Improving Delivery Behaviors During Exposure for Pediatric OCD: A Multiple Baseline Training Trial With Community Therapists

This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors (i.e., indicators of quality) that have been associated with youth outcomes in prior clinical trials of exposure therapy. Six therapists at a community mental health agency (CMHA) provided exposure therapy for 8 youth with obsessive–compulsive disorder (OCD). Using a nonconcurrent multiple baseline design with random assignment to baseline lengths of 6 to 16 weeks, therapists received gold-standard exposure therapy training with weekly consultation (baseline phase) followed by addition of EG training and feedback (intervention phase). The primary outcome was therapist behavior during in-session exposures, observed weekly using a validated coding system. Therapist behavior was evaluated in relation to a priori benchmarks derived from clinical trials. Additional outcomes included training feasibility/acceptability, therapist response to case vignettes and beliefs about exposure, and independent evaluator-rated clinical outcomes. Three therapists reached behavior benchmarks only during the EG (intervention) phase. Two therapists met benchmarks during the baseline phase; one of these subsequently moved away from benchmarks but met them again after starting the EG phase. Across all therapists, the percentage of weeks meeting benchmarks was significantly higher during the EG phase (86.4%) vs. the baseline phase (53.2%). Youth participants experienced significant improvement in OCD symptoms and global illness severity from pre- to posttreatment. Results provide initial evidence that adding the EG to gold-standard training can change in-session therapist behaviors in a CMHA setting.     

Embodied,Situated, and Co-Constructed: Young Sexual Minority Men’s Experiences of Intersectional Identity and Minority Stress

Intersectionality, minority stress, and social ecological theories have all been important frameworks for understanding mechanisms that create and maintain sexual and gender minority health disparities. In this study, we integrated these frameworks to guide a grounded theory examination of identity-related experiences in specific settings among 33 Black, White, and Latino young sexual minority cisgender men who lived in Chicago. Analyses identified four key categories: Racism Manifests in Context- and Sexual Minority-Specific Ways, Sexual Orientation Can Mean Feeling Safe and Seen or Threatened and Alone, Gender is a Matter of Self-Expression, and Bodies Are Not Always Made to Fit In. Participants reported both identity-based privilege and marginalization as well as unique forms of minority stress at the intersection of specific identities. Across these categories, participants’ experiences of their intersecting identities and associated forms of minority stress were embodied in their physical appearance, situated in specific neighborhoods and contexts, and co-constructed through their interpersonal interactions with others. Further, participants’ narratives provide powerful insights about the nuanced ways in which young sexual minority men understand and negotiate their lived experiences. Findings highlight how experiences of identity and minority stress are both intersectional and located within specific social ecological contexts, which has important implications for research, clinical practice, and advocacy.

     

Working Memory in Pediatric Epilepsy: A Systematic Review and Meta-Analysis

Neuropsychology Review - Working memory is a multicomponent system that is supported by overlapping specialized networks in the brain. Baddeley’s working memory model includes four...     

Salivary testosterone and self-report aggressive and pro-social personality characteristics in men and women

Measures of salivary testosterone and the personality dimensions of aggression and pro-social behavior were obtained in 306 (155 male and 151 female) university students. Each participant provided two samples of saliva and completed ten self-report personality scales from multiple inventories. A factor analysis of the personality scales produced two factors, an aggression factor and a pro-social behavior factor. Men averaged five times the amount of salivary testosterone as women (99 pg/ml vs. 18.5 pg/ml) and rated themselves as more aggressive and less nurturant. Within each sex, testosterone was positively correlated with aggression and negatively correlated with pro-social personality. Structural equation modelling analyses suggested that a direct effect model best described the relationship between salivary testosterone and the latent personality dimensions of aggression and pro-social behavior. © 1996 Wiley-Liss, Inc.     

The Problem with Empirical Examination of the Use of Court-appointed Experts: A Report of Non-findings

This study was designed to examine the use of court-appointed experts as an alternative to privately retained experts in Dallas, Texas. Surprisingly, there has been little empirical study of court-appointed experts. Our findings suggest one reason for the lack of research. We found that court-appointed experts are used so infrequently that it makes empirical study difficult to conduct. We discuss the implications on this problem for future research.     

Punitive legal approaches to the problem of prenatal drug exposure

Legislatures and courts have responded prematurely to the problem of prenatal drug exposure through a variety of criminal and civil legal sanctions to deter drug use and to protect fetal health. A review of the case law demonstrates that significant statutory and constitutional difficulties limit the effectiveness of these sanctions and ultimately inhibit their applicability. These constraints require that any governmental intervention through the courts be based upon individual judicial findings of imminent harm to the child and maternal unfitness in neglect proceedings.     

A Phenomenological Study on the Experience of Syrian Asylum-Seekers and Refugees in the United States

Violence in Syria has displaced an unprecedented number of people from their homes. While couple/family therapy (C/MFT) scholars have explored migration experiences, particularly among refugees, there is still limited research using a bioecological framework. This exploratory study examined the experiences of Syrian asylum-seekers and refugees living in the United States using a qualitative phenomenological approach. Twelve Syrians (n = 8 men, n = 4 women) between 20 and 52 years of age (M = 35.8, SD = 10.7) were interviewed about their experiences across three stages of resettlement: (1) pre-resettlement, (2) resettlement/migration, and (3) post-resettlement. Findings suggest that the effects of conflict-induced displacement and resettlement permeate across multiple ecologies. These range from the individual and his or her interpersonal relationships to their larger community and society. C/MFTs should account for contextual factors while becoming familiar with the sociopolitical impact of displacement and resettlement in their clinical work with this population.     

Parents’ Experiences of Their Child’s Disclosure of Child Sexual Abuse

A child’s disclosure of sexual victimization is a difficult experience for parents and has been associated with traumatization, disbelief, denial, self-blame, and clinical difficulties. To date, most studies on parents’ responses have been quantitative assessments of the psychological impact of disclosure on parents. A paucity of research has qualitatively explored mothers’ experiences of their child’s disclosure of child sexual abuse (CSA) and fathers’ experiences have been even further neglected. The current study seeks to characterize parents’ experiences of their child’s disclosure of CSA and to uncover the process-oriented nature of parental responses. This qualitative study, using a grounded theory approach to analysis, involved interviews with 10 mothers and four fathers whose children (3–18 years) had experienced sexual abuse. Three themes emerged from the analysis. The first theme—making sense of the abuse in retrospect—captured the process through which parents sought to make sense of their child’s disclosure, focusing on why their child had not disclosed the abuse to them earlier, and how they had noticed something was wrong but misattributed their child’s behavior to other factors. The second theme—negotiating parental identity as protector—reflected how parents’ identity as a protector was challenged, their perception of their world had been forever altered, and they now experienced themselves as hypervigilant and overprotective. The final theme—navigating the services—pertained to parents’ struggle in navigating child protection and police services, and feelings of being isolated and alone. These findings highlight the need for empathy and parental support following child disclosure of sexual victimization.