Family Influences on Treatment Refusal in School-linked Mental Health Services

This study analyzed family influences on treatment refusal in school-linked mental health services (SLMHS). Specifically, it assessed whether levels of family cohesion, conflict, and organization were related to whether a family refused to initiate recommended treatment. Children (N = 133) referred for emotional and behavioral problems and their families participated. Results indicated that (1) family environment factors explained a significant amount of variance in treatment refusal after controlling for demographic factors, (2) families of children with predominantly internalizing symptoms were at greater risk for refusing treatment than families of children with predominantly externalizing symptoms, and (3) lower level of family cohesion was an individual risk factor for refusing treatment. Incorporating an evaluation of family environment within SLMHS assessments may aid in the identification of areas wherein intervention may be beneficial in preventing treatment refusal.     

Treatment Planning as Collaborative Care Map Construction: Reframing Clinical Practice to Promote Client Involvement

Collaborative care map construction is proposed as an alternative reference to the clinical practice of treatment planning. This reframe is intended to highlight the importance of client–therapist collaboration in “mapping out” care. Six therapist postures or practices are presented and discussed that promote client involvement: (a) speaking tentatively, (b) revisiting role induction, (c) inviting client preferences, (d) determining direction, (e) wondering aloud, and (f) checking for clarity and soliciting feedback. Suggestions are provided for employing these postures within the time constraints and external controls of managed care entities.     

Parent and Teacher Ratings on the IOWA Conners Rating Scale

The IOWA Conners Rating Scale is a widely used brief measure of inattentive-impulsive-overactive (IO) and oppositional-defiant (OD) behavior in children. This study examined the psychometric properties of this measure when completed by mothers and teachers. Results of confirmatory factor analyses indicated that a three-factor solution, conforming to current DSM-IV formulations of the disruptive behavior disorders, provided a better fit to the observed data than the currently used two-factor model, in which no distinction is made between inattentive and hyperactive-impulsive behaviors. Both new and currently used scale scores had good internal consistency and test–retest reliability and showed that boys’ scores were significantly higher than girls’ scores. Results held for both mother and teacher ratings. Clinical cutoff scores were proposed and performed reasonably well to screen for ADHD and ODD. Results support the IOWA Conners as a screening measure for the disruptive behavior disorders or as a tool for monitoring treatment response.

Safety,Risk Acceptability,and Morality

The primary aim of this article is to develop and defend a conceptual analysis of safety. The article begins by considering two previous analyses of safety in terms of risk acceptability. It is argued that these analyses fail because the notion of risk acceptability is more subjective than safety, as risk acceptability takes into account potential benefits in a way that safety does not. A distinction is then made between two different kinds of safety-safety qua cause and safety qua recipient-and both are defined in terms of the probability of a loss of value, though the relationship between safety and the probability of loss varies in each case. It is then shown that although this analysis is less subjective than the previously considered analyses, subjectivity can still enter into judgments of safety via the notions of probability and value. In the final section of this article, it is argued that the difference between safety and risk acceptability is important because it corresponds in significant ways to the difference between consequentialist and deontological moral viewpoints.     

Treating body dysmorphic disorder with medication: evidence, misconceptions, and a suggested approach

Body dysmorphic disorder (BDD) is a relatively common and often disabling disorder with high morbidity and mortality. Both psychotropic medication and cognitive behavioral therapy (CBT) are considered first-line treatments for BDD, and medication treatment is often essential for more severely ill and suicidal patients. In this practical overview of the pharmacotherapy of BDD, we briefly describe BDD's clinical features, associated morbidity, and how to recognize and diagnose BDD. We describe the importance of forming a therapeutic alliance with the patient, the need for psychoeducation, and other essential groundwork for successful treatment of BDD. We review available pharmacotherapy research, with a focus on serotonin-reuptake inhibitors (SSRIs, or SRIs), which are currently considered the medication of choice for BDD. Many patients have substantial improvement in core BDD symptoms, psychosocial functioning, quality of life, suicidality, and other aspects of BDD when treated with appropriate pharmacotherapy that targets BDD symptoms. We also discuss practical issues such as dosing, length of treatment, and potential side effects associated with the use of SRIs. In addition, we discuss pharmacotherapy approaches that can be tried if SRI treatment alone is not adequately helpful. Finally, some misconceptions about pharmacotherapy, gaps in knowledge about BDD's treatment, and the need for additional research are discussed.     

Introduction to the Special Section: Advances in psychological prevention and treatment interventions to promote children's mental health

This paper introduces the Special Section on Advances in Psychological Prevention and Treatment Interventions to Promote Children's Mental Health. The three articles in the Special Section provide perspectives on the adaptation, evaluation, and implementation of evidence‐based psychological interventions for children in countries in Northern and Eastern Europe, and Latin America. The articles highlight disparate methodologies for the examination of intervention data, including addressing causal inference in the absence of availability of true experiment data (i.e., randomised controlled trial data), randomised trial data from a school‐based prevention programme, and predictors of change in an evidence‐based treatment programme. Together, the articles highlight the movement of evidence‐based practices into routine care settings and emerging strategies for settings in which randomised trial data are not yet available. They demonstrate the contribution of psychological research to the advancement of practices for improving children's mental health.     

Transdiagnostic internet treatment for anxiety and depression: a randomised controlled trial

Disorder-specific cognitive behavioural therapy programs delivered over the internet (iCBT) with clinician guidance are effective at treating specific anxiety disorders and depression. The present study examined the efficacy of a transdiagnostic iCBT protocol to treat three anxiety disorders and/or depression within the same program (the Wellbeing Program). Seventy-seven individuals with a principal diagnosis of major depression, generalised anxiety disorder, panic disorder, and/or social phobia were randomly assigned to a Treatment or Waitlist Control group. Treatment consisted of CBT-based online educational lessons and homework assignments, weekly email or telephone contact from a clinical psychologist, access to a moderated online discussion forum, and automated emails. Eighty one percent of Treatment group participants completed all 8 lessons within the 10 week program. Post-treatment data were collected from 34/37 Treatment group and 35/37 Control group participants, and 3-month follow-up data were collected from 32/37 Treatment group participants. Relative to Controls, Treatment group participants reported significantly reduced symptoms of anxiety and depression as measured by the Depression Anxiety and Stress Scales-21 item, Patient Health Questionnaire-9 item, and Generalised Anxiety Disorder-7 item scales, with corresponding between-groups effect sizes (Cohen’s d) at post treatment of.56,.58, and.52, respectively. The clinician spent a mean time of 84.76 min (SD = 50.37) per person over the program. Participants rated the procedure as highly acceptable, and gains were sustained at follow-up. These results provide preliminary support for the efficacy of transdiagnostic iCBT in the treatment of anxiety and depressive disorders.     

Changes in alcohol intake in response to transdiagnostic cognitive behaviour therapy for eating disorders

Objective

The aim of this study was to examine how alcohol intake changes during and after transdiagnostic cognitive behaviour therapy for eating disorders (CBT-E). Additionally, the paper considers the relationship between alcohol consumption, eating disorder diagnosis and current major depressive episode at the time of first assessment.

Method

One hundred and forty nine outpatients with an eating disorder (body mass index over 17.5) were divided into high or low alcohol intake groups (HIG and LIG) according to their intake at pre-treatment assessment. Their alcohol intake and eating disorder psychopathology were examined over the course of treatment and follow-up.

Results

There was no difference between the groups on response of the eating disorder to treatment. The HIG significantly reduced their alcohol intake following treatment whilst the intake of the LIG remained stable over the course of treatment and follow-up. There were no group differences in major depression and overall severity of eating disorder at baseline.

Conclusions

The response to CBT-E was not influenced by baseline level of alcohol use. The mean alcohol intake of the heavy drinking subjects decreased without being specifically addressed by the treatment.     

Student clinicians’ and clients’ perceptions of the therapeutic alliance and outcomes in stuttering treatment

PurposeThe purpose of this study was to examine how the therapeutic alliances (TA) of graduate student clinicians and adult clients who stutter relate to perceived treatment outcomes.MethodsStudent clinicians (N = 42) and adult clients who stutter (N = 22) completed a survey assessing their TA strength and perception of treatment outcomes. Responses were analyzed to determine similarities and differences in how clinicians and clients relate the TA to perceptions of treatment effectiveness, progress, and outcome satisfaction.ResultsResults suggest that clinicians and clients who stutter both relate the TA to treatment outcome, but in different ways. While clinicians associate the TA most with treatment effectiveness and client progress, clients relate the TA most to outcome satisfaction.ConclusionClinicians should be aware that for adult clients who stutter, outcome satisfaction is related to the degree of shared understanding, agreement on daily tasks, and bond they experience with their clinician. To ensure a strong TA and client satisfaction, clinicians should actively seek their clients’ perspective regarding TA status.     

Treatment impact on recidivism of family only vs. generally violent partner violence perpetrators

Background/ObjectiveThe outcome of a treatment program for a large sample of male perpetrators on probation for intimate partner violence (IPV) was evaluated with particular reference to the differential impact on family only (FO) versus generally violent (GV) perpetrators.MethodOfficial rates of recidivism for three years post termination of treatment and probation were examined for 456 perpetrators after they were classified as FO and GV.ResultsBoth treatment completion and type of perpetrator were predictive of IPV recidivism and time to recidivism. However, analyses conducted separately for the two groups indicated that participation in the intervention predicted both recidivism and time to recidivism for the GV but not FO perpetrators who participated in treatment. Specifically, GV men were responsive to treatment whereas FO men were not. Results were somewhat different depending on who was included in the no treatment comparison group.ConclusionsImplications of these findings for one size fits all interventions in IPV are discussed with specific reference to the need to develop different interventions for GV and FO perpetrators.