Using the Linehan Risk Assessment and Management Protocol With a Chronically Suicidal Patient: A Case Report

The Linehan Risk Assessment and Management Protocol (LRAMP) is an empirically supported, comprehensive framework used to assess suicide risk and protective factors, and provide a guide for the therapist to consider reasonable options for intervening on suicidal behavior. This protocol includes a structured checklist for assessing, managing, and documenting suicide risk. It also structures the documentation to clearly describe the presentation, assessment, in-session interventions, decision-making process, and follow-up to other members of the treatment team. This paper describes a case in which the LRAMP was used to guide the assessment, intervention, and documentation of the suicidal behavior of a patient, “Ann,” being treated with outpatient Dialectical Behavioral Therapy in a community mental health clinic. Each section of the LRAMP is discussed as it was used with this complex patient, who had history of high utilization of acute psychiatric services. Application of the LRAMP included the assessment of risk and protective factors, and the use of an individualized crisis plan that engaged the patient, her family, the therapist, and the clinical team, to decrease acute risk, continue outpatient treatment, and avoid inpatient hospitalization. The considerations for documenting clinical decision-making with chronically suicidal patients are discussed.     

Can the theory of planned behavior predict the maintenance of physical activity?

This study tested the ability of the theory of planned behavior to predict actual participation in physical activity and explored the development of activity habits in a 12-week longitudinal study. People enrolling in a gymnasium (N = 94) completed standard theory of planned behavior measures at baseline and follow-up; behavior was monitored objectively in the intervening period. The data were analyzed by using both standard and repeatable events survival analysis. Results showed that (a) perceived behavioral control was significantly predictive of intentions and actual behavior, (b) stable exercise habits developed in the first 5 weeks of the study, and (c) successful prior performance enhanced perceptions of behavioral control. The implications for developing theory-based interventions that promote the maintenance of health behavior are discussed.     

Future Well-Being Among People Who Attempt Suicide and Survive: Research Recommendations

Over 48,000 people died by suicide in 2018 in the United States, and more than 25 times that number attempted suicide. Research on suicide has focused much more on risk factors and adverse outcomes than on protective factors and more healthy functioning. Consequently, little is known regarding relatively positive long-term psychological adaptation among people who attempt suicide and survive. We recommend inquiry into the phenomenon of long-term well-being after nonfatal suicide attempts, and we explain how this inquiry complements traditional risk research by (a) providing a more comprehensive understanding of the sequelae of suicide attempts, (b) identifying protective factors for potential use in interventions and prevention, and (c) contributing to knowledge and public education that reduce the stigma associated with suicide-related behaviors.     

Stand Tall to Protect Students: School Counselors Strengthening School Connectedness

In an urban sample of 5,595 students in Grades 7–12, the authors found that (a) personalized counseling services that were responsive to student needs enhanced school connectedness, (b) risk factors (e.g., poverty, mobility rates, limited English proficiency) were associated with lower school connectedness scores, and (c) responsive counseling services acted as a protective factor that reduced some of the negative effects of risk factors on school connectedness, and consequently, student success in academic and nonacademic areas.     

Eating regulation and bulimic symptoms: the differential correlates of health-focused and appearance-focused eating regulation

Based on Self-Determination Theory, this study aimed to gain further insight in the pathway from eating regulation to bulimic symptoms by (a) examining diet-specific need frustration as an intervening mechanism, (b) investigating the associations between different types of goals underlying eating regulation and diet-specific need frustration and bulimic symptoms, and (c) considering body dissatisfaction as an antecedent of eating regulation and eating regulation goals. In a sample of 244 female adolescents, SEM analyses showed that (a) the association between eating regulation and bulimic symptoms can be accounted for by need frustration, (b) appearance-focused and health-focused eating regulation are associated differentially with need frustration and bulimic symptoms, and (c) body dissatisfaction is related positively to eating regulation and appearance-focused eating regulation. These findings suggest that the goals underlying one's eating regulation and the concept of need frustration help to understand when and why eating regulation is associated with bulimic symptoms.     

Religion, Forgiveness, Hostility and Health: A Structural Equation Analysis

Religious participation has been shown to increase certain factors thought to be protective of health, including social support and positive health habits. The current study considers whether religious participation may likewise have a positive influence on health by increasing forgiveness and diminishing hostility. A structural equation analysis of data collected from a national survey of 1,629 participants supported the hypothesized model that (a) religiosity is related to greater forgiveness, (b) greater forgiveness, in turn, is related to reduced hostility and finally, (c) reduced hostility is related to better subjective health.     

SITUATION-SPECIFIC ASSERTIVENESS IN THE EPIDEMIOLOGY OF SEXUAL VICTIMIZATION AMONG UNIVERSITY WOMEN

Protective and risk factors for sexual victimization were examined in a sample of 274 undergraduate women. Assertiveness specific to situations with the opposite gender was protective at all three assessment times. Prior victimization, alcohol use, poor adjustment (as indicated by depression and anxiety), multiple sexual partners, and insecurity about relationships with the opposite gender were significant risk factors. Prevention efforts might be more effective if (a) behavioral practice of assertiveness was added to informational and attitudinal interventions; (b) assertiveness training focused specifically on relationships with the opposite gender; (c) medical and counseling services routinely assessed for prior victimization and other risk factors, and made appropriate referrals for women with victimization histories; and (d) alcohol education-programs were integrated with acquaintance-rape programs.     

The psychosocial etiology of adolescent drug use: a family interactional approach

The purpose of this monograph was to propose a framework, family interactional theory, for explaining the psychosocial aspects of adolescent drug use. Three themes are stressed: (a) the extension of developmental perspectives on drug use, (b) the elucidation of family (especially parental) influences leading to drug use, and (c) the exploration of factors that increase or mitigate adolescents' vulnerability to drug use. We present a developmental model with two components; the first deals with adolescent pathways to drug use, and the second incorporates childhood factors. The model was tested in two studies: one cross-sectional study of 649 college students and their fathers, and one longitudinal study of 429 children and their mothers. The subjects were given self-administered questionnaires containing scales measuring the personality, family, and peer variables outlined in the model. The results of each study supported the hypothesized model, with some differences between parental influences. We also found that individual protective factors (e.g., adolescent conventionality, parent-child attachment) could offset risk factors (e.g., peer drug use) and enhance other protective factors, resulting in less adolescent marijuana use. Implications of the findings for prevention and treatment, future research, and public policy are discussed.     

Living Conditions and Psychological Distress in Latino Migrant Day Laborers: The Role of Cultural and Community Protective Factors

The purpose of this study was to examine the relationship between typically difficult living conditions and psychological distress in Latino migrant day laborers (LMDLs), with attention to the potentially protective roles of contact with family in country of origin (i.e., communication, sending money, etc.), availability of local culture (i.e., food, music, people from one's country of origin), and utilization of community resources perceived to be culturally competent (i.e., services that are respectful, able to serve Latinos, able to solve problems, in Spanish, etc.). Participants were 344 LMDLs surveyed in the San Francisco Bay Area. As hypothesized: (a) difficult living conditions were related to depression, anxiety, and desesperación [desperation], the latter a popular Latino idiom of psychological distress recently validated on LMDLs; (b) contact with family moderated the relation between difficult living conditions and depression and desesperación but not anxiety and (c) access to local culture, and utilization of community resources, mediated the relation between difficult living conditions and depression and desesperación but not anxiety. Implications for intervening at local and larger levels in order to provide some protection against distress built into the LMDL experience in the United States are discussed.     

Youth gang affiliation,violence, and criminal activities: A review of motivational,risk, and protective factors

Youth gangs are a universal phenomenon attracting increasing attention; the criminal and antisocial behavior perpetuated by youth gangs has an adverse impact on local communities across the globe. Although there is an extensive body of research that has examined the problems posed by youth gangs in America (and more recently in other countries), there have been relatively fewer empirical studies that examined the factors and psychological processes that are related to youth joining and leaving gangs. This review compiles the international research on the nature of youth gangs and critically evaluates: (a) the factors that motivate engagement in and desistance from gang-related activities, (b) risk and protective factors that impact on youths' propensity for gang membership, delinquency, and violent behavior, and the adverse consequences associated with gang affiliation, and (c) the relationship between gang-affiliation, youth violence, and criminal behavior.     

Risk Factors for Adolescent Marijuana Use Across Cultures and Across Time

An integrated analysis of the data from 3 different studies was conducted to examine the early psychosocial predictors of later marijuana use among adolescents. Longitudinal analysis of interview data was performed. The data used in the analysis were derived from (a) a sample of 739 predominantly White adolescents representative of the northeastern United States, (b) a sample of 1,190 minority adolescents from the East Harlem section of New York City, and (c) a sample of 1,374 Colombian adolescents from two cities in Colombia. South America. In 2 of the samples, participants were interviewed in their homes, and in the 3rd study, participants were assessed in school. The predictors included a number of variables from (a) the personality domain, reflecting the adolescents' conventionality and intrapsychic functioning; (b) the family domain, representing the parent-child mutual attachment relationship and parental substance use; (c) the peer domain, reflecting the peer group's delinquency and substance use; and (d) the adolescents' own use of legal drugs. The dependent variable was adolescent marijuana use. The results of the analysis demonstrated remarkable consistency in the risk and protective factors for later marijuana use across the 3 samples, attesting to the robust nature of these predictors and their generalizability across gender, time, location, and ethnic/cultural background. These findings have important implications for designing intervention programs. Programs aimed at preventing adolescent marijuana use can be designed to incorporate universal features and still incorporate specific components that address the unique needs of adolescents from different groups.     

Risk factors for adolescent marijuana use across cultures and across time.

An integrated analysis of the data from 3 different studies was conducted to examine the early psychosocial predictors of later marijuana use among adolescents. Longitudinal analysis of interview data was performed. The data used in the analysis were derived from (a) a sample of 739 predominantly White adolescents representative of the northeastern United States, (b) a sample of 1,190 minority adolescents from the East Harlem section of New York City, and (c) a sample of 1,374 Colombian adolescents from two cities in Colombia, South America. In 2 of the samples, participants were interviewed in their homes, and in the 3rd study, participants were assessed in school. The predictors included a number of variables from (a) the personality domain, reflecting the adolescents' conventionality and intrapsychic functioning; (b) the family domain, representing the parent-child mutual attachment relationship and parental substance use; (c) the peer domain, reflecting the peer group's delinquency and substance use; and (d) the adolescents' own use of legal drugs. The dependent variable was adolescent marijuana use. The results of the analysis demonstrated remarkable consistency in the risk and protective factors for later marijuana use across the 3 samples, attesting to the robust nature of these predictors and their generalizability across gender, time, location, and ethnic/cultural background. These findings have important implications for designing intervention programs. Programs aimed at preventing adolescent marijuana use can be designed to incorporate universal features and still incorporate specific components that address the unique needs of adolescents from different groups.     

Adolescent identity--a qualitative approach: self-concept, existential questions and adult contacts

In-depth interviews were performed with 12 adolescents (Swedish students, 16-19 years). Three questions were probed; what do adolescents say on the subjects of (a) themselves, (b) their existential questions, and (c) their adult contacts. The first two questions were aimed at elucidating the process of identity development, the last one at factors that may be influencing this process. The results showed that (a) balancing and controlling one's own needs and wishes in relation to others' was a central issue, (b) existential questions mainly concerned the personal future, (c) adult contacts outside the family were scarce and (d) all respondents expressed a need for adult contacts as sources of knowledge and experience. The conclusions are that identity formation during late adolescence consists of integrative issues where adults play a specific and important role.     

Searching for commonalities in human judgement: The parametric unimodel and its dual mode alternatives

The question of why even a minimal ingroup is typically evaluated more positively than the respective outgroup has stimulated extensive theoretical and empirical work in social psychology. Integrating findings from various domains of research, this chapter summarises a comprehensive research programme that focuses on cognitive rather than motivational factors that contribute to positive ingroup distinctiveness. More specifically, evidence is presented showing that (a) there is a positive ingroup default, such that novel ingroups are immediately associated with positive affect; (b) people make inferences from the self in order to define their novel groups; and (c) this process of using the self as a means of cognitive structuring is based on heuristic rather than systematic information processing. Implications for our understanding of the role of self in intergroup evaluations and of factors determining ingroup favouritism in both minimal and real groups are discussed.     

Self-esteem in childhood and adolescence: Vaccine or epiphenomenon?

Recent accounts of the adaptive significance of self-esteem during childhood and adolescence have varied dramatically and fueled the emergence of a “self-esteem debate.” On one side of the debate, self-esteem is portrayed as a powerful positive influence on youth adjustment. By contrast, the other side has argued that hypothesized effects of self-esteem do not exist at all. A review of empirical findings suggests that both views are oversimplified and inaccurate. The adaptive implications of self-esteem during childhood and adolescence instead appear to be complex and differentiated, ranging from highly beneficial to possibly even negative. Recent results indicate the importance of considering (a) multiple, distinct facets of self-esteem; (b) the moderating influence of youth characteristics, environmental experiences, and processes in the formation and maintenance of self-esteem; and (c) bidirectional, recursive linkages between self-esteem and adaptive functioning throughout development. The adaptive implications of self-esteem for children and adolescents also appear to be most usefully investigated within the context of broader frameworks that allow for consideration of the role of self-esteem as an intervening or mediational process and its interdependent relationships with other aspects of the developing self-system. Implications for interventions designed to enhance youth self-esteem are discussed.     

How do Young Adults Remember their Childhood Social Status? A Retrospective Analysis of Peer-Rejection in Childhood and Adolescence,and Protective Factors Predictive of its Remission

In this retrospective study we investigated possible protective factors involved in the remission of childhood peer-rejection by investigation of how adults remember their childhood social status. This study aimed: (a) to investigate whether most children do, indeed, achieve improved social status in late adolescence or early adulthood, (b) whether this is true also for children experiencing peer-rejection in childhood, (c) to investigate potential protective factors which may predict improved status, and (d) to investigate the subjective recall of social status. We developed an index of social rejection, based on recalled severity of rejection and its duration. Respondents (n = 940) were also asked about the presence or absence of a series of potential protective factors during three periods in their lives: elementary school, secondary school, and post-secondary (compulsory military or national service). Most respondents, who reported poor social status during childhood, also reported a marked improvement in that status in late adolescence. Factors most common for respondents who underwent an improvement in social status are examined for respondents who self-reported both peer-acceptance and peer-rejection during childhood or adolescence. Respondents who reported severe peer-rejection were able to rely on fewer protective factors than their more accepted peers. The data, similar to previous research, stresses the need to focus on the salutary potential in the rejected childs family. Implications for practice in working with peer-rejected children are presented.     

Can the chronic exclusion-resignation link be broken? An analysis of support groups within prisons

Social exclusion, especially when prolonged over time––has a strong impact on the individuals’ health and wellbeing. According to the Temporal Need-Threat Model (Williams, 2009), the experience of chronic social exclusion inescapably leads to a condition of resignation, characterized by feelings of alienation, depression, helplessness, and unworthiness. However, few empirical studies have tested this prediction and its potential moderating factors. In this research, we identified the prison as a prototypical condition of chronic social exclusion, and aimed at (a) empirically testing the link between chronic exclusion and the resignation stage, (b) investigating whether situational factors—such as attending a support group in prison—can reduce the adverse outcomes of the resignation, and (c) exploring the role of individual differences (e.g., psychological flexibility) in mediating the effect of the support group on the resignation. The study involved 136 participants—68 detainees (31 of them participated in a support group) and 68 free citizens. Results showed that prisoners without the support group showed the highest levels of feelings of resignation. By contrast, prisoners in the support group were no different from nonprisoners in terms of resignation stage outcomes, and this beneficial effect of the support group was mediated by higher levels of perceived social support and psychological flexibility. Overall, this study suggests that the link between chronic exclusion and the resignation stage could be moderated by intervening social factors, highlighting the potential benefits of group-based interventions to tackle the negative consequences of chronic exclusion in chronically excluded populations.     

Behaviorism and Unity in Psychology

The defining feature of behaviorism is that it works with publicly observable stimuli and responses. One version, stimulus-response behaviorism, predicts responses from stimuli or situations. Another version, response-response behaviorism, predicts targeted responses from other responses. Unobservable mental states are intervening variables—hypothetical constructs if they have postulated material existence—that mediate these relationships. Cognition, affect, and reaction tendency are the major conceptual categories in this psychology. Its basic axioms state that behavior is (a) a function of enduring potentials for and temporary instigation to action, (b) controlled by excitation and inhibition, and (c) a blend of coping in situations in which organisms have control and adaptation in situations in which control is lacking. This view offers the hope of bringing unity to psychology.     

Retroactive interference in rats: Independent effects of time and similarity of the intervening event with respect to acquisition

Events occurring during the retention intervals for a 5-min delayed alternation task were used to investigate the factors that influence retroactive interference. Appetitive reinforcement in an E-maze was employed to train rats on the delayed alternation task consisting of a forced-choice (target event) trial followed by a free-choice (test) trial. Occasional probe trials added a potentially interfering event either at the beginning, middle, or end of the retention period. These events also varied in similarity to the target events, ranging from low similarity to the converse of the target event. Interference increased both with the interval between the target and intervening events and with the similarity between the converse of the target event and the intervening event; however, there was no tendency, significant or otherwise, towards an interaction between stimulus similarity and the interval between the target and intervening events. Control groups demonstrated that the interference was of an associative nature and that the interval between the intervening event and the test trial was little consequence. These results are discussed in terms of two separate types of interference: similarity interference which depends on stimulus similarity of the intervening event to the converse of the target event but not on the temporal location of the intervening event, and processing interference which depends on the temporal location of the intervening event but not on its similarity to the converse of the target event.     

Adolescent Precursors of Intensity of Marijuana and Other Illicit Drug Use Among Adult Initiators

This study examined (a) adolescent psychosocial risk factors for frequency (intensity) of marijuana use and for other illicit drug use among those who started using these drugs in early adulthood (adult initiators) and (b) the protective role of parent-adolescent relations in reducing or preventing drug use when adolescents enter early adulthood. The study's participants were male and female youth from a longitudinal prospective study. The participants' mean ages were 17 and 22 years at late adolescence and early adulthood, respectively. Independent measures assessed personality, parental, peer, and self-drug-use factors during late adolescence; dependent measures assessed frequency of marijuana use and other illicit drug use during early adulthood for initiators of the respective drug categories. The authors found that intensity of marijuana use was directly associated with the personality, parental, and self-drug-use domains and indirectly associated with the peer domain. Intensity of other illicit drug use was directly associated with personality and self-drug use. Analyses also revealed that some parent-adolescent relations factors buffered the effects of risk factors for both marijuana and other illicit drug-use intensity, whereas others enhanced the effects of protective factors against other illicit drug-use intensity. The results indicate that there are both commonalities and differences in precursors of marijuana and other illicit drug-use intensity among initiators of these drugs during early adulthood.