Barriers and facilitators affecting the sustainability of dialectical behaviour therapy programmes: A qualitative study of clinician perspectives

Dialectical behaviour therapy (DBT) is a psychological treatment developed for individuals experiencing chronic suicidality and high‐risk behaviours. Despite the substantial evidence supporting the effectiveness of DBT, many programmes have problems with its sustainability. The goals of the current qualitative study were to identify factors that impact the sustainability of DBT programmes within a publicly funded mental health system and identify factors that are particularly relevant for youth DBT programmes. Interviews with trained adult and youth DBT clinicians (N = 31) were conducted to explore their experiences providing DBT. Three major themes that emerged as barriers to the sustainability of DBT programmes included the following: systemic challenges, conflicts within the consultation teams and clinician burnout. Factors influencing the success of DBT programmes included the following: systemic support, clinician commitment and “buy in”, and team cohesion. Factors specific to providing DBT with youth (i.e. level of commitment, simplifying the language, and parental investment) and recommendations for sustainability for adults and youth programmes were also identified. Findings of this study provide valuable information on factors impacting DBT programmes within the unique context of a Canadian mental health service system, where community‐based services are publicly funded. These findings have clear clinical utility and can be used to generate solutions to clinicians' perceived barriers and to foster perceived facilitators within similar contexts.     

A direct assessment of the role of state and trait negative emotion in aggressive behavior

Affective priming of aggression was examined in groups low and high in trait negative emotionality (NEM) using a Buss aggression paradigm. Negative affect was induced by exposure to aversive air blasts during some intervals (threat) and not others (safe). Phasic negative affect was assessed using startle reflex potentiation, and tonic distress was indexed by startle sensitization. Participants delivered shocks faster during threat versus safe intervals, indicating that phasic distress primed aggression. Following initial exposure to air blasts, high NEM participants showed enhanced tonic distress and delivered persistently more intense shocks than low NEM participants. These findings indicate that sustained negative affect biases high stress-reactive individuals toward more intense acts of aggression, with phasic distress affecting the rapidity of aggressive response.     

Negative mood,depressive symptoms,and major depression after smoking cessation treatment in smokers with a history of major depressive disorder

Negative mood, depressive symptoms, and major depressive episodes (MDEs) were examined in 179 smokers with a history of major depression in a trial comparing standard smoking cessation treatment to treatment incorporating cognitive-behavioral therapy for depression (CBT-D). Early lapses were associated with relatively large increases in negative mood on quit date. Mood improved in the 2 weeks after quit date among those returning to regular smoking but not among those smoking moderately. Continuous abstinence was associated with short- and long-term reductions in depressive symptoms. MDE incidence during follow-up was 15.3% and was not associated with abstinence. Unexpected was that CBT-D was associated with greater negative mood and depressive symptoms and increased MDE risk. Results suggest complex bidirectional associations between affect and smoking outcomes.     

Racism, ideology, and affirmative action revisited: the antecedents and consequences of "principled objections" to affirmative action

In 2 studies, the antecedents and consequences of "principled objections" to affirmative action (specific, "race-neutral" reasons for opposing the policy) among Whites were examined. In Study 1. data from a probability sample of Los Angeles adults indicated the following: (a) that principled-objection endorsement was driven not merely by race-neutral values but also by dominance-related concerns like racism; (b) that principled objections mediated the effects of group dominance; and (c) that education strengthened-rather than attenuated-the relationship between dominance-related concerns and principled objections. whereas it left the relationship between race-neutral values and the latter essentially unchanged. In Study 2, the education findings were conceptually replicated in a panel study of undergraduates: The completion of additional years of college boosted the correlation between racism and principled objections, whereas it had no effect on the predictive power of conservatism. These results provide support for a general group-dominance approach, which suggests that factors like racism continue to shape White opposition to race-targeted policies.     

Effects of caffeine on performance of low intensity tasks

31 college age men and women who consume less than three caffeinated beverages per week agreed to participate as subjects in research on the effects of acute caffeine intake on low intensity task performance. All subjects performed two randomly administered test conditions: (1) caffeine (5 mg/kg) and (2) placebo on separate visits following an initial 1-hr. orientation visit. Subjects were administered the beverage 30 min. prior to performing 12 separate tests assessing basic mathematics, simple response, logical reasoning, hand-eye coordination, and spatial and assembly skills. The Spielberger State Anxiety test was administered immediately after consuming the test beverage and once again at posttest. Analysis showed that caffeine did not significantly affect performance on all tests with the exception of the peripheral awareness (hand-eye coordination) test on which performance was higher after ingesting caffeine. The placebo treatment produced no effect on state anxiety, which contrasted with a significant rise in anxiety after caffeine consumption. State anxiety values were significantly greater after caffeine treatment relative to the placebo at pretest, and this difference persisted at posttest. These results demonstrated that the dose of caffeine increased scores on state anxiety for individuals who consumed less than three caffeinated beverages weekly but had very little effect on performance of low intensity tasks, except for a hand-eye coordination test involving peripheral awareness. Perhaps longer continuous performance of more demanding tasks would be more sensitive.     

Orthographic neighborhood effects in lexical decision: the effects of nonword orthographic neighborhood size

The effects of large neighborhoods (neighborhood size) and of higher frequency neighbors (neighborhood frequency) were examined as a function of nonword neighborhood size in lexical decision tasks. According to the multiple read-out model (J. Grainger & A. M. Jacobs, 1996), neighborhood size and neighborhood frequency effects should vary systematically as a function of nonword neighborhood size. In these experiments, the nonword context was more extensively manipulated than in previous studies, providing a more complete test of the model's predictions. In addition, simulations were conducted examining the model's ability to account for the facilitatory neighborhood size and neighborhood frequency effects observed in these experiments. The results suggest that the model overestimates the role of inhibition in the orthographic processing of English words.     

The Infrequency-Posttraumatic Stress Disorder scale (Fptsd) for the MMPI-2: development and initial validation with veterans presenting with combat-related PTSD

Researchers have identified difficulties associated with the use of traditional Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) validity scales with survivors of traumatic events. A new scale, the Infrequency-Posttraumatic Stress Disorder scale (Fptsd), was created from MMPI-2 items that were infrequently endorsed by 940 male combat veterans presenting for treatment at the posttraumatic stress disorder (PTSD) clinics of 2 Veterans Affairs Medical Centers. A variety of statistical methods were implemented that preliminarily established Fptsd's validity with a validation sample of 323 additional PTSD-diagnosed combat veterans. Results indicate that, relative to previously established validity and overreporting scales (F, Fb, and Fp), Fptsd was significantly less related to psychopathology and distress and better at discriminating simulated from genuinely reported PTSD. Clinical implications are discussed concerning the use of Fptsd to assess disability-seeking veterans suspected of overreporting PTSD symptoms.     

Two bs or not two Bs? A signal detection theory analysis of repetition blindness in a counting task

Stimulus repetition usually benefits performance. A notable exception is repetition blindness (RB), in which subjects fail to report a repeated stimulus in a rapid serial visual presentation. Theories differ in attributing RB to either perceptual encoding or memory retrieval and to impaired discrimination versus response bias. In the present study, subjects judged whether one or two letters were imbedded in sequences of digits. Unlike previous studies, false guesses of two unrepeated letters were distinguished from false guesses of two repeated letters. When repeated- and unrepeated-letter trials were randomly intermixed (Experiment 1), RB was entirely attributable to response bias. However, when they were separately blocked (Experiments 2 and 3), RB was manifested in discriminability (d'). The results support perceptual-encoding accounts of RB but indicate that effects on discriminability depend on subjects' processing strategies.