Transdiagnostic Theory and Application of Family-Based Treatment for Youth with Eating Disorders

This paper describes the transdiagnostic theory and application of family-based treatment (FBT) for children and adolescents with eating disorders. We review the fundamentals of FBT, a transdiagnostic theoretical model of FBT and the literature supporting its clinical application, adaptations across developmental stages and the diagnostic spectrum of eating disorders, and the strengths and challenges of this approach, including its suitability for youth. Finally, we report a case study of an adolescent female with eating disorder not otherwise specified (EDNOS) for whom FBT was effective. We conclude that FBT is a promising outpatient treatment for anorexia nervosa, bulimia nervosa, and their EDNOS variants. The transdiagnostic model of FBT posits that while the etiology of an eating disorder is unknown, the pathology affects the family and home environment in ways that inadvertently allow for symptom maintenance and progression. FBT directly targets and resolves family level variables, including secrecy, blame, internalization of illness, and extreme active or passive parental responses to the eating disorder. Future research will test these mechanisms, which are currently theoretical.     

La naturaleza de los esquemas cognitivos

Resumen

La teoría de esquemas presenta frente al conductismo un axioma respecto al conocimiento humano que supone su carácter holista o molar, no reducible a una composición de elementos simples. De este carácter molar se deducen características de los esquemas, la más importante la de la existencia de una estructura previa al conocimiento (por contrapartida a la psicología de la simulación en computadora). De todas formas, el carácter ontológico de los esquemas está por esclarecer. Brewer y Nakamura apuntan dos posibilidades: o se trata de estructuras fisiológicas, o bien de conocimientos empíricos anteriores. Sin embargo, parece plausible una naturaleza ontológica combinada, según modelos parecidos a los utilizados por la lingüística chomskiana: estructuras fisiológicas inmaduras que deben ser completadas a través de la adquisición de conocimientos empíricos.     

Sexual Harassment: Prevalence,Outcomes, and Gender Differences Assessed by Three Different Estimation Methods

This study investigates gender differences in prevalence and effects of sexual harassment using three different estimation methods. In a representative sample of 2,349 Norwegian employees, 1.1% self-labeled as targets of sexual harassment, whereas 18.4% reported exposure to sexually harassing behaviors during the last six months. When employing latent class cluster analysis as a method for estimating prevalence of sexual harassment, 2.2% could be classified as targets of frequent harassment and 19.1% could be classified as targets of unwanted sexual attention. Although more women than men self-labeled as targets of sexual harassment, men reported the same number of sexually harassing behaviors as women. Sexual harassment was found to be significantly related to mental health problems and low job satisfaction among men and women.     

Bullying at work: Epidemiological findings in public and private organizations

Abstract

The aim of the study was to investigate the prevalence of bullying and harassment at work, to identify risk groups and risk organizations, and to investigate who the victims report to be their tormentors. Bullying and harassment are defined as situations where a worker or a supervisor is systematically mistreated and victimized by fellow workers or supervisors through repeated negative acts. However, to be a victim of such bullying one must also feel inferiority in defending oneself in the actual situation. Data from 14 different Norwegian surveys (N = 7986) are presented, encompassing a broad array of organizations and professions. The results show that bullying and harassment at work are widespread problems in Norwegian working life. As many as 8.6% of the respondents had been bullied at work during the previous six months. Organizations with many employees, male-dominated organizations, and industrial organizations had the highest prevalence of victimization. Older workers had a higher risk of victimization than younger workers. Even if men and women do not differ in prevalence of bullying, significantly more men were reported as bullies. Victims reported superiors as bullies as often as they reported colleagues as their tormentor(s).     

Shortcomings of antibullying regulations: The case of Sweden

By means of a qualitative study, the article examines the possible reasons for the apparent shortcomings and limited success of the Swedish statutory regulations against workplace bullying which pioneered and inspired statutory antibullying regulations in other countries following its enactment in 1993. Semistructured interviews were carried out with 18 participants, each with extensive knowledge and experience of the issue, representing employer and trade-union organizations, enforcement authorities, academia, and victim-support organizations. A range of potential reasons for its limited success emerged from the study, encompassing shortcomings associated with the involvement (or lack of involvement) of key actors—employers, trade unions, and labour inspectorate, and with the antibullying regulatory framework itself. In addition, some cultural and socioeconomic conditions may also have hampered its effectiveness and success. In light of these findings the study raises questions about how to regulate for intangible issues such as bullying. However, the Swedish Ordinance against bullying has contributed to giving the issue credibility. Yet, in order to be successful, legal interventions must be accompanied by well-informed, trained, and motivated employers and trade unions who, in collaboration, are willing to deal with the problem proactively on an organizational level as well as responding to individual cases when they occur, supported by an enforcement agency or inspectorate which is equipped and geared up for its role.     

Neuropsychological performance in older insomniacs

ABSTRACT

The purpose of this study was to examine daytime performance in older adults fulfilling the diagnostic criteria for DSM-IV Insomnia, using a comprehensive battery of neuropsychological tests, and to compare these objective findings with measures of self-reported cognitive functioning. A total of 121 participants (69% women) with a mean age of 64.0 were part of a thorough neuropsychological examination at a University-based neuropsychological clinic in Western Norway. Twenty-five percent of the participants fulfilled the diagnostic criteria for insomnia. In sum, the insomnia patients were not different from the good sleepers on any neuropsychological test measure, and none of the results on the performance measures were associated with the sleep-related daytime complaints. However, the insomniacs did rate their subjective memory performance as significantly worse than the good sleepers, and they also reported more depressive symptoms. We conclude that DSM-IV defined insomnia was not associated with any performance based measure; only with self-reported symptoms.     

Collected Stories: Play in Four Acts

This article evolved from a group process where members of a psychoanalytic institute were faced with planning workshops for a professional weekend around the theme of “play.” The workshop that evolved consisted of four vignettes of play taking place in the therapeutic sessions of a child, an adolescent, an adult, and an elderly woman. The discussion of these vignettes that began at the conference and then was developed for this article focuses on tracing the development of play from childhood into adulthood (Mayes & Cohen, 1996; Russ, 2004) and on the relationship between play and the development of reflective functioning (Fonagy & Target, 1996). One area of particular interest that was focused upon was the use of play with adults who are described as “concrete,” people who function, at times, at a level of differentiation more typical of a young child. Play is described as being particularly helpful in facilitating a more differentiated and, thus, more reflective mode of psychic functioning for this group of individuals as well as for people at all levels of development.     

Co-occurrence frequency evaluated with large language corpora boosts semantic priming effects

In recent decades, many computational techniques have been developed to analyse the contextual usage of words in large language corpora. The present study examined whether the co-occurrence frequency obtained from large language corpora might boost purely semantic priming effects. Two experiments were conducted: one with conscious semantic priming, the other with subliminal semantic priming. Both experiments contrasted three semantic priming contexts: an unrelated priming context and two related priming contexts with word pairs that are semantically related and that co-occur either frequently or infrequently. In the conscious priming presentation (166-ms stimulus-onset asynchrony, SOA), a semantic priming effect was recorded in both related priming contexts, which was greater with higher co-occurrence frequency. In the subliminal priming presentation (66-ms SOA), no significant priming effect was shown, regardless of the related priming context. These results show that co-occurrence frequency boosts pure semantic priming effects and are discussed with reference to models of semantic network.     

Developing an outcome-based assessment for family therapy training: the Rochester Objective Structured Clinical Evaluation (ROSCE)

This paper addresses a growing need for cost-effective, outcome-based assessment in family therapy training. We describe the ROSCE, a structured, evidence-informed, learner-centered approach to the assessment of clinical skills developed at the University of Rochester Medical Center. The ROSCE emphasizes direct observation of trainees demonstrating clinical competencies. The format integrates both formative and summative assessment methods. It can readily be adapted to a wide variety of educational and training settings.     

Narrative means to manage responsibility in life narratives across adolescence

Adolescence is a passage from dependence to adult responsibility. Alongside identity development, social-cognitive development, and the ability to construct a life story, adolescents become increasingly aware of both their potential responsibility in an expanded sphere of life and of complex, contextual influences on their lives. This was partially tested in a cross-sectional study, both in terms of linguistic means and content expressed in life narratives. Indicators were defined for narrative agency, grading of responsibility, serendipity, and turning points, and tested for age differences in relative frequencies in 102 life narratives from age groups of 8, 12, 16, and 20 years, balanced for gender. Narrative grading of responsibility, serendipity, and turning points increased throughout adolescence. The relative frequency of narrative agency, in contrast, remained constant across age groups. Results are interpreted in the context of adolescent development of narrative identity.