Behavioral Research on the Severe and Persistent Mental Illnesses

We are honored to introduce the special series highlighting behavioral research on the severe and persistent mental illnesses (SPMIs) that appears in this issue of Behavior Therapy. We begin this series by providing a succinct overview of this category of disorders, noting briefly their impact, cost, etiology, and management. We then identify four recent advances in the care of persons living with a SPMI, and provide an overview of the six articles that appear in this series. The series recognizes and showcases outstanding behavioral research, and seeks to encourage new and continuing participation by behavior therapists in the care of persons living with a SPMI.     

A Question of Two Answers: Difference and Determination in Barth and von Balthasar

This essay uses the motif of 'the woman as answer' in Barth and von Balthasar to explore aspects of their accounts of sexual difference in relation to ontological and trinitarian difference. In both cases the motif is shown to be problematic for reasons which become apparent in christology. Barth's characterisation of woman as the 'sufficient answer' to the prior 'question' posed by man indicates a tendency towards the elision of difference in his anthropology, which is reflected in the nonsexuality of Christ - the 'true Man' Ð and in aspects of his trinitarian theology. Von Balthasar's 'double answer' of woman to man moves beyond viewing sexual difference as the locus of man's self-completion, but the overdetermination of 'woman' in his mariology undermines this. The pneumatology of von Balthasar's 'Spiritus Creator' suggests possibilities for the development of a christologically-focused anthropology which maintains difference.     

Quality of Life and Neurological Illness: A Review of the Literature

This article highlights some of the conceptual and methodological problems associated with quality of life (QoL) measurement in individuals with neurological illness. It is suggested that these problems have contributed to the underdeveloped status of QoL research in neurological settings. Many of the existing QoL measures that have been used, or show potential for use with individuals with neurological illness, are reviewed in terms of their theoretical basis, content, and practicality. A large proportion of these measures fail to meet adequate psychometric standards and/or have rarely been psychometrically tested. The confusion that surrounds adequate psychometric standards is discussed, and the dynamic nature of QoL is highlighted as a factor that requires further attention. Research addressing the discrepancies between proxy and patient ratings of patient QoL is also warranted. More focused research in these areas may contribute to a clearer understanding of how to assess QoL in individuals with neurological illness.     

Therapeutic work with refugees living in exile: Observations on clinical practice

Asylum seekers and refugees fleeing to Britain or other host countries face a range of dilemmas, which are qualitatively different from those facing any other client group. Refugees find themselves in an entirely different country, having often fled at short notice without making preparations. They may have suffered multiple practical and psychological losses. Significant numbers of refugees will have been subject to organised violence in their country of origin. Responding clinically to the needs of some of those becoming refugees has many implications and challenges for existing models of therapeutic intervention. This paper draws upon the author's clinical work in Britain and abroad, it details some observations on therapeutic practice and highlights the challenges and rewards of working with this client group.     

Conduct Disorder in Girls: A Review of the Literature

The study of Conduct Disorder (CD) has primarily been limited to boys. The lack of research resulted from a premise that CD in girls was rare. However, CD in girls is a relatively common psychiatric diagnosis, and appears to be associated with several serious outcomes, such as Antisocial Personality Disorder and early pregnancy. Understanding gender differences in the course and severity of CD may lead to important information about etiology. Empirical studies on precursors, developmental course, risk factors and treatment for CD in girls are reviewed, while highlighting similarities and differences between girls and boys. Generally, CD symptoms in girls are stable. Precursors to CD in girls probably include Oppositional Defiant Disorder and temperamental factors, but also may include certain negative cognitions. What distinguishes CD in girls is the high risk they have to develop comorbid conditions, especially internalizing disorders. Risk factors for CD in girls partly overlap with those known for boys, but some factors appear to be highly salient for girls. Finally, there may be some significant effects of gender on treatment efficacy. Implications of these findings for future etiologic research are discussed.     

Encouraging counsellor reflection

The evolution of an 'attributes checklist' tool for assisting counsellor development is described. The attributes relate to characteristics of case-notes that indicate evidence of counsellor reflection and consideration of the counselling process. The checklist was initially tested among a sample of 19 counsellors employed by an organisational EAP and was subsequently refined. The final checklist tool was found to be both usable and useful in differentiating 'process' from 'content' notes. The purpose of the checklist tool is not to enable quantitative assessment of counsellor notes, but rather to facilitate counsellor development within a professional supervisory relationship. The findings of the study are discussed, and suggestions for future research in this area are made.     

Alcohol Consumption and the Theory of Planned Behavior: An Examination of the Cognitive Mediation of Past Behaviorid

This study examined the predictive power of the theory of planned behavior (TPB) in explaining alcohol consumption in 3 prospective samples of students ( Ns = 178. 176. and 159). Generally, the TPB performed well. with attitudes, subjective norms and perceived behavioral control (PBC) explaining between 28% and 46% of the variability in intentions. Intentions and PBC explained between 12% and 50% of the variability in behavior. Measures of self-identity as a "drinker" and past behavior contributed to predictions of intentions over and above the contribution of attitudes. subjective norms. and PBC. Measures of past behavior but not self-identity consistently contributed to predictions of behavior over and above the contributions from intentions and PBC. The direct relationship between past behavior and intention and between past behavior and behavior (independent of the TPB variables or self-identity) could not be attributed to common method variance.     

Dietary ethyl-eicosapentaenoic acid but not soybean oil reverses central interleukin-1-induced changes in behavior, corticosterone and immune response in rats

Omega (n)-3 and n-6 fatty acids are important membrane components of neurons and immune cells, and related to psychiatric and inflammatory diseases. Increased ratio of n-6/n-3 in the blood has been reported in depressed patients and in students following stress exposure. The n-3 fatty acid, eicosapentaenoic acid (ethyl-EPA) suppresses inflammation and has antidepressant properties. Interleukin (IL)-1beta can stimulate corticosterone secretion, induce anxiety and stress-like behavior and inflammatory responses. This study was to evaluate the effect of diets enriched with coconut oil, ethyl-EPA and soybean oil on central IL-1beta induced stress and anxiety-like behavior, induced changes in the concentration of prostaglandin (PG) E2 and corticosterone and the release of IL-10. Groups of rats were fed with either 5% coconut oil (as control diet), 0.2% EPA with 4.8% coconut oil or 1% EPA with 4% coconut oil and 5% soybean oil for 7 weeks. The central administration of IL-1beta induced sickness, stress and anxiety-like behavior as indicated by a reduction in body weight, decreased time spent, and the number of entries, into the open arms of the elevated plus maze and decreased exploration and entry into the central zone of the "open field" apparatus. IL-1beta also increased PGE2 and corticosterone concentrations and decreased the release of IL-10 from leucocytes. Food enriched with ethyl-EPA but not soybean oil, significantly attenuated most of these changes. These results demonstrate that ethyl-EPA has anti-inflammatory, anti-stress and anti-anxiety effects in rats.