Increasing access to low‐intensity interventions for childhood anxiety: A pilot study of a guided self‐help program for Scandinavian parents

Cognitive Behavior Therapy (CBT) is an effective treatment for child anxiety. However, access to treatment is limited. It has been suggested that low‐intensity formats of parent‐delivered CBT may improve access to treatment. Our aim was to develop and pilot‐test the acceptability and effect of a low‐intensity therapist‐guided parent‐delivered group program for anxious children (age 7–12 years) adjusted to the Scandinavian culture. The program required 1.5 hours of therapist‐time per family. Mothers, fathers and children reported on revised child anxiety and depression scale (RCADS) at referral, pre‐ and post‐treatment. Mothers and fathers also gave a qualitative account of their experiences. Thirty‐one families were enrolled and only one family dropped out. Mean age of the children was 9 years. Intent‐to‐treat analyses revealed significant reductions in anxiety and depressive symptoms from pre‐ to post‐treatment for all informants. Large effect sizes were found for child anxiety symptoms as reported by mothers and fathers, and for child depressive symptoms as reported by mothers. Medium to large effect sizes was found for the self‐reported anxiety symptoms by the children, and for depressive symptoms reported by both children and fathers. More than 93% of the parents would recommend the program. Results suggest that our program may provide a new approach to improve access to treatment for anxious children in Scandinavia; however, further research must be conducted before firm conclusions can be drawn.     

Kombination von Settings und Verfahren in der Psychotherapie

Literature research and own clinical experiences confirm the significance of a combined use of settings and methods in the area of inpatient and outpatient psychotherapy. For inpatient treatment, the combined use of methods, such as individual psychotherapy, group therapy, creative therapies, and sport, are an essential part of the treatment. In outpatient treatment, the regulations of the German insurance do not permit such combinations. Nevertheless, they occur and are often proactively initiated by the patients. The various combined use of psychotherapy and psychotropics is very well studied, but also the combination of settings, i.e. supplementary inpatient treatment, day treatment, and outpatient treatment have to be considered. While administering their therapies, psychotherapists should keep in mind possibly concurrently ongoing treatments as well as former therapies and their effects on the patients. With the exception of combinations with psychotropic treatment, there exist almost no empirical data in this important field.     

Object- and feature-based priming in visual search

Two contrasting accounts for priming in visual search have been proposed. The main difference between the two is the level of perceptual processing at which the priming effects are assumed to occur, whether priming is assumed to operate through the selective facilitation of features or at the level of selection of objects for response. The aim of the experiments here was to contrast these accounts. In the first two experiments, observers performed a search for the odd diamond in the midst of two distractor diamonds. Each diamond had two colors, but the configurations of the colors within the diamonds were different for the two experiments in ways previously shown to lend themselves differently well to object formation. The results show that priming can be both feature- and object-based, depending on the topological properties of the stimuli. This was confirmed in a third experiment, in which a quite dissimilar stimulus set was used to address the same question, once again yielding similar results. We thus show that priming operates at various levels of perceptual processing, a result consistent with new findings from neuroimaging and neuropsychology.     

Reactivation and Consolidation of Memory During Sleep

ABSTRACT— Recent research has shown compellingly that sleep supports the consolidation of declarative memories for events and facts. During consolidation, memories are stabilized against future interference and undergo qualitative changes with regard to their "explicitness" and underlying neural representation. In this article, we argue that declarative memory consolidation during sleep is based on covert reactivations of newly encoded memory traces in the hippocampus. During slow-wave sleep (SWS), the prominent slow oscillations act to synchronize the repeated reactivation of the newly encoded representations in hippocampal networks with the generation of spindle activity in the thalamus, supporting changes in neocortical networks that contribute to long-term memory storage. In this view, sleep plays an active role in the consolidation of memories, in which the neuronal reactivation of newly acquired memories is critical for the redistribution and integration of these memories into the network of pre-existing long-term memories.     

Some psychoanalytic viewpoints on neuropsychiatric disorders in children

The author addresses issues interfacing neuropsychiatry and psychoanalysis. He recommends psychoanalysis for children with Attention Deficit, Hyperactivity Disorder (ADHD) and Dysfunction in Attention and activity control, Motility control and Perception (DAMP). He attributes its low status in neuropsychiatric treatment recommendations partly to the fact that psychoanalysts do not always declare their specific field of investigation. The scientific community then assumes that psychoanalysis aims to comment on issues outside its field of investigation, e.g. on neurobiological aetiology. The community therefore fails to discern the psychoanalyst's specific task, to help the child express and work through his conscious and unconscious experiences. Clarity on the analyst's part will improve relations with the scientific community and facilitate a relevant comparison of treatment methods. Another reason for neuropsychiatry's negative attitude towards analysis is its unwillingness to accept that unconscious conflict influences behaviour. With theoretical and clinical arguments, the author argues that unconscious factors must be taken in to understand and to treat the child. Countertransference, often cumbersome with neuropsychiatric children, becomes easier to handle if the analyst is clear about his field of investigation. If he sees through simplistic formulations on aetiology, countertransference gets even more manageable. Psychoanalysis can result in considerable intellectual and emotional development, as illustrated by work with a latency boy with DAMP, autism and slight mental retardation. In his psychoanalytic theoretical framework of the case, the author unites ego-psychological formulations with a Bionian conceptualisation of the thought disturbance.     

Personality, risky driving and accident involvement among Norwegian drivers

Despite the large body of studies, the role of personality in risk research still remains debatable and unclear. The objective of this study was to identify determinants of road user behaviour and accident involvement with the aim of developing effective accident countermeasures. Examining relationships between personality, risky driving and involvement in accidents can open up the possibility of early identification of those more likely to be involved in accidents. The aim is not to influence personality as such, but to develop measures constructed for specific groups. The results are based on a self-completion questionnaire survey carried out among a sample of Norwegian drivers in year 2000 and 2001 (n=2605). The Norwegian Directorate of Public Roads financed the study. The questionnaire included measures of risky driving, accident involvement, normlessness, sensation-seeking, locus of control and driver anger. Results showed that those who scored high on sensation seeking, normlessness and driver anger reported more frequent risky driving compared to those who scored low on these variables. They were more often involved in both speeding and ignorance of traffic rules. Respondents involved in risk taking-behaviour experienced near-accidents and crashes leading to both injuries and material damage more often than other drivers.     

Prevention of depression among Icelandic adolescents

Major depression and dysthymia are frequent, debilitating, and chronic disorders, whose highest rate of initial onset is during the late adolescent years. The effectiveness of a program designed to prevent an initial episode of major depression or dysthymia among adolescents was investigated. Participants were 171 fourteen-year-old “at risk” Icelandic adolescents who were randomly assigned to a prevention program or a treatment-as-usual assessment only control group. They were identified as “at risk” by reporting the presence of depressive symptoms or a negative attributional style. The program was based on a developmental psychosocial model of enhancement of resilience to factors associated with the occurrence of mood disorders. The results indicated that the prevention program resulted in a significantly lower rate of major depression and dysthymia than did the control group. The study demonstrated that school personnel in the school setting can implement such prevention programs.     

Psychological Reactance and Adolescents' Attitudes Toward Tobacco-Control Measures

The theory of psychological reactance predicts that, to the extent that smoking-control measures are perceived as threatening the individual's freedom to choose among behavioral alternatives, they may be met with resistance. Data were collected from a national representative sample of 2,400 young people (ages 16–20) by telephone interviews. Dispositional reactance was shown to be associated with smoking. Principal components analyses revealed that a distinction should be made between attitudes toward weak and attitudes toward strong smoking-control measures. Attitudes toward strong measures were particularly negative among regular smokers. Among regular smokers, dispositional reactance was found to be significantly associated with attitudes toward strong tobacco-control measures. Processes of psychological reactance deserve attention when designing smoking control programs.     

Personality factors as predictors of pathological gambling

The aim of this study was to investigate the relationship between different personality variables and pathological gambling (PG). The NEO-FFI and measures of impulsivity and sensation-seeking were administered to a sample of pathological gamblers (n = 90) and to a contrast group of non-pathological gamblers (n = 66) matched on sex and age. Gender, age, education level and the personality variables were entered into crude and adjusted logistic regression analyses with PG-status as the dependent variable. The results showed that educational level and all personality variables were significant predictors of PG in the crude analyses, however only four of the 12 significant predictor variables (Neuroticism, Openness, Impulsivity, and need for Stimulus Intensity) remained significant in the adjusted analysis. All predictor variables accounted for 71% of the variance in PG-status. Clinical implications of the findings are discussed.     

A motivational approach to confirmation: An interpretation of dysphagic patients' experiences

In this paper we articulate confirmation and disconfirmation as components in human motivation. We develop a theory of motivation on the basis of a model of human action and we explore aspects of confirmation and disconfirmation in the context of the meeting of dysphagic patients with their physicians. We distinguish four central elements in confirmation and disconfirmation and use these and the relations between them for the purpose of constructing a typology. Finally, on the basis of the results obtained we interpret a small volume of remarks reflecting the meaning field of some dysphagic patients in relation to their physicians. The underlying motive is to develop tools for understanding health care processes. The “SAUC-Confirmation-Model” and the theoretical framework in which it is embedded should be seen from that point of view.