Ethical Considerations of Screening and Early Intervention for Clinical High-Risk Psychosis

Research on individuals at clinical high risk for psychological and physical disorders has grown exponentially in recent years, with a variety of new screening tools and early intervention techniques being implemented. One recent example is Attenuated Psychosis Syndrome, a diagnosis for individuals who are at clinical high risk for psychosis, which was recently included in Section III of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Given the focus on prevention at early stages, at-risk individuals will continue to be a topic of significance not only in psychosis research but also in other illnesses. This document provides a comprehensive summary of the ethical dilemmas that clinicians or researchers may encounter in this domain, and possible actions consistent with the current Canadian Code of Ethics for Psychologists. We use clinical high risk for psychosis and the Canadian Code of Ethics for Psychologists as a way to illuminate these ethical issues; however, application to other jurisdictions and disciplines, as well as other high-risk populations, is also of relevance.     

Cognitive Coping Tool Kit for Psychosis: Development of a Group-Based Curriculum

This article outlines an 8-week curriculum that was created to help outpatients develop cognitive and behavioral skills for coping with delusions and hallucinations as well as to reduce patients’ comorbid subjective levels of distress (e.g., depression, anxiety). The manualized protocol consisted of psychoeducation and training in a variety of CBT skills that have shown promise in treating individuals with residual psychosis, using recovery-oriented “naturalistic” methods and culminating in the creation of an individualized “tool kit” of cognitive coping resources. A preliminary study of the effectiveness of this brief group-based CBT program for outpatients with chronic, residual symptoms of schizophrenia was conducted. Participants were 24 outpatients diagnosed with schizophrenia spectrum disorders who were stable on medications and connected to case management community follow-up. The Positive and Negative Syndrome Scale for Schizophrenia interview and the Symptom Checklist-90 self-report symptom scales were administered pre- and post-intervention. The results suggest that there were significant improvements in psychotic symptoms and self-reported distress from pre- to posttreatment.     

Exploring Predictors of Outcome in the Psychosis Prodrome: Implications for Early Identification and Intervention

Functional disability is a key component of many psychiatric illnesses, particularly schizophrenia. Impairments in social and role functioning are linked to cognitive deficits, a core feature of psychosis. Retrospective analyses demonstrate that substantial functional decline precedes the onset of psychosis. Recent investigations reveal that individuals at clinical-high-risk (CHR) for psychosis show impairments in social relationships, work/school functioning and daily living skills. CHR youth also demonstrate a pattern of impairment across a range of cognitive domains, including social cognition, which is qualitatively similar to that of individuals with schizophrenia. While many studies have sought to elucidate predictors of clinical deterioration, specifically the development of schizophrenia, in such CHR samples, few have investigated factors relevant to psychosocial outcome. This review integrates recent findings regarding cognitive and social-cognitive predictors of outcome in CHR individuals, and proposes potential directions for future research that will contribute to targeted interventions and improved outcome for at-risk youth.     

A Restorative Justice Approach to Empathy Development in Sex Offenders: An Exploratory Study

The authors describe an exploratory study in sex offender treatment using a restorative justice approach to examine the shame, guilt, and empathy development of convicted sexual offenders. Implications for clinical practice and future research are highlighted.     

Early Intervention and the Development of Self-Regulation

Self-regulation is the key mediator between genetic predisposition, early experience, and adult functioning. This paper argues that all the key mechanisms underpinning the enduring effects of early relationship experiences interface with individuals' capacity to control (a) their reaction to stress, (b) their capacity to maintain focused attention, and (c) their capacity to interpret mental states in themselves and others. These three mechanisms together function to assist the individual to work closely and collaboratively with other minds. The paper proposes a reformulation of attachment theory constructs in terms of the quality of interpersonal interpretive functioning and the interpersonal strategies adopted by individuals to maintain optimal psychological distance between themselves and others, given their particular level of interpretive capacity.     

Enhancing Children's Spatial and Numerical Skills through a Dynamic Spatial Approach to Early Geometry Instruction: Effects of a 32-Week Intervention

This study describes the implementation and effects of a 32-week teacher-led spatial reasoning intervention in K–2 classrooms. The intervention targeted spatial visualization skills as an integrated feature of regular mathematics instruction. Compared to an active control group, children in the spatial intervention demonstrated gains in spatial language, visual-spatial reasoning, 2D mental rotation, and symbolic number comparison. Overall, the findings highlight the potential significance of attending to and developing young children's spatial thinking as part of early mathematics instruction.     

Challenges to the Career Development of Urban Racial and Ethnic Minority Youth: Implications for Vocational Intervention

Urban racial and ethnic minority youth experience a variety of internal and external challenges to their career development. This article discusses several potential barriers to successful career attainment experienced by racial and ethnic minority youth and identifies a series of recommendations that vocational counselors may wish to consider in addressing the career development needs of this population.     

从史瑞伯个案看精神病理论的多路径探究

从弗洛伊德对史瑞伯个案的精神分析研究入手,探讨其后期通过研究精神病所发展的父亲情结及力比多概念,这两个关键概念影响后继者走向不同的研究路径。拉康在想象和象征的维度下重读史瑞伯个案,结构化精神病的病理性人格结构,得出精神病是除权弃绝父亲的名字的结果。德勒兹与伽塔俐从欲望的角度解读史瑞伯个案,继承弗洛伊德对力比多的强调,重视无意识的实在性,反对精神分析过度强调俄狄浦斯情结影响了欲望的流动,主张精神病在实在中自由漫步达到治愈的新见解。

     

Group Intervention Studies in the Cognitive Rehabilitation of Individuals with Traumatic Brain Injury: Challenges Faced by Researchers

There are many factors to consider in designing and interpreting group studies. These include both analytic considerations, such as the selection of valid and reliable outcome measures, and subjective considerations, such as the selection of outcomes that are perceived to be important to participants and researchers. In this paper, we review key issues to consider in the design of group studies in neurorehabilitation, using problem-solving studies in traumatic brain injury as an example.     

Community Implementation Successes and Challenges of a Cognitive-Behavior Therapy Group for Individuals with a First Episode of Psychosis

CBT for psychosis has recently been called a best practice, suggesting that studies have demonstrated its efficacy with many populations. Community settings are encouraged to implement best practices such as CBT yet many factors can make the implementation of CBT challenging. Issues such as clinician resistance, setting, as well as client variables (refusal, denial of symptoms, etc.) come into play. Examples of successes and challenges of a community based study of CBT groups for first episodes will be described. The strategies used to overcome these challenges and the successes of the program will be presented.     

Cognitive Behavior Therapy in First-Episode Psychosis With a Focus on Depression,Anxiety, and Self-Esteem

Although several reviews show that cognitive behavioral therapy (CBT) is an effective treatment for patients with chronic psychosis, the effects of CBT on patients with a first-episode psychosis are less clear. Patients undergoing a first-episode psychosis are unique in that not only are they struggling with the symptoms of the disease, but also the realization of the diagnosis. Understanding how the disease will impact their lives with respect to changes in social goals, roles, and status can also lead to depression, anxiety and low self-esteem. The main aim of the present study is to describe two clinical cases in order to demonstrate the application of CBT in first-episode psychosis patients in an early stage of their psychosis. The two cases are individuals who were in an ongoing CBT trial for first-episode psychosis patients with symptoms of social anxiety, depression, and low self-esteem. Individual case formulations based on these symptoms were developed. Psychoeducation, normalizing, evaluation of negative automatic thoughts and dysfunctional schematic beliefs, and focusing on the negative consequences of safety behavior were the main treatment targets in attempting to improve the patients’ symptoms and functioning. Both patients showed improvement in depressive symptoms, self-esteem, and general functioning. The cases described suggest that treatment designed to target depression, anxiety, and self-esteem in patients with first-episode psychosis could have potential beneficial effects; specific studies of this approach are recommended.     

Development of a Multi-Disciplinary Intervention for the Treatment of Childhood Obesity Based on Cognitive Behavioral Therapy

Along the lines of the evidence-based recommendations, we developed a multi-disciplinary intervention for overweight children 7- to 12-years-old, primarily aiming at helping children to adopt healthier eating habits and a physically active lifestyle. The program combined nutrition intervention, based on a non-dieting approach, with physical activity intervention, implemented through the basic principles of Cognitive Behavioral Therapy (CBT), along with parental support. The program was conducted by dieticians with the collaboration of child psychiatrists and pediatricians. Training and regular supervision upon CBT priniciples application was intended to enhance dieticians' efficiency. The intervention is currently being evaluated to determine its effectiveness in treating childhood obesity.     

Implications of a Person's Level of Cognitive Development for Cognitive Approaches to Counseling

Using a cognitive-developmental model of processing self-evaluations, this article presents specific counseling strategies at different levels of abstract thinking.     

Applying the Cognitive Information Processing Approach to Career Problem Solving and Decision Making to Women's Career Development

An expanded framework of the Cognitive Information Processing (CIP) approach to career problem solving and decision making is outlined for career counseling with women. The modified framework addresses structural and individual barriers in women's career development and provides practical suggestions for applying and evaluating the CIP approach in career counseling.     

Study of a Cognitive Dissonance Intervention to Address High School Students' Cheating Attitudes and Behaviors

This study examined academic dishonesty (AD) of 586 Taiwanese graduate students, the relationship between students' AD and their perceptions of AD of their peers, and their judgments regarding the seriousness of AD. Results showed that female students were more critical of AD than their male counterparts were in the areas of fraudulence, plagiarism, and falsification. Male students demonstrated more awareness of peer involvement in AD in the area of falsification than did female students. Master's students confessed to greater involvement in AD compared with the PhD students. Doctoral students were more judgmental with respect to unethical acts of fraudulence, plagiarism, and falsification.     

The Empathy Imbalance Hypothesis of Autism: A Theoretical Approach to Cognitive and Emotional Empathy in Autistic Development

The Psychological Record - There has been a widely held belief that people with autism spectrum disorders lack empathy. This article examines the empathy imbalance hypothesis (EIH) of autism....