Adding Silence to Stories: Narrative Therapy and Contemplation

A review of the literature reveals that one particular form of contemplation—mindfulness—has been integrated into cognitive-behavioral therapy. Built upon this background, this article raises the issue of combining contemplation and narrative therapy. It first examines the unique experiences that occur when one enters into silence. Then, it explores the implications of these experiences for narrative therapy. A contemplative-based approach to narrative therapy differs from traditional narrative therapy in that it utilizes: (a) contemplative skills, (b) contemplative and narrative metaphors, (c) modified interventions, and (d) broader views of reality and self. The outcome is an enlarged narrative approaches that possess numerous benefits and possibilities for future treatment models. P. Gregg Blanton is a Professor of Human Services at Montreat College. He is a Clinical Member and Approved Supervisor of AAMFT.     

Characteristics and reversibility of dementia in Normal Pressure Hydrocephalus

Studies of the cognitive outcome after shunt insertion for treatment of Normal Pressure Hydrocephalus have reported widely mixed results. We prospectively studied performance of 60 patients with Normal Pressure Hydrocephalus on a comprehensive battery of neuropsychological tests before and after shunt surgery to determine which cognitive functions improve with shunt insertion. We also administered a subset of cognitive tests before and after temporary controlled drainage of cerebrospinal fluid to determine if change on this brief subset of tests after drainage could predict which patients would show cognitive improvement three to six months after shunt insertion. There was a significant improvement in learning, retention, and delayed recall of verbal memory three to six months after surgery (using paired t-tests). The majority (74%) of patients showed significant improvement (by at least one standard deviation) on at least one of the memory tests. Absence of improvement on verbal memory after temporary drainage of cerebrospinal fluid had a high negative predictive value for improvement on memory tests at 3-6 months after surgery (96%; p=0.0005). Also, the magnitude of improvement from Baseline to Post-Drainage on few specific tests of learning and recall significantly predicted the magnitude of improvement after shunt surgery on the same tests (r2=0.32-0.58; p=0.04-0.001). Results indicate that testing before and after temporary drainage may be useful in predicting which patients are less likely to improve in memory with shunting.     

Comparison of treatment seeking compulsive buyers in Germany and the United States

OBJECTIVE: The aim of this pilot study was to compare a German (Bavaria) and an American (North Dakota) sample of women suffering from compulsive buying. METHOD: Thirty-eight German and 39 American female compulsive buyers were screened with the Compulsive Buying Scale (CBS), and the Yale-Brown Obsessive Compulsive Scale-Shopping Version (Y-BOCS-SV) prior to entering a group treatment study. Psychiatric co-morbidity was assessed with the Structured Clinical Interview for DSM-IV Axis I disorders (SCID). RESULTS: There were no statistically significant differences between the German sample and the American sample with regard to age (mean 43.7 and 45 years, respectively), and with regard to the scores on the CBS and the Y-BOCS-SV. A high lifetime co-morbidity rate with Axis I disorders, especially mood disorders, anxiety disorders, substance use disorders, OCD, and binge eating disorder was detected in both samples. Almost all participants met criteria for at least one lifetime Axis I disorder. However, German compulsive buyers showed significantly higher current prevalence rates of any affective disorder, and higher current and lifetime prevalence rates of any anxiety disorder and somatoform disorder. In addition, German compulsive buyers were significantly more likely to have more than one Axis I disorder. CONCLUSION: The groups did not differ with regard to age and with regard to the severity of compulsive buying and showed a high co-morbidity with Axis I disorders. However, the German compulsive buying sample presented with significantly more psychiatric co-morbidity compared to the American sample. Further research is needed to provide a better understanding of this disorder in general and cross-culturally.     

Graded auditory Stroop effects generated by gender words

Two auditory Stroop experiments requiring identification of the speaker's sex were conducted. An auditory Stroop effect was expected, analogous to visual effects found in Stroop literature. In Exp. 1 the speaker's sex was identified faster when sex labels ("male" and "female") and words that imply a sex (e.g., father, grandmother) were congruent with the speaker's sex. In Exp. 2, an auditory semantic gradient was established in which words that were more meaningfully tied to a particular sex produced more Stroop interference. This auditory semantic gradient is analogous to effects found in the visual Stroop literature of a semantic gradient related to color.     

Psychosocial Treatments for Children with Attention Deficit/Hyperactivity Disorder

This article reviews studies examining the efficacy of behavioral interventions for the treatment of attention-deficit/hyperactivity disorder (ADHD). A specific emphasis is placed on evidence-based interventions that include parent training, classroom, academic, and peer interventions. Results indicate that school-aged children respond to behavioral interventions when they are appropriately implemented both at home and in the classroom setting. Combined treatments (behavioral management and stimulant medication) represent the gold standard in ADHD treatment and are often recommended as the first-line treatment option due to the many problems faced by children with ADHD. Diversity issues, although an important consideration in the treatment of ADHD, continue to remain an understudied area. Recommendations for future research are made pertaining to treatment sequencing with regard to behavior management as well as for subgroups of ADHD children who may respond best to specific treatments.     

Clinical Characterization and Risk Profile of Individuals Seeking Genetic Counseling for Hereditary Breast Cancer in Brazil

Hereditary breast cancer (HBC) accounts for 5–10% of breast cancer cases and it significantly increases the lifetime risk of cancer. Our objective was to evaluate the sociodemographic variables, family history of cancer, breast cancer (BC) screening practices and the risk profile of cancer affected or asymptomatic at-risk women that undergo genetic counseling for hereditary breast cancer in public Brazilian cancer genetics services. Estimated lifetime risk of BC was calculated for asymptomatic women using the Gail and Claus models. The majority of women showed a moderate lifetime risk of developing BC, with an average risk of 19.7% and 19.9% by the Gail and Claus models, respectively. The average prior probability of carrying a BRCA1/2 gene mutation was 16.7% and overall only 32% fulfilled criteria for a hereditary breast cancer syndrome as assessed by family history. We conclude that a significant number of individuals at high-risk for HBC syndromes may not have access to the benefits of cancer genetic counseling in these centers. Contributing factors may include insufficient training of healthcare professionals, disinformation of cancer patients; difficult access to genetic testing and/or resistance in seeking such services. The identification and understanding of these barriers is essential to develop specific strategies to effectively achieve cancer risk reduction in this and other countries were clinical cancer genetics is not yet fully established.     

Who do you look like? Evidence of facial stereotypes for male names

The present research provides evidence that people use facial prototypes when they encounter different names. In Experiment 1, participants created face exemplars for fifteen common male names, subsets of which were endorsed as good examples by a second set of participants. These most typical faces were morphed to create face-name prototypes. In Experiment 2, participants matched one of the names to each of the prototype faces from Experiment 1. Participants’ matching choices showed convergence in naming the prototypes for many of the names. Experiment 3 utilized these same prototypes in a learning task designed to investigate if the face-name associations revealed in Experiment 2 impacted the learnability of the names. Participants learned face-name pairings that had a higher association (based on frequencies from Experiment 2) faster than pairings with a low association. Results suggest a more direct relationship between faces and names than has been previously proposed.     

Conceptualizing Patient Barriers to Nonadherence with Homework Assignments

Nonadherence with homework assignments and, by implication, “barriers” to homework assignments are a frequent occurrence in the practice of standard cognitive therapy (Beck, A.T., Rush, A.J., Shaw, B.F., Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press). The clinical examples in this article illustrate some of the ways in which environmental, patient, task, and therapist factors can serve as barriers to homework completion. Although these classes of barriers may be discussed independently, they are actually overlapping processes and are more helpful when discussed in tandem. This article illustrates how the therapist’s ability to conceptualize can serve as the context for making sense of the patient’s perceived ability to undertake an activity, the patient’s beliefs about the specific task, and how our ability to use the conceptualization to anticipate barriers is part of evaluating our own therapeutic skills. Several clinical case examples are discussed.     

The Self-Organization of Explicit Attitudes

ABSTRACT— How do minds produce explicit attitudes over several hundred milliseconds? Speeded evaluative measures have revealed implicit biases beyond cognitive control and subjective awareness, yet mental processing may culminate in an explicit attitude that feels personally endorsed and corroborates voluntary intentions. We argue that self-reported explicit attitudes derive from a continuous, temporally dynamic process, whereby multiple simultaneously conflicting sources of information self-organize into a meaningful mental representation. While our participants reported their explicit (like vs. dislike) attitudes toward White versus Black people by moving a cursor to a "like" or "dislike" response box, we recorded streaming x - and y -coordinates from their hand-movement trajectories. We found that participants' hand-movement paths exhibited greater curvature toward the "dislike" response when they reported positive explicit attitudes toward Black people than when they reported positive explicit attitudes toward White people. Moreover, these trajectories were characterized by movement disorder and competitive velocity profiles that were predicted under the assumption that the deliberate attitudes emerged from continuous interactions between multiple simultaneously conflicting constraints.     

A preliminary investigation of within-year growth patterns in reading and mathematics curriculum-based measures

This study examined patterns of growth across benchmark assessments for curriculum-based measures (CBM) over 2 academic years, with the twofold purpose of replicating earlier findings of growth patterns on R-CBM and conducting a preliminary investigation of growth patterns on M-CBM and CBM-Maze. The sample included 898 cases from 3rd through 5th grade over 2 academic years from one elementary school in the rural Midwest. All students participated in tri-annual benchmark assessments in which they were administered R-CBM, CBM-Maze, and M-CBM. Repeated measures analysis of variance was used to examine patterns of growth for all three measures. Students demonstrated greater R-CBM weekly growth during winter-to-spring than fall-to-winter across grade levels. Patterns for CBM-Maze and M-CBM were somewhat inconsistent across school years and grade levels. Results are discussed in terms of contextual variables that may impact within-year growth patterns and technical characteristics of CBM slopes.