Acceptance and Commitment Therapy Group Treatment for Symptoms of Borderline Personality Disorder: A Public Sector Pilot Study

A pilot study of a brief group-based Acceptance and Commitment Therapy (ACT) intervention (12 two-hour sessions) was conducted with clients of public mental health services meeting four or more criteria for borderline personality disorder (BPD). Participants were randomly assigned to receive the ACT group intervention in addition to their current treatment (ACT + TAU; N = 21) or to continue with treatment as usual alone (TAU; N = 20). There was significantly more improvement from baseline for the ACT + TAU condition than the TAU condition on the primary outcome variable—self-rated BPD symptoms. The ACT + TAU gain was both clinically and statistically significant. The ACT + TAU condition also had significantly more positive change on anxiety and hopelessness, and on the following ACT consistent process variables: psychological flexibility, emotion regulation skills, mindfulness, and fear of emotions. For all but anxiety, the improvements for the ACT + TAU condition were significant, while the TAU condition had no significant changes on any measure. Follow-up was possible for only a small number of participants. The improvements gained by the ACT + TAU participants were maintained except for fear of emotions. Anxiety continued to improve, becoming significantly different from baseline at follow-up. Examination of mediators found that psychological flexibility, emotion regulation skills and mindfulness, but not less fear of emotions, mediated BPD symptoms. Psychological flexibility and emotion regulation skills also mediated hopelessness. There is a need for a larger trial, for comparison with other established treatments for BPD, and for conducting a trial of a longer intervention. Nonetheless, this pilot study suggests that a brief group-based ACT intervention may be a valuable addition to TAU for people with BPD symptoms in the public sector.     

On the reliability, consistency, and method-specificity based on the CT-C(M–1) model

In the present study, we discuss reliability, consistency, and method specificity based on the CT-C(M?-?1) model, which provides clear definitions of trait and method factors and can facilitate parameter estimation. Properties of the reliability coefficient, the consistency coefficient, and the method-specificity coefficient of the summated score for a trait factor are addressed. The consistency coefficient and the method-specificity coefficient are both functions of the number of items, the average item consistency, and the average item method specificity. The usefulness of the findings is demonstrated in an alternative approach proposed for scale reduction. The approach, taking into account both traits and methods, helps identify the items leading to the maximum of convergent validity or method effects. The approach, illustrated with a simulated data set, is recommended for scale development based on multitrait-multimethod designs.     

Following Foucault: Tall stories of mapping and inhabiting Pierre Rivière's landscapes as a 21st century inquiry

This paper documents the research methods adopted in a series of workshops on Pierre Rivière that took place at the University of Bristol. A group of scholars from Europe and Australia used philosophical, narrative, performative and artful approaches to re-examine the life of Pierre Rivière and family as documented by Michel Foucault (1975) and his team. They watched the film of the book (Allio, 1976) listened to emerging papers and wrote themselves into pivotal moments within the narratives they heard. They conducted narrative family therapy sessions with the ‘Rivière family’ and wrote themselves into the ensuing moments of evocation and connection. They made dolls, and wrote themselves into the voices of those dolls, and they gave presentations about how Pierre Rivière might be positioned within contemporary therapeutic, educational and media discourses. They wanted to find out if different kinds of knowledge might emerge from these ways of doing research differently. And yet it seemed that whatever form of inquiry they undertook, other subliminal, imaginary, fantasy and folk and fairy tale narratives seeped under efforts to produce rational, coherent academic texts. This paper explores this dual process of investigation in real time accompanied by eruptions into imaginary folklore and fairy story times, with segues into contemporary, fantastical stories of horror and murder. Each step the research team took became a doubled step, involving doubled listening and doubled knowing. To this end they have represented their research process (after Lather, 2007) as a doubled text and yet they have still not fully captured the emotional space of the workshops they inhabited. It was as if they were, for the short, intense period of time they were working together, collectively emotionally disassociated.     

Training Analysis: Oxymoron or Viable Compromise? Training Analysis,Power, and the Therapeutic Alliance

Balint was among the first to express concern about the “hidden power dynamics” that underlie training analyses. In this paper, I identify some of the problems with this form of treatment, which simultaneously tries to educate the candidate about analytic treatment and ensures that the candidate satisfies certain requirements before he or she is permitted to practice analysis. I argue that the candidate's trying to complete the training analysis—a prerequisite to becoming a full-fledged psychoanalyst—may prevent the full manifestation of the breadth and extent of the candidate's neurosis. Paying attention to the therapeutic alliance assists the analytic dyad in navigating the complex work of a training analysis.     

A three city comparison of the public's knowledge and attitudes about AIDS

A survey of knowledge, beliefs and attitudes about AIDS was administered simultaneously in San Francisco, New York and London to a total of 399 persons. The aim was to investigate how such knowledge and attitudes may he influenced by social and cultural contexts, as well as by disease epidemiology. Across all samples of the general public (excluding risk group members) in the three cities, general fear of AIDS and anti-gay attitudes were significantly negatively correlated with knowledge about AIDS. In the London sample, general fear of AIDS and anti-gay attitudes were significantly and positively associated with both sexual and general health behavior change. Only sexual behavior change, however, was significantly correlated with general fear of AIDS and anti-gay variables for the New York sample. Neither of these variables was significantly associated with behavior change of any kind in the San Francisco sample. We accounted for these inter-city differences by proposing a four-stage model of public response to an epidemic over time. Our data support the need for specific programs aimed at the general public that take into account sociocultural and AIDS epidemiologic differences across different sociocultural contexts.     

Examination stress and changes in mood and health related behaviours

Abstract

The present exploratory study evaluated the effect of stress (an examination period) on changes in mood and health related behaviours. 83 medical students completed measures of mood and health related bchaviours at baseline and four weeks later either during their examinations period (the stress condition) or after a comparative control period (the control condition). All subjects also completed ratings of stress mediating variables: social support, perceived control and coping style at baseline. The results showed deterioration in mood in terms of increases in depression and anxiety and changes in health related behaviours in terms of increased numbers of subjects who identified thcmsehes as smokers, and dcmascs in alcohol consumption, exercise and food intake in subjects in the stress condition. The results also suggest that social support moderated the effects of the examination stress and was related to greater decreases in smoking, decrcases in alcohol craving and increases in eating behaviour. In addition, an avoidance coping style (problem avoidance, wishful thinking) was related to greater decreases in eating behaviour. 'Ihe nsults an discussed in the context of the stress/illness link and the role of behavioural change.     

The Relationship Between Deployment and Turnover in Australian Navy Personnel

Increases in the frequency of operations tempo have focused attention on the relationship between deployment and separation from military service. This retrospective study explored the association between deployment and turnover over a 10-year period in Royal Australian Navy (RAN) personnel. Participants were 2355 males who served in the RAN during the period of the 1991 Gulf War (August 1990–September 1991); approximately half had been deployed to that conflict. Data were collected 10 years later as part of the Australian Gulf War Veterans' Health Study. During that 10-year period, 61% of participants left the RAN. The likelihood of separation decreased as number of deployments increased even when controlling for age, rank, and length of service. Personnel deployed to the 1991 Gulf conflict did not have a significantly higher risk of separation. The results provide evidence that deployment is not necessarily a risk factor for separation.     

Processing Speed in Children With Attention Deficit/Hyperactivity Disorder,Inattentive Type

Attention Deficit/Hyperactivity Disorder (ADHD) is among the most common and most often reconceptualized neurobehavioral disorders of childhood. In the most recent DSM-IV, a primarily inattentive subtype of ADHD (AD) has again been identified. This study explores the neuropsychological profile of this group of children. Eighty-two children referred for school-related problems participated. Twenty-five met criteria for AD; 52 met criteria for reading disability (RD); 9 were comorbid for RD and AD. AD children performed poorly on measures of information processing speed. Children with comorbid AD/RD were distinguishable from those with RD on speed of processing measures only. Vulnerability to information processing load may be at the root of many of the behavioral manifestations of AD.     

A Practice-Based Approach to Group Identification in Nonverbal Learning Disorders

Evidence-based practice, the rigorous conduct of clinical analysis and intervention, includes practice-based evidence. Here, practice data were the source of three “clinical portraits” used for exploratory analysis of an array of cognitive and social problems in 30 children whose neurobehavioral profiles fulfilled psychometric criteria for a nonverbal learning disability (NLD). Qualitative analysis of the children's academic and adjustment difficulties revealed patterns of dissociable deficits. These findings argue for at least three groups within the NLD construct. Identifying such subgroups is of practical importance: More precise characterization of neuropsychological competencies leads to improved interventions and better outcomes.