Family crisis intervention in war contexts: a case study of a traumatised Palestinian family

The aim of this study was to analyse the phases of an innovative in vivo exposure intervention in which all family members were present at the scene of a traumatic incident. Clinical practice has borne out the efficacy of family intervention and its benefits for traumatised individuals and family groups. The intervention discussed here was conducted with a Palestinian family that had suffered trauma in a missile attack during the Israeli–Lebanese war of summer 2006. Narrative and meaning-reconstruction methods were combined with cognitive-behavioural techniques. The study highlights the limitations of the intervention as well as suggesting future directions for integrated models of crisis intervention; development of an evidence-based model is recommended.     

The effects of early relational antecedents and other factors on the parental sensitivity of mothers and fathers

This study examines the effect of early relational antecedents (ERA, i.e. the quality of parenting parents recalled receiving as children), parenting stress, marital stress, socio‐economic factors and children's characteristics (gender and disability condition) on the parental sensitivity of mothers and fathers. The sample consisted of 116 mothers and 84 fathers of 117 eighteen month old children drawn from a larger longitudinal study on the adaptation of parents to a child with a disability. Thirty‐four children were diagnosed with Down syndrome (DS), 51 with a cleft lip and/or palate (CLP), and 32 were non‐disabled children. Multiple regression analyses reveal that mothers' sensitivity is best predicted by her level of education and family income, whereas fathers' sensitivity is best predicted by their ERA, marital stress, family income and the child's disability condition. Mothers with more education and a greater family income displayed a greater sensitivity to their children, as did fathers who perceive less marital stress, those with a greater family income and those who perceived their parents as less controlling. Also, fathers of children with DS displayed less sensitivity for their children than fathers of children with CLP or fathers of non‐disabled children. These results concord with many studies about the importance of socio‐economic factors, ERA, marital stress, parent's gender and children's factors in the understanding of parental sensitivity. Copyright © 2003 John Wiley & Sons, Ltd.     

父母控制、父母婚姻冲突与中学生心理危机的关系：歧视知觉的中介作用

从歧视知觉的角度考察父母控制、父母婚姻冲突对中学生心理危机的作用机制。结果显示,父母控制和父母婚姻冲突显著正向预测中学生的心理危机水平,且父母婚姻冲突的预测力更强。歧视知觉在父母控制、父母婚姻冲突与中学生心理危机的关系中均起到部分中介作用。结果表明,与不良教养方式相比,父母婚姻冲突对中学生心理危机存在更严重的负面影响,这种影响部分通过中学生感知到的歧视水平增高来实现。     

Evidence for a sensitive period in the effects of early life stress on hippocampal volume

Exposure to stress has been causally linked to changes in hippocampal volume (HV). Given that the hippocampus undergoes rapid changes in the first years of life, stressful experiences during this period may be particularly important in understanding individual differences in the development of the hippocampus. One hundred seventy‐eight early adolescents (ages 9–13 years; 43% male) were interviewed regarding exposure to and age of onset of experiences of stress; the severity of each stressful event was rated by an objective panel. All participants underwent structural magnetic resonance imaging, from which HVs were automatically segmented. Without considering the age of onset for stressful experiences, there was a small but statistically significant negative association of stress severity with bilateral HV. When considering the age of onset, there was a moderate and significant negative association between stress severity during early childhood (through 5 years of age) and HV; there was no association between stress severity during later childhood (age 6 years and older) and HV. We provide evidence of a sensitive period through 5 years of age for the effects of life stress on HV in adolescence. It will be important in future research to elucidate how reduced HV stemming from early life stress may contribute to stress‐related health outcomes.     

Effects of parental alcoholism and life stress on hispanic and non-hispanic caucasian adelescents: A prospective study

Investigated ethnicity and parental alcoholism as factors that might influence the stress vulnerability of adolescents. It extended an initial cross-sectional study of this same sample by adding two annual assessments which allowed for additional cross-sectional analyses and longitudinal tests. Hispanic and Caucasian adolescents (N=306 at Time 1) completed measures of their own life stress, family conflict, and alcohol use. Their parents reported on adolescents' internalizing and externalizing symptoms. Cross-sectional analyses at Time 2, and prospective analyses involving Time 1 and Time 2 measures were, for the most part, consistent with the original study's results. Caucasian adolescents and children of alcoholic parents appeared to be more vulnerable to stress than Hispanic adolescents and children of nonalcoholic parents. Family conflict was a partial explanation for this increased vulnerability. This research was supported by National Institute on Drug Abuse Grant DA05227 to Laurie Chassin (pricipal investigator) and Manuel Barrera, Jr. (coprincipal investigator). Susan Li was supported by an American Psychological Association Minority Fellowship Award. Portions of this research were presented at the conference, “Resiliency in Families: Racial and Ethnic Minority Families in America” that was held at the University of Wisconsin, May 31–June 2, 1994.     

The impact of the socio-economic crisis on intrapsychic and intersubjective processes within the therapeutic relationship: Implications for the ethical practice of counselling psychology and psychotherapy

Using attachment and mentalisation theories as a framework, the present paper aims to explore the impact of the current socio-economic crisis on the micro-processes and interpersonal dynamics that emerge between client and therapist as well as the ethical dilemmas that surface within the context of the therapeutic relationship. The first part of the paper focuses on the intrapsychic level and the subjective appraisal and experience of the crisis, as this may differ from individual to individual as well as the unique meaning-making processes that take place for clients and therapists alike. It is argued that the socio-economic crisis itself cannot be seen as an entity that is entirely independent and external to the individual but as a phenomenon that interacts in unique ways with the individual’s inner current and past experience. The second part focuses on the exploration of intersubjective processes that emerge between client and therapist, in particular the transference-countertransference dynamic, as this develops within conditions of increased arousal and anxiety. The role and responsibility of counselling psychologists in preserving reflexivity, empathy and a mentalising stance (through supervision and personal therapy) are highlighted in order to safeguard the ethical and competent practice of counselling psychology.     

A crisis mental health intervention service: an innovative model for working intensively with young people on the edge of care

This paper describes the setting up and the first year of running of an innovative outreach service for adolescents on the edge of care that aimed at redressing family breakdown and preventing placements in the care system. It was a collaborative endeavour between social services and a child and adolescent mental health provision to facilitate the engagement of hard to reach young people and families that often presented high levels of risk. This article describes a distinctive model of applied psychoanalytic work with individuals, families and the networks of practitioners and agencies around the case. It focuses on the integration of two perspectives: the individual and the family on the one hand and the organisation on the other. Case examples illustrate how our psychoanalytic and developmental framework illuminated our understanding of frequently extreme acting out behaviour and parental difficulties in terms of underlying intergenerational trauma, which was often re-enacted. This framework also helped in understanding the difficulties that practitioners experienced and how these related to individual and family dynamics. The article describes the significance of containment in the treatment of adolescents and families in crisis as well as in supporting the professional network.     

A randomised controlled trial of a brief online mindfulness-based intervention

ObjectivesThere is growing evidence that mindfulness has positive consequences for both psychological and physical health in both clinical and non-clinical populations. The potential benefits of mindfulness underpin a range of therapeutic intervention approaches designed to increase mindfulness in both clinical and community contexts. Self-guided mindfulness-based interventions may be a way to increase access to the benefits of mindfulness. This study explored whether a brief, online, mindfulness-based intervention can increase mindfulness and reduce perceived stress and anxiety/depression symptoms within a student population.MethodOne hundred and four students were randomly allocated to either immediately start a two-week, self-guided, online, mindfulness-based intervention or a wait-list control. Measures of mindfulness, perceived stress and anxiety/depression were administered before and after the intervention period.ResultsIntention to treat analysis identified significant group by time interactions for mindfulness skills, perceived stress and anxiety/depression symptoms. Participation in the intervention was associated with significant improvements in all measured domains, where no significant changes on these measures were found for the control group.ConclusionsThis provides evidence in support of the feasibility and effectiveness of shorter self-guided mindfulness-based interventions. The limitations and implications of this study for clinical practice are discussed.     

早期应激对情绪调节的影响及其神经机制

在个体生命早期遭遇的长期或重大的应激经历会显著增加个体罹患抑郁、焦虑等心理疾患的风险, 而情绪调节能力的损伤是引发这些心理疾患的重要因素之一。以人类为对象的行为实验和调查研究表明, 早期应激不仅会影响日常生活中情绪调节策略的使用, 还会对情绪调节能力造成影响, 其影响方向可能与早期应激的严重程度有关。目前, 大部分研究表明严重的早期应激会损伤情绪调节能力, 但中度的早期应激也可能提高情绪调节能力。更为整合性的研究表明情绪调节能力中介了早期应激和各类疾患之间的关系。进一步, 我们从神经层面上阐述了早期应激对情绪调节相关脑区和神经环路的影响。未来研究应当注意控制无关变量, 进一步探究不同早期应激对于情绪调节的影响。     

Videoconference to supervise early intensive behavioral intervention: A preliminary evaluation of acceptability

At present, early intensive behavioral intervention (EIBI) for children with autism spectrum disorders is the intervention that has the strongest empirical support. EIBI requires frequent supervision by qualified professionals. Norway, like many other countries, has a shortage of qualified supervisors, particularly in rural regions. This study used a reversal design to investigate how supervisors and supervisees perceive the quality of EIBI supervision and the local team's preparedness when supervision was provided either on-site or via videoconference. Calculations were made on how much time could be saved on travel when part of the supervision was provided via videoconference. There were no significant differences in the supervisors' and supervisees' ratings of on-site and videoconference supervision. Moreover, the supervisors found the local EIBI teams to be better prepared when supervision was provided via videoconference, and the videoconference supervision meetings were shorter. The study discusses the implications of these findings for the accessibility of EIBI and case capacity and proposes some areas for further research.     

A review of recent studies on differential reinforcement during skill acquisition in early intervention

Although the use of differential reinforcement has been recommended in previous investigations and in early intervention curriculum manuals, few studies have evaluated the best method for providing differential reinforcement to maximize independent responding. This paper reviews previous research on the effectiveness of differential reinforcement as treatment and describes important areas of future research.     

‘Play skills’ for shy children: development of a Social Skills Facilitated Play early intervention program for extremely inhibited preschoolers

The aim of the present study was to develop and provide a preliminary evaluation of a social‐skills‐based early intervention program specifically designed to assist extremely inhibited preschoolers. Participants were a sample of n=22 extremely inhibited preschool‐aged children, who were randomly assigned to either the Social Skills Facilitated Play (SST) or Waitlist Control (WLC) condition. As compared to wait‐list controls, extremely inhibited children who participated in the SST‐facilitated play program sessions demonstrated a significantly greater post‐intervention decrease in observed socially wary behaviours and a significantly greater increase in social and socially competent behaviours at preschool. Results are discussed in terms of the importance of developing and refining early intervention programs for extremely inhibited young children. Copyright © 2010 John Wiley & Sons, Ltd.     

灾难中的心理危机干预——精神病学的视角

灾难事件是一种特殊类型的生活事件,因其超出个体应对能力,因此灾难事件后常并发一系列的精神卫生问题。急性应激障碍、创伤后应激障碍、抑郁症、自杀是灾后常见精神卫生问题。本文回顾了近年来灾难事件相关精神障碍的研究,并总结了去年发生在我国的两次重大灾难性事件的相关研究结果,从精神病学视角对灾难事件后心理危机干预策略进行了探讨。     

Forging partnerships for mental health: The case of a prefecture in crisis ravaged Greece

Public health and in particular mental health have been severely affected by the multitude of socioeconomic crises experienced by people in Greece. The severe austerity programmes, have reduced access to health services and increased demand for publically funded health care. This paper presents a case study focusing on the impact of these measures on the lives of mental health providers in one prefecture in Crete. Focus group methodology was applied and the data were analysed using thematic analysis. Analyses revealed three superordinate themes that converge at many levels and appear to be going counter to the circumstances: firstly, ‘forging partnerships for mental health’; secondly, ‘extending our reach’; and thirdly ‘transformations in professional identity through praxis’. These themes are discussed using the words of the participants and the relevant literature.     

Person‐centred counsellors' experiences of working with clients in crisis: A qualitative interview study

Aims: This study aims to explore and understand person‐centred therapists’ experiences and work with clients at the pivotal point of crisis. Specifically: how do person‐centred therapists experience working with clients in crisis? Do they identify differences in crisis intervention compared to non‐crisis work? What do they perceive as helpful to crisis clients? How relevant are therapists' own experiences of crisis? Method: Participants were all experienced person‐centred therapists. Qualitative, semi‐structured interviews were conducted and the data were analysed qualitatively using person‐centred/phenomenological methodology. Results: Respondents identified differences in their experiences. Typically, therapists described polarity in their experience of danger and opportunity, also heightened energy levels within themselves, perceived higher levels of engagement, faster pace of work, experiences of reaching ‘relational depth’ earlier, and the importance of assisting symbolisation of clients' experience in awareness. Clients were experienced as vulnerable, unable to access previous coping mechanisms, in a state of breakdown and disintegration, but also as wide open, having dropped their usual defences, and more available to engage in therapy and enter the process of change and potential post‐crisis growth. Discussion: The findings are discussed in relation to prevailing models of crisis intervention, person‐centred theory and theoretical developments in post‐traumatic growth in the aftermath of crisis.     

Screening and brief intervention of alcohol problems in primary care in South Africa: A brief report

The aim of this randomised controlled trial was to provide screening and brief intervention for alcohol problems in a primary care setting in South Africa. Outpatients were screened for hazardous or harmful alcohol use and were randomised into an experimental (one brief counselling session) or control group (received an alcohol health education leaflet). The study population of hazardous or harmful drinkers (N=140) consisted of 105 male and 35 female women, with a mean age of 30.4 years (SD=6.6). Among the 128 (91.4%) primary care outpatients who also attended the 6-month follow-up session, the time effects on the AUDIT scores were significant but the intervention effect on the AUDIT score was statistically not significant. It would seem that alcohol screening and the provision of an alcohol health education leaflet may in itself cause reduction in drinking.     

Predicting disturbed parental awareness in mothers with a newborn infant: test of a theoretical model

Parental awareness refers to parents' perceptions and making sense out of children's responses and behaviours. This study examined a theoretical model on the determinants of disturbed parental awareness, with a central place given to Belsky's buffer hypothesis. Maternal characteristics were hypothesized to have direct effects on parental awareness, whereas effects of negative childhood experiences and low levels of social support were regarded as being mediated by maternal characteristics. The model was examined in a community sample of 101 mothers from different socioeconomic backgrounds with a zero‐to‐three infant. Social nurses providing home visits reported on parental awareness, childhood experiences, social support, and maternal characteristics. Results supported a modified model that added a direct pathway between childhood experiences and parental awareness, supporting the intergenerational transmission hypothesis. Copyright © 2002 John Wiley & Sons, Ltd.     

Early life adversity potentiates the effects of later life stress on cumulative physiological dysregulation

Background and Objectives: Previous research indicates that early life adversity may heighten stress reactivity and impair mechanisms for adaptive coping, suggesting that experience of stress in early life may also potentiate adults' physiological vulnerability to stress in later life. The study tested this hypothesis by investigating whether the experience of stressful events and circumstances (SEC) in childhood or adolescence amplified the effect of adulthood SEC on physiological dysregulation (allostatic load, AL) in later midlife. Design: Observational data were used in the present study. Physiological functioning was measured in later midlife (participants' age ranged from 49 to 63 years). Both childhood/adolescence and adulthood SEC were reported retrospectively on the same occasion. Methods: Participants were 5309 Danish men and women from Copenhagen Aging and Midlife Biobank (CAMB). SEC included socioeconomic and family factors. The AL index was based on nine cardiovascular, metabolic, and immune biomarkers. Results: Experience of SEC in both early life and adulthood independently predicted higher AL. In men, experience of SEC in early life also potentiated the effect of SEC in adulthood on AL. Conclusions: The results provide further insight into the mechanisms behind the “biological embedding” of childhood stress.