Psychosocial Impact of a Positive Gene Result for Asymptomatic Relatives at Risk of Hypertrophic Cardiomyopathy

Families with a history of hypertrophic cardiomyopathy (HCM) may be offered genetic testing in addition to clinical surveillance. Asymptomatic family members who are gene positive (silent gene carriers) represent a new group of “patients” who may not develop HCM, with little evidence available to assist clinical management. This study explored experiences of HCM genetic testing to identify potential benefits and harms. Thirty-two individuals previously offered genetic testing for HCM were recruited. Semi-structured interviews were conducted face-to-face or by phone, and transcribed audio-recordings were coded using framework analysis. Key themes were as follows: (1) helping the next generation, (2) misunderstanding risk, (3) discrepancy between actual/perceived impact. Participants described multiple psychological (shock, worry, uncertainty) and behavioural (career, sport, insurance, family planning) consequences, depending on perceived risk. Most considered only the benefits of genetic testing for children or grandchildren, but there were some cases of significant adverse impact. The interpretation of the HCM genetic test result is variable for silent gene carriers and can lead to psychological and behavioural changes. The impact of a positive gene result may be mitigated by increased clarity of the clinical consequences and efforts to ensure informed decision-making, highlighting even further the important role of cardiac genetic counselling.     

Strategies included in cognitive behavioral therapy programs to treat internalized disorders: a systematic review

This review aimed to identify the strategies used in programs based on cognitive behavioral therapy (CBT) to prevent and treat symptoms of anxiety, depression, and internalized behaviors of children and adolescents. Based on an online search (ERIC, PsycInfo, Virtuose UQAM, and Google Scholar), 61 studies describing different cognitive behavioral programs were selected. Results showed that 40 strategies were implemented in at least one program. However, none of the strategies were systematically present in all programs, and only few were reported in more than 50% of the studies. Cognitive restructuring and problem-solving were the most popular strategies to treat depressive symptoms, whereas anxiety programs also generally included relaxation and exposure. Furthermore, six strategies were identified in a single anxiety program, whereas nine strategies were implemented in only one depression program. These results suggest that in anxiety and depression programs designed for children and adolescents, the label “CBT” encompasses a wide variety of programs with only few similar strategies. Such findings highlight the need to define a common basis for CBT programs, in order to better reflect CBT theory and to identify the effectiveness of the strategies included in these programs.     

The Importance of Parents' Community Connections for Adolescent Well‐being: An Examination of Military Families

Drawing from the Social Organization Theory of Action and Change (SOAC), this analysis of 223 military families, including active duty (AD) military and civilian partners, examines how parents' sense of community and community engagement (two elements of community connections) are associated with their own resilient coping, and ultimately with important outcomes capturing their adolescent offspring's individual well‐being (depression, anxiety, and self‐efficacy) and family well‐being (family functioning and parenting quality). The roles of child gender and military context were also examined. Parents with stronger community connections, including greater sense of community and community engagement, reported more resilient coping when faced with adversity. The resilient coping of mothers, in turn, was particularly significant for more positive youth outcomes, when compared to that of fathers. While gender and military context were associated with individual and family well‐being, analyses of model invariance indicated that the model fit similarly for male and female adolescents and those experiencing high and low levels of military transitions. Indirect effects were also examined. These findings illuminate malleable dimensions of both community life and family life, primarily showing that community contexts matter for multiple family members.     

The Significance of Military Contexts and Culture for Understanding Family Well-Being: Parent Life Satisfaction and Adolescent Outcomes

Formal systems and informal networks are presumed to be significant contexts that affect military families. Their effects on both parents and adolescents in active duty military families are examined (N = 236 families). Social organization and contextual model of family stress theories are employed as frameworks for the analyses of how dimensions of military culture influence parents’ life satisfaction, as well as key developmental outcomes of their adolescents (for example, mental health). Key findings from our analyses included a positive relationship between parents support from military leaders and fellow soldiers and parental well-being findings revealed the importance of civilian parents’ satisfaction with military life on adolescent outcomes for families that have experienced stressful military contexts. These findings provide support for the significance of multiple contexts for understanding resilience among military members and their families.     

My subdued ego: A psychodynamic case study of borderline personality disorder following relational trauma

Recent advances in the conceptualisation of borderline personality disorder (BPD) have highlighted the role of relational trauma as central to the onset of the disorder, whilst observing deficits in the structure of the self-concept as a result of developmental adversity. Understanding borderline states within a psychiatric framework alone has attracted significant criticism due to the lack of the medical model’s explanatory properties, which fail to account for the complexity and variation of borderline symptomatology. A reliance on psychodynamic formulation instead, can provide an aetiological framework where BPD can be understood as a disorder of the sense of self, originating in the client’s relational matrix. The purpose of the current paper is to discuss a borderline case study with a focus on formulation rather than diagnosis, in an attempt to shed light on the relational and unconscious processes underpinning the disorder and thus inform treatment interventions.     

Validation of the Five-Factor Model Personality Disorder Prototype Counts with the Personality Assessment Inventory

Five-factor model (FFM) personality disorder (PD) prototype scores drawn from the revised NEO-Personality Inventory (NEO-PI-R) have demonstrated strong convergent validity with clinical measures of PD (Miller in Journal of Personality, 80, 1565–1591, 2012). However, an examination of the relations between the Personality Assessment Inventory (PAI; Morey 1991), which is widely used in personality assessment research, and the FFM PD prototype “count” method, has not been conducted. The present study examines the convergent validity of the FFM borderline, antisocial, and psychopathy prototype counts with the Borderline Features (BOR) and Antisocial Features (ANT) full scales and subscales from the PAI. Furthermore, the BOR and ANT scales are correlated with all 30 NEO-PI-3 facets to empirically evaluate the rationally-selected facet scales used in the borderline, antisocial, and psychopathy PD counts. Five hundred thirty-five undergraduate students completed both the NEO-PI-3 and the PAI. The PD counts demonstrated strong convergent and discriminant validity with the PAI clinical scales. Facet-level analyses generally supported the structure of the PD count formulas, and the exceptions align with previous evidence that the Competence, Dutifulness, and Self-Discipline facets (from the Conscientiousness domain of the FFM) associate strongly with the BOR scale.