Cultural Influences in the Aetiological Beliefs of Saudi Arabian Primary Care Patients About Their Symptoms: The Association of Religious and Psychological Beliefs

Objective To develop a self-report questionnaire to measure the beliefs of Arabic primary care patients about the causes of their physical symptoms; to use this to quantify the beliefs of patients consulting their general practitioners (GPs) in Saudi Arabia; and to test whether patients with psychological problems differ from others in their beliefs, particularly religious and supernatural beliefs. Methods Consecutive patients (N = 224) completed a specially developed aetiological beliefs’ questionnaire. Patients were divided into two groups (cases and non-cases of emotional disorder) according to the GHQ-12. Results Religious and supernatural aspects of culture colour patients’ symptom beliefs: that their symptoms were a test or punishment from Allah’ was the most common belief. Even in non-cases, around half the patients also endorsed nerves and stress as a cause of their physical symptoms. Cases were more likely than non-cases to endorse items related to both religious and psychological factors. Conclusion There is no support for the view that Saudi Arabian patients explain symptoms supernaturally as a way of denying psychological factors. GPs and health professionals in Saudi primary care need to understand what patients believe to be the cause of their problems and to appreciate that religious and psychological beliefs are both very common. GPs should address psychological beliefs and concerns even with those patients who present physical symptoms.     

Relationship between Mental Health and Burden among Primary Caregivers of Outpatients with Schizophrenia

There is growing recognition that caring for a patient with schizophrenia often results in high levels of perceived burden and poorer overall mental health for caregivers. A quantitative cross‐sectional design and standardized instruments were used to collect data from 355 primary caregivers of adults in outpatient care with schizophrenia in China. Structural equation modeling was used to examine the association between caregiver burden and mental health among primary caregivers and whether this association is influenced by personality, coping style, and family functioning, based on a diathesis–stress perspective. Goodness‐of‐fit indices (χ²/df = 1.406, GFI = 0.919, CFI = 0.957, etc.) confirmed that the modified model fit the data well. In line with the diathesis–stress model, and with this study's hypotheses, we found that caregiver burden was significantly related to mental health outcomes directly. The final model showed that personality traits, coping style, and family function influenced the relationship between caregiver burden and mental health. The neuroticism personality traits have a direct effect on caregiver burden and family functioning in this sample. Coping style had a direct effect on the caregiver burden, and family functioning had a direct effect on the caregiver burden. Our final model about primary caregivers can be applied clinically to predict mental health outcomes from caregiver burden.     

Reinforcing staying and switching while using a changeover delay

Performance on concurrent schedules can be decomposed to run lengths (the number of responses before switching alternatives), or visit durations (time at an alternative before switching alternatives), that are a function of the ratio of the rates of reinforcement for staying and switching. From this analysis, a model of concurrent performance was developed and examined in two experiments. The first exposed rats to variable-interval schedules for staying and for switching, which included a changeover delay for reinforcers following a switch. With the changeover delay, run lengths and visit durations were functions of the ratios of the rates of reinforcement for staying and for switching, as found by previous research not using a changeover delay. The second directly assessed the effect of a changeover delay on run lengths and visit durations. Each component of a multiple schedule consisted of equivalent stay and switch schedules but only one component included a changeover delay. Run lengths and visit durations were longer when a changeover delay was used. Because visit duration is the reciprocal of changeover rate, these results are consistent with the established finding that a changeover delay reduces the frequency of switching. Together these results support the local model of concurrent performance as an alternative to the generalized matching law as a model of concurrent performance. The local model may be preferred when accounting for more molecular aspects of concurrent performance.     

The roles of hopeful thinking in preventing problems and enhancing strengths

From its most famous tale, that of Pandora, hope was meant to prevent the emergence and reemergence of life difficulties. A new model defining hope as a combination of agentic pathways and goal-directed thinking is reviewed. Comparisons of the similarities of this theory to other existing theories are made. The beneficial roles of hope in primary (before the appearance of a problem) and secondary (after a problem has appeared) prevention are explored. Primary enhancement is introduced as involving those thoughts and actions that establish optimal functioning and satisfaction. Secondary enhancement is posited to describe those thoughts and actions that are undertaken over time so as to further functioning and satisfaction in order to reach peak levels. Using hope theory as a lens, these primary and secondary enhancement processes are described. The natural synergy between prevention and enhancement activities is discussed, along with the future priorities for using hope in prevention and enhancement efforts.     

The counsellor and the GP: The gulf and the isthmus - or the dilemmas of difference

Research supervision in the field of counselling and psychotherapy is a fruitful area for investigation in view of the fact that the research supervisory relationship is powerful and highly charged, whether consciously acknowledged or not. Researchers trained as counsellors and psychotherapists possess the skills to facilitate the emergence of, and work creatively with, impasses and crises, both in the research itself and the supervisory relationship, as a result of their training and experience in dealing with crisis and catharsis in clinical work. This paper will demonstrate these points using a case vignette from my work as a supervisor of research dissertations undertaken by students on a Masters in Therapeutic Counselling course. Drawing on narrative analysis, clinical supervision theory and discursive analysis it will look at the strengths and weaknesses of a ‘psychotherapeutic’ approach to research supervision.     

Reducing depression in 9–10 year old children in low SES schools: A longitudinal universal randomized controlled trial

The Aussie Optimism: Positive Thinking Skills Program (AOP-PTS) is an innovative curriculum-based mental health promotion program based on cognitive and behavioural strategies. The program is aimed at preventing depressive and anxiety symptoms and disorders in middle primary school children aged 9–10 years. Students from 22 low SES primary schools (N = 910) were randomly assigned to an intervention or a control group and assessed at baseline, post-test, 6 months and 18 months. The intervention group received the program implemented by teachers and the control group received their regular Health Education curriculum. Students completed questionnaires on depression, anxiety, and attribution style. At risk students were further assessed with the computerised Diagnostic Interview for Children and Adolescents. Parents reported on their children's externalising and internalising problems at home. Children in the intervention condition reported a significant pre-post reduction in depressive symptoms, and there was a significant pre-post reduction in parent-reported emotional difficulties which was maintained at 6 month follow-up; no changes were evident in the control group. Both groups showed significant improvements in child-reported anxiety and attribution style, and significant improvements in parent-reported pro-social behaviours. For both groups, there were no significant post-baseline changes in incidence and recovery rates for depression, anxiety, or internalising symptoms. These findings suggest that AOP-PTS has the potential to treat depressive symptomatology in the immediate term but the effects were not sustained. There is also evidence of improved emotional resilience up to 6 months following the program. Further follow-up to investigate longer term effects is needed.     

Smokers discount their drug of abuse in the same way as other consumable rewards

Recent research shows that drug abusers discount delayed monetary rewards more than nonabusers do, and they discount delayed substances of abuse (e.g., drugs) more than delayed money. Furthermore, non-drug-abusers discount food and substances of abuse (e.g., alcohol), more than money. Here, we compare the delay and probability discounting of money with that of a directly consumable reward (chocolate) and with that of a substance of abuse (cigarettes), in a drug-using population (smokers). In line with previous research, we found in two experiments that delay discounting differentiated between smokers and nonsmokers, and between money and a nonabused directly consumable reward (chocolate). In addition, our results show that there appears to be no difference in the extent to which smokers discount their abused substance compared to another directly consumable reward. These findings support the contention that drugs and food are part of the same category of primary reinforcers, whereas money is discounted differently, as a conditioned reinforcer.     

The relationship between existential-phenomenological and cognitive-behaviour therapies

The tendency of GPs to cap the number of counselling sessions offered to their patients in primary care has led to an ongoing debate about the effectiveness of time-limited counselling and brief therapy models. the advantages and disadvantages of brief as opposed to open-ended models of counselling in primary care need to be considered from the point of view of the client, the counsellor and the GP. Given that outcome research shows no difference between the two methods, a cost-benefit analysis would indicate that, for the majority of cases, time-limited counselling works very well. But there is still a minority of clients who do need open-ended therapy, and their needs are not being served by the present NHS system. Counsellors should therefore not be debating for either brief or open-ended style in primary care, but should be organizing themselves into expanding the service to give GPs the choice of both approaches.