A cognitive‐behavioral model of anxiety disorders in children and adolescents

This study investigated a cognitive‐behavioral model of anxiety disorders in Japanese children and adolescents. Participants comprised 532 children from elementary schools and 751 adolescents from junior high schools as a community group, and 41 children and adolescents who fulfilled the criteria for childhood anxiety disorders as a clinical group. All participants completed three questionnaires about anxiety symptoms, self‐statements, and cognitive errors. While the clinical group showed more anxiety symptoms, negative self‐statements, and cognitive errors than the community group, there was no significant difference in positive self‐statements. Multigroup structural equation modeling found the presence of cognitive links for the community and clinical groups. Specifically, cognitive errors generated negative self‐statements, exacerbating a higher‐order factor (childhood anxiety) affecting six anxiety symptoms corresponding to the diagnostic criteria of psychological disorders. Mediated relationships were supported in only the community sample. Clinical implications for prevention and treatment of anxiety disorders in children and adolescents are discussed.     

The effectiveness of the peak relational training system and corresponding changes on the VB‐MAPP for young adults with autism

The current investigation sought to extend prior research evaluating the use of the PEAK Relational Training System as a comprehensive treatment model in improving language skills demonstrated by individuals with autism. Baseline PEAK‐Direct Training and Verbal Behavior Milestone Assessment and Placement Program (VB‐MAPP) assessments were conducted across 3 adult male participants, and scores on the PEAK‐Direct Training assessment were used to select targets for intervention. Language instruction guided by the PEAK‐Direct Training module was implemented for 45 to 69 days across participants. Results suggest that participants mastered target skills throughout the training phase, and VB‐MAPP test probes showed an increasing trend. Follow‐up probes suggested that scores on the VB‐MAPP maintained when training was discontinued. In addition, participants demonstrated an increase in assessment scores on the PEAK‐Direct Training assessment in the follow‐up phase, including the mastery of untargeted verbal skills.     

Assessing long‐term maintenance of staff performance following behavior skills training in a home‐based setting

We used a multiple baseline across participant design to evaluate the effects of behavior skills training on teaching three behavior therapists to implement discrete trial teaching (DTT) and evaluate the long‐term maintenance of skills acquired through behavioral skills training. For participants whose skills did not maintain, the authors evaluated an independent self‐evaluation procedure on their performance. Following DTT implementation training, maintenance probes were assessed at 2‐, 4‐, 6‐, and 8‐week follow‐ups. The results demonstrated that one participant maintained 100% procedural integrity (PI) through all follow‐ups, one participant decreased below mastery criterion at the 2‐week follow‐up, and one participant dropped below mastery criterion at the 4‐week follow‐up. Those participants that demonstrated decreased accuracy of implementation of DTT programs and were taught to implement a self‐evaluation procedure. Following self‐evaluation, PI maintained for up to 7 weeks for one participant. Our results suggest that if PI does not maintain, self‐evaluation may be a supplementary intervention to increase and maintain PI of new employees.     

Subclinical delusional ideation and a self‐reference bias in everyday reasoning

Previous studies (e.g. Moller & Husby, 2000 ; Blackwood et al., 2004 ) have revealed that delusional thinking is accompanied by an exaggerated focus upon the self and upon stimuli that are perceived to be related to the self. The objective was to examine whether those high in subclinical delusional ideation exhibit a heightened tendency for self‐reference. Using a mixed design, healthy individuals, classified into high‐ and low‐scoring groups on the Peters et al. Delusions Inventory ( Peters, Day, & Garety, 1996 ), were compared on everyday reasoning tasks across three experiments. High‐PDI scorers, in contrast to the low‐PDI group, rated self‐referent objections to everyday arguments as stronger than other‐referent objections and formulated more self‐referent assertion‐based objections to everyday arguments. The findings support the notion that subclinical delusional ideation is linked to a self‐reference bias, which is evident in the sort of everyday thinking that people engage in when forming or evaluating their beliefs and which may contribute to delusion formation.     

Diaphragmatic breathing as treatment for escape‐maintained aggression

Coping skills, such as diaphragmatic breathing, are commonly recommended to help individuals work through challenging situations. We evaluated diaphragmatic breathing as treatment for aggression of three individuals diagnosed with autism spectrum disorder or Angelman syndrome. Functional analysis results demonstrated that each participant engaged in aggression maintained by social‐negative reinforcement. Diaphragmatic breathing treatment without extinction was conducted in a work context and involved prompting diaphragmatic breathing contingent on precursors to aggression; treatment was effective in reducing the rate of aggression for one of three participants. For the two other participants, other reinforcement‐based interventions (differential reinforcement of other behavior or functional communication training with extinction) were necessary to decrease aggression.     

Child witness statements about sexual abuse in day‐care: reports from a case with confessions from the suspect

Evaluation of alleged sexual abuse at day‐care centres usually has to be based mainly on child statements about their own victimisation. This study points at other possible sources of information. Thus, the child may give contributions to the investigative procedure also as a witness of abuse of other children, as a participator of group interaction related to abuse and as a receiver of a disclosure about abuse from another child. Data are presented from a case where the suspect had confessed. A quarter of the children at the day‐care centre had given information about other children's exposure. For more than half of the children, there were witness statements that reflected what these particular children might have been exposed to. Context and statement characteristics seemed to make an evaluation of some of these statements possible. Information about interaction between children and about disclosures between children was strikingly scarce which was probably due to the lack of questions from parents and investigators in these areas. Witness statements from children about other children's exposure to abuse stand out as an interesting complementary source of information in investigations of abuse at day‐care centres and may also provide a basis for interpretations at a group level. Copyright © 2005 John Wiley & Sons, Ltd.     

Delusional verbalizations and beliefs

This study evaluated the intensity of delusional beliefs during the modification of delusional verbalizations with three chronically mentally ill inpatients. The multiple-baseline across responses design was used to evaluate the efficacy of a behavioral treatment package to modify delusional verbalizations. Results revealed that changes were obtained in delusional verbalizations to personal questions without corresponding changes in the subjects' delusional beliefs. Changes in delusional verbalizations were well-maintained for two subjects during a 6-month follow-up period. Mixed results were obtained for generalization probe interviews.     

The modification of delusional beliefs: A single-subject evaluation

The multiple-baseline across responses design was used to assess the effectiveness of a belief-modification treatment package to alter the intensity of three delusional beliefs of a chronically mentally ill inpatient. Results revealed reductions in belief intensity to zero levels for all three beliefs. Generalization effects were obtained for an individualized interview and psychiatric rating scale. These results were maintained through a 6-month follow-up period.     

Effects of a Motivational Interviewing–Based Counseling Program on Classroom Behavior of Children in a Disciplinary Alternative Education Program

A multiple single‐case research design was used to explore changes in teacher‐reported behaviors of 15 children who completed a motivational interviewing–based counseling program in a disciplinary alternative education school. Findings indicated that 7 children made a moderate to large improvement in their classroom behaviors while participating in the program. Students’ self‐motivational statements and self‐reported readiness to change were related to actual teacher‐rated behavioral changes. Implications for future research and counseling practice were discussed.     

Equivalence of serufuesutei‐mu (self‐esteem) and jisonshin in Japan

Most studies of Japanese self‐esteem have implicitly assumed that the concept of self‐esteem (SE) is indigenously meaningful. However, this has not been shown to be true. The present research investigated whether the indigenous Japanese word jisonshin is semantically equivalent to the English expression SE and, by implication, whether it denotes the same concept as originally delineated by Rosenberg, that of having a positive attitude toward oneself. Japanese participants (N = 234) responded to 11 pairs of statements about SE and several other items. Half of the statements contained the expression serufuesutei‐mu (self‐esteem), the other half the expression jisonshin. Participants independently judged the two expressions to be ‘basically’ synonymous, but endorsed some otherwise identical statements significantly more often when they contained the expression serufuesutei‐mu, suggesting that the differences were due to the foreign connotations of the expression serufuesutei‐mu.     

Proneness to hallucinations and delusions in a non‐clinical sample: Exploring associations with metacognition and negative affect

Commonly, individuals prone to hallucinations and delusions hold dysfunctional metacognitive beliefs and report higher levels of negative affect, yet, these associations have not been clearly investigated in non‐clinical samples due to the failure to control for high intercorrelations between variables. The aim of the current study was to investigate how hallucination and delusion proneness are associated with dysfunctional metacognitions and negative affect. A cross‐sectional sample of 715 students free from psychiatric diagnoses (M_age = 28.1 years, SD = 10.9, range 18–65) completed the Launay‐Slade Hallucination Scale (LSHS‐R); Peters et al. Delusion Inventory (PDI‐21); Depression, Anxiety, and Stress Scale (DASS‐21); and the Metacognition Questionnaire (MCQ‐30). Findings that participants who were prone to both hallucinations and delusions reported elevated levels of negative affect support the need for targeted mental health treatment for individuals who experience psychological distress related to their hallucinatory and delusional experiences. While metacognition beliefs of need to control thoughts and cognitive self‐consciousness, along with the anxiety and stress DASS‐21 subscales appeared as significant cross‐sectional predictors of proneness to hallucinations and delusions, only metacognitions demonstrated any notable predictive value for delusion proneness. This finding questions the role of metacognitions in determining hallucination and delusion proneness in non‐clinical samples.     

Juvenile prostitution and community rehabilitation: an exploratory analysis of beliefs and values

A community, juvenile prostitution rehabilitation programme in Bogotá, Colombia, South America is described; and beliefs and values of the residents were explored. Multiple sorting procedures and multi‐dimensional scaling analysis elicited qualitative, structured, self‐report data, and investigated cognitive constructs. Participants discriminated between belief‐statements along two global dimensions: street‐life and prostitution; and rehabilitation. These were comprised of qualitatively different elements. Clinical implications for interventions with this group and the rehabilitation programme are discussed. Copyright © 2007 John Wiley & Sons, Ltd.     

Exploring client contribution in a cognitive intervention for test anxiety

Aim: To study client contributions in cognitive therapy. Specifically, to study ways of making an intervention against test anxiety work, based on interviews with 32 test‐anxious university students. Method: Interviews after their first examination following the intervention were analysed using a thematic analysis. Results: Although most participants reacted positively to the intervention, concerns emerged that adopting positive self‐statements might be deceptive. Concerns about the untruthfulness of positive self‐statements led clients to generate several possible resolutions, namely, to examine flaws in negative self‐statements, to realise that there is more than one realistic way to construe things, to consider the evidence in the form of reduced anxiety, to consider manageable steps, and to seek interpersonal validation of positive self‐statements. Conclusions: The results offer concrete resolutions developed by clients that might be useful for other clients who have reservations about positive self‐statements.     

Assessment of delusional beliefs during the modification of delusional verbalizations

This study examined the strength of delusional beliefs during the modification of delusional verbalizations of a 51 year-old chronically mentally ill inpatient. The changing-criterion design was used to document the effectiveness of a behavioral treatment package to alter the rate of delusional responses to personal background questions. The results revealed a stepwise decline in the frequency of delusional responses. Generalization effects to novel interviewers were obtained. No changes were obtained on the subject's ratings of delusional beliefs, with the subject assigning ratings of absolute conviction to his beliefs throughout the duration of the study.     

Basic Self‐Awareness

Basic self‐awareness is the kind of self‐awareness reflected in our standard use of the first‐person. Patients suffering from severe forms of depersonalization often feel reluctant to use the first‐person and can even, in delusional cases, avoid it altogether, systematically referring to themselves in the third‐person. Even though it has been neglected since then, depersonalization has been extensively studied, more than a century ago, and used as probe for understanding the nature and the causal mechanisms of basic self‐awareness. In this paper, I argue that depersonalized patients indeed have an impaired basic self‐awareness, and that their study allows us both to favor one specific theory of basic self‐awareness and to understand what is wrong with its rivals. According to the favored theory, which I call Cartesian, we are basically self‐aware in virtue of being acquainted with ourselves through introspection.     

On the nature of intuitive and delusional thought: Its implications in clinical work with psychotic patients

The author tries to differentiate intuitive imagination from delusional imagination and hypothesises that psychosis alters the system of intuitive thinking, which consequently cannot develop in a dynamic and selective way. Scholars of different disciplines, far removed from psychoanalysis, such as Einstein, Hadamard or Poincar, believe that intuitive thinking works in the unconscious by means of hidden processes, which permit a creative meeting of ideas. Thanks to Bion's work, psychoanalysts have begun to understand that waking thinking is unconsciously intertwined with dream‐work. The delusional construction is similar to a dreamlike sensorial production but, unlike a real dream, it remains in the waking memory and creates characters which live independently of the ‘dreamer's’ awareness. It is a dream that never ends. On the contrary, the real dream disappears when it has brought its communicative task to an end. In the analysis of psychotic patients it is very important to analyse the delusional imagination which dominates the personality and continuously transforms the mental state, twisting emotional truth. The delusional imagination is so deeply rooted in the patient's mental functioning that, even after systematic analysis, the delusional world, which had seemed to disappear, re‐emerges under new configurations. The psychotic core remains encapsulated; it produces unsteadiness and may induce further psychotic states in the patient. The author reports some analytic material of a patient, who, after a delusional episode treated with drugs, shows a vivid psychotic functioning. Some considerations are added on the nature of the psychotic state and on the therapeutic approach used to transform the delusional structure. This paper particularly deals with the difficulty in working through the psychotic episode and in ‘deconstructing’the delusional experience because of the terror connected with it. In the reported case, the analytic work changed the delusional construction into a more benign one characterised by phobic qualities. The analysis of the psychotic transference allowed the focus to be on the hidden work which had been continuously influencing the transferential picture of the analyst and the patient's psychic reality.     

Reasoning, emotions, and delusional conviction in psychosis

The aim of the study was to elucidate the factors contributing to the severity and persistence of delusional conviction. One hundred participants with current delusions, recruited for a treatment trial of psychological therapy (PRP trial), were assessed at baseline on measures of reasoning, emotions, and dimensions of delusional experience. Reasoning biases (belief inflexibility, jumping to conclusions, and extreme responding) were found to be present in one half of the sample. The hypothesis was confirmed that reasoning biases would be related to delusional conviction. There was evidence that belief inflexibility mediated the relationship between jumping to conclusions and delusional conviction. Emotional states were not associated with the reasoning processes investigated. Anxiety, but not depression, made an independent contribution to delusional conviction.     

The application of civil commitment law and practices to a case of delusional disorder: a cross-national comparison of legal approaches in the United States and the United Kingdom

Legal approaches to civil commitment in the United States and the United Kingdom are compared. A concise overview of the historical evolution of civil commitment in both countries precedes a discussion of the present scheme of commitment standards in each system. These current standards in U.S. and U.K. jurisdictions are then applied to a hypothetical case of delusional disorder. A discussion of the constructive use of civil commitment in patients with delusional disorder who may be dangerous focuses on its value as a preventive measure against potential harm to self or others, as well as the pros and cons of coercive assessment and treatment. Despite the many differences in approach to commitment, the authors concur that in both countries the patient with delusional disorder was committable before the commission of a serious criminal offense.     

The detrimental effects of physical restraint as a consequence for inappropriate classroom behavior.

Functional analyses produced inconclusive results regarding variables that maintained problem behavior for 2 students with developmental disabilities. Procedures were modified to include a contingent physical restraint condition based on in‐class observations. Results indicated that under conditions in which physical restraint (i.e., basket‐hold time‐out) was applied contingent on problem behavior, rates of these behaviors increased across sessions for both subjects. Implications for the use of physical restraint in the classroom are discussed.