A systematic review of interventions for adults who stutter

PurposeTo examine the effectiveness of (i) face to face interventions (ii) models of service delivery and (iii) psychological treatments combined with speech-focused interventions for adults who stutter.MethodsFive electronic databases and three clinical trial registries were searched. Systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with adults who stutter were included. Pharmaceutical interventions were excluded. Primary outcomes included a measure of stuttering severity. Risk of bias assessment was conducted on included studies and overall quality of the evidence was graded.ResultsFive RCTS, four registered trials and three systematic reviews met inclusion criteria. Intervention approaches included speech restructuring programs (e.g. Camperdown Program) and transcranial direct current stimulation (tDCS). One study investigated cognitive behaviour therapy (CBT) alongside speech restructuring. Overall, studies were classified low risk of bias and good quality. Speech restructuring was included in all but one study (tDCS study) and had the most evidence i.e. supported by the greatest number of RCTs. On average, stuttering frequency was reduced by 50–57 % using speech restructuring approaches. No study reduced stuttering to the same level as community controls who don’t stutter. The study on tDCS reduced stuttering frequency by 22–27 %. Speech restructuring delivered via telehealth was non-inferior to face-to-face intervention. One study reported CBT was an effective adjunct to speech restructuring interventions.ConclusionSpeech restructuring interventions were found to reduce stuttering in adults, however degree and maintenance of fluency varied. The body of evidence surrounding tDCS and psychological interventions is limited. Replication studies should be considered.     

The stories we tell,the reputations we form: Narrative identity and person perception

We explored the degree of consensus and accuracy in observers’ ratings of targets’ traits and autobiographical narratives. Targets narrated life high, low, and turning points and reported their personality traits. The conceptual content of these stories had previously been quantified. Here, groups of observers provided ratings of targets’ traits, knowability (how well the observer felt they ‘knew’ the target), and story conventionality, after reading each narrative. Observers exhibited consensus in perceptions of traits, knowability, and story conventionality. These ratings corresponded with targets’ self-ratings of traits, to a modest degree. The knowability of narrators did not moderate this relation, nor did key scene type. The conceptual content of targets’ narratives partially accounted for the relation between observer-reported and target-reported traits.     

The role of ultrarunning in drug and alcohol addiction recovery: An autobiographic study of athlete journeys

PurposeThere is contentious understanding of the role of sport in adult recreational drug and alcohol addiction recovery. This study explored athlete autobiographies as cultural sites of analysis in relation to the role that one sport (i.e., ultrarunning) plays in addiction recovery capital pathways.DesignWorking at the intersection of an autobiographical approach grounded in relativist narrative inquiry, a social constructionist narrative thematic analysis was conducted of two autobiographies--Catra Corbett and Carlie Engle—about addiction recovery through ultrarunning (i.e., distances of 43 km or more). The narratives used to construct life transformation and recovery capital in relation to ultrarunning were centralized in the analysis using Frank’s (2013) work on illness narratives and the body.ResultsTwo narrative themes threaded athletes’ addiction recovery journeys: chaos narrative and quest narrative. Two sub-themes related to fluid identity transformation intertwined with ultrarunning were identified within these narratives: 1. ‘addict-runner’ (chaos) and 2. ‘addict runner to ultra-runner’ (quest). Nuanced meanings of suffering were connected to identity transformation and running and two forms of addiction recovery capital: human (e.g., psychological adjustment, life perspective) and social (e.g., family connection, community).ConclusionsThe research findings provide insight into the role of sport in psychosocial aspects of addiction recovery using an autobiographical approach grounded in narrative theory. This study also extends work in sport psychology focusing on autobiographies as research and pedagogical resources to learn more about athlete mental health.     

Functional analysis and treatment of adult problem behavior: A review

Functional analysis (FA) methodology has been deemed the best practice in the field of applied behavior analysis. The data collected in an FA allows behavior analysts to develop the most effective and ethical behavior interventions. With the diagnosis for individuals with autism on the rise along with the forecast of adults who will need support, it may be time to take stock of the available literature. The purpose of this review was to evaluate the behavior analytic research over the last 25 years (1997–2022) on FA and treatment for adults who engage in severe problem behavior. Utilizing specific inclusion and exclusion criteria resulted in the identification of 28 articles. These articles were examined across participant characteristics, target behavior, FA type, FA settings, interventions, generalization, and maintenance. Implications on adult FA and treatment are discussed along with recommendations for practitioners who desire to support this population.     

Embracing the other: Revisiting the epistemological foundations of family systems therapy

Family systems therapy originated in the 1960s, 1970s, and 1980s through the work of innovative thinkers and clinicians. However, despite the creative contributions of the mentioned colleagues and of later innovations in family therapy theory and practice, it seems as though the dominant culture of establishment psychiatry in the United States (and in most Western countries) to this day has not seriously incorporated relationships, social context, or community connectedness into the treatment of individuals with psychiatric diagnoses. For the “psychiatric” patients diagnosed according to the DSM-5, the dominant underlying epistemological perspective is the medical “scientific” paradigm. Within this approach there is a dearth of reflections about the truthfulness of so-called “empirical facts” and a lack of skepticism about the techniques of “measurement” of the psychiatric illness. The alternative, relationship-oriented, context-sensitive, and community-connected thinking paradigm is highlighted here in contrast to the “psychiatric” foundation. This paradigm consists of (a) the awareness that all human Subjects (including “psychiatric” clients) are constituted as such by their relational connection to others; (b) the awareness of our sensitivity to and embeddedness in a socio-economic, cultural, and racial context; and (c) the awareness of our involvement in and connectedness with many kinds of communities.     

Relationships,not boundaries

The authors find it more useful to payattention to relationships than to boundaries.By focusing attention on bounded, individualpsychological issues, the metaphor ofboundaries can distract helping professionalsfrom thinking about inequities of power. Itoversimplifies a complex issue, inviting us toignore discourses around gender, race, class,culture, and the like that support injustice,abuse, and exploitation. Making boundaries acentral metaphor for ethical practice can keepus from critically examining the effects ofdistance, withdrawal, and non-participation.The authors describe how it is possible toexamine the practical, moral, and ethicaleffects of our participation in relationshipsby focusing on just relationships rather thanon boundaries. They give illustrations andclinical examples of relationally-focusedethical practices that derive from a narrativeapproach to therapy.     

Child Psychopathy: Theories,Measurement, and Relations with the Development and Persistence of Conduct Problems

To develop more accurate explanatory and predictive models of child and adolescent conduct problems, interest has grown in examining psychopathic traits in youth. The presence or absence of these traits may help to identify unique etiological pathways in the development of antisocial behavior. The current review provides a detailed summary and analysis of (a) the conceptualization and measurement of child and adolescent psychopathy, (b) research on relations between psychopathic traits and a range of conduct problems and associated variables, (c) efforts to utilize data on child and adolescent psychopathy to delineate a subgroup of youth whose conduct problems share a relatively homogenous etiology and developmental trajectory, and (d) current challenges and limitations in the study of youth psychopathy and directions for future research efforts. Specific sections include the origins of the youth psychopathy construct, conceptualization and measurement, relations between psychopathic traits and conduct problems, relations between measures of psychopathy and measures of individual and contextual variables, efforts to identify a unique subgroup of children with conduct problems using psychopathic traits, and finally, challenges that face the field and goals for the next generation of research.     

Post–traumatic stress disorder in patients with coronary artery disease: A review and evaluation of the risk

Psychosocial factors are known to impact on the prognosis of patients with coronary artery disease independently of disease severity. However, few studies have looked at whether these patients are at risk of developing post-traumatic stress disorder, and the potential implications for morbidity and mortality. Through a review of the empirical literature, the objectives were to investigate whether patients with coronary artery disease are at risk of developing this disorder, to look at relations between post-traumatic stress disorder and heart disease, and to stimulate further research. The review indicated that some patients with coronary artery disease are at risk of developing post-traumatic stress disorder, although the prevalence varied considerably. Methodological issues together with recommendations for future research are discussed. Although only some cardiac patients may develop post-traumatic stress, this disorder should not be overlooked due to its potential role in reinfarctions and mortality.     

Narrators and comparators: the architecture of agentive self-awareness

This paper contrasts two approaches to agentive self-awareness: a high-level, narrative-based account, and a low-level comparator-based account. We argue that an agent’s narrative self-conception has a role to play in explaining their agentive judgments, but that agentive experiences are explained by low-level comparator mechanisms that are grounded in the very machinery responsible for action-production.