The influence of maternal optimality and infant temperament on parenting stress at 12 months among mothers with substance abuse and psychiatric problems

The present prospective longitudinal study aimed to investigate the long‐term impact of maternal optimality assessed during pregnancy on parenting stress at infant age 12 months. In this study the concept of optimality was utilized to investigate maternal variations regarding resources during pregnancy in relation to later parenting stress, among three different groups of mothers that were recruited from substance abuse treatment, psychiatric outpatient treatment and well‐baby clinics respectively. The influence of infant temperament on parenting stress was also examined. All mothers were interviewed during pregnancy. At 12 months, infant temperament (Colorado Childhood Temperament Inventory; Rowe & Plomin, 1977) and stress in the parent and child domain (Parenting Stress Index; Abidin, 1955) were assessed. Results demonstrated higher levels of parenting stress among mothers in the clinical groups, compared to the non‐clinical group. Furthermore, it was the maternal psychiatric optimality index in combination with child temperament characteristics (child emotionality) that contributed uniquely to stress in the parent domain, while stress in the child domain was significantly associated only with child temperament characteristics (both child emotionality and soothability). The association between maternal psychiatric optimality assessed in pregnancy, infant temperament and parenting stress when the infants were 12 months old, points to the importance of simultaneously addressing the mothers' own psychological distress, and to support positive mother–infant interactions. Each woman's individual optimality profile may be used to display needs of follow‐up in order to prevent enduring effects of non‐optimality on parenting stress.     

Altered sleep in Borderline Personality Disorder in relation to the core dimensions of psychopathology

The aim of the study was to review the literature regarding sleep disturbances in Borderline Personality Disorder (BPD) and to relate the reported sleep alterations to the underlying core dimensions of BPD pathology. We present a qualitative and theoretical review regarding the empirical studies that investigated objective and subjective sleep quality in BPD and in different psychiatric conditions showing high co‐morbidity with this disorder. We show that disturbed sleep including sleep fragmentation, alterations in Slow Wave Sleep and REM sleep, and dysphoric dreaming are prevalent symptoms in BPD. We provide a framework relating the specific sleep alterations to the core dimensions of BPD pathology in order to clarify the inconsistencies of the different findings. The specific sleep disturbances in BPD seem to be related to different dimensions of psychopathological functioning and may have detrimental consequences on waking affect and cognition. Investigating disturbed sleep in BPD in relation to waking symptoms and underlying neural functioning would shed more light on the nature of this complex disorder. Moreover, a stronger emphasis on sleep disturbances would enrich the treatment protocols of BPD.     

Silence and survival: Working with strategies of denial in families of traumatized pre-school children

Silence and denial about previous traumatic experiences are common features in families exposed to organized violence. Mutual protection between family members, and especially between parents and children, is seen as the fundament for the silencing of traumatic experiences. This strategy is suggested to have adaptive advantages in dangerous situations in general, where it serves the function of saving the child's internal representations of his/her parents as secure bases. If, however, the dangerous situation escalates and a psychic trauma cannot be avoided, the strategy of mutual silence concerning the event(s) becomes an obstacle for giving traumatized children parental support and professional treatment. It is argued that clinicians need to take seriously the strong reasons families have for upholding their strategy of denial, if they want to help traumatized families to a better functioning. A case presentation is made to illustrate how it is possible to use refugee children's re-enacting play as a source of information about past traumatic events in order to change destructive post-traumatic family dynamics and improve parental support to the child.     

Dimensions of temperament and depressive symptoms: Replicating a three-way interaction

High negative emotionality (NE), low positive emotionality (PE), and low self-regulatory capacity (i.e., effortful control or EC) are related to depressive symptoms and furthermore, may moderate one another’s relations to such symptoms. Indeed, preliminary evidence suggests they may operate in a three-way interaction (Dinovo & Vasey, 2011), but the replicability of that finding remains unknown. Therefore, we tested this NE × PE × EC interaction in association with depressive symptoms in 5 independent samples. This interaction was significant in 4 of the 5 samples and a combined sample and approached significance in the fifth sample. In contrast, the NE × PE × EC interaction was unrelated to general anxious symptoms and thus may be specific to symptoms of depression. Implications, directions for future research, and limitations are discussed.     

Religious Involvement and Depression: Evidence for Curvilinear and Stress‐Moderating Effects Among Young Women in Rural China

Debates about whether the relationship between religiousness and depression is nonlinear have continued, but no definitive conclusions thus far have been drawn. Unlike most previous research in this area, which has been based on U.S. populations, this study focuses on a sample of 882 young rural Chinese women. Results from analyses reveal an inverse U‐shaped relationship between intrinsic religiosity and depression. In addition, results show that intrinsic religiosity and religious activities exacerbate the deleterious effects of particular life events such as childbirth issues and marital conflicts. Implications of the findings for future studies on the subject are discussed.     

OTR Burnout

When job stress beconies chronic, it can result in the syndrome of burnout. This is characterized by feelings of reduced personal accomplishment, emotional exhaustion, and depersonalizing attitudes towards patients and colleagues. This pilot study explored burnout in a sample of hospital-based registcrcd occupational therapists employed in Virginia. Scores from 129 OTRs on the Maslach Burnout lnventory and a demographic data sheet were analyzed. Burnout scores were compared for OTRs working in physical disabilities, mental health, and developmental disabilitics. Also, the subjects were compared bascd on time spent in direct patient scrvice. The sample rcported moderate levels of burnout. The only statistically significant finding was that the OTRs who spent the least time with patients reported more depersonalization (intensity only) than their peers. Thc results did not replicate those from a previous report that psychiatric occupational therapists arc experiencing more burnout than other occupational therapists. Much further research appears to bc needed on the topic.     

Post-Traumatic Stress Disorder,Sensory Integration,and Aquatic Therapy: A Scoping Review

The prevalence of post-traumatic stress disorder (PTSD) continues to increase. Symptomology of PTSD include sensory deficits much like those displayed in children with sensory integration (SI) disorder. The aim of this scoping review is to review symptoms of PTSD and SI, and make a case of how aquatic therapy may be an effective modality in treating clients with PTSD. Eighteen articles were selected for review. From this review, it is suggested that aquatic therapy can be an effective modality in reducing symptoms of PTSD; however, future research is essential in determining its effectiveness.     

Propranolol and the Prevention of Post-Traumatic Stress Disorder: Is it Wrong to Erase the “Sting” of Bad Memories?

The National Institute of Mental Health (Bethesda, MD) reports that approximately 5.2 million Americans experience post-traumatic stress disorder (PTSD) each year. PTSD can be severely debilitating and diminish quality of life for patients and those who care for them. Studies have indicated that propranolol, a beta-blocker, reduces consolidation of emotional memory. When administered immediately after a psychic trauma, it is efficacious as a prophylactic for PTSD. Use of such memory-altering drugs raises important ethical concerns, including some futuristic dystopias put forth by the President's Council on Bioethics. We think that adequate informed consent should facilitate ethical research using propranolol and, if it proves efficacious, routine treatment. Clinical evidence from studies should certainly continue to evaluate realistic concerns about possible ill effects of diminishing memory. If memory-attenuating drugs prove effective, we believe that the most immediate social concern is the over-medicalization of bad memories, and its subsequent exploitation by the pharmaceutical industry.     

Coping with the Uncontrollable: The Use of General and Religious Coping by Caregivers to Spouses with Dementia

SUMMARY

Using a transactional model of stress and coping, we examined the general (i.e., Problem-Focused, Emotion-Focused) and religious (i.e., Self-Directing, Collaborative, Deferring) coping strategies used by 64 caregivers to spouses with dementia to cope with their most significant, albeit uncontrollable, caregiving hassle over a two-month period. With respect to general coping, we hypothesized that caregivers who used Emotion-Focused coping would demonstrate fewer Depressive Symptoms at Month 2 after controlling for Depressive Symptoms at Month 1. With respect to religious coping, we hypothesized that care-givers who used Deferring Coping would also demonstrate fewer Depressive Symptoms. Results revealed interesting patterns between caregivers' use of general and religious coping strategies. Contrary to our hypotheses, caregivers who used Emotion-Focused and Collaborative coping reported greater Depressive Symptoms. Implications for the empirical study of stress and coping and directions for future research are discussed.     

Interoceptive Exposure Therapy Combined with Trauma‐related Exposure Therapy for Post‐traumatic Stress Disorder: a Case Report

Trauma‐related exposure therapy is a useful but not universally effective treatment for post‐traumatic stress disorder. Anxiety sensitivity may play an important role in this disorder, as it does in panic disorder. Studies have shown that interoceptive exposure therapy reduces anxiety sensitivity in panic disorder. The present case study was a preliminary investigation of the merits of including interoceptive exposure therapy in the treatment of post‐traumatic stress disorder, in order to improve treatment outcome for a patient who had no history of panic disorder or panic attacks. Interoceptive exposure therapy (4 sessions) was one component of treatment, combined with trauma‐related exposure therapy (4 sessions of imaginal exposure followed by 4 sessions of in vivo exposure). Treatment outcome was assessed with the Clinician‐Administered Post‐traumatic Stress Disorder Scale, a self‐report measure of post‐traumatic stress disorder symptoms, and measures of symptoms and cognitions commonly associated with post‐traumatic stress disorder. Scores on all outcome measures decreased over the course of treatment, with gains maintained at 1‐ and 3‐month follow‐up. Symptoms of anxiety sensitivity and post‐traumatic stress disorder decreased during interoceptive exposure therapy. The results indicate that interoceptive exposure therapy is a promising adjunctive intervention for post‐traumatic stress disorder. Further research is needed into the merits of combining interoceptive exposure therapy and trauma‐related exposure therapy as a means of boosting treatment efficacy.