Global Mental Health: A Call for Increased Awareness and Action for Family Therapists

Global mental health (GMH) is an emerging field that focuses on the need for culturally sensitive mental health services in low‐ and middle‐income countries (LMICs). While many new initiatives have been established worldwide to understand GMH needs and to provide care in LMICs, family therapists have primarily worked with families in high‐income countries. The few existing family‐based initiatives in GMH focus on psychoeducation and are typically not based on general systems theory. However, emerging trends in family therapy may enable family therapists to impact mental health issues in LMICs. These trends, which are shared interests of both family therapy and GMH, include collaborative care, a growing emphasis on the importance of culture in understanding and treating mental health issues, recognition of the ability of families to support or impede recovery from mental illness, and the use of strength‐based and evidence‐based treatments. This paper describes ways for family therapists to become active in the GMH community.     

Changing Me,Changing Us: Relationship Quality and Collective Efficacy as Major Outcomes in Systemic Couple Therapy

We examine the sensitivity to change in the Evaluation of Social Systems (EVOS) scale, which assesses relationship quality and collective efficacy. In Study 1 we conducted a waitlist‐control, short‐term couple therapy RCT study (N = 43 couples) with five systemic therapy sessions treating communication and partnership problems; our intent was to provide high external validity. Construct validity of EVOS was assessed by comparison with additionally applied scales (Family Scales; Outcome Questionnaire, OQ‐45.2). In Study 2, N = 332 individuals completed an experiment with high internal validity in order to verify sensitivity to change in three different social contexts. Results from Study 1 revealed a significant increase in relationship quality in the treatment group directly after treatment, as compared to the control group. Sensitivity to change was slightly better for EVOS than for other measures. While this positive change could not be fully sustained between posttreatment and a 4‐week follow‐up, EVOS score did not fall below baseline and pretreatment levels, supporting moderate‐to‐large sensitivity to change. Study 2 supported high sensitivity to change in EVOS for couple relations, family relations, and work‐team relationships. Therefore, EVOS can be used as an outcome measure to monitor the process of systemic interventions focusing on relationship quality and collective efficacy. Due to its sensitivity to change, EVOS can provide evidence for treatment success with regard to relationship aspects.     

Dimensions of perceived control: A factor analysis of three measures and an examination of their relation to activity level and mood in a student and cross-cultural patient sample

Abstract

This study investigated whether measures of three perceived control (PC) concepts tapped independent dimensions, were invariant to population characteristics of health and culture, were differentially sensitive to health outcomes, and were discriminable from self-report disability. The Multidimensional Health Locus of Control, Generalized Self-efficacy, and Perceived Health Competence (PHC) Scales were administered to 106 Scottish students and 145 Scottish, Spanish and Irish patients, who also completed versions of the Sickness Impact Profile. Principal Components analyses revealed five factors reflecting scale constructions for students and six factors for patients, as PHC items fell on two factors. Disability items fell on a separate factor from all PC items. Results suggest: (a) PC is multidimensional regardless of health and culture; (b) adequate assessment requires multiple PC measures; and (c) it is meaningful to consider PC as a possible influence on disability.     

Training in and implementation of Acceptance and Commitment Therapy for depression in the Veterans Health Administration: Therapist and patient outcomes

ObjectiveThe U.S. Department of Veterans Affairs has implemented a national dissemination and training initiative to promote the availability of Acceptance and Commitment Therapy for depression (ACT-D). This paper reports on therapist and patient outcomes associated with competency-based training in and implementation of ACT-D.MethodTherapist and patient outcomes were assessed on eleven cohorts of therapists (n = 391) and their patients (n = 745).ResultsThree-hundred thirty four therapists successfully completed all requirements of the Training Program. Ninety-six percent of therapists achieved competency by the end of training, compared to 21% at the outset of training. Mixed effects model analysis indicated therapists' overall ACT-D competency scores increased from 76 to 112 (conditional SD = 6.6), p < 0.001. Moreover, training was associated with significantly increased therapist self-efficacy and positive attitudes toward ACT-D. Therapeutic alliance increased significantly over the course of therapy. Mixed effects model analysis revealed that mean BDI-II scores decreased from 30 at baseline assessment to 19 (conditional SD = 5.6) at final assessment, t(367) = ?20.3, p < 0.001. Quality of life scores also increased.ConclusionsTraining in and implementation of ACT-D in the treatment of Veterans is associated with significant increases in therapist competency and robust improvements in patient outcomes.     

Temperament and Gender: Correlates of Toddler Social Competence

The relation between temperament, gender, and social competence was examined in a sample of 202 children ranging from 12 to 36 months of age. Gender and specific characteristics of temperament corresponded more with toddler social competence than did a more general style of temperament. Females were rated by mothers and group caregivers as more socially competent than males on all four measures used in the study and significantly more so on three of these measures. Characteristics of temperament most closely associated with toddler social competence were approach/withdrawal, adaptability to change, and general quality of mood.     

Belief in luck and luckiness: Conceptual clarification and new measure validation

Research on the dimensionality and measurement of luck beliefs has yet to produce a clear conceptual and metrical consensus. This research theorizes a bidimensional model of luck beliefs that is tested through a series of studies (total n = 1205) validating the new Belief in Luck and Luckiness Scale. Unlike existing conceptualizations and measures, this new model is applicable to both believers and non-believers in luck, and reveals belief in luck and personal luckiness to be discrete, uncorrelated, and respectively unidimensional constructs.     

Impact of cognitive profile on social functioning in prepubescent females with Turner syndrome

Social deficits are prevalent in Turner syndrome (TS); however, the extent to which these difficulties are secondary to characteristic cognitive impairments is not well known. Here, we sought to establish the relative contribution of executive functions, visuospatial abilities, and IQ to social difficulties in young girls with TS. Forty TS girls and 19 typically developing (TD) children were assessed with the Social Responsiveness Scale (SRS), the Motor-Free Visual Spatial Test (MVPT-3), the Behavior Rating Inventory of Executive Function (BRIEF), and an IQ test. Hierarchical multiple regression analyses were conducted with the SRS subscales as outcome variables. In a first step, the cognitive factors were entered (verbal IQ, BRIEF global score, MVPT-3, and age), followed by the group variable in a second step. In comparison to TD, TS participants were significantly impaired on all main measures. All six regression models with the SRS subscales were significant and revealed that global executive functions explained the largest portion of the variance on all subscales and the total score. Even after controlling for cognitive elements, the group factor still explained a significant portion of the variance of the Social Cognition, Social Awareness, and Autistic Mannerisms subscales. In contrast, the group factor was not a significant predictor of Social Motivation and Social Communication scores. These results suggest that executive dysfunctions play a role in social impairments encountered in TS, but also that some specific aspects of social behavior are altered beyond what can be attributed to cognitive difficulties in this population.     

Grapheme–colour synaesthesia yields an ordinary rather than extraordinary memory advantage: Evidence from a group study

In synaesthesia, the input of one sensory modality automatically triggers an additional experience, not normally triggered by the input of that modality. Therefore, compared to non-synaesthetes, additional experiences exist and these may be used as retrieval cues when memory is tested. Previous case studies have suggested that synaesthesia may yield even extraordinary memory abilities. However, group studies found either a task-specific memory advantage or no performance advantage at all. The aim of the present study was to test whether grapheme–colour synaesthesia gives rise to a general memory benefit using a standardised memory test (Wechsler Memory Scale). The synaesthetes showed a performance advantage in episodic memory tests, but not in short-term memory tests. However, performance was still within the ordinary range. The results support the hypothesis that synaesthesia provides for a richer world of experience and as a consequence additional retrieval cues may be available and beneficial but not to the point of extraordinary memory ability.     

Elaborate reflections on a simple manifesto

In an earlier article (^{McFall, 1991}), I urged clinical psychologists to work toward the goal of integrating science and practice and proposed the adoption of a principle and two corollaries aimed at achieving this goal. In general, I argued that all aspects of clinical psychology must be guided by the highest scientific and ethical standards, that clinical practice be limited to empirically supported procedures, and that clinical training be devoted to producing clinical scientists. In the present article, I elaborate and defend these points by offering reflections on a number of submitted questions provoked by the earlier article. I address four major issues: the philosophical foundations for a scientific epistemology, the implications of this epistemology for clinical practice, the implications for clinical training, and the likely impact of adopting this epistemology on the field of clinical psychology.     

The educational therapy contribution to a family systems approach

This article draws on the experience of one specialist education unit to demonstrate the usefulness of engaging families directly in the treatment of children showing difficulty in managing tasks and relationships in school. It will look at the overlap of psychoanalytic and systemic ideas and show how theory and practice from both 'schools of thought' allow for a fuller understanding of blocks to school success and also support the family and child in their efforts to 'defeat' a difficulty. I look in particular at the way a psychodynamic focus on a child's inner world can work alongside the systemic focus on family structure, hierarchy and history.