Brief Strategic Family Therapy: Twenty-Five Years of Interplay Among Theory, Research and Practice in Adolescent Behavior Problems and Drug Abuse

This article describes a systematic program of research that focuses on Brief Strategic Family Therapy (BSFT) and the adaptations that were developed based on BSFT principles. The culture-specific origins of BSFT are reviewed, as well as its broader applications to the field of family therapy. Research is reviewed demonstrating that BSFT is a promising family-based approach to treating Hispanic youth behavior problems and drug abuse. Treatment innovations are described that address the combination of intergenerational and cultural differences that occur among youths and their Hispanic parents. Programmatic work is described that challenges basic principles of family therapy by expanding BSFT to a One Person modality and a strategic engagement procedure. Both of these novel approaches are intended to add tools to therapists' repertoire in working with difficult-to-engage families. A preview discussion of results is presented from a randomized clinical trial that is an application of an ecosystemic prevention version of BSFT. The implications of the work of the Center for Family Studies are discussed in the context of the broader service system. Ultimately, this article articulates a way of thinking about adolescent problem behavior, its social interactional determinants, and a range of theoretically consistent family-centered strategies that attempt to change social ecological processes that impact adolescent developmental trajectories.     

Mood, personality disorder symptoms and disability in obsessive compulsive hoarders: a comparison with clinical and nonclinical controls

Hoarding is a symptom of obsessive compulsive disorder (OCD), as well as a diagnostic criterion for obsessive compulsive personality disorder (OCPD). One recent study suggests that people who suffer from compulsive hoarding report more general psychopathology than people who do not [Frost, R.O., Krause, M.S., & Steketee, G. (1996). Hoarding and obsessive compulsive symptoms. Behavior Modification, 20, 116-132]. The present study addressed whether persons with OCD hoarding exhibit more depression, anxiety, OCD and personality disorders symptoms than community controls, OCD nonhoarders, or other anxiety disorder patients. Disability was also examined. Hoarding subjects were older than the other three groups, but age did not account for any of the differences observed among the groups. Compared to controls, OCD hoarding, nonhoarding OCD and anxiety disorder patients showed elevated YBOCS scores, as well as higher scores on depression, anxiety, family and social disability. Compared to nonhoarding OCD and anxiety disorder patients, OCD hoarding patients scored higher on anxiety, depression, family and social disability. Hoarding subjects had greater personality disorder symptoms than controls. However, OCD hoarding subjects differed from OCD nonhoarding and anxiety disorder subjects only on dependent and schizotypal personality disorder symptoms. The findings suggest that hoarding is associated with significant comorbidity and impairment compared to nonhoarding OCD and other anxiety disorders.     

Chronicity, severity, and timing of maternal depressive symptoms: relationships with child outcomes at age 5

The relationships between severity, chronicity, and timing of maternal depressive symptoms and child outcomes were examined in a cohort of 4,953 children. Mothers provided self-reports of depressive symptoms during pregnancy, immediately postpartum, and when the child was 6 months old and 5 years old. At the age 5 follow-up, mothers reported on children's behavior and children completed a receptive vocabulary test. Results suggest that both the severity and the chronicity of maternal depressive symptoms are related to more behavior problems and lower vocabulary scores in children. The interaction of severity and chronicity of maternal depressive symptoms was significantly related to higher levels of child behavior problems. Timing of maternal symptoms was not significantly related to child vocabulary scores, but more recent reports of maternal depressive symptoms were associated with higher rates of child behavior problems.     

Eye height scaling of absolute size in immersive and nonimmersive displays

Eye-height (EH) scaling of absolute height was investigated in three experiments. In Experiment 1, standing observers viewed cubes in an immersive virtual environment. Observers' center of projection was placed at actual EH and at 0.7 times actual EH. Observers' size judgments revealed that the EH manipulation was 76.8% effective. In Experiment 2, seated observers viewed the same cubes on an interactive desktop display; however, no effect of EH was found in response to the simulated EH manipulation. Experiment 3 tested standing observers in the immersive environment with the field of view reduced to match that of the desktop. Comparable to Experiment 1, the effect of EH was 77%. These results suggest that EH scaling is not generally used when people view an interactive desktop display because the altitude of the center of projection is indeterminate. EH scaling is spontaneously evoked, however, in immersive environments.     

Biparental failure in the childhood experiences of borderline patients

The purpose of this study was to assess the role of biparental abuse and neglect in the development of borderline personality disorder (BPD). A semistructured research interview was used to blindly assess the childhood experiences of biparental abuse and neglect reported by 358 borderline inpatients and 109 axis II controls. Eighty-four percent of borderline patients reported having experienced some type of biparental abuse or neglect before the age of 18; 55% reported a childhood history of biparental abuse; 77% reported a childhood history of biparental neglect. These experiences were also reported by a substantial percentage of Axis II controls (biparental abuse or neglect [61%], biparental abuse [31%], and biparental neglect [55%]). However, borderline patients were significantly more likely than axis II controls to report having been verbally, emotionally, and physically but not sexually abused by caretakers of both sexes. They were also significantly more likely than controls to report having caretakers of both sexes deny the validity of their thoughts and feelings, fail to provide them with needed protection, neglect their physical care, withdraw from them emotionally, and treat them inconsistently. It was also found that female borderlines who reported a previous history of neglect by a female caretaker and abuse by a male caretaker were at significantly higher risk for having been sexually abused by a noncaretaker. Taken together, the results of this study suggest that biparental failure may be a significant factor in the etiology of BPD. They also suggest that biparental failure may significantly increase a preborderline girl's risk of being sexually abused by someone other than her parents.     

Attributional Style, Self-Esteem, and Human Immunodeficiency Virus: A Test of the Hopelessness and Self-Esteem Theories of Depression

Research on the hopelessness and self-esteem theories of depression (Abramson, Metalsky, & Alloy, 1989; Metalsky, Joiner, Hardin, & Abramson, 1993) suggests that HIV-infected persons with depressotypic attributional style (AS) and low self-esteem (SE) may be at risk for onset of a syndrome referred to as hopelessness depression (HD). In a prospective study conducted to test these theories, measures of anxiety and depression, AS, and SE were administered to 85 HIV+ and 43 HIV– men; symptoms were reassessed 6 months later. Results indicated that: (1) The interaction of AS, SE, and HIV status predicted change in HD symptoms, but not overall depression or anxiety symptoms; (2) HIV+ men with depressotypic AS and high SE had increased HD symptom levels while other men with high SE had decreased HD symptom levels; (3) HD symptoms remained stable over the 6-month interval among men with low SE; and (4) High SE predicted decreases in anxiety symptoms among HIV– men, but not among HIV+ men. Contrary to the study hypothesis, these findings suggest that among individuals with life-threatening illnesses such as HIV infection, those with depressotypic AS and high SE may be at highest risk for onset of HD.     

Problem solving deteriorates following mood challenge in formerly depressed patients with a history of suicidal ideation

The authors divided 34 participants who had a history of depression into 2 groups, those having previous suicidal ideation or behavior (n=19) and those having no such symptoms (n=15), then compared the 2 groups with a group of participants who had no history of depression (n=22). Assessment of interpersonal problem-solving performance using the Means-Ends Problem-Solving (MEPS) task before and after a mood-induction procedure showed that only those formerly depressed people with a history of suicidal ideation shifted in MEPS performance, producing significantly less effective problem solutions following mood challenge, consistent with a differential activation account of vulnerability for recurrence of suicidal ideation and behavior. The deterioration in effectiveness following mood challenge was moderated by lack of specificity in autobiographical memory.     

Toward a biopsychosocial model for 21st-century genetics

Advances in genomic research are increasingly identifying genetic components in major health and mental health disorders. This article presents a Family System Genetic Illness model to address the psychosocial challenges of genomic conditions for patients and their families, and to help organize this complex biopsychosocial landscape for clinical practice and research. This model clusters genomic disorders based on key characteristics that define types of disorders with similar patterns of psychosocial demands over time. Key disease variables include the likelihood of developing a disorder based on specific genetic mutations, overall clinical severity, timing of clinical onset in the life cycle, and whether effective treatment interventions exist to alter disease onset and/or progression. For disorders in which carrier, predictive, or presymptomatic testing is available, core nonsymptomatic time phases with salient developmental challenges are described pre- and post-testing, including a long-term adaptation phase. The FSGI model builds on Rolland's Family System Illness model, which identifies psychosocial types and phases of chronic disorders after clinical onset. The FSGI model is designed to be flexible and responsive to future discoveries in genomic research. Its utility is discussed for research, preventive screening, family assessment, treatment planning, and service delivery in a wide range of healthcare settings.     

Online attentional-focus manipulations in a soccer-dribbling task: implications for the proceduralization of motor skills

A focus of attention on the step-by-step control of a skill has been shown to be detrimental to experts' performance but to have no significant effect on novices' performance (e.g., S. L. Beilock, T. H. Carr, C. MacMahon, & J. L. Starkes, 2002), contrary to the results of manipulations of the direction of attentional focus (e.g., G. Wulf, M. H?ss, & W. Prinz, 1998). In previous studies, researchers have not separated the focus of attention from the nature of the instruction provided or the skill level of the participants. In the present experiment, 10 skilled and 10 less skilled soccer players dribbled a ball after receiving instructions directing attention to an internal, skill-relevant feature (foot); an internal, skill-irrelevant feature (arm); or a skill-irrelevant task (word-monitoring). Performance was evaluated in relation to a no-attentional-focus control condition. For skilled performers, an internal focus on the arms and feet interfered with performance. For less skilled performers, an internal, yet skill-relevant, focus of attention (foot) did not degrade performance, whereas attention to the arms and word monitoring had a detrimental effect. No significant differences were observed across the three attentional manipulations when the skilled performers used the nondominant foot. The results generally supported the deautomization of skills hypothesis.     

Coping in context: the role of stress, social support, and personality in coping

Personality and social relationships play an important role in almost every aspect of stress and coping. Daily process methods are particularly useful in elucidating how these factors might influence both responses to and outcomes of stress. Our work has linked both dimensions of personality, particularly the Big Five, and aspects of social relationships, particularly social support, to the likelihood of engaging in certain coping strategies and the effectiveness or outcomes of these coping strategies. In addition, we have found the effect of personality on coping and stress outcomes to vary by the situational context in which stress occurs. We review findings from our recent daily process studies of stress, coping, and social support. Further, we discuss the costs and benefits of the daily process methodology for addressing these questions, highlighting the clinical utility of findings gleaned with the use of this approach. Finally, we discuss future directions and applications of daily process methods to the study of stress and coping.