Differential effects of manual assisted cognitive behavior therapy in the treatment of recurrent deliberate self-harm and personality disturbance: the POPMACT study

A total of 480 patients were treated in a large, multicenter randomized trial of a brief form of cognitive therapy, manual-assisted cognitive behavior therapy (MACT) versus treatment as usual (TAU) for recurrent deliberate self-harm. Each patient was randomized after a self-harm episode assessed at an accident and emergency center and followed up over 1 year. The main hypothesis tested was that those allocated to MACT would have a lower proportion of self-harm episodes in the succeeding year. A total of 60% of those allocated to MACT had face-to-face treatment and 430 (90%) of all patients had self-harm data recorded after 1 year. Although the results showed no significant difference between those repeating self-harm in the MACT group (39%) compared with the TAU group (46%) (P = 0.20), the treatment was cost effective (10% cheaper than TAU) and the frequency of self-harm episodes was fewer (50%) in the MACT group. A total of nine of 10 patients had some personality disturbance (42% of these with disorder), and for those where information on parasuicide events was collected, the proportion having a repeat episode ranged from 33% to 63% for different personality disorders. Those with BPD were most likely to repeat episodes quickly (mean 89 days for 25% to repeat) with dissocial personality disorder (equivalent mean 384 days) the slowest to repeat. Total costs were significantly greater in those with personality disorder and were reduced in those allocated to MACT; this saving was reversed in those with borderline disorder. On average, MACT appeared to increase the cost of those patients with BPD (BPD) and reduce the cost of those with other personality disorders. It is concluded that MACT has value in preventing self-harm cost effectively but this appears to be confined mainly to those who do not have BPD.     

Acceptance of Illness Among Patients Pursuing Transplantation or Left Ventricular Assist Device

Acceptance of illness is related to better mental health among patients with chronic illness; however, this construct has not been evaluated as part of routine transplantation evaluations. The purpose of this study was to create a brief measure of acceptance of illness for patients pursuing organ transplantation and examine how acceptance is related to distress. Retrospective medical record reviews were conducted for 290 patients who completed a routine psychosocial evaluation prior to transplant listing which included the Illness Acceptance Scale (IAS). Internal consistency for the IAS was excellent (Cronbach’s alpha?=?.92). Illness acceptance was negatively correlated with depression, anxiety, and catastrophizing and was not related to health literacy or health numeracy. The IAS is a reliable and valid measure for patients who are pursuing thoracic transplant or left ventricular assist device. Clinicians may want to screen transplant candidates for illness acceptance and refer those with lower levels to psychological interventions.

     

Proposing Abolition Theory for Carceral Medical Education

Medical schools, like all institutions, are conservative since they seek to maintain and expand on their accomplishments. Stakes are high in carceral medicine given the risks of replicating the inhumane social conditions that exist within prisons and allow prisons to exist. Given the increasing number of partnerships between state and municipal carceral systems with academic medical centers, medical schools must consider which guiding theory they will use to teach carceral medicine. The interdisciplinary theory of prison abolition is best fit for the task of training medical students to think about the long term goals of societal change and public health.

     

Life's little (and big) lessons: identity statuses and meaning-making in the turning point narratives of emerging adults

A longitudinal study examined relations between 2 approaches to identity development: the identity status model and the narrative life story model. Turning point narratives were collected from emerging adults at age 23 years. Identity statuses were collected at several points across adolescence and emerging adulthood, as were measures of generativity and optimism. Narratives were coded for the sophistication of meaning-making reported, the event type in the narrative, and the emotional tone of the narrative. Meaning-making was defined as connecting the turning point to some aspect of or understanding of oneself. Results showed that less sophisticated meaning was associated particularly with the less advanced diffusion and foreclosure statuses, and that more sophisticated meaning was associated with an overall identity maturity index. Meaning was also positively associated with generativity and optimism at age 23, with stories focused on mortality experiences, and with a redemptive story sequence. Meaning was negatively associated with achievement stories. Results are discussed in terms of the similarities and differences in the 2 approaches to identity development and the elaboration of meaning-making as an important component of narrative identity.     

How to be a Normativist about the Nature of Belief

According to the normativist, it is built into the nature of belief itself that beliefs are subject to a certain set of norms. I argue here that only a normativist account can explain certain non‐normative facts about what it takes to have the capacity for belief. But this way of defending normativism places an explanatory burden on any normativist account that an account on which a truth norm is explanatorily fundamental simply cannot discharge. I develop an alternative account that can achieve explanatory adequacy where this sort of truth privileging account falls short.     

Aunt Jemima Isn't Keeping Up with the Energizer Bunny: Stereotyping of Animated Spokescharacters in Advertising

This study sought to examine one aspect ofstereotyping in television advertising, specifically,the use of animated spokes-characters as productrepresentatives and whether spokes-characters contribute to gender-stereotyped portrayals. Undergraduatestudents — of a variety of races and an almostequal number of men and women — identifiedmemorable spokes-characters, presumed genders, notedgender-distinguishing characteristics, and viewed programmingfeaturing commercials with spokes-characters. Hypotheseswere confirmed that participants will recall more maleanimated characters than female and that most of the spokes-characters in television advertising aremale. Using male spokes-characters reinforces thestereotypical notion that males are more important thanfemales. Such effects may be greater than those associated with other aspects of advertisinglargely because of the memorability and popularity ofanimated spokes-characters.     

Evidence for the Continuity of Early Problem Behaviors: Application of a Developmental Model

Evidence of the continuity of early problem behaviors in young girls and boys was examined developmentally. Data were gathered on 104 mother-child dyads from low-income families when children were between 1 and 5 years of age. Difficult temperament, aggression, and noncompliance from 12 to 24 months, and externalizing and internalizing problems at 36 and 60 months, were assessed. The results provide evidence for the continuity of early behavioral and emotional problems and support for the early differentiation between internalizing and externalizing problems. Implications of the current findings for prevention efforts are presented.     

The relation between attention deficit hyperactivity disorder and substance abuse: what role does conduct disorder play?

This paper presents a comprehensive review of the literature examining the relation between childhood attention deficit hyperactivity disorder (ADHD) and substance abuse. A number of researchers have statistically controlled for conduct disorder (CD) when examining the ADHD—substance-abuse relation. These studies have generally found that the ADHD—substance-abuse relation disappears when the high overlap between ADHD and CD is taken into account. On this basis, one may conclude that ADHD is unimportant to substance abuse. However, there is some evidence from both empirical studies and related fields that ADHD and CD may interact to afford a higher risk for substance abuse than may either disorder alone. Thus, ADHD appears to be important to substance abuse in that it interacts with CD to increase the risk. This paper calls for more research that directly examines the joint effects of ADHD and CD on risk for substance abuse. There is also a need for more research that examines gender differences, and mechanisms of the relations among ADHD, CD, and substance abuse.     

The Emergence of Narrative Identity

This paper reviews the current research on narrative identity. Narrative identity is quickly becoming accepted as a promising process approach to self‐development in a variety of fields, including developmental, clinical, cultural, personality, and social psychology. This paper reviews factors surrounding the emergence of narrative identity in adolescence, relations between narrative patterns and age and personality, as well as factors that are important to developing a coherent narrative identity, such as the emotional valence of experience, storytelling, and culture. Finally, new and emerging issues are raised for those interested in the study of narrative identity, with a particular focus on narratives that are difficult to tell and may violate cultural norms.