Treatment Outcome of 18-Month, Day Hospital Mentalization-Based Treatment (MBT) in Patients with Severe Borderline Personality Disorder in the Netherlands

Psychoanalytically oriented day hospital therapy, later manualized and named mentalization-based treatment (MBT), has proven to be a (cost-) effective treatment for patients with severe borderline personality disorder and a high degree of psychiatric comorbidity (BPD) in the United Kingdom (UK). As to yet it has not been shown whether manualized day hospital MBT would yield similar results when conducted by an independent institute outside the UK. We investigated the applicability and treatment outcome of 18-month, manualized day hospital MBT in the Netherlands by means of a prospective cohort study with 45 Dutch patients with severe BPD and a high degree of comorbid Axis I and Axis II disorders. Outcomes were assessed each six months. Symptom distress, social and interpersonal functioning, and personality pathology and functioning all improved significantly, with effect sizes between 0.7 and 1.7. Suicide attempts, acts of self-harm, and care consumption were also significantly reduced. The results indicate that MBT can effectively be implemented in an independent treatment institute outside the UK. This study also supports the clinical effectiveness of manualized day hospital MBT in patients with severe BPD and a high degree of psychiatric comorbidity.     

Getting the big picture: Development of spatial scaling abilities

Spatial scaling is an integral aspect of many spatial tasks that involve symbol-to-referent correspondences (e.g., map reading, drawing). In this study, we asked 3–6-year-olds and adults to locate objects in a two-dimensional spatial layout using information from a second spatial representation (map). We examined how scaling factor and reference features, such as the shape of the layout or the presence of landmarks, affect performance. Results showed that spatial scaling on this simple task undergoes considerable development, especially between 3 and 5 years of age. Furthermore, the youngest children showed large individual variability and profited from landmark information. Accuracy differed between scaled and un-scaled items, but not between items using different scaling factors (1:2 vs. 1:4), suggesting that participants encoded relative rather than absolute distances.     

Multisystemic therapy for young offenders: families' experiences of therapeutic processes and outcomes

Multisystemic Therapy (MST) has been found to be effective in reducing youth antisocial behavior, but little is known about the process and impact of MST from the perspective of families themselves. This qualitative study explored parents' and young people's experiences of MST, focusing on aspects of the intervention that promoted or limited change. Thirty-seven semistructured interviews were conducted with a consecutive sample of 21 families (21 parent interviews, 16 young people) who had participated in a randomized controlled trial of MST for young offenders in the United Kingdom. Thematic analysis yielded 10 themes, organized into two domains: (a) engagement in MST and initial processes of change captures the central importance of the therapeutic relationship and the MST engagement model in families' positive experiences of MST; and (b) outcomes are complex reflects the range of positive outcomes reported (notably increased parental confidence and skills, improved family relationships, a return to education, and greater reflection and aspiration on the part of the young person) and mixed behavior outcomes. Even when the young person had reoffended, respondents indicated a range of other benefits for the family. The findings support the MST theory of change as well as point to some outcomes not usually measured in MST outcome studies. They also suggest some adaptations that may increase the impact of the intervention, including more attention to the influence of deviant peers, and ongoing support for families struggling to maintain strategies beyond the prescribed treatment period.     

Can the Innate Right to Freedom Alone Ground a System of Public and Private Rights?

The state regulates the way in which social power is exercised. It sometimes permits, enables, constrains, forbids how we may touch others, make offers, draw up contracts, use, alter, possess and destroy things that matter to people, manipulate, induce weakness of the will, coerce, engage in physical force, persuade, selectively divulge information, lie, enchant, coax, convince, … In each of these cases, we (sometimes unintentionally) get others to act in ways that serve our interests. Which such exercises of power should the state forbid? Which should it permit? An intuitively appealing way to answer this question is, with Ripstein and Kant, to point to the role of freedom: exercises of social power can be legitimately prohibited when (and only when) they restrict people's freedom. But this raises a further question: How do we identify when such exercises of power make people unfree in the relevant sense? Ripstein, in defending Kant, draws a crucial distinction between actions that subject others’ wills to our choices (and which it would therefore be presumptively legitimate for the state to forbid) and actions that merely affect the contexts in which others act (and which it would therefore be presumptively illegitimate for the state to forbid). I query that distinction, and argue that the idea of independence cannot bear, on its own, the weight it is expected to bear within the Kantian framework.     

The relationship between cognitive function and life space: the potential role of personal control beliefs

We examined the relationship of cognitive and functional measures with life space (a measure of spatial mobility examining extent of movement within a person's environment) in older adults, and investigated the potential moderating role of personal control beliefs. Internal control beliefs reflect feelings of competence and personal agency, while attributions of external control imply a more dependent or passive point of view. Participants were 2,737 adults from the ACTIVE study, with a mean age of 74 years. Females comprised 76% of the sample, with good minority representation (27% African American). In multiple regression models controlling for demographic factors, cognitive domains of memory, reasoning, and processing speed were significantly associated with life space (p < .001 for each), and reasoning ability appeared most predictive (B = .117). Measures of everyday function also showed significant associations with life space, independent from the traditional cognitive measures. Interactions between cognitive function and control beliefs were tested, and external control beliefs moderated the relationship between memory and life space, with the combination of high objective memory and low external control beliefs yielding the highest life space (t = -2.07; p = .039). In conclusion, older adults with better cognitive function have a larger overall life space. Performance-based measures of everyday function may also be useful in assessing the functional outcome of life space. Additionally, subjective external control beliefs may moderate the relationship between objective cognitive function and life space. Future studies examining the relationships between these factors longitudinally appear worthwhile to further elucidate the interrelationships of cognitive function, control beliefs, and life space.     

Timing is everything: Anticipatory stress dynamics among cortisol and blood pressure reactivity and recovery in healthy adults

Psychological states of anticipation modulate biological stress responsivity. While researchers generally investigate how subjective distress corresponds to the magnitude of stress reactivity, physiological recovery after acute stressors must also be considered when investigating disease vulnerabilities. This study assessed whether anticipatory stress would correspond to stress reactivity and recovery of salivary cortisol and blood pressure levels in response to a well-validated psychosocial stressor. Thirty participants (63% female; mean?±?SEM age 45.4?±?2.12 years) were exposed to the Trier Social Stress Test (TSST) consisting of a public speech and mental arithmetic. Ten salivary cortisol samples and systolic and diastolic blood pressure recordings were collected at time points spanning 50?min before and up to 50?min after stress exposure. These data were transformed into parameters representing stress reactivity (area under the curve) and stress recovery (percent change). The Primary Appraisal Secondary Appraisal scale assessed anticipatory stress before exposure to the TSST. Our results revealed that increased anticipatory stress predicted increased stress reactivity for cortisol (p?=?0.009) but not blood pressure. For stress recovery, increased anticipatory stress predicted greater decrements of cortisol concentration (p?=?0.015) and blood pressure (p?=?0.039), even when controlling for total systemic "output" by incorporating baseline activity. This efficient shutdown of stress responses would have otherwise been ignored by solely investigating reactive increases. These findings underscore the importance of measuring multiple dynamic parameters such as recovery when investigating physiological stress response patterns as a function of psychosocial factors.     

Predictors of Deliberate Self-Harm Behavior Among Emerging Adolescents: An Initial Test of a Self-Punitiveness Model

The current study examined the extent to which an expanded self-punitiveness model could be applied to deliberate self-harm (DSH) among students making the transition to university. Specific components of the self-punitiveness model included perfectionism, overgeneralization, self-criticism, and shame. A sample of 319 university students completed a measure of deliberate self-harm as well as two multidimensional perfectionism measures and measures of self-criticism, overgeneralization, and shame. Correlational analyses found few significant associations among deliberate self-harm and the self-punitiveness factors among men. In contrast, among women, deliberate self-harm was associated with dimensions of trait perfectionism such as parental criticism and socially prescribed perfectionism, as well as with overgeneralization, self-criticism, and both characterological shame and bodily shame with the strongest associations found with shame. Supplementary analyses found a strong link between overgeneralization and shame and an association between self-criticism and shame among women. The results support the contention that particularly among young women making the transition to university, deliberate self-harm behavior is a reflection of a self-punitive personality orientation with multiple facets and a sense of shame associated with an overgeneralized sense of failing to meet social expectations.     

Assessing intentional binding with the method of constant stimuli

Intentional binding describes the phenomenon that actions and their effects are perceived to be temporally approximated. We introduced a new method of duration estimation to the research field, the method of constant stimuli. Participants freely chose to press one of two keys or experienced passive key presses. After an interval of 250ms or 600ms a visual effect occurred. In Experiment 1, each key produced an effect after a specific interval. In Experiment 2, both keys produced an effect after the same interval that varied between sessions. Participants compared the duration of the action-effect interval with a tone of varying duration. To assess intentional binding, we compared the perceived duration of the action-effect interval between the active and passive condition. We showed intentional binding for 600ms, but not for 250ms action-effect intervals in both experiments. Thus, the method of constant stimuli is suitable to assess intentional binding.     

The Laboratory-Clinician Team: A Professional Call to Action to Improve Communication and Collaboration for Optimal Patient Care in Chromosomal Microarray Testing

The International Standards for Cytogenomic Arrays (ISCA) Consortium is a worldwide collaborative effort dedicated to optimizing patient care by improving the quality of chromosomal microarray testing. The primary effort of the ISCA Consortium has been the development of a database of copy number variants (CNVs) identified during the course of clinical microarray testing. This database is a powerful resource for clinicians, laboratories, and researchers, and can be utilized for a variety of applications, such as facilitating standardized interpretations of certain CNVs across laboratories or providing phenotypic information for counseling purposes when published data is sparse. A recognized limitation to the clinical utility of this database, however, is the quality of clinical information available for each patient. Clinical genetic counselors are uniquely suited to facilitate the communication of this information to the laboratory by virtue of their existing clinical responsibilities, case management skills, and appreciation of the evolving nature of scientific knowledge. We intend to highlight the critical role that genetic counselors play in ensuring optimal patient care through contributing to the clinical utility of the ISCA Consortium's database, as well as the quality of individual patient microarray reports provided by contributing laboratories. Current tools, paper and electronic forms, created to maximize this collaboration are shared. In addition to making a professional commitment to providing complete clinical information, genetic counselors are invited to become ISCA members and to become involved in the discussions and initiatives within the Consortium.     

Racial and Ethnic Differences in Direct-to-Consumer Genetic Tests Awareness in HINTS 2007: Sociodemographic and Numeracy Correlates

To examine the association of 1) race/ethnicity and 2) numeracy with awareness of DTC genetic tests. Secondary analysis of 6,754 Hispanic, black, and white adult respondents to the National Cancer Institute’s 2007 Health Information National Trends Survey (HINTS). Logistic regression was used to examine sociodemographic predictors of DTC genetic tests awareness including race/ethnicity, income, education, and gender. Next, two numeracy variables were added to the model. After controlling for sociodemographic variables, black respondents were significantly less likely to have heard of DTC genetic tests compared to white respondents (OR = 0.79; CI: 0.65–0.97). When numeracy variables were added to the model, the effect of black race was no longer significant (OR = 0.84; CI: 0.69–1.04). Hispanic respondents did not significantly differ from white respondents in awareness of DTC genetic tests. Other significant correlates of DTC genetic tests awareness in the full model included education, income, age, and numeracy variables including degree to which people use medical statistics and numbers to make health decisions, and preference for words or numbers when discussing “the chance of something happening.” Although black respondents were generally less aware of DTC genetic tests than white respondents, this relationship appears to be partially mediated by numeracy.