Clinicians and supervisors' experiences with developing practices of open dialogue in network meetings in public mental health services

Open Dialogue is a dialogical approach focusing on the perspectives of patients and their social networks on treatment and recovery processes. As part of a larger research project, this prospective cohort study explores what promotes and hinders the development of Open Dialogue in network meetings (ODNM) based on the experiences of thirty-seven clinicians and seven supervisors. Multistage focus group interviews were used to collect data and were analysed thematically. We generated two main themes: (1) togetherness and isolation and (2) challenging and evolving. The findings show that ODNM can be developed in public mental healthcare, but this leads to both challenges and opportunities at the organisational level, such as conflicting perspectives, the difficulty of maintaining interest in ODNM, the need for committed and involved leaders, and the growing change in the traditional view of treatment, which has made clinicians collaborate more with patients and their relatives.     

False memories for end-of-life decisions

OBJECTIVE: To examine people's false memories for end-of-life decisions. DESIGN: In Study 1, older adults decided which life-sustaining treatments they would want if they were seriously ill. They made these judgments twice, approximately 12 months apart. At Time 2, older adults and their self-selected surrogate decision makers tried to recall the older adults' Time 1 decisions. In Study 2, younger adults made treatment decisions twice, approximately 4 months apart. At Time 2, younger adults tried to recall their Time 1 decisions. MAIN OUTCOME MEASURES: Percentage of participants who falsely remembered that their original treatment decisions were the same as their current decisions. RESULTS: In Study 1, older adults falsely remembered that 75% of their original decisions were the same as their current decisions; surrogates falsely thought that 86% of older adults' decisions were the same. In Study 2, younger adults falsely remembered that 69% of their original decisions were the same as their current decisions. CONCLUSION: Age alone cannot account for people's false memories of their end-of-life decisions; we discuss other mechanisms. The results have practical implications for policies that encourage people to make legal documents specifying their end-of-life treatment decisions.     

Group Narrative Therapy for Women With Attention‐Deficit/Hyperactivity Disorder

Women with attention‐deficit/hyperactivity disorder (ADHD) often struggle with the developmental challenges of adulthood and ADHD‐related problems. The authors provide specific clinical interventions from a narrative‐based group approach to help women with ADHD understand their symptoms, create strength‐based narratives, and apply these narratives to the developmental tasks of early adulthood.     

Emotional, behavioral, and cognitive factors that differentiate obsessive-compulsive disorder and other anxiety disorders in youth

Abstract The current study examined specific emotional, behavioral, and cognitive variables that may distinguish obsessive-compulsive disorder (OCD) from generalized anxiety disorder (GAD), social phobia (SoP), and separation anxiety disorder (SAD) in youth. Youth with OCD (n=26) and other anxiety disorders (ADs; n=31), aged 7-12 years (56.1% males), and their parents participated. The study compared the two anxious groups on levels of emotional, behavioral, and cognitive functioning, as well as impairment associated with the disorder. Results indicated that in comparison to youth with GAD, SoP, or SAD, youth with OCD were found to have poorer emotion regulation skills, as well as greater oppositionality, cognitive problems/inattention, and parent impairment associated with the disorder. The findings suggest that there are unique characteristics of OCD that may differentiate this disorder from other ADs in youth. Potential clinical implications and directions for future research are discussed.     

Emotional,behavioral, and cognitive factors that differentiate obsessive-compulsive disorder and other anxiety disorders in youth

Abstract

The current study examined specific emotional, behavioral, and cognitive variables that may distinguish obsessive-compulsive disorder (OCD) from generalized anxiety disorder (GAD), social phobia (SoP), and separation anxiety disorder (SAD) in youth. Youth with OCD (n=26) and other anxiety disorders (ADs; n=31), aged 7–12 years (56.1% males), and their parents participated. The study compared the two anxious groups on levels of emotional, behavioral, and cognitive functioning, as well as impairment associated with the disorder. Results indicated that in comparison to youth with GAD, SoP, or SAD, youth with OCD were found to have poorer emotion regulation skills, as well as greater oppositionality, cognitive problems/inattention, and parent impairment associated with the disorder. The findings suggest that there are unique characteristics of OCD that may differentiate this disorder from other ADs in youth. Potential clinical implications and directions for future research are discussed.     

The COMT Val/Met polymorphism is associated with reading‐related skills and consistent patterns of functional neural activation

In both children and adults there is large variability in reading skill, with approximately 5–10% of individuals characterized as having reading disability; these individuals struggle to learn to read despite adequate intelligence and opportunity. Although it is well established that a substantial portion of this variability is attributed to the genetic differences between individuals, specifics of the connections between reading and the genome are not understood. This article presents data that suggest that variation in the COMT gene, which has previously been associated with variation in higher‐order cognition, is associated with reading and reading‐related skills, at the level of both brain and behavior. In particular, we found that the COMT Val/Met polymorphism at rs4680, which results in the substitution of the ancestral Valine (Val) by Methionine (Met), was associated with better performance on a number of critical reading measures and with patterns of functional neural activation that have been linked to better readers. We argue that this polymorphism, known for its broad effects on cognition, may modulate (likely through frontal lobe function) reading skill.     

Processes in acceptance and commitment therapy and the rehabilitation of chronic fatigue

Acceptance and commitment therapy (ACT) has never been tested for patients with chronic fatigue. We aimed to test if a 3.5‐week ACT rehabilitation program for patients with chronic fatigue improved quality of life (QoL), fatigue, and psychological flexibility. Further, to test if improvements in QoL and fatigue were associated with improvement in psychological flexibility, and if psychological flexibility explained variance above and beyond maladaptive cognitions typically targeted in CBT for fatigue. Patients (n = 140) who had been on sick leave > 8 weeks due to chronic fatigue received a 3.5‐week non‐controlled inpatient rehabilitation program based on ACT. A physician and a psychologist examined the patients, assessing medication use and SCID‐I diagnoses. Patients completed questionnaires about somatic complaints, psychological complaints, and maladaptive cognitions before and after treatment. At post‐treatment, patients reported improved QoL (p < 0.001; g = 1.07) and less fatigue (p < 0.001; g = 1.08), but not increased psychological flexibility (p = 0.6). Changes in psychological flexibility was associated with improved QoL, but not fatigue, in hierarchical regression analyses. When adjusting for other cognitions, changes in fear‐avoidance cognitions and all‐or‐nothing thoughts, but not psychological flexibility, were associated with improved QoL and fatigue. The ACT‐based treatment improved QoL and reduced fatigue for patients with chronic fatigue with large effect sizes. Improvement was associated with a reduction in fear‐avoidance cognitions and all‐or‐nothing thoughts, but not psychological flexibility.     

An Uncontrolled Examination of a 5-Day Intensive Treatment for Pediatric OCD

This study examined the feasibility of a 5-day intensive treatment for pediatric obsessive-compulsive disorder (OCD). Fifteen children with OCD received a week-long treatment based on exposure and response prevention (ERP). The intervention also emphasized teaching children and parents how to conduct ERP independently at home. All families completed the week-long treatment and symptoms improved significantly as measured by self- and parent-report forms, as well as the Children's Yale-Brown Obsessive-Compulsive Scale, F(2, 22) = 45.67, p < .05. Total CY-BOCS scores decreased significantly from pretreatment (M = 28.00, SD = 4.24) to posttreatment [M = 16.00, SD = 6.0, F(1, 11) = 34.38, p < .05] and from posttreatment to 5-month follow-up [M = 11.5, SD = 7.3; F(1, 11) = 12.94, p < .05]. This level of improvement was consistent with other intensive treatments for pediatric OCD. The study suggests that the 5-day program is a promising treatment for children with OCD who do not have access to local providers.     

Evaluation of school architecture postoccupancy

A questionnaire for the postoccupancy evaluation of school architecture was developed. It contains distinct modules covering different parts of a school building. A module of the questionnaire comprises a semantic differential section and items covering six content domains which were selected based on a literature review, namely, aesthetics, equipment, room climate, spatial cognition, privacy and publicity, and personalization of and identification with space. The questionnaire is available in the German language and can be used with students age 10 years or older and teachers.