Barriers and facilitators affecting the sustainability of dialectical behaviour therapy programmes: A qualitative study of clinician perspectives

Dialectical behaviour therapy (DBT) is a psychological treatment developed for individuals experiencing chronic suicidality and high‐risk behaviours. Despite the substantial evidence supporting the effectiveness of DBT, many programmes have problems with its sustainability. The goals of the current qualitative study were to identify factors that impact the sustainability of DBT programmes within a publicly funded mental health system and identify factors that are particularly relevant for youth DBT programmes. Interviews with trained adult and youth DBT clinicians (N = 31) were conducted to explore their experiences providing DBT. Three major themes that emerged as barriers to the sustainability of DBT programmes included the following: systemic challenges, conflicts within the consultation teams and clinician burnout. Factors influencing the success of DBT programmes included the following: systemic support, clinician commitment and “buy in”, and team cohesion. Factors specific to providing DBT with youth (i.e. level of commitment, simplifying the language, and parental investment) and recommendations for sustainability for adults and youth programmes were also identified. Findings of this study provide valuable information on factors impacting DBT programmes within the unique context of a Canadian mental health service system, where community‐based services are publicly funded. These findings have clear clinical utility and can be used to generate solutions to clinicians' perceived barriers and to foster perceived facilitators within similar contexts.     

Examining the narrative roles in suicide notes

The present study examines suicide notes, using a sample of suicide notes from published corpora (N = 50), combined with a sample of recent suicide notes from a suicide website (N = 50). The present study proposes a model of differentiation in completed suicides. The characteristics of the suicide notes were analysed using a content dictionary developed by Giles in 2007, and the data subjected to smallest space analysis. Four themes of suicide completer were discovered: Egoistic Victim, Anomic Hero, Altruistic Professional and Fatalistic Revenger. The implications of these findings and the potential use in therapy work with suicide survivors and those with suicidal ideation are discussed, as well as suggestions for the direction of future research.     

Cross-Sectional and Longitudinal Associations between Leisure Time Physical Activity,Mental Well-Being and Subjective Health in Middle Adulthood

Previous studies have shown that participation in leisure time physical activity is related to better mental well-being and subjective health. However, the associations between different types of leisure time physical activities and different dimensions of mental well-being have rarely been studied. In addition, longitudinal research, analyzing possible causal relations between these variables, is lacking. To investigate these research questions, data gathered at ages 42 and 50 (present N = 303) for the Finnish Jyväskylä Longitudinal Study of Personality and Social Development were used. Physical activity was assessed as frequency of participation at ages 42 and 50, and at age 50 also as frequency of participation in different types of physical activities. Mental well-being was captured by emotional, psychological and social well-being and subjective health by self-rated health and symptoms. Cross-sectionally, different types of physical activities were related to different dimensions of well-being. Walking had positive associations with psychological and social well-being, rambling in nature with emotional and social well-being, and endurance training with subjective health. Rambling in nature was also positively related to subjective health but only among men. Longitudinally, mental well-being predicted later participation in leisure-time physical activity, whereas no longitudinal associations between subjective health and physical activity were found. The results suggest that leisure time physical activities are related to current mental well-being and subjective health in midlife. Across time, good mental well-being seems to be a resource promoting engagement in physical activity.

     

Possession and Applicability of Signature Character Strengths: What Is Essential for Well-Being,Work Engagement,and Burnout?

Signature character strengths can foster health-related outcomes in work and private life, thus being particularly important for endangered occupational groups like physicians. However, situational circumstances need to allow character strengths demonstration (applicability) first to enable their application. Therefore, this study addresses the role of (1) applicability of signature character strengths in work and private life beyond their possession and (2) relationships with well-being, work engagement, and burnout dimensions (emotional exhaustion, depersonalization, and reduced personal accomplishment). Hospital physicians (N = 274) completed an online survey examining their signature character strengths and applicability, well-being, work engagement, and burnout dimensions. The top-five individual signature character strengths were fairness, honesty, judgment, kindness, and love. Hierarchical multiple linear regressions revealed that the possession as well as the applicability of signature character strengths was important in work and private life, but to different degrees. Possessing fairness, honesty, or kindness indicated significant positive relations with subjective well-being, whereas judgment and kindness seemed to negatively interact with reduced personal accomplishment. Hospital physicians’ applicability of fairness, honesty, judgment, and love was particularly essential for their psychological well-being and work engagement, whereas the applicability of fairness (reduced personal accomplishment) and judgment (emotional exhaustion, depersonalization) at work interacted negatively with the respective outcomes. Therefore, creating awareness for individual signature character strengths as well as providing applicability in hospitals and private life could be a promising approach to improve physicians’ well-being and consequently patient care as well as the performance of the health-care system in general.

     

Psychometric Characteristics of the German Values in Action Inventory of Strengths 120-Item Short Form

The original Values in Action Inventory of Strengths (VIA-IS) is an international 240 item validated self-report questionnaire measuring character strengths. A validated and reliable English 120-item short form (VIA-120) is available. However, there is limited information about the psychometric properties of the German VIA-120. This article addresses this gap and reports the reliability, validity and comparability of the German VIA-120 with the German VIA-240 version. Two independent samples were recruited: a general population sample (N = 1073, Sample 1) and a sample consisting of medical students and physicians (N = 685, Sample 2). Internal consistency of the VIA-120-scales ranged from α = .58 (modesty) to α = .87 (spirituality) in Sample 1 and α = .63 (honesty) to α = .90 (spirituality) in Sample 2. Intercorrelations between the scales of the 120-item version and the original 240-Items version (Sample 1) ranged from r = .52 (hope) to r = .89 (prudence). Criterion validity with the Satisfaction with Life Scale (SWLS) and the Brief Inventory of Thriving (BIT) was demonstrated. The comparison of the factor structure between the original and the short form showed a good convergence (Tucker’s Phi .93–.99 Sample 1, .95–.98 Sample 2). Overall, the German VIA-120 was reliable, showed good convergence with the German VIA-240 and thus presents a similar level of validity for the assessment of character strengths. This study provides the first indication that the VIA 120 short form is comparable regarding the validity and reliability of the original VIA 240-item version indicating its potential to be used in large scale research studies.

     

Challenges of home visitor interventions with adolescent mothers and their infants

Issues in designing a home visitor intervention and research program for 130 adolescent mothers, 17 and under, and their infants from birth to 30 months are discussed. The overall project is described, and various aspects of creating and maintaining a home visitor intervention program are discussed, including: (1) Issues and problems that arise with the integration of a home visitor intervention component into an ongoing health department program; (2) the recruitment and training of lay home visitors in the context of arduous, often disheartening work; (3) issues of supervision and quality control faced by the mental health consultants; (4) coping with potential stresses and dangers faced by the home visitors; (5) assisting and maintaining maximum communication for the research components of the study to be successful.     

Smiling and relative status in news photographs

To test the hypothesis that lower social status is associated with more smiling, the authors used newspaper photographs and their associated news stories as the basis for scoring the smiling and relative social status of the 2 individuals in each photograph. Independent raters judged smiling and 5 dimensions of relative status for 496 individuals in 248 newspaper photographs. There was no relation between status and smiling, although status and smiling were both related to other variables such as gender, age, and story valence. These findings add to a growing body of evidence that there is no generalized relation between smiling and status.     

Relationship between the rorschach and the MMPI-2 in a Swedish population: a replication study of the effects of first-factor related test-interaction styles

A sizeable amount of research literature has failed to demonstrate a stable relationship between self-report and the Rorschach (Exner, 1993). However, principal component first-factor related test-interaction style has been shown to moderate convergence. In this study 78 psychiatric patients completed the Rorschach and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Hathaway & McKinley, 1989). Practically no correlation was evident between the MMPI-2 and the Rorschach, measuring similar constructs, in all patients. Patients with similar test-interaction styles demonstrated positive intermethod correlations between both conceptually related and conceptually not directly related test indexes. The same scales were negatively correlated in patients with discordant test-interaction styles, and this difference between test-interaction style groups was significant. It is suggested that first-factor related test-interaction style moderates convergence. It is further suggested that test-interaction style moderates convergence between both conceptually related and conceptually not directly related measures of distress or psychopathology.