Linking vitamin D status,executive functioning and self‐perceived mental health in adolescents through multivariate analysis: A randomized double‐blind placebo control trial

The aim of the present randomized double‐blind placebo control trial was to investigate if vitamin D supplementation had an effect on vitamin D status, executive functioning and self‐perceived mental health in a group of Norwegian adolescents during winter time. Fifty adolescents were randomly assigned into an intervention group (vitamin D pearls) or a control group (placebo pearls). Before (pre‐test in December/January) and after (post‐test in April/May) the intervention period the participants were exposed to a test procedure, consisting of blood draw, completion of cognitive tests (Tower of Hanoi and Tower of London), and the Youth Self‐report version of the Child Behavior Checklist. Multivariate data analysis showed that participants with low vitamin D status scored worse on the Tower of London tests and the more difficult sub‐tasks on the Tower of Hanoi tests. They also had a tendency to report higher frequency of externalizing behavior problems and attention deficit. At pre‐test, the overall mean vitamin D status measured as 25‐hydroxy vitamin D was 42 nmol/L, defining deficiency (Intervention group = 44 nmol/L, Control group = 39 nmol/L). However, vitamin D supplementation caused a significant increase in vitamin D status resulting in a sufficient level in the Intervention group at post‐test (mean 62 nmol/L). The results also revealed that the intervention group improved their performance on the most demanding sub‐tasks on the ToH. Overall, the study indicates that vitamin D status in adolescents may be important for both executive functioning and mental health.     

Longitudinal Assessment of Pain, Coping, and Daily Functioning in Children with Sickle Cell Disease Receiving Pain Management Skills Training

Objective. To conduct intensive pain management skills training (IST) in children with sickle cell disease (SCD) and their parents and to comprehensively evaluate pain, coping, and daily functioning in children pre, immediately post, and 3 months following treatment. Methods. Three children who received IST in nonpharmacological and pharmacological pain management strategies completed a Coping Strategies Questionnaire (CSQ) at pre, post, and follow-up assessments, and daily pain and activity diaries for 18 weeks, spanning from 1 week pretreatment to 11 weeks posttreatment. Results. From pre- to posttreatment, 1 child receiving IST indicated increased report of active coping attempts and all 3 children indicated decreased report of negative thinking on the CSQ. Participants in IST used coping skills on 90% of days with pain and reported the skills to be moderately helpful on the daily diaries. For daily activities such as eating dinner, playing with friends, and hours slept, children participated similarly on days with pain and days without pain during the posttreatment period. Given the small number of participants in this study, individual cases are discussed to highlight similarities and differences in how participants responded to the treatment and during the 3-month follow-up period. Conclusions. In this pilot study, each participant showed improvement in coping and daily functioning after completing the IST program. Individual differences in response to treatment indicate the need for more targeted intervention programs that incorporate pharmacological and nonpharmacological components. The results of this study highlight both the promise and the complications of conducting comprehensive pain intervention and functional outcome studies in children with SCD.     

Change in metacognitions predicts outcome in obsessive–compulsive disorder patients undergoing treatment with exposure and response prevention

Wells' (Wells, A. (1997). Cognitive therapy of anxiety disorders: a practice manual and conceptual guide. Chichester, UK: Wiley) metacognitive model of obsessive–compulsive disorder (OCD) predicts that metacognitions must change in order for psychological treatment to be effective. The aim of this study was to explore: (1) if metacognitions change in patients undergoing exposure treatment for OCD; (2) to determine the extent to which cognitive and metacognitive change predicts symptom improvement and recovery. The sample consisted of 83 outpatients with a diagnosis of OCD who completed exposure and response prevention treatment. The Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), the Metacognitions Questionnaire (MCQ-30) and the Obsessive Beliefs Questionnaire (OBQ-44) were administered before treatment, after treatment, and at 12-month follow-up. Treatment resulted in significant changes in symptoms, metacognition score, responsibility and perfectionism. Regression analysis using post-treatment Y-BOCS as the dependent variable indicated that when the overlap between predictors was controlled for, only changes in metacognition were significant. Changes in metacognitions explained 22% of the variance in symptoms at post-treatment when controlling for pre-treatment symptoms and changes in mood. A further regression revealed that two MCQ-30 subscales made individual contributions. The patients had significantly higher scores compared to community controls on the MCQ-30. Patients who achieved clinical significant change had lower scores on the MCQ-30 compared to patients who did not change. The results did not change significantly from post-treatment to follow-up assessment. These findings provide further support for the importance of metacognitions in treating OCD.     

Systemic Family Therapy Competences in Child and Adolescent Mental Health Care

This article is based on a doctoral research project aiming to identify a comprehensive and detailed outline of the systemic therapist competences in child and adolescent mental health care in Norway. Because of the growing demands to offer specialized services within child and adolescent mental health care, I intended the identified competences to target the psychosocial difficulties that are categorized as associated abnormal psychosocial situations (axis 5) in the multiaxial diagnostic system (WHO, Multiaxial classification of child and adolescent psychiatric disorders. The ICD-10 classification of mental and behavioural disorders in children and adolescents. Cambridge University Press, Cambridge, 1996). The project is based on twelve qualitative in-depth interviews with six experienced systemic family therapists, and fieldwork observations of the therapists (participants) in practice. The qualitative methodology is based on Grounded Theory and five overarching categories were identified through the analysis: (1): the importance of ethical and contextual awareness in systemic therapy; (2) the systemic therapist’s stance; (3) therapeutic processes; (4) therapeutic practices; and (5) session-specific features. Challenges, such as limiting the systemic approach to five overarching competences, are discussed alongside this strengths and limitations of the study. The detailed outline of systemic therapist competences is intended to offer a framework for delivering flexible, yet specialized systemic therapy in the context of child and adolescent mental health care. This research may therefore facilitate a “bridge-building process” between mental health’s biomedical focus and postmodern systemic ideas.     

Sleep deprivation and hallucinations. A qualitative study of military personnel

Much anecdotal evidence suggests that sleep deprivation not only impairs performance, but also brings about other extraordinary effects like hallucinations. However, knowledge about how sleep deprivation may trigger hallucinations is limited. To qualitatively describe hallucinatory experiences during sleep deprivation 12 male military officers from the Norwegian Armed Forces who all had experienced at least one sleep loss-induced hallucinatory experience were recruited. Data were collected and analyzed by semi-structured interviews and thematic analysis. This resulted in the identification of three distinct main themes: (1) Modalities, (2) circumstances/triggers and (3) reactions to hallucinations. Hallucinations were experienced in several modalities (visual, auditory and multi-modality), although visual hallucinations seemed to dominate. Typical reported circumstances/triggers were sleep loss, physical exhaustion, time-of-day, low calorie intake, mental exhaustion and lack of external stimuli (low sensory and social input, boring situations, and monotonous activity). Negative emotions were dominant during the hallucinatory episodes. Often some reasoning and checking on behalf of the officers were necessary to differentiate between real percepts and hallucinations. In some cases the hallucinations caused erroneous actions. Retrospectively, most officers viewed their hallucinatory experiences in light of positive emotions and several emphasized having learned something from them. The results are discussed in relation to the existing literature and suggestions for future studies are outlined.     

Coming to terms: Client subjective experience of ending psychotherapy

How do clients consider their own contribution and that of their therapist in the last phase of therapy when they are moving toward the end? Thirty-seven clients who had received therapy from highly experienced clinicians were interviewed. Since the time for ending had not been decided at the onset, clients in both short- and long-term therapies were included. Thematic case-by-case analyses were carried out. Clients actively engaged in looking back and looking ahead, as means of reflecting on their capability to handle issues on their own. The majority of clients were satisfied with what they perceived as a reciprocal engagement that enabled them to come to terms with emotionally charged issues in life and in therapy. For some clients unresolved issues remained: wondering whether a therapist with another approach could have helped more; feeling pushed away by the therapist; having to take the lead in ending therapy; the fear of being an “unworthy” client; or wanting to end without the therapist’s approval. Coming to terms with the ending of therapy was highly personally meaningful and loaded with affective tensions, in ways that were not always shared with their therapist.     

Images behind bars: The evaluation of a phototherapeutic intervention in prison

This article follows a previous study that has been published in Narrare i Gruppi and that described an intervention using photographic techniques within treatment programs addressed to inmates. The aim of the treatment was promoting inmates' re-socialization and re-education. Photography and other creative media have been reported to promote emotional intelligence (EI) and reduce recidivism among inmates. We hypothesized that the use of photography may increase the inmates' EI and promote their well-being. This study reports on the efficacy of a 10-session phototherapeutic intervention (called Talking Pictures Group Intervention) with two different categories of inmates (minimum custody and protective custody inmates) in terms of enhancing EI skills, reducing depression, and increasing the ability to cope with trauma. Results show an increase in EI in the minimum custody group while depression symptoms are found to increase in the protective custody group, possibly as a result of a greater awareness of their condition. The ability to cope with trauma remains unvaried before and after the intervention.     

The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: a systematic review

Clinical supervision is a central part of psychotherapist training but the empirical support for specific supervision theories or features is unclear. The aims of this study were to systematically review the empirical research literature regarding the effects of clinical supervision on therapists’ competences and clinical outcomes within Cognitive Behavior Therapy (CBT). A comprehensive database search resulted in 4103 identified publications. Of these, 133 were scrutinized and in the end 5 studies were included in the review for data synthesis. The five studies were heterogeneous in scope and quality and only one provided firm empirical support for the positive effects of clinical supervision on therapists’ competence. The remaining four studies suffered from methodological weaknesses, but provided some preliminary support that clinical supervision may be beneficiary for novice therapists. No study could show benefits from supervision for patients. The research literature suggests that clinical supervision may have some potential effects on novice therapists’ competence compared to no supervision but the effects on clinical outcomes are still unclear. While bug-in-the-eye live supervision may be more effective than standard delayed supervision, the effects of specific supervision models or features are also unclear. There is a continued need for high-quality empirical studies on the effects of clinical supervision in psychotherapy.     

Hick’s law equivalent for reaction time to individual stimuli

Hick’s law, one of the few law-like relationships involving human performance, expresses choice reaction time as a linear function of the mutual information between the stimulus and response events. However, since this law was first proposed in 1952, its validity has been challenged by the fact that it only holds for the overall reaction time (RT) across all the stimuli, and does not hold for the reaction time (RT_i) for each individual stimulus. This paper introduces a new formulation in which RT_i is a linear function of (1) the mutual information between the event that stimulus i occurs and the set of all potential response events and (2) the overall mutual information for all stimuli and responses. Then Hick’s law for RT follows as the weighted mean of each side of the RT_i equation using the stimulus probabilities as the weights. The new RT_i equation incorporates the important speed–accuracy trade-off characteristic. When the performance is error-free, RT_i becomes a linear function of two entropies as measures of stimulus uncertainty or unexpectancy. Reanalysis of empirical data from a variety of sources provide support for the new law-like relationship.