After the attempt: maintaining the therapeutic alliance following a patient's suicide attempt

The risk of a patient's suicide is a prominent occupational hazard for psychotherapists. The precise number of patients who attempt suicide while in treatment and then resume therapy with the same therapist is not known, but this situation is a relatively common occurrence in clinical practice. Such scenarios can pose significant challenges to the reestablishment of the therapeutic trust and a workable treatment alliance. The aim of this paper is to identify the challenges facing a clinician treating a patient who resumes therapy following a serious suicide attempt, and to offer guidelines for maintaining the viability of the therapeutic alliance.     

Infants’ listening in multitalker environments: Effect of the number of background talkers

Infants are often spoken to in the presence of background sounds, including speech from other talkers. In the present study, we compared 5- and 8.5-month-olds’ abilities to recognize their own names in the context of three different types of background speech: that of a single talker, multitalker babble, and that of a single talker played backward. Infants recognized their names at a 10-dB signal-to-noise ratio in the multiple-voice condition but not in the single-voice (nonreversed) condition, a pattern opposite to that of typical adult performance. Infants similarly failed to recognize their names when the background talker’s voice was reversed—that is, unintelligible, but with speech-like acoustic properties. These data suggest that infants may have difficulty segregating the components of different speech streams when those streams are acoustically too similar. Alternatively, infants’ attention may be drawn to the time-varying acoustic properties associated with a single talker’s speech, causing difficulties when a single talker is the competing sound.     

Attentional bias to respiratory- and anxiety-related threat in children with asthma

This study investigated attentional biases in children with asthma. The study aimed at testing whether children with asthma are vigilant to asthma and/or anxiety cues. Thirty-six children (18 with asthma and 18 healthy controls) aged 9–12 completed a computerised dot probe task designed to measure attentional bias to three different categories of words: asthma, anxiety symptom and general negative emotion. Main caregiver anxiety was also assessed, as was frequency of inhaler use for those with asthma. Children with asthma showed an attentional bias towards asthma words but not anxiety or general negative emotion words. Children without asthma showed no significant attentional biases to any word categories. Caregiver anxiety was correlated with asthma word attentional bias in the asthma group. The findings indicate that attentional bias is present in children with asthma. Further research is required to ascertain if this exacerbates or maintains health-related problems.     

Purity, Privacy and Procreation: Constructions and Experiences of Sexual and Reproductive Health in Assyrian and Karen Women Living in Australia

It is widely recognised that sexual and reproductive health services are underutilised by culturally and linguistically diverse migrant communities, leading to risk of poor health outcomes. This study examined the constructions and experiences of reproductive and sexual health, and associated services, in Assyrian and Karen women who had arrived in Australia as refugees. Forty two women, across a range of age groups and marital status, participated in five focus groups, with thematic analysis and positioning theory used to analyse the results. Two major themes were identified. The first, the ??Premarital Chastity Imperative?? centres on the cultural prohibition of coital hetero-sex before marriage, and taboos associated with same-sex relationships. This has implications for unmarried women??s access to sexual health services, such as contraception, cervical screening, and abortion; prohibition of sex education and communication about sex; and lack of recognition of non-heterosexual identities. The second theme, ??Marital Sex and Reproductive Imperative??, positioned coital sex and motherhood as mandatory within marriage, and was associated with women??s inability to refuse marital sex, limited knowledge about contraception and sexual pain, acceptance of fertility services, as well as lack of recognition of post-natal depression. It is concluded that health care workers need to be aware of cultural constructions of sex and sexuality, as well as the construction of gendered roles within heterosexual relationships, when designing and offering sexual health services to non English speaking or migrant communities.     

Failure to delay gratification following septal lesions in rats: Implications for an animal model of disinhibitory psychopathology

It has been proposed that dysfunction within a neural system composed of the medial septum, the posterior hippocampus and the orbito-frontal cortex (SHF system) may constitute the physiological basis of several disinhibitory syndromes in humans—psychopathy, hyperkinesis, alcoholism and extraversion. Consequently, the syndrome produced by lesions of the SHF system in animals is offered as a tentative behavioral model that may elucidate basic psychological components of human disinhibitory psychopathology. As predicted from this model, rats with septal lesions, like disinhibited humans, were less likely to delay gratification than controls when given a choice between waiting 10 sec for an assured reinforcement and an immediately available, though infrequently delivered, reinforcement. Inquiry into the nature of this deficit suggested that these rats are subject to an interference effect, such that the influence of future rewards on behavior could be disrupted or ‘eclipsed’ by the presence of more immediate, prominent, motivationally significant cues. The possibility that various disinhibitory syndromes in humans may also be due to a similar rigid focus of attention upon the most immediate or prominent motivationally significant event was briefly discussed.     

Identifying psychopathy subtypes on the basis of personality structure

The authors used model-based cluster analysis to identify subtypes of criminal psychopaths on the basis of differences in personality structure. Participants included 96 male prisoners diagnosed as psychopathic, using the Psychopathy Checklist Revised (PCL-R; R. D. Hare, 1991). Personality was assessed using the brief form of the Multidimensional Personality Questionnaire (MPQ-BF; C. J. Patrick, J. J. Curtin, and A. Tellegen, 2002). The best-fitting model yielded two clusters. Emotionally stable psychopaths were characterized by low Stress Reaction and high Agency. Aggressive psychopaths were characterized by high Negative Emotionality, low Constraint, and low Communion. These results suggest that psychopaths as defined by the PCL-R includes distinct subtypes, distinguishable in terms of personality structure, that may reflect different etiologies.     

Self-Esteem and Its Relationship to Mental Health and Quality of Life in Adults with Cystic Fibrosis

Research from the general population indicates an important role for self-esteem in mental health, but limited research in this area exists in the cystic fibrosis (CF) literature. This study aimed to explore the predictive value of self-esteem and health-related quality of life (HRQoL) in mental health symptoms in adults with CF. Seventy-four participants, recruited online, completed the Clinical Outcomes in Routine Evaluation-Outcome Measure 34 (CORE-OM), Rosenberg Self-esteem Scale and Cystic Fibrosis Questionnaire-Revised (CFQ-R). Comparably high levels of self-esteem were found, but HRQoL was lower than previous research. Thirty percent of participants scored within the clinical range for mental health difficulty. Hierarchical regression, controlling for gender, explored the value of four CFQ-R subscales (physical, social, emotional and role functioning) and self-esteem in predicting CORE-OM total score. Gender accounted for 8.2 % of the variance in mental health scores while the five independent variables accounted for a further 73.0 % of variance. Of the five variables, CFQ-R emotional functioning and self-esteem were significant predictors of mental health symptoms. Results are discussed in relation to clinical implications and potential uses for internet technologies to promote socialisation.     

The singles scene: Safe sex practices and attitudes among at-risk heterosexual adults

Patient uncertainty is associated with conditions with no known cause or cure, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), and despite its potential role in chronic illness management, it is still a poorly understood concept. This study constitutes an in-depth investigation of patient uncertainty in SLE and RA. We conducted (i) structured interviews with a sample of rheumatology health care professionals (HCPs) (n?=?8) and (ii) in-depth, semi-structured interviews with a sample of SLE (n?=?17) and RA (n?=?15) patients. Interviews were audio-taped, transcribed verbatim and analysed thematically using detailed line-by-line coding. Patient uncertainty was conceptualised in a framework of five domains: symptoms and prognosis, medical management, self-management, impact and social functioning. Even though these five domains were present in both the SLE and RA data, there were some differences at the sub-domain level. Several sources of uncertainty were put forward by the HCPs and subsequently confirmed in the patient interviews including the illness trajectory, age, gender and timing. Patients reported uncertainty relative to various aspects of their illness, its management and impact. Finally, HCPs discussed the behavioural and psychosocial impact of uncertainty, which further suggests its important role in patient management.