Parents’ and psychotherapists’ goals prior to psychodynamic child psychotherapy

In order to explore goals of parents and psychotherapists prior to child psychotherapy, the following questions were asked: (1) How are goals for psychotherapy formulated? (2) How can similarities and differences between parents’ and psychotherapists’ goals be understood? Questionnaires regarding psychodynamic child psychotherapies (n = 33) with parallel parental work were analysed using qualitative methodology. The child psychotherapists’ goals were often connected to the intrapsychic and relational development of the child. The parental therapists formulated goals focused on providing support to parents. The parents’ goals, on the other hand, concerned to a great extent giving the child help and to a lesser degree receiving help for themselves. They expressed their expectations concerning the child’s psychological development with a more everyday use of language, often with an emphasis on general psychological wellbeing. The study also indicated that parents had limited knowledge about the therapy’s implementation and framework. Some clinical conclusions could be made. Negotiating goals prior to parental and child psychotherapy can help create realistic expectations and promote a beneficial therapy situation.     

Children in psychodynamic psychotherapy: changes in global functioning

This study was part of the Erica Process and Outcome Study. The aim was to investigate if children's global functioning improves after psychodynamic psychotherapy. Variables that may predict changes in global functioning were examined both statistically and qualitatively, for example, the child's age and gender; diagnosis and comorbidity; treatment variables. The sample consisted of 33 children (five to 10 years of age) who participated in psychodynamic psychotherapy with parallel work with parents. Twenty-nine children had at least one DSM-IV diagnosis, and 15 children had comorbid conditions. At the start of psychotherapy, the most frequent diagnoses were attention disorder and disruptive behaviour. Child psychotherapists rated the children's global functioning using CGAS and HCAM. Large effect sizes were obtained (d = 1.80 and d = 1.98). However, no statistical correlations were found between global functioning and the selected variables. In order to illuminate the complex connection between process and outcome the study was complemented with in-depth case studies where data were taken from questionnaires, completed by the child therapists every third month. Two child therapies were selected: one in which the therapist rated a large change and one in which a small change was rated (CGAS). The analysis showed that important individual change, for example, attainment of formulated goals, was not always reflected in the change rated using the CGAS. Findings suggest that psychodynamic child psychotherapy can be beneficial. However, further research is needed to identify factors that contribute to change in children's global functioning.     

Meta-analysis of CBT for Bulimia Nervosa: Investigating the Effects Using DSM-III-R and DSM-IV Criteria

This meta-analysis reports the effects of cognitive-behavioural treatment (CBT) on bulimia nervosa as defined by the DSM-III-R or DSM-IV criteria. In a previous meta-analysis, 26 studies were included using less strict diagnostic criteria for inclusion. The present meta-analysis only included randomized controlled studies fulfilling the DSM-III-R or DSM-IV criteria. Computer searches in MedLine, PsychLIT and references cited herein resulted in a large number articles, of which only seven fulfilled the criteria for inclusion. Effect sizes for binge eating and purging frequency were estimated using both between-group (treatment vs control) and within-group (pre- vs post-treatment) comparisons. The combined within-group effect size for binge eating was r = 0.55 ( d = 1.32) and for purging r = 0.61 ( d = 1.54). The corresponding combined effects for the between-group comparisons were r = 0.23 ( d = 0.47) and r = 0.28 ( d = 0.58), respectively. The combined probabilities for frequency of purging in between- and within-group comparisons were p = 0.00001 and p = 0.00000001, respectively. Although the number of studies included in the meta-analysis was limited, the obtained results are in line with the findings of the previous meta-analysis, and support the efficacy of CBT for the treatment of bulimia nervosa. This suggestion is also supported by the fact that in all the studies except one, comparison groups had received other active treatments.     

Last issue of SJBT

Abstract

A system providing prompts (verbal encouragement) at prearranged time intervals was used with a woman with total blindness and profound intellectual disability who had discontinuous performance. The woman was to transport objects from one end of a corridor to the other (a space in which orientation was not a problem) and then assemble them. Data indicated that there was a clear increase in the number of objects transported and assembled in the sessions with the prompting system. Implications of the findings are discussed.     

What could have been done (but wasn’t). On the counterfactual status of action in Alva Noë’s theory of perception

Alva Noë’s strategy to solve the puzzle of perceptual presence entirely relies on the principle of presence as access. Unaccessed or unattended parts or details of objects are perceptually present insofar as they are accessible, and they are accessible insofar as one possesses sensorimotor skills that can secure their access. In this paper, I consider several arguments that can be opposed to this claim and that are chiefly related to the modal status of action, i.e. the fact that the action that would secure access to the absent aspects is a possibility, something that can (or maybe could) be done. The main difficulty Noë’s account must face is –as several situations demonstrate– that the action that should be performed for the absent aspects to be actually accessed does not have to be itself available for these aspects to be perceptually present. What matters for the absent aspects to be present is not their de facto (i.e. effective) accessibility, but their de jure accessibility. To overcome those difficulties, I propose to rely on a ternary model of the role of action possibilities in perceptual awareness. This model builds on Husserl’s analysis of the role of perceptual circumstances in perception and connection between sense (Sinn) registering and horizontal intentionality.     

Internet-delivered transdiagnostic and tailored cognitive behavioral therapy for anxiety and depression: a systematic review and meta-analysis of randomized controlled trials

Anxiety and depressive disorders are often comorbid. Transdiagnostic and tailored treatments seem to be promising approaches in dealing with comorbidity. Although several primary studies have examined the effects of Internet-delivered cognitive behavior therapy (iCBT) for anxiety and depression, no meta-analysis including different types of iCBT that address comorbidity has been conducted so far. We conducted systematic searches in databases up to 1 July 2016. Only randomized trials comparing transdiagnostic/tailored iCBT for adult anxiety and/or depression with control groups were included. Nineteen randomized trials with a total of 2952 participants that met inclusion criteria were analyzed. The quality of the studies was high, however the blinding criteria were not fulfilled. The uncontrolled effect size (Hedges’ g) of transdiagnostic/tailored iCBT on anxiety and depression outcomes was large and medium for quality of life. The controlled effect size for iCBT on anxiety and depression outcomes was medium to large (anxiety: g = .82, 95% CI: .58–1.05, depression: g = .79, 95% CI: .59–1.00) and medium on quality of life (g = .56, 95% CI: .37–.73). Heterogeneity was small (quality of life) to moderate (anxiety, depression). There was a large effect on generic outcome measures and a moderate effect on comorbidities. When compared to disorder-specific treatments there were no differences on anxiety and quality of life outcomes, however there were differences in depression outcomes. Transdiagnostic and tailored iCBT are effective interventions for anxiety disorders and depression. Future studies should investigate mechanisms of change and develop outcome measures for these interventions.     

Atypical EEG power correlates with indiscriminately friendly behavior in internationally adopted children

While effects of institutional care on behavioral development have been studied extensively, effects on neural systems underlying these socioemotional and attention deficits are only beginning to be examined. The current study assessed electroencephalogram (EEG) power in 18-month-old internationally adopted, postinstitutionalized children (n = 37) and comparison groups of nonadopted children (n = 47) and children internationally adopted from foster care (n = 39). For their age, postinstitutionalized children had an atypical EEG power distribution, with relative power concentrated in lower frequency bands compared with nonadopted children. Both internationally adopted groups had lower absolute alpha power than nonadopted children. EEG power was not related to growth at adoption or to global cognitive ability. Atypical EEG power distribution at 18 months predicted indiscriminate friendliness and poorer inhibitory control at 36 months. Both postinstitutionalized and foster care children were more likely than nonadopted children to exhibit indiscriminate friendliness. Results are consistent with a cortical hypoactivation model of the effects of early deprivation on neural development and provide initial evidence associating this atypical EEG pattern with indiscriminate friendliness. Outcomes observed in the foster care children raise questions about the specificity of institutional rearing as a risk factor and emphasize the need for broader consideration of the effects of early deprivation and disruptions in care.     

Prolonged institutional rearing is associated with atypically large amygdala volume and difficulties in emotion regulation

Early adversity, for example poor caregiving, can have profound effects on emotional development. Orphanage rearing, even in the best circumstances, lies outside of the bounds of a species-typical caregiving environment. The long-term effects of this early adversity on the neurobiological development associated with socio-emotional behaviors are not well understood. Seventy-eight children, who include those who have experienced orphanage care and a comparison group, were assessed. Magnetic resonance imaging (MRI) was used to measure volumes of whole brain and limbic structures (e.g. amygdala, hippocampus). Emotion regulation was assessed with an emotional go-nogo paradigm, and anxiety and internalizing behaviors were assessed using the Screen for Child Anxiety Related Emotional Disorders, the Child Behavior Checklist, and a structured clinical interview. Late adoption was associated with larger corrected amygdala volumes, poorer emotion regulation, and increased anxiety. Although more than 50% of the children who experienced orphanage rearing met criteria for a psychiatric disorder, with a third having an anxiety disorder, the group differences observed in amygdala volume were not driven by the presence of an anxiety disorder. The findings are consistent with previous reports describing negative effects of prolonged orphanage care on emotional behavior and with animal models that show long-term changes in the amygdala and emotional behavior following early postnatal stress. These changes in limbic circuitry may underlie residual emotional and social problems experienced by children who have been internationally adopted.