An Emotion Regulation Treatment for Young People With Complex Substance Use and Mental Health Issues: A Case-Series Analysis

Individuals accessing treatment within the youth alcohol and other drug (AoD) sector represent a highly vulnerable population who present with complex patterns of substance use and mental health comorbidity. Current treatments often fail to address this complexity. Emotion regulation (ER) has been identified as a promising transdiagnostic treatment target for this population of young people. The current study aimed to investigate the acceptability and feasibility of an adjunct ER intervention, ERIC (Emotion Regulation and Impulse Control) in young people receiving AoD treatment at a residential rehabilitation service. A mixed methods case series design was utilized. Ten participants aged between 16–20 years old completed 4–6 sessions of ERIC as an adjunct to their existing residential treatment. Participants undertook a post intervention feedback session and completed a number of self-report measures of ER, depression and anxiety at baseline and 2 weeks after receiving ERIC. Qualitative feedback from young people following the delivery of ERIC was positive, and suggested that ERIC was a viable and useful intervention. Participants reported that the components of ERIC, which involved metaphors and experiential exercises, were particularly beneficial and memorable. Pre-post measures indicated that 60% of the young people had both reliable and clinically significant reductions in overall emotion dysregulation, while reliable and clinically significant reductions in depression and anxiety were observed in 50% and 60% of participants respectively. Results support the acceptability of ERIC for this cohort of young people with complex substance use and mental health needs. Furthermore, these findings support the viability of delivering flexible and adjunctive ER treatments to young people seeking AoD treatment.     

The role of spousal relationships in fibromyalgia patients’ quality of life

Fibromyalgia (FM) is a chronic pain syndrome that includes debilitating symptoms such as widespread pain and tenderness, fatigue, and poor physical functioning. Research has shown FM patients’ choice of coping style and relationship quality with their spouse can impact their mental quality of life (QoL), but no known study has examined the protective nature of relationship quality and coping behaviors on both patient physical and mental QoL in the context of chronic pain. We examined 204 patients with FM on the (a) roles of coping styles and relationship quality on patient quality of life, and (b) moderating effect of relationship quality on the association between negative coping style and patient QoL. A series of multiple regressions found patients’ coping styles were not significantly associated with physical QoL, but were significantly associated with mental QoL. Patients’ relationship quality with their spouse was significantly associated with mental QoL, but not physical QoL and no significant interactions with negative coping style were found. Our results emphasize the importance of coping styles and relationship quality between patients and their spouses in the context of chronic pain. Clinicians can incorporate the patient’s relationship as part of a more holistic approach to care and improving outcomes.     

Were the “Pioneer” Clinical Ethics Consultants “Outsiders”? For Them,Was “Critical Distance” That Critical?

“Clinical ethics consultants” have been practicing in the United States for about 50 years. Most of the earliest consultants—the “pioneers”—were “outsiders” when they first appeared at patients' bedsides and in the clinic. However, if they were outsiders initially, they acclimated to the clinical setting and became “insiders” very quickly. Moreover, there was some tension between traditional academics and those doing applied ethics about whether there was sufficient “critical distance” for appropriate reflection about the complex medical ethics dilemmas of the day if one were involved in the decision making. Again, the pioneers deflected concerns by identifying and instituting safeguards to assure professional objectivity in clinical ethics consultation services. One might suggest that in moving inside and establishing normative practices, the pioneer clinical ethics consultants anticipated adoption of their routines and professionalization of the field.     

Seeking revenge or seeking reconciliation? How concern for social‐image and felt shame helps explain responses in reciprocal intergroup conflict

In conflicts with reciprocal violence, individuals belong to a group that has been both perpetrator and victim. In a field experiment in Liberia, West Africa, we led participants (N = 146) to focus on their group as either perpetrator or victim in order to investigate its effect on orientation towards inter‐group reconciliation or revenge. Compared to a perpetrator focus, a victim focus led to slightly more revenge orientation and moderately less reconciliation orientation. The effect of the focus manipulation on revenge orientation was fully mediated, and reconciliation orientation partly mediated, by viewing the in‐group's social‐image as at risk. Independent of perpetrator or victim focus, shame (but not guilt) was a distinct explanation of moderately more reconciliation orientation. This is consistent with a growing body of work demonstrating the pro‐social potential of shame. Taken together, results suggest how groups in reciprocal conflict might be encouraged towards reconciliation and away from revenge by feeling shame for their wrongdoing and viewing their social‐image as less at risk. As victims and perpetrators are widely thought to have different orientations to inter‐group reconciliation and revenge, we suggest that work on reciprocal conflicts should account for the fact that people can belong to a group that has been both perpetrator and victim.     

Comparisons of synthesized and individual reinforcement contingencies during functional analysis

Researchers typically modify individual functional analysis (FA) conditions after results are inconclusive (Hanley, Iwata, & McCord, 2003). Hanley, Jin, Vanselow, and Hanratty (2014) introduced a marked departure from this practice, using an interview‐informed synthesized contingency analysis (IISCA). In the test condition, they delivered multiple contingencies simultaneously (e.g., attention and escape) after each occurrence of problem behavior; in the control condition, they delivered those same reinforcers noncontingently and continuously. In the current investigation, we compared the results of the IISCA with a more traditional FA in which we evaluated each putative reinforcer individually. Four of 5 participants displayed destructive behavior that was sensitive to the individual contingencies evaluated in the traditional FA. By contrast, none of the participants showed a response pattern consistent with the assumption of the IISCA. We discuss the implications of these findings on the development of accurate and efficient functional analyses.     

Multiple schedules in practical application: Research trends and implications for future investigation

Researchers began studying multiple schedules in basic laboratories, but recent advances have extended research on multiple schedules to a wide variety of socially significant applications, especially during the last decade. Applied researchers have used multiple schedules to (a) promote stimulus control over high‐rate appropriate behaviors, (b) thin the schedule of reinforcement following functional communication training, and (c) obtain stimulus control over problem behaviors maintained by automatic reinforcement. In the current paper, we reviewed 31 studies with 147 applications identified through a search of the applied literature on multiple schedules. Using these studies, we (a) reviewed the empirical literature on multiple schedules, (b) recommended multiple‐schedule procedures that serve as best practice guidelines for applied behavior analysts, (c) identified the generality and boundaries of current knowledge about the effectiveness of multiple schedules, and (d) critically analyzed the literature to provide directions for future multiple‐schedule research.     

Experts and Deviants: The Story of Agentive Control

This essay argues that current theories of action fail to explain agentive control because they have left out a psychological capacity central to control: attention. This makes it impossible to give a complete account of the mental antecedents that generate action. By investigating attention, and in particular the intention‐attention nexus, we can characterize the functional role of intention in an illuminating way, explicate agentive control so that we have a uniform explanation of basic cases of causal deviance in action as well as other defects of agency (distraction), explain cases of skilled agency and sharpen questions about the role of thought in agency. This provides for a different orientation in the theory of action.     

Overshadowing and latent inhibition in nausea-based context conditioning in humans: Theoretical and practical implications

Volunteer participants underwent nausea-inducing body rotation in a distinctive context, and the acquired ability of the contextual cues to evoke nausea was subsequently assessed by a symptom rating scale. One group received prior exposure to the context (a latent inhibition procedure); a second consumed a novel flavour prior to rotation (an overshadowing procedure); a third group experienced both procedures; and a control group received neither. When tested in the context in the absence of rotation, all groups reported an increase in nausea-related symptoms at the time when rotation had previously occurred, an outcome consistent with the occurrence of conditioned nausea. The magnitude of this increase did not differ across the groups, but the overall level of responsiveness (the degree to which nausea-related symptoms were reported) was enhanced in the latent inhibition and reduced in the overshadowing condition. Cortisol levels showed the same pattern. The implications of these findings for the proposal that overshadowing and latent inhibition procedures might be used to control the development of anticipatory nausea in patients undergoing chemotherapy is considered.