An A to Z guide to DSM-IV conundrums

The work on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) poses many puzzling conundrums that touch on complicated and important theoretical and practical issues. None of these can be resolved in the DSM-IV, but we hope that the Task Force's decisions will be informed by thorough reviews of the currently available evidence and extensive input from all sectors of the mental health field. In this article we provide an alphabetical guide to DSM-IV conundrums that we hope will stimulate comments, suggestions, and criticisms about the work of the Task Force.     

Stages of Change in Smoking Cessation: A Comparison of Expectancies Among Precontemplators and Contemplators

Previous research has shown that smokers progress through a series of stages of change as they attempt to quit their habit. This study evaluated smokers in the precontemplation and contemplation stages in order to explore how we can effectively facilitate positive stage transition. Precontemplators (n = 71) and contemplators (n = 30) were compared in terms of two types of expectancies: self-efficacy beliefs and response outcome expectancies. Stage of change was defined according to both categorical and continuous dimensions, each of which led to different results. The findings are discussed in terms of their potential applications to smoking cessation programs and their implications regarding the stage model of change.     

When a Skeptical Hypothesis Is Live

I’m going to argue for a set of restricted skeptical results: roughly put, we don’t know that fire engines are red, we don’t know that we sometimes have pains in our lower backs, we don’t know that John Rawls was kind, and we don’t even know that we believe any of those truths. However, people unfamiliar with philosophy and cognitive science do know all those things. The skeptical argument is traditional in form: here's a skeptical hypothesis; you can’t epistemically neutralize it, you have to be able to neutralize it to know P; so you don’t know P. But the skeptical hypotheses I plug into it are “real, live” scientific‐philosophical hypotheses often thought to be actually true, unlike any of the outrageous traditional skeptical hypotheses (e.g., ‘You’re a brain in a vat’). So I call the resulting skepticism Live Skepticism. Notably, the Live Skeptic's argument goes through even if we adopt the clever anti‐skeptical fixes thought up in recent years such as reliabilism, relevant alternatives theory, contextualism, and the rejection of epistemic closure. Furthermore, the scope of Live Skepticism is bizarre: although we don’t know the simple facts noted above, many of us do know that there are black holes and other amazing facts.     

Maternal Care and Individual Differences in Defensive Responses

Abstract— Familial transmission of mental illness is common. Recent studies in behavioral neuroscience and biological psychiatry reveal the importance of epigenetic mechanisms of transmission that center on the developmental consequences of variations in parental care. Studies with rats suggest that environmental adversity results in patterns of parent–offspring interactions that increase stress reactivity through sustained effects on gene expression in brain regions known to regulate behavioral, endocrine, and autonomic responses to stress. While such effects might be adaptive, the associated cost involves an increased risk for stress-related illness.     

The pearl of great price

“The Pearl of Great Price” is a short story that explores the ways faith can go wrong. The central character, Janet, a single mom in a dead end job, is drawn into a multi-level marketing scheme, Benevite, by an unscrupulous salesman. She is encouraged to believe in herself and her dream and to give everything she has to it. She is fed the standard clichés to the effect that you can achieve whatever you want if you try hard enough. In the end her faith in her dream leads to the loss of her relationship with her child and other losses. Her pursuit exhibits many of the standard features of faith, belief, desire, resilience, tenacity, passion, and yet she does not save herself. The story is not meant as an indictment of faith in general, but as an acknowledgement of the fact that faith can be a vice and an exploration of when this might be so.     

Parental Meta-Emotion Philosophy and Emotion Coaching in Families of Children and Adolescents with an Anxiety Disorder

Using a multi-method approach, this study examined differences in parental meta-emotional philosophy (including, parental emotional awareness and emotion coaching) for families with anxiety disordered (AD; n = 74) and non-AD (n = 35) children (aged 7 to 15). Further, it was investigated whether children’s emotion regulation (ER) varied across the AD and non-AD groups. Parent(s) were interviewed about their awareness of emotions and emotion coaching; completed a battery of questionnaires that included a measure assessing children’s emotion regulation; and engaged in a parent-child discussion task. Results indicated that compared to parents of non-AD youth, parents of AD youth were less aware of their own emotions and their children’s emotions, and these results varied by emotion type. Parents of AD youth engaged in significantly less emotion coaching than parents of non-AD youth. AD youth were identified as having significantly greater difficulty regulating their emotions when compared to non-AD youth. Implications for the role of parental meta-emotional philosophy and AD youth’s emotion regulation are discussed.     

A longitudinal investigation of older adults’ physical activity: Testing an integrated dual-process model

Objective: To assess the effects of conscious and non-conscious processes for prediction of older adults’ physical activity (PA), we tested a dual-process model that integrated motivational (behavioural intention) and volitional (action planning and coping planning) processes with non-conscious, automatic processes (habit).

Method: Participants (N = 215) comprised community-dwelling older adults (M = 73.8 years). A longitudinal design was adopted to investigate direct and indirect effects of intentions, habit strength (Time 1), and action planning and coping planning (Time 2) on PA behaviour (Time 3). Structural equation modelling was used to evaluate the model.

Results: The model provided a good fit to the data, accounting for 44% of the variance in PA behaviour at Time 3. PA was predicted by intentions, action planning, and habit strength, with action planning mediating the intention-behaviour relationship. An effect of sex was also found where males used fewer planning strategies and engaged in more PA than females.

Conclusions: By investigating an integration of conscious and non-conscious processes, this study provides a novel understanding of older adults’ PA. Interventions aiming to promote PA behaviour of older adults should target the combination of psychological processes.     

Understanding the Sexuality of Infants Within Caregiving Relationships in the First Year

Infants’ innate joyful sexuality in the 1st year, as well as parental sexuality, are relatively neglected in models of clinical work with infants. We offer a developmental perspective that pays close attention to the body of the infant, in contrast to some psychoanalytic theories that view infantile sexuality as phantasy. With greater awareness of the infant’s body as sexual, therapists could develop a more resonant countertransference and become more aware of the experiences of the infant as subject. Some symptomatic difficulties are described, and the relevance for psychotherapeutic intervention with adults is indicated.     

Training Genetic Counsellors to Deliver an Innovative Therapeutic Intervention: their Views and Experience of Facilitating Multi-Family Discussion Groups

Innovations in clinical genetics have increased diagnosis, treatment and prognosis of inherited genetic conditions (IGCs). This has led to an increased number of families seeking genetic testing and / or genetic counselling and increased the clinical load for genetic counsellors (GCs). Keeping pace with biomedical discoveries, interventions are required to support families to understand, communicate and cope with their Inherited Genetic Condition. The Socio-Psychological Research in Genomics (SPRinG) collaborative have developed a new intervention, based on multi-family discussion groups (MFDGs), to support families affected by IGCs and train GCs in its delivery. A potential challenge to implementing the intervention was whether GCs were willing and able to undergo the training to deliver the MFDG. In analysing three multi-perspective interviews with GCs, this paper evaluates the training received. Findings suggests that MFDGs are a potential valuable resource in supporting families to communicate genetic risk information and can enhance family function and emotional well-being. Furthermore, we demonstrate that it is feasible to train GCs in the delivery of the intervention and that it has the potential to be integrated into clinical practice. Its longer term implementation into routine clinical practice however relies on changes in both organisation of clinical genetics services and genetic counsellors’ professional development.     

Examining Parents’ Preferences for Group Parent Training for ADHD When Individual Parent Training is Unavailable

Parent training programs are considered well-established interventions for attention deficit hyperactivity disorder in children as they reduce behavioral impairment, but limited parent engagement decreases service effectiveness. We used a discrete choice experiment to examine how parent preferences for group vs. individual format might influence their participation in Parent training. Parents (N?=?260) seeking mental health services for children with elevated symptoms of attention deficit hyperactivity disorder in Ontario, Canada were participants. They preferred Individual parent training in another study and completed a discrete choice experiment composed of 30 choice tasks measuring Parent training format preference. In this paper, parents’ preferences for alternatives to Individual Parent training, specifically Group Parent training and Minimal Information options, were estimated. Specifically, this study asked “if first choice is unavailable, what is the second choice?” This question is important as many clinics may not be able to offer both group and individual therapy given state funding cuts for youth mental health services. Simulations predicted that 85.8?% of parents who initially preferred Individual Parent training would switch to Group Parent training that included step-by-step solutions to children’s emotional and behavior problems, and the possibility of feeling informed and confident. The remaining 14.2?% of parents preferred Minimal Information; these parents preferred internet services offered conveniently and timely. Findings highlight consideration of less appealing factors that families might trade for more desirable service elements in a cost-restrictive environment.