Brief Cognitive-Behavioral Therapy for Suicidal Inpatients

Suicide risk is elevated in psychiatric patients following discharge from inpatient care. Despite this vulnerability, there has been limited research investigating suicide prevention protocols that take into account the unique system characteristics of this setting (e.g., short lengths of stay, crisis stabilization treatment model, multidisciplinary team coordination). Cognitive-behavioral therapy (CBT) has demonstrated efficacy for improving suicide risk in outpatients, but has not been validated with inpatients. The current study was a treatment development and pilot feasibility open trial that modified brief cognitive-behavioral therapy (BCBT) for an inpatient setting (BCBT-I). Key treatment modifications included administering up to 10 sessions (depending on patient length of stay), daily, and in a standardized order, with core crisis management skills introduced during the first three sessions. In addition, coordination with the inpatient treatment team was included in BCBT-I implementation. Six adult inpatients with a recent suicide attempt enrolled and completed an average of 4.67 BCBT-I sessions (SD = 1.36). The treatment was highly acceptable (Client Satisfaction Questionnaire total score M = 3.49, SD = 0.73). Pre- to posttreatment effect sizes demonstrated improvements in suicidal ideation (d = 0.97), depression (d = 1.33), and suicidal implicit associations (d = 1.28). All but one of the participants (83%) completed follow-up assessments 1-, 2-, and 3-months postdischarge. Over follow-up, two participants reported suicidal ideation (both without intent), and none reported suicide attempts, preparatory acts or behaviors, or nonsuicidal self-injury. This study provided preliminary evidence supporting the feasibility of CBT to treat suicidal inpatients. Future research is needed to validate BCBT-I in a larger, randomized controlled trial to determine whether BCBT-I reduces suicide risk beyond that afforded by inpatient treatment alone.     

Clinical Implications for Multi-Racial Individuals

Abstract

Multi- racial individuals experience distinctive struggles and challenges that can impact their mental health. However, despite the growing population and unique presenting issues there remains a scarcity of literature to effectively support them. In addition, there is a lack of research exploring the unique experience of the multiple heritage population. The article offers implications for effectively working with individuals of multi-racial decent as well as a call to action for MFTs to develop multicultural competencies for the profession.     

Nonmonetary and nonreciprocal freecycling: Motivations for participating in online alternative giving communities

This research examines consumers' participation in a nonmonetary, nonreciprocal form of online consumer exchange wherein consumers may decide to give only, receive only, or both give and receive. Given the lack of financial incentives or relational norms that would traditionally drive participation in this societally beneficial consumption activity for which we advance the term alternative giving, this research examines consumers' participation motivations. Are consumers, as prior research suggests, motivated to participate in alternative giving activities on the basis of prosocial motives or for other reasons? Through a content analysis of the online Freecycle Network, we found that participation is driven primarily by fundamental consumer needs and wants, though other prosocial, less materialistic factors are also drivers. Our findings also identify an inconsistency in product categories between what givers offer and what receivers seek, suggesting that supply–demand imbalances can emerge within alternative giving communities.     

Reviews: Books, Art

POLITICS ON THE COUCH: CITIZENSHIP AND THE INTERNAL LIFE. By Andrew Samuels, 235 pp. New York: Karnac (Other Press). $16.00. MARTHA, MARTHA: HOW CHRISTIANS WORRY. By Elaine Leong Eng, M.D. Binghamton, NY: Haworth Press, Inc., 2000. $14.95. SPILT MILK: PERINATAL LOSS AND BREAKDOWN. Edited by Joan Raphael-Leff. 100 pp. London: Institute of Psychoanalysis, 2000. MOTHERHOOD AND SEXUALITY. By Marie Langer, 305 pp. New York: Other Press, 2000. $30.00. BRANCHING STREAMS FLOW IN THE DARKNESS: ZEN TALKS ON THE SANDOKAI. By S. Suzuki. Eds: M. Weitsman and M. Wegner. 193 pp. Berkeley, CA: University of California Press. $22.50. RESTORED HARMONY: AN EVIDENCE BASED APPROACH FOR INTEGRATING TRADITIONAL CHINESE MEDICINE INTO COMPLEMENTARY CANCER CARE. By Stephen Sagar, MD. xviii + 134 pp. Hamilton, Ontario, Canada: Dreaming Dragonfly Communications, 2001. $19.95 (US); $29.95 (Can.), paperback. (ISBN: 0-9689488-0-4). CHIYO-NI, WOMAN HAIKU MASTER. By Patricia Donegan and Yoshie Ishibashi, 184 pp. Boston: Charles E. Tuttle Co., 1998. $16.95. THE METAPHYSICAL CLUB: A STORY OF IDEAS IN AMERICA. By Louis Menand, 442 pp. New York: Farrrar, Straus, and Giroux, 2001. $27.00. BUDDHISM WITHOUT BELIEFS: A CONTEMPORARY GUIDE TO AWAKENING. By Stephen Bachelor, 127 pp. Riverhead Books, 1997. $21.95. Video Art is Dead, Long Live Video Art     

Coincident induction of long-term facilitation at sensory-motor synapses in Aplysia: presynaptic and postsynaptic factors

Induction of long-term synaptic changes at one synapse can facilitate the induction of long-term plasticity at another synapse. Here we show that if Aplysia sensory neuron (SN) somata and their remote motor neuron (MN) synapses are simultaneously exposed to serotonin (5HT) pulses, which at either site alone are insufficient to induce long-term facilitation (LTF), processes activated at these sites interact to induce LTF. Coincident induction of LTF requires: (1) that the synaptic pulse occurs within a brief temporal window of the somatic pulse and (2) that local protein synthesis occurs immediately at the synapse, followed by delayed protein synthesis at the soma. LTF at the SN-MN synapses can also be induced with cell-wide application of repeated pulses of 5HT. However, these two forms of LTF differ mechanistically: (1) coincident LTF requires protein synthesis in the postsynaptic motor neuron, whereas repeated 5HT LTF does not, and (2) repeated 5HT LTF is accompanied by intermediate-term (3 h) facilitation, whereas coincident LTF is not. Thus LTF expressed in the same temporal domain can result from different underlying mechanisms.     

Body checking and avoidance and the core features of eating disorders among obese men and women seeking bariatric surgery

This study examined two aspects of body checking and avoidance, and their relations to the core psychopathology of eating disorders (EDs), in severely obese men and women seeking bariatric surgery. A consecutive series of 260 (44 male and 216 female) gastric bypass candidates were administered measures to assess body checking and avoidance, binge eating, restraint, and overevaluation of weight and shape. The majority of patients reported regularly pinching areas of their body to check for fatness and avoided wearing clothing that made them particularly aware of their body. Significant associations were observed between checking and restraint, and between avoidance and binge eating. Both checking and avoidance behaviors were significantly associated with overevaluation of weight and shape. The positive associations between each of the two behaviors (body checking and avoidance) with overevaluation of weight/shape remained significant even after controlling for the effects of avoidance on body checking and vice versa. Stepwise multiple regression analyses revealed that binge eating, body checking, and avoidance behaviors made significant unique contributions and jointly accounted for 22-25% of the variance in overevaluation of weight and shape, respectively. This study documents the presence of eating disorder psychopathology among severely obese patients seeking bariatric surgery. The findings support the view that body checking and avoidance behaviors are manifestations of overevaluation of weight and shape and disordered eating.     

The social context of imitation in infancy

Infants increasingly generalize deferred imitation across environmental contexts between 6 and 18 months of age. In three experiments with 126 6-, 9-, 12-, 15-, and 18-month-olds, we examined the role of the social context in deferred imitation. One experimenter demonstrated target actions on a hand puppet, and a second experimenter tested imitation 24h later. When the second experimenter was novel, infants did not exhibit deferred imitation at any age; when infants were preexposed to the second experimenter, all of them did. Imitating immediately after the demonstration also facilitated deferred imitation in a novel social context at all ages but 6 months. Infants' pervasive failure to exhibit deferred imitation in a novel social context may reflect evolutionary selection pressures that favored conservative behavior in social animals.     

Experimental research on just-world theory: problems, developments, and future challenges

M. J. Lerner (1980) proposed that people need to believe in a just world; thus, evidence that the world is not just is threatening, and people have a number of strategies for reducing such threats. Early research on this idea, and on just-world theory more broadly, was reviewed in early publications (e.g., M. J. Lerner, 1980; M. J. Lerner & D. T. Miller, 1978). In the present article, focus is directed on the post-1980 experimental research on this theory. First, 2 conceptualizations of the term belief in a just world are described, the typical experimental paradigms are explained, and a general overview of the post-1980 experiments is provided. Second, problems with this literature are discussed, including the unsystematic nature of the research. Third, important developments that have occurred, despite the problems reviewed, are described. Finally, theoretical challenges that researchers should address if this area of inquiry is to advance in the future are discussed.     

Genetic Cancer Risk Assessment and Counseling: Recommendations of the National Society of Genetic Counselors

These cancer genetic counseling recommendations describe the medical, psychosocial, and ethical ramifications of identifying at-risk individuals through cancer risk assessment with or without genetic testing. They were developed by members of the Practice Issues Subcommittee of the National Society of Genetic Counselors Cancer Genetic Counseling Special Interest Group. The information contained in this document is derived from extensive review of the current literature on cancer genetic risk assessment and counseling as well as the personal expertise of genetic counselors specializing in cancer genetics. The recommendations are intended to provide information about the process of genetic counseling and risk assessment for hereditary cancer disorders rather than specific information about individual syndromes. Key components include the intake (medical and family histories), psychosocial assessment (assessment of risk perception), cancer risk assessment (determination and communication of risk), molecular testing for hereditary cancer syndromes (regulations, informed consent, and counseling process), and follow-up considerations. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. These recommendations do not displace a health care provider's professional judgment based on the clinical circumstances of a client.