Addressing Challenges in Individual Psychotherapy with Delusional Patients: A Case Study

Although cognitive-behavioral treatments for schizophrenia and other psychotic disorders demonstrate strong results in clinical trials, not all patients respond to these treatments. Common challenges in psychotherapy with delusional patients include a mismatch between the therapist’s and the patient’s expectations about the purpose of therapy, the patient’s lack of motivation to reduce delusional beliefs in service of other goals, and the patient’s dependence on the delusions in order to preserve an intact sense of self. This case highlights the value of integrating a psychodynamic perspective with cognitive-behavioral interventions to address challenges in psychotherapy with chronically delusional patients.     

Attachment to objects as compensation for close others' perceived unreliability

Attachment theory posits that close interpersonal relationships provide people with psychological security across the lifespan. Research shows that when people perceive that close others are unreliable, they may seek alternative, non-social sources of security (e.g., deities). Building on this work, the authors hypothesized that attachment to objects compensates for threatened attachment security when close others are unreliable. Participants primed with close others', but not strangers', unreliability reported increased attachment to belongings (Study 1), and this effect was mediated by feelings of attachment anxiety (concern over close others' availability), but not attachment avoidance (avoiding emotional dependence; Study 2), suggesting that object attachment compensates for the perception that close others are unreliable rather than consistently rejecting. In Study 3, when a valued belonging was removed, participants primed with uncertainty about their relationships showed increased separation anxiety and motivation to reunite with the belonging, regardless of the belonging's perceived importance for facilitating relationships.     

Patterns of Adolescents’ Beliefs About Fighting and Their Relation to Behavior and Risk Factors for Aggression

This study examined adolescents' patterns of beliefs about aggression, and how these patterns relate to aggressive and prosocial behavior, and to risk factors associated with aggression. A sample of 477 sixth graders from two urban schools and a school in a nearby county completed measures of beliefs, behavior, and individual, peer and parental factors associated with aggression. Teacher ratings of participants' behavior and emotion regulation were also obtained. The urban sample was 84% African American; the county school was in a rural fringe area with a student population that was 45% Caucasian and 40% African American. Latent class analysis of items on a beliefs measure supported hypotheses predicting three groups: (a) a Beliefs Against Fighting (BAGF) group that opposed the use of aggression (31% of the sample); (b) a Fighting is Sometimes Necessary (FSNEC) group that endorsed beliefs that fighting is sometimes necessary or inevitable (41%), and (c) a Beliefs Supporting Fighting (BSUPF) group that supported aggression across multiple contexts (28%). Differences across groups were found on race/ethnicity and family structure, but not on gender. Significant differences were also found such that the FSNEC group fell between levels of the BAGF and BSUPF groups on most measures. In contrast, the FSNEC and BAGF groups both differed from the BSUPF group, but not from each other on measures of empathy, perceived effectiveness of nonviolence and aggression, and parental messages supporting nonviolence. These differences suggest the need for tailoring prevention approaches for subgroups of adolescents who differ in their patterns of beliefs.     

Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial

This study further evaluates the efficacy of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP). A diagnostically heterogeneous clinical sample of 37 patients with a principal anxiety disorder diagnosis was enrolled in a randomized controlled trial (RCT) involving up to 18 sessions of treatment and a 6-month follow-up period. Patients were randomly assigned to receive either immediate treatment with the UP (n=26) or delayed treatment, following a 16-week wait-list control period (WLC; n=11). The UP resulted in significant improvement on measures of clinical severity, general symptoms of depression and anxiety, levels of negative and positive affect, and a measure of symptom interference in daily functioning across diagnoses. In comparison, participants in the WLC condition exhibited little to no change following the 16-week wait-list period. The effects of UP treatment were maintained over the 6-month follow-up period. Results from this RCT provide additional evidence for the efficacy of the UP in the treatment of anxiety and comorbid depressive disorders, and provide additional support for a transdiagnostic approach to the treatment of emotional disorders.     

Family Functioning and the Course of Adolescent Bipolar Disorder

The symptoms of bipolar disorder affect and are affected by the functioning of family environments. Little is known, however, about the stability of family functioning among youth with bipolar disorder as they cycle in and out of mood episodes. This study examined family functioning and its relationship to symptoms of adolescent bipolar disorder, using longitudinal measures of family cohesion, adaptability, and conflict. Parent- and adolescent-reported symptom and family functioning data were collected from 58 families of adolescents with bipolar disorder (mean age = 14.48 ± 1.60; 33 female, 25 male) who participated in a 2-year randomized trial of family-focused treatment for adolescents (FFT-A). Cohesion and adaptability scores did not significantly change over the course of the study. Parent-reported conflict prior to psychosocial treatment moderated the treatment responses of families, such that high-conflict families participating in FFT-A demonstrated greater reductions in conflict over time than low-conflict families. Moreover, adolescent mania symptoms improved more rapidly in low-conflict than in high-conflict families. For all respondents, cohesion, adaptability, and conflict were longitudinally correlated with adolescents’ depression scores. Finally, decreases in parent-reported conflict also predicted decreases in adolescents’ manic symptoms over the 2-year study. Findings suggest that family cohesion, adaptability, and conflict may be useful predictors of the course of adolescent mood symptoms. Family conflict may be an important target for family intervention in early onset bipolar disorder.     

The Impact of Neighborhood Factors on the Well-Being of Survivors of Intimate Partner Violence Over Time

Intimate partner violence (IPV) is a pervasive social problem impacting the psychological well-being of millions of US women annually. The extant literature draws our attention to the devastating mental health effects of IPV, but largely overlooks how ecological factors may further explain survivors' well-being. This study examined how neighborhood disadvantage may contribute to survivors' compromised well-being, in addition to the abuse women experienced. Neighborhood disorder and fear of victimization significantly impacted survivors' well-being, over and above abuse. Although between-women effects of neighborhood disorder and fear were unrelated to change in women's depression or quality of life (QOL), significant within-woman effects were detected. Change in neighborhood disorder was negatively associated with change in QOL, and this relationship was fully mediated by fear. While no direct relationship between change in neighborhood disorder and depression was detected, an indirect effect through survivors' fear was revealed. Implications for future research and practice are discussed.     

Modulation of N400 in chronic non-fluent aphasia using low frequency Repetitive Transcranial Magnetic Stimulation (rTMS)

Low frequency Repetitive Transcranial Magnetic Stimulation (rTMS) has previously been applied to language homologues in non-fluent populations of persons with aphasia yielding significant improvements in behavioral language function up to 43 months post stimulation. The present study aimed to investigate the electrophysiological correlates associated with the application of rTMS through measurement of the semantic based N400 Event-related brain potentials (ERP) component. Low frequency (1 Hz) rTMS was applied to the anterior portion of the homologue to Broca’s area (pars triangularis), for 20 min per day for 10 days, using a stereotactic neuronavigational system. Twelve non-fluent persons with aphasia, 2-6 years post stroke were stimulated. Six participants were randomly assigned to receive real stimulation and six participants were randomly assigned to receive a blind sham control condition. ERP measures were recorded at baseline, 1 week and 2 months subsequent to stimulation. The findings demonstrate treatment related changes observed in the stimulation group when compared to the placebo control group at 2 months post stimulation indicating neuromodulation of N400 as a result of rTMS. No treatment related changes were identified in the stimulation group, when compared to the sham group from baseline to 1 week post stimulation. The electrophysiological results represent the capacity of rTMS to modulate neural language networks and measures of lexical-semantic function in participants with non-fluent aphasia and suggest that time may be an important factor in brain reorganization subsequent to rTMS.     

Do proposed facial expressions of contempt, shame, embarrassment, and compassion communicate the predicted emotion?

Shame, embarrassment, compassion, and contempt have been considered candidates for the status of basic emotions on the grounds that each has a recognisable facial expression. In two studies (N=88, N=60) on recognition of these four facial expressions, observers showed moderate agreement on the predicted emotion when assessed with forced choice (58%; 42%), but low agreement when assessed with free labelling (18%; 16%). Thus, even though some observers endorsed the predicted emotion when it was presented in a list, over 80% spontaneously interpreted these faces in a way other than the predicted emotion.