‘But the patient doesn’t seem borderline’: some observations on a common diagnostic error

ABSTRACT Introduction Anxiety is central to the psychotherapy process, yet psychotherapists routinely infer a client's anxiety intensity from observable behaviour rather than from formal measurement, with no widely accepted framework to organise which observable markers indicate which levels of anxiety. This exploratory study examined how therapists make such classifications. Method Ninety‐one mental health professionals were randomly assigned to classify 41 text‐described behavioural and physiological markers using either a 5‐level or a simplified 3‐level category system, both derived from an integrated model of state anxiety in psychotherapy. Results Response distributions departed significantly from uniformity for nearly all markers in both formats, and the rank ordering of markers by intensity was highly consistent across formats, suggesting that therapists may share broad intuitions about relative marker intensity. Which markers elicited agreement, however, was far less reproducible, depending substantially on the response format. Convergence also depended on where the agreement criterion was set, declining from 90.2% to 51.2% of markers in the 3‐level format and from 63.4% to 22.0% in the 5‐level format as the criterion rose from > 0.50 to > 0.70. The 3‐level format yielded more classifiable markers at every criterion, although this advantage was not consistent across indices, whereas the 5‐level format elicited fewer ‘Insufficient to Determine’ responses. Markers placed at the highest intensity levels were classified most consistently. Discussion These findings offer preliminary groundwork for research on marker operationalisation, contextualised rating tasks and the development of training materials for psychotherapy process research.

This study examines adult romantic attachment among university students, focusing on attachment anxiety and attachment avoidance. A quantitative, descriptive, cross-sectional design was used, involving 50 students aged 18 to 28 years. Data were collected through an online questionnaire using the 12-item Experiences in Close Relationships?Short Form (ECR-S). The results showed moderate attachment anxiety (M = 3.78, SD = 1.03) and low-to-moderate attachment avoidance (M = 3.16, SD = 0.90). A weak positive correlation was observed between the two dimensions (r = .16, p = .264), but the relationship was not statistically significant. Exploratory analysis identified a statistically significant difference in attachment avoidance across years of study, while the observed gender difference in attachment anxiety was not statistically significant. These demographic findings require cautious interpretation because of the small subgroup sizes. Overall, participants reported greater concern about rejection than discomfort with emotional closeness. The findings support examining attachment anxiety and avoidance as distinct dimensions of romantic attachment. However, the small convenience sample, reliance on self-reported responses, and cross-sectional design limit the generalisability of the results. Further research involving larger and more diverse student populations is recommended to examine attachment patterns and their relationship with demographic and interpersonal factors.

This study explored attachment-related responses and self-reported relationship experiences among adults. A quantitative, cross-sectional survey was conducted using an online questionnaire; the supplied response file contained 57 records. The questionnaire included demographic questions, 12 attachment-related statements, six relationship-experience statements, and an optional open-ended question about healthy relationships. Descriptive statistics were calculated. For exploratory analysis, four items concerning fear of rejection and reassurance were averaged into an anxiety-related index, and four items concerning emotional disclosure, closeness, and independence were averaged into an avoidance-related index. These researcher-created indices are not validated psychological scales. Spearman rank correlations were used to examine associations with relationship-experience ratings. The six-item relationship-experience composite had a mean of 3.65 on a 1-5 scale. The anxiety-related index was positively associated with the composite (ρ = .315, p = .017), as was the avoidance-related index (ρ = .430, p = .001), contrary to the initially anticipated negative direction. Since the items were not validated, no reverse-scoring was applied, and the sample was a convenience sample with uneven demographic representation, these findings must be interpreted cautiously. They do not establish causation or justify classifying individuals by attachment style.

Experiences of bullying can have significant psychological consequences, including an increased risk of social anxiety. This study aimed to examine changes in social anxiety following Virtual Reality Social Exposure (VRSE) among bullying victims. A one-group pretest–posttest design without a control group was employed with 12 participants. The intervention consisted of three gradual exposure sessions in virtual environments representing social situations. Social anxiety was measured before and after the intervention, and the data were analyzed using the Wilcoxon Signed-Rank Test. The results indicated a statistically significant decrease in social anxiety scores following the intervention (p = 0.002), with a reported effect size of 0.974. These findings suggest that VRSE may be a promising approach for reducing social anxiety among bullying victims. However, the absence of a control group and the small sample size limit conclusions regarding its effectiveness and safety. Further studies with larger samples, control groups, and systematic safety assessments are needed.

Stress arising from academic, professional and financial demands is common among students and young professionals, and the coping methods within easiest reach, such as listening to music, do not always suffice. This paper presents a survey-driven design for a virtual reality (VR) gadget that combines selectable immersive natural environments, environment-matched sound therapy and heart-rate biofeedback for short relaxation sessions. An online questionnaire completed by 24 respondents, mostly college students, supplies the user requirements. Among those who answer the relevant items, 65.2% report daily stress, 73.9% name academic or job pressure as the main cause, and 47.8% state that a busy schedule prevents regular yoga or meditation. Music is the most common coping method (63.6%). Asked about a 10–15 minute VR relaxation session described as free of side effects, 83.3% answer “yes, definitely” and 8.3% answer “maybe” if the price is under Rs. 5000. The findings yield design requirements, a system architecture, a session workflow and a protocol for comparing the gadget with guided breathing, meditation and relaxing music. That comparison is planned, not yet carried out: the prototype has not been tested with users, and the paper makes no claim of clinical effectiveness.