Incorporating Religion/Spirituality Into Treatment for Serious Mental Illness

This paper examines whether religion and spirituality (R/S) should be incorporated into treatment for patients with serious mental illness. This question merits attention, especially in light of the strong presence of R/S in the United States and, in particular, among members of ethnic minorities. While the literature is somewhat mixed, prior research supports the view that incorporating adaptive R/S elements into treatment for patients with serious mental illness is beneficial, particularly for patients who do not exhibit severe psychotic symptoms. Drawing from our experiences in developing a family-focused Culturally-Informed Therapy for Schizophrenia (CIT-S), we will also highlight the importance of addressing spiritual issues within minority populations. In the second half of this paper, we will present several case illustrations of how R/S issues were used in CIT-S to help patients make sense of adverse situations and obtain much-needed support and coping resources outside the treatment room. Findings from this study indicate that religion and spirituality can often be incorporated into treatment in a way that coalesces with patients’ values and enhances treatment gains. Future research should investigate how therapists’ own R/S values interact with those of their clients, and whether congruency in R/S values has any impact on treatment efficacy.     

Correction to: Secret Agent Society: a Randomized Controlled Trial of a Transdiagnostic Youth Social Skills Group Treatment

Research on Child and Adolescent Psychopathology -     

Stigma,Expressed Emotion,and Quality of Life in Caregivers of Individuals with Dementia

Expressed emotion (EE) is a measure of a caregiver's critical and emotionally overinvolved (EOI; e.g., intrusive, self‐sacrificing) attitudes and behaviors toward a person with a mental illness. Mounting evidence indicates that high levels of these critical and EOI attitudes and behaviors (collectively termed high EE) in family members are associated with a poorer course of illness for people with a range of disorders, including dementia (Nomura et al., 2005). However, less is known about factors that might trigger high EE and how high EE might impact dementia caregivers’ own mental health. In this study we propose that caregivers who perceive stigma from their relative's illness may be more likely to be critical or intrusive (high EOI) toward their relative in an attempt to control symptomatic behaviors. We further hypothesized that high EE would partially mediate the link between stigma and quality of life (QoL) as there is some evidence that high EE is associated with poorer mental health in caregivers themselves (Safavi et al., 2015). In line with study hypotheses and using a sample of 106 dementia caregivers, we found that greater caregiver stigma was associated with both high EE (for criticism and EOI) and with poorer QoL. Mediational analyses further confirmed that high EE accounts for much of the association between stigma and poorer QoL. Study results suggest that addressing caregiver stigma in therapy could reduce levels of high EE and indirectly therefore improve caregiver QoL. Intervening directly to reduce high EE could also improve caregiver QoL.     

An examination of the Clinical Impairment Assessment among women at high risk for eating disorder onset

Identifying measures that reliably and validly assess clinical impairment has important implications for eating disorder (ED) diagnosis and treatment. The current study examined the psychometric properties of the Clinical Impairment Assessment (CIA) in women at high risk for ED onset. Participants were 543 women (20.6 ± 2.0 years) who were classified into one of three ED categories: clinical ED, high risk for ED onset, and low risk control. Among high risk women, the CIA demonstrated high internal consistency (α = 0.93) and good convergent validity with disordered eating attitudes (rs = 0.27-0.68, ps < 0.001). Examination of the CIA's discriminant validity revealed that CIA global scores were highest among women with a clinical ED (17.7 ± 10.7) followed by high risk women (10.6 ± 8.5) and low risk controls (3.0 ± 3.3), respectively (p < 0.001). High risk women reporting behavioral indices of ED psychopathology (objective and/or subjective binge episodes, purging behaviors, driven exercise, and ED treatment history) had higher CIA global scores than those without such indices (ps < 0.05), suggesting good criterion validity. These data establish the first norms for the CIA in a United States sample. The CIA is psychometrically sound among high risk women, and heightened levels of impairment among these individuals as compared to low risk women verify the relevance of early intervention efforts.     

Open-ended categorization of chick-a-dee calls by black-capped chickadees (Poecile atricapilla)

The authors trained black-capped chickadees (Poecile atricapilla) in an operant discrimination with exemplars of black-capped and Carolina chick-a-dee calls, with the goal of determining whether the birds memorized the calls of conspecifics and heterospecifics or classified the calls by species. Black-capped calls served as both rewarded (S+) and unrewarded (S-) stimuli (the within-category discrimination), whereas Carolina chick-a-dee calls served as S-s (the between-category discrimination) in the black-capped chick-a-dee call S+ group. The Carolina call S+ group had Carolina calls as S+s and S-s (within-category) and black-capped calls as S-s (between-category). Both groups discriminated between call categories faster than within a call category. In 2 subsequent experiments, both S+ groups showed transfer to novel calls and propagation back to between-category calls. The results favor the hypothesis that the acoustically similar social calls of the 2 species constitute separate open-ended categories.     

Selective punishment early and late in fixed-ratio schedules of food reinforcement

Pigeons key pecked for grain on a fixed-ratio 100 schedule; electric shocks occurred intermittently at the fifteenth or eighty-fifth response in the ratio. In Experiment I, shock was at the fifteenth response for two birds, and at the eighty-fifth response for two others, in every sixth, twelfth, or eighteenth ratio. Rate of responding decreased as frequency of shock increased, and the pattern of responding included an increased initial pause and low rates or pause-run sequences that extended further into the ratio when shock was at the fifteenth response than when it was at the eighty-fifth response. Shock early in the ratio engendered longer initial pauses than shock late in the ratio. In Experiment II, four birds responded on a two-component multiple schedule in which shock occurred at the fifteenth response of the third ratio in the presence of a white keylight and at the eighty-fifth response of the third ratio in the presence of a green keylight. The overall rates of responding decreased as shock intensity increased. All four birds responded differentially to the white and green keylights, but with a pattern that varied between birds. In general, punishment reduced the probability of responses that preceded it, regardless of the ordinal position of those responses. Both studies confirm that the probability of responding is reduced less by aversive stimuli produced late in a fixed-ratio than by aversive stimuli produced early in a fixed-ratio.     

Controllability perceptions and reactions to symptoms of schizophrenia: a within-family comparison of relatives with high and low expressed emotion

In a sample of 35 family members of patients with recent-onset schizophrenia, attributions of control and the content of critical comments were compared for 2 relatives of the same household who held discrepant expressed emotion (EE) attitudes (1 high and 1 low) toward their mentally ill family member. Attributions and the content of critical comments were also compared for low-EE relatives from low-EE homes versus low-EE relatives from high-EE homes. Our results indicate that high-EE relatives tend to attribute more control over behavior to patients than do low-EE relatives of the same patient. In addition, low-EE relatives from high-EE homes attribute more behavioral control to patients than do low-EE relatives from low-EE homes. These findings suggest that EE status is linked to attributions of control over behaviors, but additional patient factors or influences among family members may also affect EE attitudes.     

Culturally Adapted Psychosocial Interventions for Schizophrenia: A Review

Recent research examining the potential efficacy of culturally adapted interventions for various mental disorders illustrates increasing interest in the integration of cultural perspectives into mental health systems. Despite recent evidence demonstrating that culturally adapted interventions may be more effective than a one-size-fits-all approach, few psychosocial treatments for schizophrenia consider cultural factors that may enhance their efficacy with diverse populations. The aim of this review is to discuss the empirical evidence examining the potential utility of culturally adapted group interventions for schizophrenia, as a means to encourage further work and expansion in this area. Specifically, this article provides an in-depth review of the empirical literature on culturally adapted psychosocial interventions for individuals with schizophrenia and their family members, with a focus on group-based interventions. This review is followed by a discussion of a few cultural constructs that may impact patient and family member functioning, and therefore may be important to address in psychosocial treatments for schizophrenia. Finally, we end this review with a broad discussion of research limitations and potential areas for additional research, clinical implications for adapting EBTs to better address cultural concerns, and a case vignette to illustrate how cultural considerations can be integrated into a traditional multifamily group therapy approach.