Concomitant group therapy with anorectics and their parents as a supplement to family therapy

A study was made of family therapy with anorexia nervosa patients in a child psychiatric outpatient department. Eight families referred in 1984 were offered group therapy and family therapy simultaneously, one group for patients with anorexia nervosa and one group for their parents. The participants of both groups reported that they had learned a lot from the experience but stated that they felt group therapy could not replace family therapy.     

Effects of a carbohydrate supplement upon resting brain activity

Glucose is a major energy source for the brain, and along with several monosaccharide derivatives as components of brain gangliosides, they play important roles in neurologic function. However, there is little information available on the role of glucose and other monosaccharides on resting brain activity. This study was designed to evaluate the effects of a single dose of a carbohydrate supplement containing glucose and several of its derivatives on resting brain activity in 20 healthy male college students. The supplement provided an insignificant amount of carbohydrate (3.9 g), protein (0.28 g), fat (0 g), and calories (14 kcal). The amount of glucose in the supplement was 0.5 g (1% the amount of glucose used in adult studies of cognitive functioning and memory). We hypothesized that the glyconutrient supplement would enhance brain activity associated with alertness and attention. The study design was double blind, with subjects randomly assigned to one of two orders, either carbohydrate supplement week one followed by placebo a week later, or the opposite. Electrical brain activity was monitored by 15 electrodes positioned at nine standard international 10–20 system locations, including three bilateral pairs at frontal, parietal, and occipital sites. Thirty minutes following ingestion of a placebo or carbohydrate supplement drink, EEG activity was recorded for 10-mins while subjects focused on a stationary visual target. Spectral power of resting brain activity was computed and analyzed contrasting the placebo and supplement groups. Relative to placebo, the carbohydrate supplement significantly enhanced power in three brain wave frequencies (theta, alpha, and beta) that are known to be associated with attention and arousal. Since changes were observed in the supplement but not placebo group, our study suggests that additional sugars in the glyconutritional supplement facilitate enhancement of brain electrical activity. Whether the apparent enhancement of arousal in baseline recordings is associated with improved task performance remains to be determined.     

Individual therapy as a special form of complex psychotherapy]

A combination of several psychotherapeutic methods will be meaningfull only if they are tuned to, and supplement, each other. Indiscriminate combinations may produce harmful effects. The choice of psychotherapeutic methods depends upon the objective that the psychotherapist desires to accomplish. In psychotherapy it is essential that all actions taken be governed by plans worked out in accordance with the particular objectives to be accomplished.     

Using motivational interviewing as a supplement to obesity treatment: a stepped-care approach.

OBJECTIVE: This investigation was designed to improve behavioral weight loss program (BWLP) treatment outcomes by providing stepped care (SC) to individuals experiencing difficulties with weight loss during treatment. SC entails transition to more intensive treatments when less intensive treatments fail to meet treatment goals. In a BWLP, motivational interviewing (MI) may increase participants' motivation toward behavioral change and thus complement the acquisition of behavioral change skills. It was hypothesized that BWLP+SC (MI) participants (i.e., participants who failed to meet weight loss goals and received MI) would demonstrate superior treatment outcomes when compared with BWLP (SC matched) participants (i.e., participants who failed to meet weight loss goals but did not receive MI). DESIGN: Fifty-five obese, sedentary adults were randomly assigned to a BWLP+SC or a BWLP. MAIN OUTCOME MEASURES: Changes in weight, cardiorespiratory fitness, self-reported physical activity, and diet (i.e., calories, percentage daily intake of fat, protein, and carbohydrates) in response to treatment were assessed. RESULTS: Participants significantly decreased their weight, increased physical activity/fitness, and improved dietary intake (ps<.05). BWLP+SC (MI) participants lost more weight and engaged in greater weekly exercise than BWLP (SC matched) participants who did not receive MI (ps<.05). CONCLUSION: For individuals experiencing weight loss difficulties during a BWLP, MI may have considerable promise.     

Psychosis and autism as diametrical disorders of the social brain

Autistic-spectrum conditions and psychotic-spectrum conditions (mainly schizophrenia, bipolar disorder, and major depression) represent two major suites of disorders of human cognition, affect, and behavior that involve altered development and function of the social brain. We describe evidence that a large set of phenotypic traits exhibit diametrically opposite phenotypes in autistic-spectrum versus psychotic-spectrum conditions, with a focus on schizophrenia. This suite of traits is inter-correlated, in that autism involves a general pattern of constrained overgrowth, whereas schizophrenia involves undergrowth. These disorders also exhibit diametric patterns for traits related to social brain development, including aspects of gaze, agency, social cognition, local versus global processing, language, and behavior. Social cognition is thus underdeveloped in autistic-spectrum conditions and hyper-developed on the psychotic spectrum.;>We propose and evaluate a novel hypothesis that may help to explain these diametric phenotypes: that the development of these two sets of conditions is mediated in part by alterations of genomic imprinting. Evidence regarding the genetic, physiological, neurological, and psychological underpinnings of psychotic-spectrum conditions supports the hypothesis that the etiologies of these conditions involve biases towards increased relative effects from imprinted genes with maternal expression, which engender a general pattern of undergrowth. By contrast, autistic-spectrum conditions appear to involve increased relative bias towards effects of paternally expressed genes, which mediate overgrowth. This hypothesis provides a simple yet comprehensive theory, grounded in evolutionary biology and genetics, for understanding the causes and phenotypes of autistic-spectrum and psychotic-spectrum conditions.     

Sequential analysis as a method of feedback for family therapy process

Abstract

The purpose of this study was to examine the relationship between therapist verbal behavior and family cooperation and resistance during the second session of family therapy with juvenile delinquents. Sequential analysis was used to investigate the impact of one therapist's behavior on family resistance and cooperation in a sample of 12 families. The results of the sequential analysis revealed that therapist “support” and “teach” behaviors were associated with significant increases in the likelihood of family cooperation. The study provides an example of how sequential analysis can be used to inform family therapists about the impact of their behavior on families.     

Suicide ideation as a predictor of treatment outcomes in cognitive-behavioral therapy for unipolar mood disorders

Background/Objective: Suicide ideation is common in depressed patients. However, no studies to date have examined whether pretreatment suicide ideation is associated with poorer outcomes after cognitive-behavioral therapy for adult depression. Method: 475 depressed outpatients (age: M = 39.9 years, SD = 11.71; 60.2% female) took part in a pre-treatment and a post-treatment assessment. Pre-treatment suicide ideation measured with the BDI suicide item was considered as a predictor of treatment outcomes – controlling for age, gender, number of attended therapy sessions, as well as pre-treatment depression severity. Results: Hierarchical regression revealed that age, gender, number of completed therapy sessions and depression severity at baseline could explain 25% of the variance in post-treatment BDI-scores. Adding suicide ideation significantly improved the amount of variance explained to 27%. Treatment outcomes were worse for patients with more severe depression, suicidal patients, patients receiving more therapy-sessions and older patients. Conclusions: Suicide ideation added only little incremental variance to the prospective prediction of post-treatment depression severity. Depressed patients with suicide ideation can attain almost as good treatment outcomes as patients without suicide ideation, which is a clinically encouraging result.     

Adherence as a determinant of effectiveness of internet cognitive behavioural therapy for anxiety and depressive disorders

Since 2009, the Clinical Research Unit for Anxiety and Depression (CRUfAD) has been providing primary care clinicians with internet cognitive behaviour therapy (iCBT) courses to prescribe to patients. Although these courses have demonstrated efficacy in research trials, adherence in primary care is less than half that of the research trials. The present studies pose three questions: first, do course non-completers drop out because of lack of efficacy? Second, can changes in delivery (e.g. adding choice, reminders and financial cost) improve adherence? Last, does clinician contact improve adherence? The results showed that non-completers derive benefit before dropping out; that adding reminders, choice of course and timing, and financial cost can significantly improve adherence; and that clinician contact during the course is associated with increased adherence. It is concluded that improved adherence is an important determinant of effectiveness.     

The family as its own reflecting team: a family therapy method

Social research has suggested that people, in general, tend to overestimate their skills and abilities. Interestingly, research has found that peers are better predictors of a person's behaviour than self‐assessment, suggesting that others know us better than we know ourselves. Family therapists should be aware that family members might not give accurate accounts of themselves. In order to overcome this problem, therapists should incorporate peer assessments into therapy. Reflecting teams and videotaping do incorporate peer assessments, yet these methods can be impractical. This article describes a method of family therapy using enactments as a means of setting up the family as its own reflecting team. The method suggests that the family and therapist switch roles several times during the enactment, and then encourages a discussion on the peer observations on how each person addresses a problem in the family. Case examples illustrate how feedback from peers promotes insights.