How Therapists Discuss Causality with Families in an Integrated Family Management and Therapy Service, a Qualitative Study with Focus Groups

Family therapy (FT) and family management (FM) approaches to psychosis have been distinguished by their understanding of causality. FM holds a biological understanding which could have negative consequences for the person with psychosis. FT, with its focus on interactions, has been criticised for its potential for implying that families are to blame for their relative’s psychosis. Although these two approaches have been integrated, the manner in which causality is discussed in family sessions within an integrated approach has not been researched. Qualitative research was conducted with clinicians working in an established integrated family intervention service to explore how they discuss causality. Four focus groups were conducted and a framework approach to thematic analysis used. Four themes developed from the analysis: how a shared understanding of causality is constructed; the use of an ‘explorative conversational’ therapeutic style to discuss causality; factors that limited the exploration of causality; and the challenges of working with issues of blame. The stress-vulnerability model, genograms, interactional-cycles and formulation were identified as useful tools to develop a shared understanding of causality. The therapeutic style of ‘explorative conversation’–based in FT, integrated with the stress-vulnerability model–based in FM, was identified as key to the integrated model and clinicians felt these two aspects addressed the criticisms that have been levelled at each approach. Complex family problems, abuse and illicit drug use were factors that challenged causality discussions. Families feeling blamed/blaming themselves and attempts to transform blame made up a dominant theme of the research.     

The Relationship Between Personality,Burnout, and Engagement Among the Indian Clergy

This study examined the relationship between the Big Five personality dimensions, burnout, and engagement among 511 Indian Catholic diocesan priests. We expected that Neuroticism would be positively associated with burnout and negatively associated with engagement. Moreover, we expected Extraversion, Openness, Agreeableness, and Conscientiousness to be negatively associated with burnout and positively associated with engagement. Hierarchical regression analyses largely confirmed these expectations. Results are discussed in the context of the broader literature on burnout and engagement, as well as the literature on priesthood.     

Can skilled readers perform a second task in parallel? A functional connectivity MRI study

When asked to search for a target letter while reading, the patterns with which people miss the target letter reveal information about the process of reading itself. Questions remain as to whether this paradigm reflects normal reading processes however. We used a novel continuous-performance neuroimaging paradigm to address this question. In separate scanning runs, subjects either read alone, read while searching for a target letter, or searched non-words continuously. Functional connectivity analysis recovered the full extent of brain areas identified for reading in a localizer scan, with no differences between reading alone and the dual task condition. Differences were found, however, between both reading conditions and the nonword search condition. These results demonstrate that in skilled readers brain activation associated with reading is unaffected by a concurrent letter-search task. They further demonstrate the utility of a naturalistic, continuous-performance paradigm for studying the neural basis of language processing.     

The interplay of attention and emotion: top-down attention modulates amygdala activation in psychopathy

Psychopathic behavior has long been attributed to a fundamental deficit in fear that arises from impaired amygdala function. Growing evidence has demonstrated that fear-potentiated startle (FPS) and other psychopathy-related deficits are moderated by focus of attention, but to date, no work on adult psychopathy has examined attentional modulation of the amygdala or concomitant recruitment of relevant attention-related circuitry. Consistent with previous FPS findings, here we report that psychopathy-related differences in amygdala activation appear and disappear as a function of goal-directed attention. Specifically, decreased amygdala activity was observed in psychopathic offenders only when attention was engaged in an alternative goal-relevant task prior to presenting threat-relevant information. Under this condition, psychopaths also exhibited greater activation in selective-attention regions of the lateral prefrontal cortex (LPFC) than did nonpsychopaths, and this increased LPFC activation mediated psychopathy’s association with decreased amygdala activation. In contrast, when explicitly attending to threat, amygdala activation did not differ in psychopaths and nonpsychopaths. This pattern of amygdala activation highlights the potential role of LPFC in mediating the failure of psychopathic individuals to process fear and other important information when it is peripheral to the primary focus of goal-directed attention.     

A Primer Of Closed Head Injury Sequelae In Post-Traumatic Stress Disorder

Abstract

By definition, an individual diagnosed with post-traumatic stress disorder (PTSD) has been exposed to a serious threat of physical harm that engenders concomitant feelings of fear, helplessness, or horror (American Psychiatric Association, 1994). According to the current diagnostic taxonomy, PTSD may develop when the person witnesses harm against someone else or learns of harm occurring to an intimate other. Yet, all too often, PTSD is associated with the direct experience of physical injury through assault, accident, or other violence. As such, individuals with PTSD are at increased risk of having sustained a head injury, particularly during the traumatic events that elicited the PTSD symptoms (Knight, 1996). Consistent with this assertion, there are indications that individuals who sustain a head injury are increasingly likely to develop subsequent PTSD (Bryant & Harvey, 1998; Chemtob et al., 1998), with the prevalence of PTSD in this population estimated to be as high as 30% (Bryant & Harvey, 1996). Moreover, among people with PTSD, those who have sustained head injuries are apt to have more severe symptoms than those who have not (Chemtob et al., 1998).     

Assessment of a “Transgender Identity Stigma” scale among trans women in India: Findings from exploratory and confirmatory factor analyses

Background: Sexual minority stigma has been shown to influence mental health and sexual risk, but limited research is available on measuring transgender-identity stigma among trans women in India. We adapted an Exposure to Transphobia scale to the Indian context and tested a 14-item Transgender Identity Stigma Questionnaire (TGISQ) among trans women in India. We aimed to assess and validate the factor structure of the TGISQ and to assess its reliability.

Methods: Data were from a cross-sectional survey among 300 trans women (including hijras/thirunangais) from six urban/semi-urban sites in India. The TGISQ consisted of self-reported ratings on 14 items. We initially conducted exploratory factor analysis, using principal axis factoring (PAF) and promax rotation, and assessed reliability (internal consistency) using Cronbach's alpha; we then conducted confirmatory factor analysis to assess construct validity (factorial validity). Construct validity of the final 13-item Transgender Identity Stigma Scale (TGISS) was also examined by computing Pearson's correlations between TGISS and relevant theoretical constructs (e.g., depression, social support).

Results: PAF identified two factors: enacted stigma (5 items) and felt normative stigma (8 items). The final 13-item TGISS had high reliability and acceptable construct validity.

Conclusions: The TGISS was found to have adequate psychometric properties, making it the first valid and reliable scale to measure stigma and discrimination faced by trans women in India. Future studies can further refine TGISS, which might help in comparing the differences in stigma experiences among diverse subgroups of trans women, and in monitoring and evaluating the success of stigma reduction programs.     

Interpersonal pathoplasticity in individuals with generalized anxiety disorder

Recent theories of generalized anxiety disorder (GAD) have emphasized interpersonal and personality functioning as important aspects of the disorder. We examined heterogeneity in interpersonal problems in 2 studies of individuals with GAD (n = 47 and n = 83). Interpersonal subtypes were assessed with the Inventory of Interpersonal Problems-Circumplex (Alden, Wiggins, & Pincus, 1990). Across both studies, individuals with GAD exhibited heterogeneous interpersonal problems, and cluster analyses of these patients' interpersonal characteristics yielded 4 replicable clusters, identified as intrusive, exploitable, cold, and nonassertive subtypes. Consistent with our pathoplasticity hypotheses, clusters did not differ with GAD severity, anxiety severity, or depression severity. Clusters in Study 2 differed on rates of personality disorders, including avoidant personality disorder, further providing support for the validity of interpersonal subtypes. The presence of interpersonal subtypes in GAD may have important implications for treatment planning and efficacy.