The Questioning Process in Maudsley Family-Based Treatment. Part 1: Deviation Amplification

Maudsley family based treatment (FBT) continues to demonstrate promising evidence in the treatment of adolescent presentations of anorexia nervosa. In the earlier stages of this treatment modality, the process of empowering families, and in particular, helping parent to follow their natural instincts in making united decisions around re-feeding their child is critical. This paper aims to provide FBT practitioners with structured interviewing guidelines around the amplification of familial interactions around food, drawing on existing familial strengths and therefore empowering parents and families in their process of change. The questioning skills outlined are discussed in light of the theoretical tenets of the Maudsley FBT model.     

Dating Violence Prevention Programming: Directions for Future Interventions

Dating violence among college students is a widespread and destructive problem. The field of dating violence has seen a substantial rise in research over the past several years, which has improved our understanding of factors that increase risk for perpetration. Unfortunately, there has been less attention paid to dating violence prevention programming, and existing programs have been marred with methodological weaknesses and a lack of demonstrated effectiveness in reducing aggression. In hopes of sparking new research on dating violence prevention programs, the current review examines possible new avenues for dating violence prevention programming among college students. We discuss clinical interventions that have shown to be effective in reducing a number of problematic behaviors, including motivational interventions, dialectical behavior therapy, mindfulness, and bystander interventions, and how they could be applied to dating violence prevention. We also discuss methodological issues to consider when implementing dating violence prevention programs.     

Maternal Expressive Style and Children's Emotional Development

Maternal expressive styles, based on a combination of positive and negative expressive patterns, were identified at two points in time and related to multiple aspects of preschool children's emotional development. Mother–child pairs from 260 families participated when the children were 3 years old, and 240 participated again at aged 4 years. Expressive styles were identified at age 3 using cluster analysis, replicated at age 4 and examined in relation to children's emotional understanding, expressiveness and regulation. Three expressive styles were identified: high positive/low negative, very low positive/average negative and average positive/very high negative. Cluster membership was stable in 63% of families from age 3 to 4 years; no systematic patterns of change were evident in the remaining families. Expressive style was related to aspects of children's emotional expression at 3 years and to emotion expression and regulation at 4 years. Children's expressiveness and regulation at age 3 were also related to changes in mothers' expressive styles over 1 year. Identifying mothers' expressive styles provides a unique way to understand the potential role of the emotional climates in which preschool‐aged children learn to express and regulate their own emotions. Copyright © 2011 John Wiley & Sons, Ltd.     

Knowing minds, controlling actions: the developmental relations between theory of mind and executive function from 2 to 4 years of age

This longitudinal study examined the concurrent and predictive relations between executive function (EF) and theory of mind (ToM) in 82 preschoolers who were assessed when they were 2, 3, and 4 years old. The results showed that the concurrent relation between EF and ToM, after controlling for age, verbal ability, and sex, was significant at 3 and 4 years of age but not at 2 years of age. Hierarchical regression analyses showed that EF at age 2 significantly predicted ToM at age 3 and that EF at age 3 significantly predicted ToM at age 4, over and above the effects of age, verbal ability, and prior performance on ToM tasks. However, ToM at ages 2 and 3 did not explain a significant amount of variance in EF at age 4. Bootstrap procedures revealed that verbal ability at age 3 fully mediated the relation between ToM at age 2 and EF at age 4.     

Introduction: babies in the consulting room: what happens when analyst, mother, and infant meet?

Analytic work with a pregnant woman may foster the psychological gestation of the self-as-mother. For the mother--as for the infant--the developmental process continues well beyond delivery. It should not surprise us, then, that many mothers continue to bring their babies to sessions after birth. Analytic work in this context can affect a patient's sense of herself, and perhaps her competence, as a mother. Yet the presence of babies in the consulting room is an underacknowledged feature of contemporary practice. For this section of JAPA, we have collected three papers that explore some of the unique challenges and opportunities that arise when a patient brings her baby to treatment. Earlier versions of each paper were first presented at a panel, "Babies in the Consulting Room," at the June 2011 meeting of the American Psychoanalytic Association in San Francisco.     

Toddlers benefit from labeling on an executive function search task

Although labeling improves executive function (EF) performance in children older than 3 years, the results from studies with younger children have been equivocal. In the current study, we assessed performance in a computerized multistep multilocation search task with older 2-year-olds. The correct search location was either (a) not marked by a familiar picture or given a distinct label, (b) marked by a familiar picture but not given a distinct label, (c) marked by a familiar picture and labeled by the experimenter, or (d) marked by a familiar picture and labeled by the participant. The results revealed that accuracy improved across conditions such that children made the fewest errors when they generated the label for the hiding location. These findings support the hierarchical competing systems model, which postulates that improved performance can be explained by more powerful representations that guide search behavior.     

Maximal care considerations when treating patients with end-stage heart failure: ethical and procedural quandaries in management of the very sick

Deciding who should receive maximal technological treatment options and who should not represents an ethical, moral, psychological and medico-legal challenge for health care providers. Especially in patients with chronic heart failure, the ethical and medico-legal issues associated with providing maximal possible care or withholding the same are coming to the forefront. Procedures, such as cardiac transplantation, have strict criteria for adequate candidacy. These criteria for subsequent listing are based on clinical outcome data but also reflect the reality of organ shortage. Lack of compliance and non-adherence to lifestyle changes represent relative contraindications to heart transplant candidacy. Mechanical circulatory support therapy using ventricular assist devices is becoming a more prominent therapeutic option for patients with end-stage heart failure who are not candidates for transplantation, which also requires strict criteria to enable beneficial outcome for the patient. Physicians need to critically reflect that in many cases, the patient’s best interest might not always mean pursuing maximal technological options available. This article reflects on the multitude of critical issues that health care providers have to face while caring for patients with end-stage heart failure.     

The Use of Propensity Scores in Mediation Analysis

Mediation analysis uses measures of hypothesized mediating variables to test theory for how a treatment achieves effects on outcomes and to improve subsequent treatments by identifying the most efficient treatment components. Most current mediation analysis methods rely on untested distributional and functional form assumptions for valid conclusions, especially regarding the relation between the mediator and outcome variables. Propensity score methods offer an alternative whereby the propensity score is used to compare individuals in the treatment and control groups who would have had the same value of the mediator had they been assigned to the same treatment condition. This article describes the use of propensity score weighting for mediation with a focus on explicating the underlying assumptions. Propensity scores have the potential to offer an alternative estimation procedure for mediation analysis with alternative assumptions from those of standard mediation analysis. The methods are illustrated investigating the mediational effects of an intervention to improve sense of mastery to reduce depression using data from the Job Search Intervention Study (JOBS II). We find significant treatment effects for those individuals who would have improved sense of mastery when in the treatment condition but no effects for those who would not have improved sense of mastery under treatment.