The "prodromal" patient: both symptomatic and at-risk

This article discusses conceptual issues relevant to the prospective diagnosis of the schizophrenic prodrome. Recent efforts to diagnose these patients with operational criteria based on current symptoms are reviewed. Symptomatic patients so identified appear to be treatment-seeking and to have mild cognitive impairments. In addition to being currently symptomatic, these patients are imminently at risk for progression of illness and development of schizophrenia. Data from three international centers suggest that this risk is approximately 40% over the next year of follow-up if untreated. The implications of the reviewed data for the appropriateness of the term "prodromal" and for treatment/prevention research for these patients are discussed.     

Neural Recruitment and CognitiveAging: Two Hemispheres Are Better Than One, Especially as You Age

Several neuroimaging studies have reported that older adults show weaker activations in some brain areas together with stronger activations in other areas, compared with younger adults performing the same task. This pattern may reflect neural recruitment that compensates for age-related neural declines. The recruitment hypothesis was tested in a visual laterality study that investigated age differences in the efficiency of bihemispheric processing. Letter-matching tasks of varying complexity were performed under two conditions: (a) matching letters projected to the same visual field (hemisphere) and (b) matching letters projected to opposite visual fields (hemispheres). As predicted by the recruitment hypothesis, older adults generally performed better in the bilateral than unilateral condition, whereas younger adults showed this pattern onlyfor the most complex task. We discuss the relation between these results and neuroimaging evidence for recruitment, and the relevance of the present bihemispheric advantage to other evidence for age-related changes in interhemispheric transfer.     

Racial socialization and racial identity: can they promote resiliency for African American adolescents?

Although there is a rich body of research on resiliency, much of the literature fails to include minority youths or does not take into consideration their distinctive racial and environmental circumstances. Additionally, limited attention has been given to protective factors that are unique to nonmajority populations. This article posits that racial socialization and racial identity protect urban African American adolescents against some of the harmful effects of a discriminatory environment. These factors are hypothesized to influence academic achievement-an indicator of resiliency that has been used in many studies. A theoretical framework is provided that combines character development in a hostile environment, bicultural identity, and urban stress models. Implications for practice and future research are discussed.     

The norm of self-interest

The self-interest motive is singularly powerful according to many of the most influential theories of human behavior and the layperson alike. In the present article the author examines the role the assumption of self-interest plays in its own confirmation. It is proposed that a norm exists in Western cultures that specifies self-interest both is and ought to be a powerful determinant of behavior. This norm influences people's actions and opinions as well as the accounts they give for their actions and opinions. In particular, it leads people to act and speak as though they care more about their material self-interest than they do. Consequences of misinterpreting the "fact" of self-interest are discussed.     

Social support and the course of bipolar disorder

The current study prospectively examined the impact of social support on symptom severity and recovery from episodes in bipolar disorder, both as a direct influence and as a buffer of life events. Fifty-nine individuals with Bipolar I disorder were followed longitudinally with monthly symptom severity interviews. Social support was measured by the Interpersonal Support Evaluation List and the Interview Schedule for Social Interaction, and life events were assessed using the Life Events and Difficulties Schedule. Individuals with low social support took longer to recover from episodes and were more symptomatic across a 6-month follow-up. Results suggest a polarity-specific effect, in that social support influences depression but not mania. Discussion focuses on theoretical implications of a series of polarity-specific findings within the field.     

When days are numbered: calendar structure and the development of calendar processing in English and Chinese.

Unlike English, Chinese uses a numerical system for naming months and days. This study explored whether this difference in naming affects the development of simple calendar calculation. Eight- and 10-year-old children as well as undergraduates in China and the United States were asked to name the day or month that comes a specified time before or after a given day or month. In each age group Chinese speakers primarily used calculation based on calendar names to solve these tasks, while English speakers primarily resorted to reciting the names. The magnitude of these differences was substantial; on difficult tasks Chinese fourth graders performed at speeds comparable to those of English-speaking adults. Implications for models of how linguistic structure affects cognition are discussed.     

Rethinking a Familiar Model: Psychotherapy and the Mental Health of Refugees

This paper examines with a somewhat critical eye the primary role that psychotherapy and other clinic-based services currently play in addressing the mental health needs of political refugees in the industrialized countries. Two factors are considered which suggest that refugee mental health needs might be better served by complementing clinic-based treatments with a variety of community-based interventions. The first factor concerns the pervasiveness of psychological distress within refugee communities, coupled with the reluctance of many refugees to utilize formal psychological and psychiatric services. This calls into question both the adequacy and appropriateness of clinical-based services as cornerstones of our response to the mental health needs of refugees. More precisely, it suggests the need to complement such services with a variety of culturally grounded, community-based strategies that do not require attendance in formal mental health settings. Second, recent findings have shown consistently that a considerable amount of the distress reported by refugees is related not to prior exposure to violent events, but to a constellation of exile-related stressors such as the loss of one's community and social network, the loss of important life projects, changes in socioeconomic status and related concerns about economic survival, the loss of meaningful structure and activity in daily life, and the loss of meaningful social roles. It is suggested that while psychotherapy can play an important adjunctive role in helping people confront these exile-related stressors, they may most effectively be addressed through targeted community-based interventions. Examples of such community-based approaches are briefly described, and suggestions are offered for community-level strategies that might be explored. The paper concludes by emphasizing the complementary nature of clinical and community-based programs, and by suggesting that psychotherapy might best be conceptualized as one component of a more comprehensive approach to addressing the mental health needs of refugee communities.     

Trauma Accommodation and Anniversary Reactions in Children

Anniversary reactions in traumatized children have been well recognized in the literature. Examined herein are temporal issues in the mourning process often realized by traumatized children. The case study of Laura is presented as a clinical illustration of problems in trauma accommodation that include anniversary reactions in children. Anniversary reactions in children are more common than is generally recognized in clinical practice. Such reactions are more likely to be found among children who exhibit persistent, repetitive, but insufficient efforts of trauma mastery through their incomplete grief and inadequate mourning process. Clinical issues are discussed.     

Exploring Decision Making Around Therapist Self‐Disclosure in Cognitive Behavioural Therapy

Background

Therapist self‐disclosure (TSD) usage varies greatly among different psychotherapy orientations. Anecdotal evidence seems to suggest that there are reasons for its judicious use, and a small number of researchers have proposed guidelines for how TSD should be used to help therapists across psychotherapy models make decisions around disclosure. However, there is almost no literature specifically exploring how cognitive behaviour therapy (CBT) practitioners make decisions around employing TSD within the CBT framework.

Objective

This study aimed to explore how experienced CBT practitioners make decisions around TSD.

Method

In‐depth qualitative interviews were conducted with six clinical psychologists who were trained and experienced in CBT, and the interviews were analysed thematically.

Results

There were two overarching themes in terms of how they made decisions to self‐disclose: (A) the rules for TSD use, which included sub‐themes (a) it must have a clear purpose, (b) it must fit, (c) the therapist must maintain boundaries, and (d) the therapist must always reflect on his/her use of TSD; and (B) how they use TSD, which included subthemes of (a) using it as a tool for change and (b) using it to manage the therapeutic relationship.

Conclusion

Participants’ decisions on whether or not to self‐disclose were strongly influenced by the CBT model, and this process went beyond what is suggested in the transtheoretical literature. Understanding this process may lead to the development of CBT‐specific guidelines for making TSD‐related decisions.