Trauma,personality disorders and chronic depression – the role of the conversational model of psychodynamic psychotherapy in treatment resistant depression

Objective: To report preliminary data describing the interim treatment outcome of 44 patients referred with treatment-resistant depression (TRD), comorbid personality disorders and histories of early childhood trauma using the Conversational Model (CM) of psychodynamic psychotherapy. Method: Patients (N = 44), 13 males and 31 females with long histories of depression ranging from 2 to 30 years, resistant to multiple trials of treatment, were referred by mental health practitioners, including psychiatrists. They were treated with twice weekly CM psychotherapy by multidisciplinary trainees and supervised by experienced trained clinicians. Questionnaires were administered at assessment and at 12 months to assess symptoms, functioning, self-esteem, history of trauma, personality functioning and suicidality. In this preliminary study, there was no separate control group, and patients served as their own controls. Results: Patients with TRD were found to have comorbid severe personality disorders and histories of early childhood trauma. Significant improvement in symptoms, self-esteem, functioning and suicidality was noted after 12 months. Conclusion: Patients responded with symptomatic and functional improvement to twice weekly CM therapy.     

Stronger Than You Think: Older Women and Physical Activity

Many negative stereotypes of older women are related to changes in the body that render it incompetent (e.g., weak, frail, debilitated). Such stereotypes disempower women in the eyes of others and in their own eyes if they come to embody the stereotype. One way to resist the stereotype and remain empowered is to engage in regular physical activity, which increases stamina, energy, muscle strength, joint flexibility, and balance. Here we review the physical and mental health benefits of physical activity for older women and discuss the barriers that keep many older women from regular exercise. We discuss ways that feminist therapists can encourage their older clients to become more physically active, provide information about role models who can inspire clients, and suggest resources suitable for recommendation.     

Group-Schematherapy for Adolescents: Results from a Naturalistic Multiple Case Study

Personality disorders are complex mental health problems, associated with chronic dysfunction in several life domains. Adolescents suffer from these disorders as well. The present study is a naturalistic case study, investigating whether group schematherapy (GST) can be applied to adolescents with personality disorders or personality disorder traits. Four clinically referred patients were included and completed questionnaires on quality of life, symptoms of psychopathology, schema modes, early maladaptive schemas, and schema coping styles. Patients participated in weekly GST sessions complemented by weekly or 2-weekly individual sessions. The parents of the adolescents participated in a separate parent group. From pre- to post-treatment, results demonstrated improvements for some patients in quality of life and symptoms of psychopathology. Changes in a number of modes and schemas were observed in all patients from pre- to post-therapy. In addition to assessing changes from pre- to post-treatment, the current study investigated the temporal changes in modes during therapy as well. Results demonstrated that maladaptive modes decreased, whereas healthy modes increased for all patients across the course of therapy. The present study provides preliminary support for the applicability of GST for adolescents as well as the effectiveness of GST. It is a starting point for further research on this intervention.     

Family Cohesion and Adaptation in Pediatric Chronic Conditions: The Missing Link of the Family’s Condition Management

The quality of family functioning has been considered an important predictor of adaptation in children with chronic conditions and their parents. Previous research suggests that beyond general family functioning, the specific experience of the family’s condition management is paramount for understanding family members’ adaptation. This study’s first goal was to compare family functioning and parents’ and children’s adaptation outcomes across four chronic conditions: asthma, diabetes, epilepsy, and obesity. Secondly, we explored the mediating role of family life difficulties and parental mutuality, as two potential paths through which family cohesion is linked to family members’ adaptation. A total of 263 parents of children (3–19 years old) with asthma (n = 77), obesity (n = 79), epilepsy (n = 52) and diabetes (n = 55) completed self-report measures of family cohesion, family life difficulty, parental mutuality, anxiety and depressive symptoms, and their children’s health-related quality of life (HrQoL). The results showed that families of children with diabetes, obesity, and epilepsy were at higher risk of experiencing family difficulties and children’s deteriorated HrQoL when compared to families of children with asthma. With regard to the links among study variables, although family cohesion had both a direct and indirect relationship with parental depressive symptoms, its links with parental anxiety symptoms and children’s HrQoL were only indirect, through family life difficulty. These associations were consistent across the four clinical groups. These findings emphasize the relevance of family-centered interventions aimed at promoting family cohesion, parents’ mutuality, and effective coping with the demands of pediatric chronic conditions.     

Does Theory of Mind in Pre-kindergarten Predict the Ability to Think About a Reader’s Mind in Elementary School Compositions? A Longitudinal Study

A critical skill in emergent writing is the developing ability to take the perspective of different readers; however, the precursors of this skill have not yet been identified. In this longitudinal study, 105 children (90 after attrition) were tested at 3 time points: pre-kindergarten (3–4 years old, n = 105), kindergarten (5 years old, n = 97), and Grade 1 (6–7 years old, n = 90). Theory of mind (ToM) in pre-kindergarten significantly predicted children’s awareness of a reader’s epistemic state when they dictated letters in both kindergarten and Grade 1 even after controlling for language (Peabody Picture Vocabulary Task [PPVT]) and inhibitory control. In addition, ToM in pre-kindergarten remained a significant predictor of reader awareness in Grade 1 after further controlling for reader awareness in kindergarten. There was little relationship between higher-order ToM tasks in kindergarten and reader awareness, but higher-order ToM in Grade 1 concurrently predicted reader awareness. Receptive vocabulary (PPVT) was significantly related to reader awareness at all time points, longitudinally and concurrently. This study has both theoretical implications for the relationship between ToM and emergent literacy and practical implications for the early identification and remediation of children at risk for later writing difficulties.     

Frequency and impact of trauma in older women: A military and nonmilitary sample

Understanding the impact of trauma on late-life functioning in older females is needed in order to provide best care. We explored the impact of trauma on late-life psychological and physical health and functioning among older women (n = 48) who served in the military, or participated in a military lifestyle. Eleven of these women were not veterans, but married to military personnel. Number of traumatic exposures and types of events experienced was associated with increased trauma symptom severity. Trauma symptom severity was associated with decreased physical functioning and increased pain. Increased numbing and avoidance was significantly associated with poorer physical functioning and increased pain. Older women in this study remained at risk of experiencing negative consequences of trauma in terms of increased quantity and severity of trauma symptoms and physical decline and pain. Clinical and research implications are discussed.     

Psychometric properties of Spanish version of the Mini-Mental Adjustment to Cancer Scale

Background/ObjectiveThe aim of the study was to examine the factor structure and psychometric properties of the Spanish version of the Mini-Mental Adjustment to Cancer Scale (Mini-MAC) in a large sample of patients with non-metastatic, resected cancer.MethodsProspective, observational, multicenter study for which 914 patients were recruited from 15 Spanish hospitals. Exploratory and confirmatory factor analyses, validity and reliability analyses were conducted.ResultsFactor-analytic results indicated a 4-factor structure of the Spanish version of the Mini-MAC. Three subscales have psychometric properties similar to those of Helplessness, Anxious preoccupation, and Cognitive avoidance of the original the Mini-MAC. The Fighting spirit and the Fatalism subscales were combined on the Positive attitude scale. The four factor-derived scale scores exhibited acceptable accuracy for individual measurement purposes, as well as stability over time in test-retest assessments at 6 months. Validity assessments found meaningful relations between the derived scale scores, and Brief Symptom Inventory depression and anxiety scores and Functional Assessment of Chronic Illness Therapy spiritual well-being scores.ConclusionsThe Spanish version of the Mini-MAC provides reliable and valid measures for patients with non-metastatic, resected cancer, and results corroborate the instrument’s cross-cultural validity.     

Cultural differences in distraction processing: influence of context at retrieval

Cultural differences in information processing affect perceptual judgment, attention, and memory. We investigated whether cultural differences in processing patterns, specifically East Asian participants’ tendency to encode holistically, compared to Western tendencies to process analytically, affect performance on an implicit memory test. First, participants completed a 1-back task on pictures with superimposed distracting words. After a delay filled with a computerised Corsi block task, they performed a word fragment task in which some fragments could be completed with the distracting words from the 1-back task. Critically, fragments were presented with the same pictures as previously seen (matched condition), with no pictures (control condition), or with pictures from other trials on the 1-back task (mismatched condition). Non-Asian Canadian participants showed virtually no priming for distraction, independent of the reinstatement of encoding context. East Asian Canadian participants showed superior priming for fragments that had been paired with their original pictures. They did not show evidence of a detriment for the mismatched, relative to control, condition.     

THE INTERPLAY OF THE TWO HEMISPHERES OF THE BRAIN IN PSYCHOANALYSIS

Several authors have written intriguingly about the right and left hemispheres of the brain. Each hemisphere perceives the world differently, impacting that which it looks upon and reinforcing our particular world view. Notably, the left hemisphere, has always been assumed to be the dominant hemisphere, but only because it has language and is so adept at formulating arguments. The detached mode of the left hemisphere, while useful and necessary to get distance, is no more real than the engaged, imaginative approach of the right hemisphere. Having written about self-sufficiency as a defense against feeling alone and helpless, I now consider these rational, problem solving, answer generating, and planning activities as products of the left hemisphere. The approach that I am suggesting is of calling our patients’ attention to how their left hemisphere overpowers the new, more uncertain voice of the right hemisphere just after it speaks in a session.