, even when facing a fate that cannot be changed. At such a time, an individual is challenged to activate his or her uniquely human potential at its best, and thereby transform a personal tragedy into a triumph of human achievement.  As noted by Frankl: „When we are no longer able to change a situation – just think of an incurable disease such an inoperable cancer – we are challenged to change ourselves … suffering ceases to be suffering at the moment it finds a meaning (p. 116).“

Mervin Smucker