Group Cognitive-Behavioral Therapy for Insomnia in a VA Mental Health Clinic

Effective cognitive-behavioral therapies for insomnia have been developed over the past 2 decades, but they have not been systematically evaluated in some clinical settings. While insomnia is common among veterans with mental health problems, the availability of effective treatments is limited. We report on the group application of a cognitive-behavioral therapy for chronic insomnia in a veteran population with significant comorbidity for both psychiatric problems and chronic medical conditions. Outcome measures were obtained for both sleep (via sleep diaries) and daytime functioning. Substantial posttreatment improvements were evident for measures of sleep consolidation, total sleep time, depression, anxiety, and fatigue. The unique suitability of the group therapy approach with this population is discussed. Controlled evaluations of the group cognitive-behavioral treatment for comorbid insomnia in this and other ambulatory settings are warranted.     

Grandparents as family stabilizers during economic hardship in Bulgaria

T he present study of three generations' families living together during a period of marked economic dislocation investigates whether supportive grandparents can ameliorate the negative effects of economic stress on parenting and on teen outcomes. The study focuses on harsh parenting and adolescent depression, which has been shown to be especially responsive to economic stress. Three hypotheses were investigated: (1) in extended families there is a link between economic adversity and adolescent depression that is mediated by harsh parenting; (2) grandparent support diminishes the relationship between economic pressure and harsh parenting; and (3) grandparent support diminishes the relationship between harsh parenting and adolescent depression. Data were collected from a community sample of 62 extended families with an adolescent during a period of marked economic dislocation in Bulgaria. Mothers, fathers, and adolescents completed questionnaires about perceived economic pressure, parents' harsh parenting, and perceived support of grandparents. Adolescents also completed a measure of self‐reported depression. Additional interviews were conducted with every eligible family member about family relations. Results showed that even though there was significant economic stress reported by parents, adolescents reported moderate levels of depression and low levels of harsh parenting by mothers and fathers. Correlation and regression analyses revealed that whenever respondents experienced support by grandparents, it made a difference for family members. More specifically, despite economic stress, mothers who experienced the support of grandparents tended to exercise less harsh parenting practices than mothers who lacked such support. Furthermore, when grandparents were supportive, harsh parenting was not associated with adolescent depression. These findings are discussed in the light of existing studies of families under economic pressure with a special focus on extended family relations and the role of cultural context.     

Influence of Different Sitting Positions on Healthy Infants' Reaching Movements

The authors analyze the influence of different sitting positions (ring and flexion) on the reaching performance (spatiotemporal variables) of full-term infants 6 and 7 months old. In addition, they correlated level of trunk control, measured by the Segmental Assessment of Trunk Control, with performance during reaching. The different sitting positions only influenced the reaching movements of 6-month-old infants, who showed the best performance in the ring position. However, this influence was observed only for the trunk displacement, deceleration time, movement units, straightness index and mean velocity. In contrast, there was no influence of positions on 7-month-old infants’ reaching performance. Regarding the correlations, it was observed that infants with more level of trunk control showed a better performance when reaching, regardless of position and the age assessed.     

Implicit sequence learning in deaf children with cochlear implants

Deaf children with cochlear implants (CIs) represent an intriguing opportunity to study neurocognitive plasticity and reorganization when sound is introduced following a period of auditory deprivation early in development. Although it is common to consider deafness as affecting hearing alone, it may be the case that auditory deprivation leads to more global changes in neurocognitive function. In this paper, we investigate implicit sequence learning abilities in deaf children with CIs using a novel task that measured learning through improvement to immediate serial recall for statistically consistent visual sequences. The results demonstrated two key findings. First, the deaf children with CIs showed disturbances in their visual sequence learning abilities relative to the typically developing normal-hearing children. Second, sequence learning was significantly correlated with a standardized measure of language outcome in the CI children. These findings suggest that a period of auditory deprivation has secondary effects related to general sequencing deficits, and that disturbances in sequence learning may at least partially explain why some deaf children still struggle with language following cochlear implantation.     

Establishing an Alcohol and Other Drug Assessment and Intervention Program Within an On‐Site Counselor Education Research and Training Clinic

The authors describe the Substance Information Program, a university alcohol and other drug (AOD) assessment and intervention program. The Substance Information Program is housed in a counseling department's on‐site training and research clinic and gives counselors‐in‐training an opportunity to gain practical addictions training.     

The role of atypical antipsychotics in glucose/insulin dysregulation and the evolving role of the psychiatrist in a new era of drug treatment options

This article examines the issue of atypical antipsychotics, glucose/insulin, and other metabolic derangements (ie, metabolic syndrome), including a general introduction to the health concerns of our patients, a review of the literature, possible mechanisms of antipsychotic induced glucose dysregulation, monitoring approaches, and management and prevention of metabolic syndrome. Literature review leads to mechanism hypotheses and risk estimations, leading to guidelines for monitoring and treatment. The patient population suffers from a higher degree of baseline metabolic dysregulation resulting in cardiovascular disease through components of the metabolic syndrome, and this risk increases with administration of atypical antipsychotic medication at different rates, depending on both drug and patient risk factors. The growing knowledge of mechanisms behind drug induced glucose/insulin and other metabolic dysregulation, as well as advances in pharmacogenomics, will help refine drug selection and monitoring for adverse, life-threatening metabolic effects.     

Evaluating the success of Caucasian fathers in guiding adolescents

The purpose of this study was to identify guidance strengths and learning needs of fathers of adolescents. Perceptions of two generations were used to determine how well fathers perform as parents and realms of knowledge they have yet to acquire. The Parent Success Indicator, a 60-item Likert-type instrument, was administered to 126 Caucasian fathers and 185 adolescents. Significant differences obtained between generations for the total inventory, some scales, and many items. The amount of time spent together had the greatest influence on how both generations evaluated father success. Findings are discussed in terms of developing a curriculum to enhance the success of fathers.     

The treatment of sexual dysfunction: Some theoretical considerations

Journal of Contemporary Psychotherapy -     

Psychoanalytic supervision of the difficult patient

Control cases from the broad group of non-neurotic but potentially analyzable patients appear with increasing frequency. The intense, complex transferences they develop place great stress on the psychoanalytic relationship and evoke marked countertransference reactions in psychoanalytic candidates, which reverberate within the supervisory relationship. Through application of a case study method, common themes emerge in the candidate-supervisor dyad: idealization of the supervisor and of classical technique, identification with the patient, parallel process enactments, difficulty maintaining the analytic frame, and the importance of concurrent training analysis. Classical supervisory techniques must be adapted to the "difficult" (non-neurotic) control case. Complex countertransference issues must be carefully addressed while maintaining the teach/treat boundary.