CBT/DBT-Informed Intensive Outpatient Treatment for Anxiety and Depression: A Naturalistic Treatment Outcomes Study

Anxiety and depression are highly prevalent and disabling mental health disorders, with comorbidity often posing as a barrier to successful treatment outcomes, thus creating a need for more intensive treatment options. Outpatient clinicians are more likely to refer patients with severe symptoms of anxiety and depression to inpatient hospitalizations rather than partial hospital programs (PHPs) or intensive outpatient programs (IOPs), despite evidence that inpatient hospitalization is associated with high costs and other risks following discharge. The present study reviews two case studies of patients who received cognitive-behavioral therapy/dialectical behavior therapy (CBT/DBT)-based IOP treatment in a private New York clinic. We evaluated treatment outcomes for 73 adult patients (50.7% female) with a mean age of 29.10 years (SD = 10.30). At intake, patients averaged 2.15 diagnoses (SD = 0.94, range = 4) and the majority (80.8%) were prescribed psychotropic medication. Treatment was structured and individually tailored, with patients receiving an average of 21.77 hours (SD = 15.06) of psychotherapy over 12.63 treatment sessions (SD = 9.76), across 12.21 days (SD = 9.61). We observed a clinically and statistically significant change in symptoms of anxiety (t = 6.24, p < .001), depression (t = 5.55, p < .001), and suicidality (t = 2.32, p < .05) over the course of the IOP. After completing treatment, 68.1% of participants tapered down to once-weekly treatment. The present study highlights the clinical utility of an IOP and suggests that this approach can be effective for adult patients presenting with severe symptoms of anxiety and/or depression.     

Learning from parents' stories about what works in early intervention

Using a multiple case study approach, this ethnography examined the experiences of parents of children deemed at risk for developmental delays or disabilities who had received early intervention (EI) services (birth to age 3 years) in a large urban location in Western Canada. Participants (11 adult parents and 7 children) were drawn from six families. Methods of data collection included focus groups (FG), face‐to‐face interviews and file reviews. Member check and expert reviews were conducted throughout data collection and data analyses as part of the validation process in this ethnography. Qualitative content analyses followed by thematic analyses highlighted the implementation of family‐centred practices (FCP) as a main theme. Parents identified how EI professionals using FCP embraced collaborative practices. FCP resulted in parents leading the EI process for their children. More specifically, EI professionals shared strategies and information to support parents in gaining a deeper understanding of their children's individual developmental characteristics. Parents expressed how empowering this level of understanding was for them as they learned to articulate what were their children's needs for developmental, health and educational services. Recommendations for future research include inquiring about parents' experiences for families of diverse constellations and/or residing in smaller urban or rural communities.     

Unravelling Crime Series Patterns amongst Serial Sex Offenders: Duration,Frequency, and Environmental Consistency

Crime linkage and the investigation of behavioural consistency amongst serial offenders has been a flourishing field of research over the past decade or so, especially with respect to serial sex offenders. The emerging research in this field has often portrayed serial sex offenders as a single, distinct, and homogeneous group. Such an assumption, however, has never been empirically examined. Using a criminal career approach and a sample of 72 serial sex offenders who have committed a total of 361 sexual assaults on stranger victims, the current study aims to examine and describe subgroups of crime series patterns amongst serial sex offenders in terms of duration and frequency of offending. The level of environmental consistency display (i.e. offender's choice of crime location and characteristics of the crime site selected) across subgroups of crime series patterns is also examined. Study findings suggest the presence and heterogeneity of crime series patterns amongst serial sex offenders, advocating for the consideration of subgroups of crime series patterns when studying serial sex offenders. Moreover, the offenders' level of environmental consistency varies across the different crime series patterns identified, allowing for the identification of subgroups of offenders showing a higher or lower level of environmental consistency. Copyright © 2014 John Wiley & Sons, Ltd.     

Topic-focused analysis in a case of integrative psychotherapy with a father fearing his own anger

Even though evidence-based knowledge is considered the foundation of clinical practice, many clinicians question the clinical relevance of published research. Clinicians increasingly define themselves as having an integrative stance, in contrast to the tendency for most research to be based on clearly defined psychotherapies. Qualitative single case studies make it possible to generate knowledge about what actually occurs in integrative therapy. Topic change process analysis (TCPA) is used in the analysis of brief integrative therapy conducted by a very experienced psychotherapist drawing on a complex variety of therapeutic approaches. The client was a man in his late thirties, worrying about his strong anger, particularly related to one of his children. Analysis of topic areas, topic shifts, response patterns within topics and changes in perspective made it possible to identify key processes and key patterns of the therapy which resulted in a very positive outcome for the client. Implications of these findings for practice, and future research, are discussed.     

Modeling Nonstationary Emotion Dynamics in Dyads using a Time-Varying Vector-Autoregressive Model

Emotion dynamics are likely to arise in an interpersonal context. Standard methods to study emotions in interpersonal interaction are limited because stationarity is assumed. This means that the dynamics, for example, time-lagged relations, are invariant across time periods. However, this is generally an unrealistic assumption. Whether caused by an external (e.g., divorce) or an internal (e.g., rumination) event, emotion dynamics are prone to change. The semi-parametric time-varying vector-autoregressive (TV-VAR) model is based on well-studied generalized additive models, implemented in the software R. The TV-VAR can explicitly model changes in temporal dependency without pre-existing knowledge about the nature of change. A simulation study is presented, showing that the TV-VAR model is superior to the standard time-invariant VAR model when the dynamics change over time. The TV-VAR model is applied to empirical data on daily feelings of positive affect (PA) from a single couple. Our analyses indicate reliable changes in the male’s emotion dynamics over time, but not in the female’s—which were not predicted by her own affect or that of her partner. This application illustrates the usefulness of using a TV-VAR model to detect changes in the dynamics in a system.     

基于叙事医学“细读”方法探讨中医医案叙事分析方法

医案作为叙事文本,可进行故事分析与叙事分析。叙事分析结果能够完善故事分析结果。叙事医学提出的细读方法是医学叙事分析方法的集大成者。为增加医案研读结果的完整度,借鉴叙事医学的细读方法,提出了分析医案“框架”、“形式”、“时间”、“情节”、“意愿”的方法,介绍了时间性、独特性、因果关系/偶然性、伦理性、主体间性特征等叙事医学概念对医案分析需求的启发。为了便于记录与规范医案叙事分析的过程,设计了医案叙事分析表。本研究丰富了医案研究方法,扩大了叙事医学细读方法的运用范围。     

《四分律》中的耆婆医案探析

耆婆在中印医学交流中发挥了重要作用,《四分律》中关于耆婆医案的记载最为集中,案例涉及疾病病种有头痛、痔疮、肠扭结、水肿,治疗方法涉及外治法、内治法、手术疗法。通过对耆婆的生平、《四分律》中关于耆婆的六则医案以及医案反映出的医学思想等三个方面进行介绍,说明耆婆在我国医学发展史上的重要地位,突出耆婆在医学上丰富的诊疗经验和高超的医学技术,有助于准确把握耆婆诊疗方式、手术治疗特点、用药特色,挖掘当时医学的发展进程,有助于梳理耆婆医学思想在医学发展史上的历史意义以及更好地指导临床实践。