Personality and the coherence of psychotherapy narratives

The stories people construct about themselves and their social worlds are key aspects of their identities [Bruner, J. S. (1990). Acts of meaning. Cambridge, MA: Harvard University Press; McAdams, D. P. (2001). The psychology of life stories. Review of General Psychology, 5, 100–122]. Whereas certain expected life experiences (e.g., leaving home, getting a job) may be relatively easy to narrate, more unexpected and difficult events, such as undergoing psychotherapy, may pose a challenge to successful narration. Yet it is especially important to successfully narrate one’s experience in psychotherapy in order to maintain the gains from treatment [Frank, J. D. (1961). Persuasion and healing: A comprehensive study of psychotherapy. Baltimore, MD: Johns Hopkins University Press; Spence, D. P. (1982). Narrative truth and historical truth: Meaning and interpretation in psychoanalysis. New York: W.W. Norton]. The present study collected psychotherapy narratives from 76 adult former clients and coded them for the fundamental story criterion of coherence [Baerger, D. R., & McAdams, D. P. (1999). Life story coherence and its relation to psychological well-being. Narrative Inquiry, 9, 69–96]. Former clients that were high in trait Openness to experience and those at higher stages of ego development told more coherent stories about therapy. The relationship between ego development and narrative coherence remained significant even when controlling for Openness. The findings suggest that high ego development may provide narrators with the kind of sophisticated frameworks for meaning-making that are especially well-suited for the important task of making good sense of psychotherapy.     

The temporal structure of motivation. V. A within-episodes analysis of priming and provocation

Rats provided with chronic, continuous access to intracranial self-stimulation (ICS) exhibit discrete episodic response patterns. Response episodes under two conditions were examined for systematic trends in the spacing of times between successive responses (interresponse times; IRTs) to better identify the motivational bases of ICS. Three trends were observed in self-initiated and experimenter-provoked episodes. First, initial responses of spontaneous episodes typically had declining interresponse times. Second, this trend was not present when responses were provoked rather than spontaneous. Third, absolute times between responses varied across conditions, with provoked behavior having significantly lower initial IRTs. The findings suggest that for spontaneously initiated responding a transient facilitatory process cumulates at the beginning of ICS episodes. For provoked responding, it is possible that a manipulation which increased the initial probability of responding over time may have done so by maximizing an initial phasic priming process. At their onset, spontaneous and provoked episodes may be characterized by quantitatively differing motivational profiles.     

Prior Trauma Exposure for Youth in Treatment Foster Care

Very little research has focused on rates of trauma exposure for youth in treatment foster care (TFC). Available research has utilized record review for assessing exposure, which presents limitations for the range of trauma types examined, as records are predominantly focused on abuse and neglect. The current study examines exposure rates and association with emotional and behavioral outcomes for 229 youth in 46 TFC agencies. The youth in this study had exceptionally high rates of trauma exposure by foster parent report, similar to youth in traditional foster care, with nearly half of the sample exposed to four or more types of traumatic events. A composite child abuse and neglect exposure variable was associated with child and adolescent emotional and behavioral outcomes. Implications for services provided as part of TFC are discussed.     

High Behavioral Approach System (BAS) sensitivity, reward responsiveness, and goal-striving predict first onset of bipolar spectrum disorders: a prospective behavioral high-risk design

A prospective, behavioral high-risk design provided a theoretically guided examination of vulnerability to first onset of bipolar spectrum disorder based on the Behavioral Approach System (BAS) model. Adolescents (ages 14-19) at an "age of risk" for bipolar disorder onset were screened on BAS sensitivity by interviewers blind to current symptoms, lifetime history, and family history of psychopathology. Participants were selected with high versus moderate levels of BAS sensitivity and administered a lifetime diagnostic interview. Those with a bipolar spectrum disorder, psychosis, or hypomanic episode with onset prior to the BAS sensitivity assessment were excluded. High BAS (n = 171) and moderate BAS (n = 119) sensitivity participants in the final sample completed baseline measures of symptoms, goal-setting, and reward responsiveness and were followed prospectively with semistructured diagnostic interviews every 6 months. Consistent with the vulnerability hypothesis of the BAS model of bipolar disorder, high BAS participants had a greater likelihood, and shorter time to onset, of bipolar spectrum disorder than moderate BAS participants across an average of 12.8 months of follow-up (12.9% vs. 4.2%), controlling for baseline depressive and hypomanic symptoms, and family history of bipolar disorder. High reward responsiveness on a behavioral task and ambitious goal-striving for popular fame and financial success (but not impulsivity) also predicted first onset of bipolar spectrum disorder controlling for the covariates and BAS risk group, and ambitious goal-striving partially mediated the BAS risk group effect. We discuss implications of the findings for the BAS model of bipolar disorder and early intervention efforts.     

An Assessment of Time Involved in Pre-test Case Review and Counseling for a Whole Genome Sequencing Clinical Research Program

Whole genome sequencing (WGS) is being used for evaluation of individuals with undiagnosed disease of suspected genetic origin. Implementing WGS into clinical practice will place an increased burden upon care teams with regard to pre-test patient education and counseling about results. To quantitate the time needed for appropriate pre-test evaluation of participants in WGS testing, we documented the time spent by our clinical research group on various activities related to program preparation, participant screening, and consent prior to WGS. Participants were children or young adults with autism, intellectual or developmental disability, and/or congenital anomalies, who have remained undiagnosed despite previous evaluation, and their biologic parents. Results showed that significant time was spent in securing allocation of clinical research space to counsel participants and families, and in acquisition and review of participant’s medical records. Pre-enrollment chart review identified two individuals with existing diagnoses resulting in savings of $30,000 for the genome sequencing alone, as well as saving hours of personnel time for genome interpretation and communication of WGS results. New WGS programs should plan for costs associated with additional pre-test administrative planning and patient evaluation time that will be required to provide high quality care.     

Measuring Callous Unemotional Behaviors in Early Childhood: Factor Structure and the Prediction of Stable Aggression in Middle Childhood

This study sought to replicate the results of our earlier study, which were published in this Journal (Willoughby et. al 2011), that used mother-reported items from the Achenbach System of Empirically Based Assessment to develop a screening measure of callous unemotional (CU) behaviors for use with preschool-aged children. We further sought to extend those results by exploring the predictive validity of the CU measure with aggression trajectories in early-/mid- childhood. The current study involved secondary data analysis of the NICHD Study of Early Childhood and Youth Development (NICHD-SECCYD) dataset. Factor analyses included N?=?1,176 children who participated in the age 3 year assessment of the NICHD-SECCYD. Predictive models included N?=?1,081 children for whom four of the six possible teacher ratings of aggressive behavior were available from annual assessments spanning 1st–6th grades. Consistent with prior work, a three-factor confirmatory factor model, which differentiated CU from oppositional defiant (ODD) and attention deficit/hyperactive-impulsive (ADHD) behaviors, provided the best fit to the data. Among children with disorganized attachment status, the combination of high levels of mother-rated ODD behaviors and CU behaviors, was predictive of stable elevated levels of teacher-rated aggression from 1st–6th grade (predicted probability?=?0.38, compared with a base rate of 0.07). These results demonstrate that CU behaviors can be reliably measured by parent report in young children and are dissociable from more commonly assessed dimensions of disruptive behavior. Three-year-old children who exhibit elevated levels of ODD and CU behaviors, and who have disorganized attachments, are at increased risk for exhibiting elevated levels of aggression across middle childhood. Results are discussed from the perspective of early assessment and intervention.