An Exploration of Mothers' Successful Completion of Family-Centered Residential Substance Use Treatment

Behavioral health and substance use centers have started focusing efforts on creating, adopting, and implementing evidence-based practices and programs that effectively address the needs of women and, particularly, mothers entering treatment with children. However, women with substance use disorders (SUDs) remain an underserved and understudied population; even less studied are the complexities and unique SUD treatment needs of women who have children. Family therapists' systemic training is a valued approach in conceptualizing and implementing treatment for mothers with SUDs and their families. This study explored the construct of mothering children during family-centered substance use treatment using a transcendental phenomenological approach. Analysis revealed themes related to motherhood, parenting, and support for mothers and children. Two themes emerged from the data: (a) grappling with motherhood and addiction leading to the decision for treatment and (b) specific aspects of the treatment program conducive to motherhood. Results indicated the positive impact of mothers' experiences in family-centered substance use treatment, aligning with previous literature that suggests mothers are more engaged in treatment when their children remain in their care. The insights gleaned from the participants in this study provide suggestions for further improving programming that supports mothers and their children during the recovery process. Treatment considerations are offered for family therapists working with mothers with SUDs and their families.     

Lessons from the Transition to Relational Teletherapy During COVID-19

When the World Health Organization declared the coronavirus outbreak a pandemic, clinicians were challenged to maintain continuity of care. Teletherapy became the primary means of service delivery for many who had never or only sparingly used it. The Family Institute at Northwestern University, in response to encouraging findings with respect to the effectiveness of teletherapy and recognizing advantages with respect to access to care, launched our teletherapy services in 2018. As a relationship-based organization, we were keen to exploit the opportunity that teletherapy provides to integrate additional members of the client system into the treatment. Over these two plus years, we have learned a great deal. Our learning was greatly accelerated by our transition to a 100% teletherapy practice in the wake of the pandemic. Teletherapy is a different context. Intentionally managing the context’s constraints and exploiting its strengths is key to providing high-quality couple and family therapy. This step is often overlooked or resisted when teletherapy is an occasional add-on to a face-to-face practice.     

Understanding bike-sharing acceptability and expected usage patterns in the context of a small city novel to the concept: A story of ‘Greek Drama’

Developing initiatives that allow societies to embrace more sustainable travel behaviour patterns is a prerequisite for creating more livable urban futures. Bike-sharing, a measure designed to inspire modal shift from short car-trips, despite its recent exponential growth, is still understudied. This paper discusses a quantitative survey of 640 responses examining road users' attitudes towards bike-sharing and its possible introduction to Drama, a small Greek city resembling many others in terms of size, transport culture and socio-economic characteristics, which has never been exposed to a similar intervention. Most of the respondents recognised that bike-sharing is a mode with pro-environmental, cost-effective and health-improving qualities and the potential to promote a greener identity for the city. Evidence is provided that people would support a bike-sharing investment even in cases where the frequency of their current bicycle use and the regularity with which they intend to use an eventual scheme is low. Age, gender, the primary factor for modal choice, its perceived effectiveness in reducing traffic congestion and their usage expectations were all factors influencing the respondents’ acceptability of such an introduction. The lack of cycling infrastructure and road safety concerns were identified as possible usage barriers but the pro-social potential of bike-sharing combined with policy efforts to create a more pro-cycling culture could outweigh them. The present analysis suggests that bike-sharing can go beyond, what is typically regarded as its primary function, that of a last-mile solution for metropolitan areas, and be a publicly acceptable investment for smaller cities.     

Developing ways to encourage early detection and presentation of oral cancer: What do high-risk individuals think?

The aim of this pilot research was to improve understanding of individuals at risk of oral cancer, to determine their attitudes towards and responses to early detection interventions. In-depth interviews with the target group (n?=?25) were used to determine their views, attitudes and requirements for an intervention to encourage early detection of oral cancer. This data was used in combination with theory-based constructs to develop written material that aimed to increase awareness of oral cancer, encourage mouth self-examination (MSE) and early presentation. A second pilot study used a think-aloud protocol to assess the target groups’ (n?=?14) reactions to the written information. In both studies the tape-recorded responses were analysed using framework analysis. The target group had limited knowledge about oral cancer, particularly the signs and symptoms. Participants saw benefits in performing MSE but noted the main barriers were not knowing what signs to look for or where to look. The written information was generally well-received but required some modifications. In particular, the target group required further persuasion that their lifestyle contributed to an increased risk of oral cancer. The results of these pilot studies have informed the development of a theory-based intervention for the early detection of oral cancer.     

Randomized,placebo-controlled trial of cognitive-behavioral therapy alone or combined with sertraline in the treatment of pediatric obsessive–compulsive disorder

Background

To examine the efficacy of sequential sertraline and cognitive-behavioral therapy (CBT) treatment relative to CBT with pill placebo over 18 weeks in children and adolescents with obsessive–compulsive disorder (OCD).

Methods

Forty-seven children and adolescents with OCD (Range = 7–17 years) were randomized to 18-weeks of treatment in one of three arms: 1) sertraline at standard dosing + CBT (RegSert + CBT); 2) sertraline titrated slowly but achieving at least 8 weeks on the maximally tolerated daily dose + CBT (SloSert + CBT); or 3) pill placebo + CBT (PBO + CBT). Assessments were conducted at screening, baseline, weeks 1–9, 13, and 17, and post-treatment. Raters and clinicians were blinded to sertraline (but not CBT) randomization status. Primary outcomes included the Children's Yale-Brown Obsessive–Compulsive Scale, and response and remission status. Secondary outcomes included the Child Obsessive Compulsive Impact Scale–Parent/Child, Children's Depression Rating Scale-Revised, Multidimensional Anxiety Scale for Children, and Clinical-Global Impressions-Severity.

Results

All groups exhibited large within-group effects across outcomes. There was no group by time interaction across all outcomes suggesting that group changes over time were comparable.

Conclusions

Among youth with OCD, there was no evidence that sequentially provided sertraline with CBT differed from those receiving placebo with CBT.

ClinicalTrials.gov Identifier

NCT00382291.     

Modifying Students' Classroom Behaviors Using an Electronic Daily Behavior Report Card

This study examined the effects of e-mailed daily behavior report cards (DBRC) on students' disruptive classroom behaviors. Additionally, teacher acceptability of e-mailed DBRC as an intervention was assessed. Participants included 46 elementary students (37 males and 9 females), that were assigned to one of three conditions; delayed treatment control, e-mailed DBRC, and e-mailed DBRC with performance feedback. Student behaviors were measured by direct observations and teacher ratings. Results suggest that e-mailed DBRC can decrease students' disruptive behaviors, that e-mailed DBRC with performance feedback did not produce superior outcomes, and that e-mailed DBRC was perceived as acceptable.     

Improving executive functioning in children with fetal alcohol spectrum disorders

An extensive body of literature has documented executive function (EF) impairments in children with fetal alcohol spectrum disorders (FASD); however, few studies have aimed specifically at improving EF. One treatment program that shows promise for children with FASD is the Alert Program for Self-Regulation®, which is a 12-week treatment specifically designed to target self-regulation, a component of EF. The present study sought to examine if Alert would produce improvements in self-regulation that would generalize to other aspects of EF, behavior, and social skills in children with FASD. Twenty-five children aged 8–12 years diagnosed with an FASD were assigned in alternating sequence to either an immediate treatment (TXT) or a delayed treatment control (DTC) group. Both groups received a comprehensive evaluation of EF at baseline and upon completing therapy (TXT), or after a 12- to 14-week interval from baseline (DTC). Parents also completed questionnaires assessing EF and behavior at both time points. For the TXT group only, parent questionnaires were readministered at 6-month follow-up. At the 12-week follow-up, the TXT group displayed significant improvements in inhibitory control and social cognition. Parents of children in the TXT group reported improved behavioral and emotional regulation, as well as reduced externalizing behavior problems. These behavioral improvements along with further improved parent-rated inhibitory control was maintained at the 6-month follow-up. The EF disabilities in children with FASD can be remediated through a targeted treatment approach aimed at facilitating self-regulation skills.     

One Session Group Treatment of Spider Phobia by Direct or Modelled Exposure

Exposure therapy is the most effective treatment for specific phobias. The one-session procedure is a further development of the effectiveness of exposure therapy. The aims of this study were to determine whether a modelled version of exposure is also effective and what kind of efficiency gradient different procedures produce. A total of 38 patients with spider phobia participated in the study. They were assigned randomly to 3 different procedures: (i) direct exposure; (ii) model exposure; or (iii) video exposure. Diagnosis was established with DSM-III-R and the Fear Survey Schedule. Self-report questionnaires assessed cognitions, body sensation symptoms, self-efficacy and long-term effect evaluation. The results gave a significant time effect for cognitions, body sensations and self-efficacy. There was also a significant time effect and interaction for the evaluation of treatment and a time by group interaction for self-efficacy. Direct exposure seemed to produce the best long-term results.     

Water Mist Punishment for Two Classes of Problem Behaviour

A study with multiple baseline design across situations and response-classes was used to evaluate the effects of a water mist procedure used for punishment of two classes of problem behaviour in a 50-year-old woman with severe mental retardation. Problem behaviour was reduced to less than 5% of baseline. After 19 months the problem behaviour was still reduced, and had stabilized at a level below 10% of baseline. Due to financial economies the local community authorities terminated the treatment, which resulted in a marked increase in the rate of problem behaviour.     

The Treatment Acceptability/Adherence Scale: Moving Beyond the Assessment of Treatment Effectiveness

It is becoming more broadly recognized that beyond effectiveness, the acceptability of interventions for anxiety disorders is an important consideration for evidence-based practice. Although advances in treatments for anxious psychopathologies have demonstrated that cognitive-behavioural interventions are more desirable than other types of psychotherapy or pharmacotherapy, there continue to be problems with adherence and dropout. It has been suggested that low treatment acceptability may be partially responsible for high dropout rates. Although a number of preliminary investigations in this domain have been conducted, further progress is hampered by the absence of a single self-report measure that assesses both acceptability and anticipated adherence. Therefore, the current paper aimed to test the psychometric properties of the newly developed Treatment Acceptability/Adherence Scale (TAAS). In two studies of brief cognitive-behavioural interventions, the TAAS was administered immediately following the therapy session. In Study 1 (N = 120 non-clinical undergraduates), the therapy included two variants of an exposure-based intervention for contamination fear. In Study 2 (N = 27 individuals with obsessive-compulsive disorder), the therapy was a cognitively based intervention evaluating a novel treatment technique for checking compulsions. Measures of convergent and divergent validity were included. Results demonstrated that the TAAS exhibited sound psychometric properties across the two samples. It is hoped that this measure will help clinicians to predict and intervene when a treatment is not acceptable and/or when the client anticipates poor adherence to it. Furthermore, the TAAS may aid researchers in continuing to improve upon effective interventions for anxiety and related disorders.