Clinical Management of Gender Dysphoria in Adolescents

SUMMARY

This paper aims to provide professionals working with adolescents with gender-dysphoric feelings practical clinical guidelines for diagnosis and treatment. The different phases of the assessment procedure and treatment process are described. Differential diagnostic considerations and possible psychotherapeutic treatment options are given. Physical interventions, including GnRH analogues to inhibit puberty and cross-sex hormones, are described with consideration of eligibility and readiness issues. We end with discussion of post-treatment evaluation.     

Differences in High and Low Anxiety Sensitive Women's Responses to a Laboratory‐Based Cold Pressor Task

Anxiety sensitivity (AS) has been linked to a variety of disabling chronic health conditions, including pain‐related conditions. A recent study has found that healthy women with high AS reported significantly higher levels of sensory and affective pain on an experimental cold pressor task compared to women with low AS. However, this study found no differences between AS groups for pain tolerance or pain threshold. In the present study, which was designed to replicate and extend these findings, 90 undergraduate university women were selected for inclusion in 1 of 2 AS groups (high or low) based on their screening scores on a 16‐item measure of AS. Participants were tested individually on a lab‐based cold pressor task using a variety of self‐report and observer‐measured variables. Data analyses revealed that, as expected, the high AS participants reported significantly more fear in response to the cold pressor on a relevant item of the McGill Pain Questionnaire – Short Form (SF‐MPQ) than did the low AS participants. Also as expected, the high AS participants reported more pain in response to the cold pressor on the Present Pain Index (PPI) of the SF‐MPQ than did the low AS participants. High AS participants did not differ from low AS participants on other aspects of the cold pressor response (e.g. pain threshold, pain tolerance, pain recovery). These results support the role of pain‐related fear as a mediating variable between AS and increased perceived pain intensity.     

Psychometric properties of the Norwegian version of the Dysfunctional Attitude Scale (Form A)

The present study reports the reliability and validity of the Norwegian version of the Dysfunctional Attitude Scale in non‐clinical and clinical populations. The participants were 344 young male military recruits, 41 healthy controls and 142 psychiatric outpatients. All the participants completed the Dysfunctional Attitude Scale, the Beck Depression Inventory and the Automatic Thoughts Questionnaire. The analysis of the Dysfunctional Attitude Scale revealed a Cronbach's alpha of 0.85, indicating satisfactory reliability. Evidence for the construct validity was obtained by the correlation between the Dysfunctional Attitude Scale and the Beck Depression Inventory (r?=?0.47) and the Dysfunctional Attitude Scale and the Automatic Thoughts Questionnaire (r?=?0.47). Finally, the Dysfunctional Attitude Scale significantly discriminated between clinically depressed, non‐depressed psychiatric patients and healthy controls. The results showed that the Norwegian version of the Dysfunctional Attitude Scale possess satisfactory psychometric properties suggesting that this instrument is appropriate for use as a cognitive measure in a Norwegian cultural context.     

Combining Pharmacotherapy with Cognitive‐Behavioral Interventions for Obsessive‐Compulsive Disorder

This paper reviews the evidence‐based literature concerning the efficacy and effectiveness of cognitive behavior therapy (CBT), drug treatment and their combination for obsessive‐compulsive disorder (OCD). After a brief outline of the seminal studies, the state of the art is presented with reference to the consensual recommendations proposed in the last 10 years. Management of OCD rests on potent selective serotonin re‐uptake inhibitors and CBT, used separately, sequentially, or concurrently. A hierarchical model for clinical decision‐making is reported. With greater severity of OCD, it is recommended to add medications. However, the response rate is still too low in many patients, and some patients remain refractory to any kind of treatment. This stresses the importance of joint efforts of psychological and biological teams to develop new treatments.     

Materials used to support cognitive behavioural therapy for depression: a survey of therapists’ clinical practice and views

ABSTRACT

Use of supporting materials in cognitive behavioural therapy (CBT) is widely advocated, and homework increases effectiveness. The study aimed to identify materials most frequently used by CBT therapists to support CBT for depression, and those perceived clinically most effective. Questionnaires were sent to 3665 accredited CBT therapists asking about their use of resources commonly described in CBT manuals, and their views on effectiveness. Of 3665 approached by post/email, 994 (27%) responded. Another 33 completed the questionnaire via the study website. 818/1027 (80%) of respondents were accredited practitioners who deliver one-to-one therapy. Symptom measures, lists of problems/goals, activity schedules, behavioural activation diaries/plans, and case formulation worksheets were used “frequently” or “very frequently” by over 85% of respondents. Sleep diaries and computerised CBT were used least. Most resources were used within and between sessions. Activity schedules, behavioural activation diaries/plans, case formulation worksheets, thought records, and resources to support the identification of conditional beliefs were regarded as most effective. Symptom measures, sleep diaries, and computerised/online materials were considered only moderately effective. Therapists use a wide range of materials to support individual CBT. For delivering CBT, technology-enabled approaches should incorporate a range of materials to enable therapists to tailor treatment effectively.     

Vicarious Trauma in Social Workers: The Role of Trauma History,Social Support,and Years of Experience

Vicarious trauma, a disruption in schemas and worldview often accompanied by symptoms similar to those of posttraumatic stress disorder, occurs as a result of chronic secondary exposure to traumatic material. The aim of this study was to examine the role of personal trauma history, social support, and experience level in the development of vicarious trauma among licensed social workers in Maryland (N = 160). Results indicated an increase in social support and in experience level of social workers predicted less severe vicarious trauma. In addition, an interaction effect between trauma history and social support trending on significance indicated higher levels of social support might help protect those without a trauma history but not those with a trauma history against vicarious trauma. Research and clinical implications are discussed.     

Coping with Intimate Partner Violence: Battered Women's Use and Perceived Helpfulness of Emotion-Focused Coping Strategies

This study investigated intimate partner violence (IPV) victims' emotion-focused coping efforts, as well as their retrospective ratings of the perceived helpfulness of these efforts, in the context of a longitudinal study of battered women's experiences over time. Four hundred and six primarily African American, low-income battered women who had experienced IPV within the previous 12 months were interviewed. Patterns of coping use and perceived helpfulness were explored. The correlation between prevalence of use of emotion-focused coping strategies and perceived helpfulness of these strategies was examined, and results showed that the strategies used by more battered women were less helpful in dealing with feelings about abuse. Implications for clinical interventions with battered women are discussed.     

The trajectory of psychoanalysis: A prognosticationy3

I present an overview of the development to this point of psychoanalysis as a discipline'both as a theory of the mind and a treatment of the disorders of the mind' and offer a prediction concerning evolving development over its (near) future. My focus is on the coherence of psychoanalysis as a theoretical structure, starting with Freud's strenuous endeavours to maintain the psychoanalysis that he had single‐handedly created as a unitary and unified theory, tracing then the breakdown of this effort, even in Freud's lifetime, into the burgeoning theoretical diversity or pluralism that characterises worldwide psychoanalysis today, and then going on to the beginning appearance of evidences' not yet widely remarked' of growing convergences from within very disparate and even seemingly very opposed theoretical perspectives, at least at the level of technical interventions and experience‐near clinical theory, with implications, however, even for the level of experience‐distant general (metapsychological) theory. Such a development, if sustained, as I anticipate, would strengthen the credibility of psychoanalysis as a science of the mind, amenable to growth through empirical research in accord with the canons of scientific method.     

临床思维学的教学实践与理论探索

思维是人类理性活动的基本方式,思维能力是最具人类特色的能力,临床思维能力的培养是一个非常重要、然而又常为人们所忽视的问题,主要介绍临床思维学的课程设置、主要内容、教学目的和教学效果,通过对教学实践的阶段性总结,对理论体系进行初步的探索,以推动临床思维学的普及和发展,提高临床诊断治疗水平。     

Randomized Controlled Trial of Cognitive–Behavioral Group Therapy for Irritable Bowel Syndrome in a Medical Setting

Standard medical treatments have not been effective for irritable bowel syndrome (IBS) patients. Though individualized cognitive–behavior therapy is an empirically supported treatment option, cognitive–behavioral group therapy (CBGT) has yet to be established as an effective alternative in a randomized controlled trial. This study compared the efficacy of a 10-session CBGT with a home-based symptom monitoring with weekly telephone contact (SMTC) treatment for IBS, extending previous quasi-experimental research in this area. Twenty-eight refractory IBS patients, evaluated and referred by gastroenterologists using the Rome criteria, participated in the study. IBS symptoms, psychological functioning, and health-related quality of life were assessed pre- and posttreatment, and at 3-month follow-up. CBGT patients reported significantly more gastrointestinal (GI) symptom improvement than SMTC patients on posttreatment global measures and had significantly reduced daily diary pain scores at 3-month follow-up. Based on MANOVA, there was significant improvement in psychological distress and health-related quality of life for the CBGT patients in comparison to the SMTC patients. These improvements were also maintained at the 3-month follow-up. Reductions in GI symptoms, psychological distress, and improved health related quality of life may contribute to less behavioral avoidance, disability, and health care utilization in refractory IBS patients.