Psychotherapy with the adolescent children of concentration camp survivors

Summary The offspring of people who have experienced overwhelming physical and mental trauma may themselves manifest some of the aftereffects of their parents' trauma. Some children of survivors manifest aspects of their parents' survivor syndrome. These children appear depressed, withdrawn and have difficulty establishing and maintaining interpersonal relationships. In psychotherapy, an important focus is helping the patient establish an identity that is free of the persecutory and depressive elements of the survivor syndrome. Crucial aspects of psychotherapy with survivors' children involve helping the patient deal with the emotional impoverishment and depression of his parents and alleviating resulting guilt feelings. A therapeutic approach that is both nurturant and firm seems essential to provide restitution for the affectional deprivation and to set limits for the survivors' child. Of important concern for the therapist are countertransference attitudes which may lead to rejecting the adolescent.     

Lives in a balance: perceived family functioning and the psychosocial adjustment of adolescent cancer survivors.

Childhood cancer patients have a greater likelihood of long-term survival than ever before. This study examined both the perceived family functioning of adolescents who had successfully completed treatment for pediatric cancer and the relationship between family functioning and post-treatment adjustment. Eighty-eight adolescent survivors of hematologic malignancies were assessed regarding their family functioning, mental health, self-esteem, global competence, and problem behaviors. Contrary to expectations about the influence of cancer on these families, adolescent cancer survivors reported lower levels of family cohesion than the normative sample of healthy adolescents and their families. While current age, gender, age at diagnosis, and time since treatment completion were generally not associated with adolescents' adjustment, perceived family cohesion and adaptability were strongly related to post-treatment psychological adjustment.     

Health, happiness and health promotion

This article claims that health promotion is best practiced in the light of an Aristotelian conception of the good life for humans and of the place of health within it.     

Surviving cancer competently intervention program (SCCIP): a cognitive-behavioral and family therapy intervention for adolescent survivors of childhood cancer and their families.

Psychological reactions to having had childhood cancer often continue after treatment ends, for survivors and their parents. Based on our previous research, we developed an intervention program for adolescent survivors of childhood cancer, their parents, and siblings. Surviving Cancer Competently: An Intervention Program--SCCIP--is a one-day family group intervention that combines cognitive-behavioral and family therapy approaches. The goals of SCCIP are to reduce symptoms of distress and to improve family functioning and development. SCCIP is described and data from a pilot study of 19 families are presented. Program evaluation data indicated that all family members found SCCIP helpful. Standardized measures administered before the intervention and again at 6 months after SCCIP showed that symptoms of posttraumatic stress and anxiety decreased. Changes in family functioning were more difficult to discern. Overall, the results were promising with regard to the feasibility of the program and its potential for reducing symptoms of distress for all family members.     

Health behaviour and attitudes to publicity campaigns for health promotion

Abstract

A sample of 403 members of the public responded to a postal questionnaire concerning their own health behaviour and their attitudes towards health publicity. A principal components analysis of these attitudes revealed three factors, the first of which reflected a tendency to deny the “relevance” of health campaigns. This tendency was higher among those who smoked, took less exercise and had less healthy diets. It is inferred that the direct effects of such campaigns may be impeded by the fact that they appeal most to those people whose own behaviour (from the point of view of health) is in least need of change.     

Conceptualizing parental autonomy support: adolescent perceptions of promotion of independence versus promotion of volitional functioning

In current research on parenting, 2 ways of conceptualizing perceived parental autonomy support can be distinguished. Parental autonomy support can be defined in terms of promotion of independence (PI) or in terms of promotion of volitional functioning (PVF). This study aimed to establish the empirical distinctiveness of both conceptualizations and to examine their relative contribution to the prediction of adolescents' adjustment. The authors conducted 3 studies, 2 which sampled late adolescents (N=396, mean age=18.70 years, 79% female; and N=495, mean age=19.30 years, 74% female, respectively) and 1 which sampled middle adolescents (N=153, mean age=15.12 years, 70% female). Factor analyses pointed to the distinction between perceived PVF and PI. Structural equation modeling (SEM) indicated that whereas perceived PVF uniquely predicted adjustment (ps<.01), perceived PI did not (ps>.05). SEM also demonstrated that adolescents' self-determined functioning significantly mediates the relationship between perceived parental PVF and adjustment (ps<.001). Results are discussed in terms of the type of autonomy that parents might want to facilitate among their adolescents to foster well-being.     

Mediators of behavior change in two tailored physical activity interventions for adolescent girls

ObjectivesIt has been suggested that the lack of knowledge regarding the mechanisms responsible for behavior change may be responsible for the low levels of effectiveness in physical activity interventions among youth. While it is common for physical activity interventions to cite a theoretical framework, few test the validity of their constructs using an established mediation analysis technique. The purpose of this study was to identify mediators of physical activity behavior change in two tailored interventions for adolescent girls.DesignThis study involved an experimental design.MethodsParticipants (N=161) were randomly allocated to a control (CON) group, an intervention based on the Health Promotion (HP) Model or an intervention developed from the HP Model that included two processes from the Transtheoretical Model (THP). Both interventions included school-based education sessions, individual counseling sessions, and two physical activity sessions completed with the participants' mothers. Measures were assessed prior to the intervention, at post-intervention and at a 6-month follow-up. The following constructs were included in the mediation analyses: perceived benefits, perceived barriers, self-efficacy, exposure to models, social support, interpersonal norms, planning, stimulus control, and counterconditioning.ResultsPerceived benefits, perceived barriers, self-efficacy, and commitment to planning satisfied the criteria for mediation in the THP intervention. Self-efficacy and commitment to planning were identified as mediators in the HP intervention.ConclusionThe results of this study provide evidence that both interventions were successful in increasing physical activity through changes in the theoretical constructs.     

Deviant adolescent subcultures: assessment strategies and clinical interventions.

Alienation is a contributing factor in adolescents' participation in Satanism, the neo-Nazi skinhead movement, and violent street gangs. Many of their needs are met by gang and/or cult affiliation, including a sense of belonging, self-worth, companionship, and excitement. Emphasizing prevention may minimize deviant subculture involvement, but some adolescents require clinical intervention, ranging from a few outpatient sessions to lengthy inpatient hospitalization. Therapists must be knowledgeable about adolescents' involvement, empathic to their circumstances, and sophisticated in the approach to treatment.     

Challenges of home visitor interventions with adolescent mothers and their infants

Issues in designing a home visitor intervention and research program for 130 adolescent mothers, 17 and under, and their infants from birth to 30 months are discussed. The overall project is described, and various aspects of creating and maintaining a home visitor intervention program are discussed, including: (1) Issues and problems that arise with the integration of a home visitor intervention component into an ongoing health department program; (2) the recruitment and training of lay home visitors in the context of arduous, often disheartening work; (3) issues of supervision and quality control faced by the mental health consultants; (4) coping with potential stresses and dangers faced by the home visitors; (5) assisting and maintaining maximum communication for the research components of the study to be successful.     

BodiMojo: Effective Internet-based promotion of positive body image in adolescent girls

This study tested the efficacy of an Internet-based health promotion program, BodiMojo, designed to promote positive body image in adolescents. Participants were 178 students (mean age 15.2 years, 67.6% ethnic minority) in three public high schools. Intervention groups used BodiMojo for four weekly health class periods, while controls participated in their usual health curriculum. Body image measures were given at baseline, post-intervention, and 3 months. Girls reported decreased body dissatisfaction (p < .05), decreased physical appearance comparison (p < .05), and increased appearance satisfaction (p < .05), relative to controls. Effects were not maintained at 3-month follow-up. No significant differences were found between the intervention and control groups with boys. Moderation analyses suggested positive effects for diverse adolescents as well as those who were overweight or indicated baseline high body dissatisfaction. BodiMojo appears to be modestly effective in decreasing body image concerns among adolescent girls in the short term.     

An ecological assessment of community-based interventions for prevention and health promotion: Approaches to measuring community coalitions

Presented an ecological assessment of a community coalition to prevent alcohol, tobacco, and other drug abuse, and related risks. Ecological assessment is defined as occurring at multiple social levels and along a continuum of stages of coalition readiness. The assessment is aided by the triangulation, or combining of assessment methods and strategies. Measures used to assess the coalition's formation, implementation of community initiatives, and production of community impacts are described, along with the triangulation strategies used to enhance the assessment findings. We thank our evaluation team members including Erica Adams, Simon Choi, Cindy Crusto, Katie Davino, David delaCruz, Pamela Goodman, Maury Nation, and Diana Seybolt. We also thank the members of the community coalitions for substance abuse prevention and especially the project directors: James Bown, Dian Crain, Johneta Davis, Kelli Kenninson, Paul Pittman, Greg Sparkman, Sheryl Taylor, and Kenneth Wright.     

The chance project: Complex interventions with adolescent school drop-outs in Naples

Abstract

In this paper the authors describe their long experience, as psychoanalytically oriented psychotherapists, with an experimental school project with adolescent school drop-outs, a project that has been running in three deprived contexts of Naples. In the paper the structure of the psychological project supporting workers involved with these disruptive adolescents is analysed in detail along with the theoretical framework that lies behind it. The authors also give some illustrations that show the intense dynamics present in this field of work and some meaningful developments observed in the relationships and communications between adolescents and adults and in the group of peers.     

Maternal unresolved attachment status impedes the effectiveness of interventions with adolescent mothers

Children of adolescent mothers are at risk for a variety of developmental difficulties. In the present study, the effectiveness of a brief intervention program designed to support adolescent mothers' sensitivity to their infants' attachment signals was evaluated. Participants were adolescent mothers and their infants who were observed at 6, 12, and 24 months of age. The intervention conducted by clinically trained home visitors consisted of eight home visits between 6 and 12 months in which mothers were provided feedback during the replay of videotaped play interactions. At 12 months, 57% of the mother–infant dyads in the intervention group and 38% of the comparison group dyads were classified as secure in the Strange Situation. Seventy‐six percent of the mothers in the intervention group maintained sensitivity from 6 to 24 months compared with 54% of the comparison mothers. Further analyses indicated that the intervention was effective primarily for mothers who were not classified as Unresolved on the Adult Attachment Interview.     

Health promotion from the perspective of social cognitive theory

Abstract

This article examines health promotion and disease prevention from the perspective of social cognitive theory. The areas of overlap with some of the most widely applied psychosocial models of health are identified. The models of health promotion and disease prevention have undergone several generational changes. We have shifted from trying to scare people into health, to rewarding them into health, to equipping them with self-regulatory skills to manage their health habits, to shoring up their habit changes with dependable social supports. These transformations have evolved a multifaceted approach that addresses the reciprocal interplay between self-regulatory and environmental determinants of health behavior. Social cognitive theory addresses the socio structural determinants of health as well as the personal determinants. A comprehensive approach to health promotion requires changing the practices of social systems that have widespread detrimental effects on health rather than solely changing the habits of individuals. Further progress in this field requires building new structures for health promotion, new systems for risk reduction and greater emphasis on health policy initiatives. People's beliefs in their collective efficacy to accomplish social change, therefore, play a key role in the policy and public health approach to health promotion and disease prevention.     

Fitness promotion for adolescent girls: the impact and effectiveness of promotional material which emphasizes the slim ideal

This study looks at techniques for promoting fitness participation among adolescent girls, in particular those which emphasize the "slim ideal." Various promotional posters were designed which systematically used different models (slim, average, and overweight) and different messages (slimness, activity, and health). The relative effectiveness of these posters was tested using a probability sample of 627 female high school students. The slim model was found to be the most effective poster, while slimness was the least effective of the messages. Demographic and self- and body-image factors had relatively little effect on the ratings of the posters. Focus group interviews conducted with the student sample indicated that they were concerned about their body weight, and that they associated slimness with fitness. However, the slimness message was not thought to encourage participation in fitness because overt emphasis on body image may lead to self-consciousness and fear of social rejection. The idea that participation would lead to a slim physique was also thought to be unrealistic. The students were more critical of the slimness message than of the slim model in the posters. Overall, the data indicate that promoting fitness through messages relating fitness to slimness is not an effective approach with adolescent girls. The use of very slim models in promotional material may be effective, but this approach may not be desirable because it reinforces the dominant cultural stereotype of the "ideal" slim female form.     

Predicting posttraumatic growth in breast cancer survivors.

Wide variability exists with respect to how breast cancer survivors respond to common psychological and psychosocial challenges of their disease, ranging from posttraumatic stress disorder to posttraumatic growth. This cross-sectional study examined contextual, disease-related, and intraindividual predictors of posttraumatic growth in 224 randomly selected breast cancer survivors. A series of hierarchical regression analyses found that age at diagnosis, marital status, employment, education, perceived intensity of disease, and active coping accounted for 34%, 35%, and 28% of the variance in growth in relationships with others, new possibilities, and appreciation for life. These findings suggest that a more comprehensive model of growth will be helpful in understanding the various factors that play a role in breast cancer survivors' perception of psychological and psychosocial growth.     

A pilot study of an intervention for breast cancer survivors and their spouses

Recent studies have shown that interventions that increase breast cancer patients' communication with family members lead to reduced patient distress. In this article, we report on a treatment development and pilot study of an intervention for couples coping with breast cancer. In phase 1 of this study, 10 couples participated in two focus groups that generated ideas and themes for the intervention. In phase 2, we developed and pilot tested our intervention with 48 couples: 12 in a 2-session format, 21 in a 1-session format, and 15 in a non-experimental control group. Our response rate shows that breast cancer patients and spouses were willing to participate and that treatment providers were willing to refer patients and their spouses. The 2-session format showed the most promise for producing positive change in mental health functioning and cancer-related stress.