A Model for Adapting Evidence-Based Interventions to Be LGBQ-Affirmative: Putting Minority Stress Principles and Case Conceptualization Into Clinical Research and Practice

The mental health field now possesses clinical trials attesting to the efficacy of affirmative practice with sexual minority individuals. With the goal of efficiently moving the results of these clinical trials into real-world clinical practice, this paper offers a model for adapting existing evidence-based practices originally developed for the general population to be lesbian, gay, bisexual, and queer (LGBQ)-affirmative. The adaptation model presented here guides clinicians to incorporate six LGBQ-affirmative transtheoretical principles of change into practice. These principles facilitate raising awareness of the impact of minority stress on sexual minority clients’ mental health and on client self-evaluation while drawing upon sexual minority resilience and intersectional experiences to build empowering coping skills and validating relationships. The adaptation model also provides a transtheoretical approach to case conceptualization that directs clinicians to consider the role of early and ongoing minority stress on sexual minority clients’ cognitive, affective, motivational, behavioral, and self-evaluative experiences that maintain current distress. This case conceptualization approach highlights common associations among these experiences, suggesting clear routes of interventions for many sexual minority client presentations. Case examples from recent clinical trials of LGBQ-affirmative cognitive-behavioral therapy illustrate how these principles and this case conceptualization can be effectively utilized in practice. While the principles and case conceptualization are meant to be transtheoretical and therefore applicable across therapeutic techniques, to date they have been tested only in clinical trials for cognitive-behavioral treatments. Therefore, this paper concludes with a call for future research to determine the effectiveness of implementing this adaptation model across diverse therapeutic modalities and client presentations.     

Race in the Space: Clinical Considerations for Addressing Race in Treatment

During a period of intense racial unrest in the nation, we were working as clinicians delivering a manualized protocol to LGBTQ adults of varying racial and ethnic backgrounds. Intrigued by the differences in our modes of engagement with clients, we, a Black, cis female therapist and White, cis male therapist, set out to further explore how our positionalities informed our communications with, and expectations of, White and non-White clients during this time. In this paper, we reflect on these differences when delivering therapy in cross-racial and same-race dyads. We highlight where our experiences overlap as clinicians trained in the same program and where they diverge due to our respective worldviews. We conclude with considerations for practitioners to engage with race in psychotherapeutic treatment.     

On the longevity of behavioral interventions for challenging behavior

The capacity for a treatment to maintain its effects over time may be the most critical component of behavioral interventions for challenging behavior as treatments that fail to persist are likely to be of little value to society. We reviewed the quality and quantity of different types of post-intervention data for the treatment of challenging behavior in studies published over the last 7 years. We found that for the majority of participants at least one measure of maintenance, fading, or follow-up was reported but with limited information regarding the quality of those measures. Reports of secondary variables related to post-intervention data (e.g., latency to measurement) were also uncommon. We discuss possible explanations for the paucity of post-intervention data, barriers to obtaining post-intervention data, strategies for obtaining these data, and implications for the external validity of behavioral interventions for challenging behavior. We provide recommendations for increasing the probability that post-intervention data are included in applied research on challenging behavior.     

Le médecin expert confronté aux confidences de la personne expertisée

During an expertise, if the expert “discovers” or is entrusted with information concerning an offence, should he report it to the authorities? Could the expert be sanctioned in the absence of denunciation of a tort or criminal act? The answer will be nuanced on a case-by-case basis. The expert confronted with the revelation of a crime or misdemeanor must decide in good conscience what he reveals in his report, or even report it to the prosecution.     

Ordinance influences individuals' perceptions towards prospects of social circumstance but not the status quo: An experimental field study on sexual minorities issues in Japan

Scientific evidence shows that institutional decisions can change individuals' private attitudes towards relevant issues. However, little is known about their effect on individuals' perceptions of social norms. This intriguing question has gained the attention of scholars. Nonetheless, the findings are primarily observed only in samples of the Western, Educated, Industrialised, Rich, and Democratic countries, leading to doubts about their generalisability. This study experimentally tested residents' (N = 411) reactions to the new Tokyo ordinance prohibiting discrimination against sexual minorities enacted on October 5, 2018, and tested whether it dispelled self–other discrepancies regarding tolerance towards sexual minorities (i.e., pluralistic ignorance). The results showed that exposure to information about enactment increased future perceptions of support and understanding of sexual minorities. By contrast, private attitudes, perceptions of current social norms, and willingness to speak out did not change. Willingness to speak out was indirectly enhanced through increased perceptions of gaining future support. Furthermore, Tokyo residents overestimated other residents' negative attitudes towards sexual minorities. However, even when informed of the new ordinance, this self–other discrepancy in intolerance towards sexual minorities was not corrected. These findings suggest that institutional decisions can shape the perception of social norm change in the future beyond Western countries.     

Treating Young Adult Depression With Text-Delivered Cognitive Behavioral Therapy: A Pilot Randomized Clinical Trial

Young adults (ages 18 to 25) in the U.S. suffer from the highest rates of past-year major depressive episode and are the least likely to receive treatment compared to other age groups. As such, we examined the feasibility, acceptability, and efficacy of a text-message delivered cognitive behavioral therapy: CBT-txt with young adults. The study was a 2-month pilot RCT to test a 4-week intervention for depression that contained 197 text messages (average 12 texts every other day). The sample, recruited via Facebook and Instagram, was 102 U.S. young adults who presented with at least moderate depressive symptomatology. Assessments occurred at baseline prior to randomization and at 1 and 2 months post enrollment. The primary outcome, severity of depressive symptoms, was assessed using the Beck Depression Inventory II. Feasibility benchmarks were met and participants reported high levels of engagement with and acceptability of the intervention. Logistic regression indicated that treatment participants were three times as likely to have minimal or mild depression symptoms at 2 months compared to waitlist control participants. Latent change score modeling found that the strongest significant treatment effect appeared at the 1-month follow-up period, particularly for participants who began with severe depressive symptoms. Mediation analysis revealed significant indirect treatment effects of increases in behavioral activation on reducing depressive symptoms, suggesting a mechanism of change. Limitations were that the sample was relatively small and consisted of primarily women. These results provide initial evidence for the feasibility, acceptability, and efficacy of a text-delivered treatment for young adult depression.     

亲子依恋与儿童抑郁症状的关系：儿童对环境的生物敏感性的作用及父母差异

不良的亲子依恋是导致儿童抑郁症状的风险因素,但其对儿童的影响会因儿童对环境的生物敏感性不同而存在差异。为探究家庭中母子、父子依恋对儿童抑郁症状的影响及儿童生物敏感性(本文中采用迷走神经抑制作为指标)在其中的作用,本研究结合行为任务、问卷报告、生理测量等多种研究手段,招募150名学龄儿童(平均年龄8.64岁,63名女孩)参与研究。结果表明：(1)学龄儿童的母子依恋水平高于父子依恋水平。(2)高水平的母子依恋与父子依恋会同等程度地降低儿童的抑郁症状。(3)儿童对环境的生物敏感性对母子依恋影响儿童抑郁症状路径的调节作用显著,生理上对环境更敏感(高迷走神经抑制)的儿童更易得益于高母子依恋,表现出较低的抑郁水平;但同时,这类儿童在母子依恋较低时也更易表现出较高的抑郁水平。(4)儿童的生物敏感性对父子依恋影响儿童抑郁症状路径的调节作用不显著,高父子依恋对生物敏感性水平不同的儿童均存在有利影响。(5)在不同情境中测量的迷走神经抑制对亲子依恋影响儿童抑郁症状的调节作用模式相似,表现出跨情境一致的特点。本研究率先揭示儿童迷走神经抑制与亲子依恋对儿童抑郁症状的联合作用机制及父母角色差异。     

HIV and the obligation to treat

The paper is an attempt to review the basis for the claim that physicians have a professional obligation to treat AIDS patients. Considered are the historical record, two professional codes of ethics, and several recent articles. The paper concludes that the arguments considered, which attempt to support the claim that physicians have an obligation to treat, fail. It is suggested, rather, that common humanity, which physicians share with those who suffer from AIDS, ought to be the basis for engaging in the care of AIDS patients.     

Effects of active student response during error correction on the acquisition and maintenance of geography facts by elementary students with learning disabilities

An alternating treatments design was used to compare the effects of Active Student Response (ASR) error correction and No Response (NR) error correction during instruction of the capitals of states and countries. Three students with learning disabilities were provided one-to-one daily instruction on four sets of 14 unknown capitals (7 ASR capitals and 7 NR capitals). Student errors during instruction on ASR capitals were immediately followed by the teacher stating the capital and the student repeating it (an active student response). Errors on NR capitals were immediately followed by the teacher stating the capital while the student visually attended to a geography card with the correct capital handwritten on it (an on-task response). During instruction each of the three students correctly stated more capitals taught with ASR instruction than he or she stated with NR error correction. Results of same-day and next-day tests show that all three students learned more capitals with ASR error correction than with NR error correction The students also correctly stated more ASR error correction capitals on 1-week maintenance tests.     

Family preservation using multisystemic treatment: Long-term follow-up to a clinical trial with serious juvenile offenders

In a randomized clinical trial, multisystemic family preservation was shown to significantly reduce rates of criminal activity and incarceration in a sample of 84 serious juvenile offenders and their multi-need families. In the current study, archival records were searched for re-arrest an average of 2.4 years post-referral. Survival analysis showed that youths who received multisystemic family preservation were less likely to be re-arrested than were youths who had received usual services. Such results represent the first controlled demonstration that family preservation, when delivered via a clearly specified treatment model, has lasting effects with serious juvenile offenders. Implications for family preservation and juvenile justice research are discussed.