Using Technology to Promote Therapist Use of Exposure Therapy for Childhood Anxiety Disorders: A Randomized Pilot Study

Increasing the use of exposure by community therapists during the treatment of childhood anxiety disorders is critical to improving the quality of available treatment. The aim of the current study was to investigate whether a brief training in the delivery of an exposure-focused and technology-assisted treatment protocol increased community therapist openness to exposure therapy, use of exposure in treatment, and improvement in patient symptoms. Participants were 17 therapists recruited from a large health system to provide outpatient therapy to 32 youth ages 8–18 (M = 12.13, 78.1% girls) with treatment as usual or with the Anxiety Coach application (AC-app). Consistent with two of three hypotheses, therapists in the AC-app condition increased their openness to, and use of, exposure—however, these changes did not translate into improved therapeutic outcomes. Comparisons to benchmark studies suggest that the community therapists did not implement enough in vivo exposure of sufficient intensity or include parents enough to improve outcome. Results support the ability of exposure-focused treatment protocols to increase community therapists’ use of evidence-based treatment and suggest that future efforts should focus on improving the quality, in addition to quantity, of therapist-delivered exposure.     

Identification with arts‐based groups improves mental wellbeing in adults with chronic mental health conditions

People experiencing chronic mental health conditions (CMHC) often report feeling socially marginalised. There is emerging evidence that social and mental wellbeing can be enhanced through participation in arts‐based programmes. In this paper, a social identity theoretical approach was applied to explore how participation in the arts may improve mental health in a longitudinal study. A one‐year prospective study of 34 choir members and 25 creative writing group members (M_age = 46, 51% female) with CMHC, involved three assessments of participants’ group identification and mental wellbeing, measured by the Warwick Edinburgh Mental Wellbeing Scale. The programmes were community‐based and facilitated by arts professionals. Multilevel modelling analyses demonstrated that participants’ mental wellbeing significantly improved over time. Greater identification with their arts‐based group (ABG) was significantly related to an increased rate of improvement in mental wellbeing. The trajectory of improvement in mental wellbeing did not differ between participants partaking in the choir or creative writing group. This study demonstrates that participation in ABGs can be effective in improving mental wellbeing in adults with chronic mental health problems, particularly for those who strongly identify with the group. This study supports ABG participation as an accessible component of mental health services.     

Colour and spatial cueing in low-prevalence visual search

In visual search, 30-40% of targets with a prevalence rate of 2% are missed, compared to 7% of targets with a prevalence rate of 50% (Wolfe, Horowitz, & Kenner, 2005). This "low-prevalence" (LP) effect is thought to occur as participants are making motor errors, changing their response criteria, and/or quitting their search too soon. We investigate whether colour and spatial cues, known to improve visual search when the target has a high prevalence (HP), benefit search when the target is rare. Experiments 1 and 2 showed that although knowledge of the target's colour reduces miss errors overall, it does not eliminate the LP effect as more targets were missed at LP than at HP. Furthermore, detection of a rare target is significantly impaired if it appears in an unexpected colour-more so than if the prevalence of the target is high (Experiment 2). Experiment 3 showed that, if a rare target is exogenously cued, target detection is improved but still impaired relative to high-prevalence conditions. Furthermore, if the cue is absent or invalid, the percentage of missed targets increases. Participants were given the option to correct motor errors in all three experiments, which reduced but did not eliminate the LP effect. The results suggest that although valid colour and spatial cues improve target detection, participants still miss more targets at LP than at HP. Furthermore, invalid cues at LP are very costly in terms of miss errors. We discuss our findings in relation to current theories and applications of LP search.     

Prevalence of Personality Disorders at Midlife in a Community Sample: Disorders and Symptoms Reflected in Interview,Self, and Informant Reports

This report is concerned with the prevalence of symptoms of specific personality disorders in a representative community sample and draws attention to the importance of different sources of diagnostic information. We recruited a sample of 1,630 people between the ages of 55 and 64 to participate in a study regarding personality and health. Using careful recruitment methods, our participation rate was 43 %. Participants completed the SIDP-IV interview as well as a questionnaire (self-report MAPP). Informants completed the same questionnaire (informant MAPP), describing the participant’s maladaptive personality characteristics. According to the diagnostic interview, 7 % of participants met criteria for exactly one PD, 1 % met criteria for 2 or 3 PDs, and 2 % met criteria for PD NOS (defined as 10 or more miscellaneous criteria). Avoidant and obsessive compulsive PDs were the most common types. Correlations between the three sources of information indicated significant agreement among these measurement methods, but they are not redundant. In comparison to interview and self-report data, informants reported more symptoms of personality pathology (except for avoidant PD). Symptoms of personality pathology are continuously distributed, and subthreshold features may have an important impact on health and social adjustment. In this community sample, rates of co-morbidity among PDs and the proportion of PDNOS diagnoses are substantially lower than reported from clinical samples. Future research must evaluate the validity of diagnostic thresholds and competing sources of diagnostic information in relation to important life outcomes.     

Impact de la discrimination envers les personnes LGBTQ+ en milieu de travail : recension systématique

In the United States, between 3% and 12% of employees are part of the LGBTQ+ community. Despite numerous anti-discrimination laws, they continue to be the target of discrimination in their workplaces. The purpose of this systematic review is to examine the impact of direct and indirect discrimination against LGBTQ+ individuals in the workplace and on the organization. Sixty-one articles published between January 2000 and June 2021 and indexed in PsycINFO, Web of Science, Business Source Premier and Gender Studies Data Base and Erudit were analyzed. The results first show that there is no consensus on the definition of discrimination and that few studies distinguish between direct and indirect discrimination. The effects of direct discrimination on individuals can be summarized into five broad categories: 1) hiding one's sexual orientation or gender identity, 2) experiencing financial consequences, 3) experiencing mental or physical health problems, 4) being excluded, and 5) feeling discomfort. The four effects of indirect discrimination on individuals are 1) hiding sexual orientation or gender identity, 2) experiencing negative emotions, 3) mental or physical health problems, and 4) lack of promotion. Finally, the five categories of consequences of direct discrimination on organizations are 1) lack of commitment and satisfaction, 2) lack of trust in the organization, 3) loss of workforce, 4) decreased performance, and 5) harassment. The only identified effect of indirect discrimination on the organization is a deteriorated work climate.     

Exploring the Role of Social Support in Promoting Community Integration: An Integrated Literature Review

Community integration has emerged as a priority area among mental health advocates, policy makers, and researchers (Townley, Miller, & Kloos, 2013; Ware, Hopper, Tugenberg, Dickey, & Fisher, 2007). Past research suggests that social support influences community integration for individuals with serious mental illnesses (Davidson, Haglund, Stayner, Rakfeldt, Chinman, & Tebes, 2001; Davidson, Stayner, Nickou, Styron, Rowe, & Chinman, 2001; Wong & Solomon, 2002), but there has not yet been a systematic review on this topic. Therefore, the purpose of this paper was to explore the influence of social support on community integration through a review of the existing literature. An extensive literature search was conducted, resulting in 32 articles that met the search criteria. These articles were organized into three categories: defining community integration, supportive relationships, and mental health services. The search results are analyzed according to the types of support being provided. Article strengths, limitations, implications, and future directions are also addressed. Overall, the findings of this review suggest that social support, which may be provided by a variety of individuals and services, plays an important role in promoting community integration for individuals with serious mental illnesses. Therefore, as community mental health research and practice continues to promote community integration for individuals with serious mental illnesses, the mental health field should emphasize the importance of social support as a key factor influencing community integration.     

Parent Perspectives on Community Mental Health Services for Children with Autism Spectrum Disorders

The community mental health (CMH) system provides treatment for behavioral and psychiatric problems in children with autism spectrum disorders (ASD). Although parent stakeholder perspectives are important to improving care, these perspectives have not been systematically examined for this population in the CMH sector. Twenty-one semi-structured qualitative interviews were conducted with parents of children with ASD who received services in CMH clinics. Themes related to child clinical histories, service access and experiences with the CMH system revealed a specific trajectory of service need identification, obtaining a diagnosis, and experience with services. Each trajectory stage was marked by high parent stress. Results provide information about the characteristics of children with ASD served in community mental health clinics and direction for targeted improvement efforts.     

Mental Health Problems of Children in Foster Care

We compared the rates of mental health problems in children in foster care across three counties in California. A total of 267 children, ages 0 to 17, were assessed two to four months after entry into foster care using a behavioral screening checklist, a measure of self-concept and, in one county, an adaptive behavior survey. Results confirmed previous research and indicated consistently high rates of mental health problems across the three counties. Behavior problems in the clinical or borderline range of the CBCL were observed at two and a half times the rate expected in a community population. Fewer children fell within the clinical range on the self-concept measure. No significant differences in rates between the three county foster care cohorts were observed, despite the different demographic characteristics of the counties. On the adaptive behavior scale, the mean scores for children in foster care were more than one standard deviation below the norm. Our findings suggest that the most important mental health screening issue with children in foster care is to identify what specific mental health problems need to be addressed so that the most effective treatment services can be provided.     

Sexual orientation among Icelandic year 10 adolescents: Changes in health and life satisfaction from 2006 to 2014

Minority sexual orientation may add additional stresses to the period of adolescence thus affecting mental health and wellbeing. The whole population of year 10 students in 2006, 2010, and 2014 in Iceland were surveyed as part of the Health Behaviour in School‐aged Children Survey. Sexual orientation could be identified in 1,994 participants from 2006 (43.8% of population; 988 girls), 3,777 from 2010 (78.6%; 1,863 girls) and 3,526 in 2014 (80.1%; 1,731 girls). About 3.1%, 3.6%, and 4.4% were identified as lesbian, gay, or bisexual (LGB) in 2006, 2010, and 2014, respectively. Given the sampling proportions, the results reflect parameters (population values) rather than statistics (sample values). LGB adolescents were worse off across most of the psychosocial measures across the three surveys as compared with adolescents of unknown sexual orientation (USO). However, the gap between LGB and USO adolescents appears to be closing, at least for the 2010 to 2014 change, suggesting that outcomes for LGB adolescents have improved compared to four years earlier. Social support, liking school and one's classmates, being bullied, and physical and mental health all seem to play an important part in life satisfaction and general wellbeing. While advances have been made for LGB adolescents, gaps between LGB and USO adolescents still exist and need to be closed through evidence‐based school and society‐wide programs.     

Women–Focused Treatment Agencies and Process Improvement: Strategies to Increase Client Engagement

Behavioral health treatment agencies often struggle to keep clients engaged in treatment. Women clients often have additional factors such as family responsibilities, financial difficulties, or abuse histories that provide extra challenges to remaining in care. As part of a national initiative, four women-focused drug treatment agencies used process improvement to address treatment engagement. Interviews and focus groups with staff assessed the nature and extent of interventions. Women-focused drug treatment agencies selected relational-based interventions to engage clients in treatment and improved four-week treatment retention from 66% to 76%. Process improvement interventions in women-focused treatment may be useful to improve engagement.     

Treating Elders With Compulsive Hoarding: A Pilot Program

Hoarding among elderly clients can have serious health and safety consequences, including death. Because medications and standard behavioral treatments have yielded limited benefits for people with serious hoarding problems, we employed a specialized cognitive behavioral treatment (CBT) based on Frost and colleagues' model of hoarding problems. Of 11 elderly clients who met screening criteria for hoarding at a community mental health center, 6 completed an average of 35 sessions of therapy administered by a B.A.-level therapist trained and supervised in CBT methods. Treatment consisted of weekly home visits that included motivational interviewing, organizing and decision-making skills, cognitive therapy regarding hoarding and related beliefs, and practice sorting, discarding, and not acquiring. Modest improvement was evident in ratings of clutter, risky situations in the home, and functioning. Clients were generally satisfied with treatment. Challenges in treating hoarding in elderly clients include health and safety risks as well as reduced physical capacity that required problem-solving strategies.     

Improving Delivery Behaviors During Exposure for Pediatric OCD: A Multiple Baseline Training Trial With Community Therapists

This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors (i.e., indicators of quality) that have been associated with youth outcomes in prior clinical trials of exposure therapy. Six therapists at a community mental health agency (CMHA) provided exposure therapy for 8 youth with obsessive–compulsive disorder (OCD). Using a nonconcurrent multiple baseline design with random assignment to baseline lengths of 6 to 16 weeks, therapists received gold-standard exposure therapy training with weekly consultation (baseline phase) followed by addition of EG training and feedback (intervention phase). The primary outcome was therapist behavior during in-session exposures, observed weekly using a validated coding system. Therapist behavior was evaluated in relation to a priori benchmarks derived from clinical trials. Additional outcomes included training feasibility/acceptability, therapist response to case vignettes and beliefs about exposure, and independent evaluator-rated clinical outcomes. Three therapists reached behavior benchmarks only during the EG (intervention) phase. Two therapists met benchmarks during the baseline phase; one of these subsequently moved away from benchmarks but met them again after starting the EG phase. Across all therapists, the percentage of weeks meeting benchmarks was significantly higher during the EG phase (86.4%) vs. the baseline phase (53.2%). Youth participants experienced significant improvement in OCD symptoms and global illness severity from pre- to posttreatment. Results provide initial evidence that adding the EG to gold-standard training can change in-session therapist behaviors in a CMHA setting.     

Neither separate nor equivalent: Relationships between feature representations within bound objects

Evidence suggests that binding, or encoding a feature with respect to other features in time and space, can convey cognitive advantages. However, evidence across many kinds of stimuli and paradigms presents a mixed picture, alternatively showing cognitive costs or cognitive advantages associated with maintaining bound representations. We examined memory for colored letters drawn from similar and distinct color sets under circumstances that encouraged or discouraged the maintenance of color-letter binding. Our results confirmed previous change recognition research showing feature recognition improvement under explicit instructions to maintain binding. Color memory improved during binding, showing a reduced detrimental effect of feature similarity on retrieval, particularly when the letter served as the retrieval cue for a letter-color object. We found that feature recognition improved when two conditions were met: 1) relationships between features were to-be-remembered, and 2) the feature conjunction was relevant at test. Our results further suggest that this feature advantage arises because the encoded relationship between the features facilitates retrieval, not because features and objects are represented simultaneously in separate buffers.     

Community treatment of severe, refractory obsessive-compulsive disorder

Despite the existence of effective psychological and pharmacological interventions for obsessive-compulsive disorder (OCD), there are a large proportion of individuals for whom intervention is not effective. The study reports on the results of a community treatment service for individuals with treatment-refractory OCD who have not benefitted from previous cognitive behavioural or pharmacological treatment by community mental health services. A total of 205 individuals accepted for treatment by a specialist community OCD treatment service in London were provided with a combination of behavioural, cognitive, and pharmacological treatment within a specialist OCD service, with 158 completing treatment. Treatment was associated with significant reduction in clinician-rated and self-reported OCD symptoms after 12 weeks, with further reductions in OCD symptoms over a subsequent 12-week period. A significant reduction in symptoms of depression was also observed after 12 and 24 weeks. Approximately 40% of individuals treated experienced clinically significant improvement in their symptoms, with approximately 10% deemed to have recovered by the end of treatment. Our results add to previous research into refractory OCD, and provide support for the existence of specialist community treatment services which may provide assistance to individuals who have not responded to previous treatment.     

Does controlling for comorbidity matter? DSM‐oriented scales and violent offending in chicago youth

Mental health problems have long been linked to antisocial behaviors. Despite an impressive body of literature demonstrating this relationship and claims that comorbidity matters, few studies examine comorbidity using multiple distinct mental health indicators, with most studies instead adopting single or composite mental health measures. This study tested separate and comorbid effects of five DSM‐oriented mental health issues on self‐reported violence using a community‐based sample of Chicago youths from the Project on Human Development in Chicago Neighborhoods. Moreover, it utilized both primary caregiver and youth self‐reports of psychopathology across four developmental stages of childhood and adolescence. When examined separately, the results indicated affective/depressive, anxiety, attention deficit hyperactivity, and oppositional defiant/antisocial personality problems independently predicted violence. When considering comorbidity, however, only oppositional defiant and antisocial personality problems significantly predicted violence at any stage, regardless of informant type. Implications for future studies and policy are discussed. Aggr. Behav. 36:141–157, 2010. © 2010 Wiley‐Liss, Inc.     

Religion and Infant Mortality in the United States: A Community‐Level Investigation of Denominational Variations in Postneonatal Deaths

Although a growing body of research has detected the effects of community‐level religiosity on various health outcomes, very little scholarship has examined the influence of religious ecology on infant mortality rates (IMRs). We conduct ordinary least squares (OLS) regression analyses on postneonatal IMRs (PNIMRs) using county‐level data from the National Center for Health Statistics Linked Birth and Infant Death Data (1990, 2000, and 2006–2010), churches and church membership data, and the Area Health Resource File. We find that while overall rates of postneonatal deaths have decreased over time, the effects of religion on this outcome have become more pronounced. Specifically, we find that counties with greater proportions of mainline Protestant and Catholic adherents exhibit significantly lower PNIMRs. We further find that a greater proportion of conservative Protestants, and especially fundamentalists, increases postneonatal infant mortality. Our findings lend additional support to cultural explanations of U.S. infant mortality.     

Do Dynamic Facial Expressions Convey Emotions to Children Better Than Do Static Ones?

Past research has shown that children recognize emotions from facial expressions poorly and improve only gradually with age, but the stimuli in such studies have been static faces. Because dynamic faces include more information, it may well be that children more readily recognize emotions from dynamic facial expressions. The current study of children (N = 64, aged 5–10 years old) who freely labeled the emotion conveyed by static and dynamic facial expressions found no advantage of dynamic over static expressions; in fact, reliable differences favored static expressions. An alternative explanation of gradual improvement with age is that children's emotional categories change during development from a small number of broad emotion categories to a larger number of narrower categories—a pattern found here with both static and dynamic expressions.     

Is There an App for That? A Review of Popular Apps for Depression,Anxiety, and Well-Being

Smartphone apps for mental health (MH apps) and wellness reach millions of people and have the potential to reduce the public health burden of common mental health problems. Thousands of MH apps are currently available, but real-world consumers generally gravitate toward a very small number of them. Given their widespread use and the lack of empirical data on their effects, understanding the content within MH apps is an important public health priority. An overview of the content within these apps could be an important resource for users, clinicians, researchers, and experts in digital health. Here, we offer summaries of the content within highly popular MH apps. Our aim is not to provide comprehensive coverage of the MH app space. Rather, we sought to describe a small number of highly popular MH apps in three common categories: meditation and mindfulness, journaling and self-monitoring, and AI chatbots. We downloaded the two most popular apps in each of these categories (respectively: Calm, Headspace; Reflectly, Daylio; Replika, Wysa). These six apps accounted for 83% of monthly active users of MH apps. For each app, we summarize information in four domains: intervention content, features that may contribute to engagement, the app’s target audience, and differences between the app’s free version and its premium version. In the years ahead, rigorous evaluations of highly popular MH apps will be needed. Until then, we hope that this overview helps readers stay up-to-date on the content within some of the most widely used digital mental health interventions.