Barriers to Addressing Substance Abuse in Domestic Violence Court

Substance abuse commonly co-occurs with intimate partner violence among both perpetrators and survivors. Specialized courts that focus on intimate partner violence provide a unique opportunity to address both problems simultaneously, but research has yet to identify whether this happens. In this qualitative study of a domestic violence court in a large midwestern metropolitan area, key informants were interviewed to understand how the Court treats substance abuse. Results indicate that substance abuse typically is not identified among perpetrators or survivors going through the Court unless it is mentioned in a police report. Barriers to such identification are the organization of the Court, bounded definition of actors’ roles in the Court, limited resources, and negative attitudes towards survivors. These results suggest that specialized courts that attend to only one problem may overlook the possibility of addressing issues that commonly co-occur.     

A Bifactor Model of Anxiety Sensitivity: Analysis of the Anxiety Sensitivity Index-3

The purpose of the current study was to investigate the fit of a bifactor model of the Anxiety Sensitivity Index-3 (ASI-3; Taylor et al. Psychological Assessment, 19, 176–188, 2007) as well as to examine measurement invariance of the ASI-3 across gender. Participants were undergraduate students from the University of Cincinnati (n?=?954; 63 % female). Results indicated that the bifactor model was the best fit to the data, and that this model of AS is fully invariant in terms of gender. The current findings suggest that anxiety sensitivity consists of a general factor and three independent group factors (rather than a higher-order factor with three correlated lower-order factors). The ASI-3 subscales from the bifactor model however did not provide incremental predictive utility above and beyond the general AS factor with respect to an external anxiety criterion. Related research and clinical implications are discussed.     

Explanation,Contrast, and the Primacy of Practice

Abstract: The common practice of giving (comparing, rejecting and inferring) explanations of phenomena is at the root of articulate learning, including the enterprises we collect under the noun ‘science’. The way that practice privileges a single item from the myriad relevant to any phenomenon tells us something about articulateness itself.     

Virtual Reality and Cognitive-Behavioral Therapy for Driving Anxiety and Aggression in Veterans: A Pilot Study

Within the U.S. military, motor vehicle accidents (MVAs) are the leading cause of preventable morbidity and mortality. Prior combat exposure and anxiety symptoms are associated with risky and aggressive driving, which is responsible for over half of MVA fatalities. Therefore, interventions are needed to reduce driving anxiety and aggression in veterans in order to mitigate the public health impact of MVAs. Virtual reality exposure therapy (VRET) offers safe, controlled exposure to distressing stimuli. The current study piloted a novel virtual reality and cognitive behavioral intervention (VRET + CBT) for veterans that integrated both anxiety and anger management components. Virtual reality driving scenarios were delivered in a driving simulator and tailored for the military population. Six previously deployed veterans completed eight intervention sessions, as well as pre/post, one month follow-up and six to nine month follow-up assessments. Repeated measures ANOVAs demonstrated significant decline and large effect sizes for PTSD symptoms, driving phobia, hyperarousal in driving situations, anxiety/anger-related thoughts and behaviors, and risky driving. Hyperarousal in driving situations declined by 69%, aggressive driving declined by 29%, and risky driving declined by 21%. Treatment gains were maintained at follow-up. Recruitment, retention, immersion, simulator sickness scores, and qualitative feedback demonstrated feasibility of the intervention. Implications for future research and adaptation are discussed.     

On Psychodynamic Meanings of Psychiatric Treatment: Discussion of “From Dyad to Triad”

Dr. Bar-Haim has covered vast territory in her contribution “From Dyad to Triad: On Psychodynamic Meanings of Psychiatric Treatment,” (this issue) and I welcome the opportunity to offer my thoughts on her contribution and this important topic more generally. The issues touched upon include the various meanings of psychiatric treatment for patient and therapist; factors that impact compliance; resistances to suggesting medication consultation on the part of the therapist; challenges of the prescribing therapist; the role of a “disease” model in mental suffering; the overdetermined meaning of “symptom”; and, most important, recommendations for establishing effective treatment when a treatment triangle exists. I address some of these issues and comment on two clinical vignettes to illustrate my way of thinking.     

Patients’ Views of Treatment-Focused Genetic Testing (TFGT): Some Lessons for the Mainstreaming of <Emphasis Type="Italic">BRCA1</Emphasis> and <Emphasis Type="Italic">BRCA2</Emphasis> Testing

This paper explores patients’ views and experiences of undergoing treatment-focused BRCA1 and BRCA2 genetic testing (TFGT), either offered following triaging to clinical genetics (breast cancer) or as part of a mainstreamed care pathway in oncology (ovarian cancer). Drawing on 26 in-depth interviews with patients with breast or ovarian cancer who had undergone TFGT, this retrospective study examines patients’ views of genetic testing at this point in their care pathway, focusing on issues, such as initial response to the offer of testing, motivations for undergoing testing, and views on care pathways. Patients were amenable to the incorporation of TFGT at an early stage in their cancer care irrespective of (any) prior anticipation of having a genetic test or family history. While patients were glad to have been offered TFGT as part of their care, some questioned the logic of the test’s timing in relation to their cancer treatment. Crucially, patients appeared unable to disentangle the treatment role of TFGT from its preventative function for self and other family members, suggesting that some may undergo TFGT to obtain information for others rather than for self.     

Development and Pilot Testing of a Decision Aid for Genomic Research Participants Notified of Clinically Actionable Research Findings for Cancer Risk

Germline genomic testing is increasingly used in research to identify genetic causes of disease, including cancer. However, there is evidence that individuals who are notified of clinically actionable research findings have difficulty making informed decisions regarding uptake of genetic counseling for these findings. This study aimed to produce and pilot test a decision aid to assist participants in genomic research studies who are notified of clinically actionable research findings to make informed choices regarding uptake of genetic counseling. Development was guided by published literature, the International Patient Decision Aid Standards, and the expertise of a steering committee of clinicians, researchers, and consumers. Decision aid acceptability was assessed by self-report questionnaire. All 19 participants stated that the decision aid was easy to read, clearly presented, increased their understanding of the implications of taking up research findings, and would be helpful in decision-making. While low to moderate levels of distress/worry were reported after reading the booklet, a majority of participants also reported feeling reassured. All participants would recommend the booklet to others considering uptake of clinically actionable research findings. Results indicate the decision aid is acceptable to the target audience, with potential as a useful decision support tool for genomic research participants.     

The Longitudinal Impact of a Family-Based Communication Intervention on Observational and Self-Reports of Sexual Communication

Parents can play a vital role in shaping teenagers’ sexual attitudes, behavior, and contraceptive use through communication, however, less is known about how to modify parent–adolescent communication among youth with mental health problems. The impact of a family-based sexual risk prevention intervention on both observational and self-report of parent–adolescent sexual communication was examined at 12 months among adolescents with mental health problems. Of the 721 parent–adolescent dyads recruited for the study, 167 videotapes of sexual discussions between parents and adolescent were coded for the family-based intervention and 191 videotapes for the active comparison. Longitudinal analyses examined differences between conditions (family-based vs. comparison) in self-reported and observed parent–adolescent sexual discussions and also examined the impact of gender on intervention response. More parent I-statements, healthier parent body language, and fewer adolescent Negative Vocalizations were detected for family-based intervention participants 12 months after participating in the brief intervention (11?h of total intervention time) relative to those in the comparison condition. Parents in the family-based intervention also self-reported better sexual communication at 12 months. The current study provides supporting evidence that a relatively brief family-based intervention was successful at addressing parent–adolescent sexual communication among a mental health sample.