Is cognitive behavioural therapy effective in reducing suicidal ideation and behaviour when delivered face-to-face or via e-health? A systematic review and meta-analysis

Cognitive Behavioural Therapy (CBT) is a widely used psychotherapeutic intervention for suicide prevention despite its efficacy for suicide prevention in adults remaining ambiguous. Reluctance or inability to access face-to-face help suggests that e-health delivery may be a valuable resource for suicidal people. The aim of this study was to systematically review and conduct meta-analysis on research assessing the efficacy of CBT delivered via face-to-face and e-health for suicidal ideation and behaviour. A comprehensive literature search of MEDLINE, PsycINFO, Scopus, PubMed and The Cochrane Central Register of Controlled Trials was conducted. From 764 identified articles, 26 met the inclusion criteria for investigating CBT for suicidal ideation and behaviours in adult populations. Data were extracted on study characteristics and meta-analysis was performed where possible. There was a statistically significant, small to medium effect for face-to-face delivered CBT in reducing suicidal ideation and behaviour although there was significant heterogeneity between the included studies. CBT delivered via e-health was not found to be efficacious for reducing suicidal ideation and behaviour in adults though the number of studies reviewed was small.     

学前儿童抑制控制的发展趋势及其对言语理解和数学认知的预测作用

以长春市某幼儿园的122名3~6岁幼儿为被试,采用2(测试任务:无嵌套规则白天黑夜任务,有嵌套规则的白天黑夜任务)×2(测试时间:间隔9个月的第一次测试和第二次测试)×4(年龄分组:3.00~3.75岁组,3.76~4.50岁组,4.51~5.25岁组,5.26~6.00岁组)的三因素混合设计,来分析不同复杂程度的抑制控制在学前阶段的发展趋势,并在控制幼儿年龄和工作记忆水平后,分析不同复杂程度抑制控制对言语理解和数学认知的独立预测作用。结果发现:(1)对3~6岁儿童来说,有嵌套规则的白天黑夜任务的难度水平要显著高于无嵌套规则的白天黑夜任务;(2)较简单的抑制控制(无嵌套规则的白天黑夜任务)在学前阶段的发展速度先快后慢,但较复杂的抑制控制(有嵌套规则的白天黑夜任务)在3~6岁期间持续快速发展;(3)独立于年龄和工作记忆,较复杂的抑制控制能够显著预测幼儿的数学认知和言语理解,但较简单的抑制控制对言语理解和数学认知的预测作用不显著。根据上述结果,在描述学前儿童抑制控制发展趋势时要注意任务难度的设定,而且难度适当的抑制控制任务成绩更能预测幼儿的言语理解和数学认知。     

After-School Youth Development Programs: A Developmental-Ecological Model of Current Research

Although there has been a rapid increase in funding and attention to after-school programs, there is little understanding of how after-school programs impact children's developmental trajectories. The heterogeneity of American children makes it very unlikely that all children need after-school programming or that there is but one brand of after-school programming suitable for all youth. We discuss the numerous developmental and contextual factors that may influence which children benefit most from after-school programs as well as the nature of the after-school programs most beneficial to children's needs. The value of utilizing an ecological and developmental perspective to after-school program evaluation are presented, including the need for improved research designs and more detailed analyses of program type and services as well as a more complete determination of which children benefit the most from after-school participation.     

Enhancing frequency recording by developmental disabilities treatment staff

We evaluated a staff training and management package for increasing accuracy of recording frequency of problem behavior in a residential care facility. A multiple baseline design across the first and second work shifts showed that 2 of 8 participants increased their accuracy following in-service training, and all 8 improved during a condition with supervisor presence and feedback. Improvements were maintained when feedback was removed and generalized to activity periods when neither supervisor presence nor feedback was provided. Other staff behavior was not adversely affected by the intervention package.     

Assessment of deviant arousal in adult male sex offenders with developmental disabilities

Ten individuals, residing in a treatment facility specializing in the rehabilitation of sex offenders with developmental disabilities, participated in an arousal assessment involving the use of the penile plethysmograph. The arousal assessments involved measuring change in penile circumference to various categories of stimuli both appropriate (adult men and women) and inappropriate (e.g., 8- to 9-year-old boys and girls). This approach extends the existing assessment literature by the use of repeated measurement and single-subject experimental design. Data from these assessments were analyzed to determine if clear and informative outcomes were obtained. Overall, three general patterns of results emerged. Some participants showed differentiated deviant arousal or higher levels of arousal to specific inappropriate stimuli (deviant is a term used in the existing sex-offender literature to describe this type of arousal). Other participants showed undifferentiated deviant arousal, in which case they showed nonspecific arousal to inappropriate stimuli. The remaining participants showed no arousal to inappropriate stimuli but did show arousal to appropriate stimuli. Implications for assessment, treatment, and future directions are discussed.     

Examining the State-Trait Anxiety Relationship: A Behavioural Genetic Approach

State and trait anxiety define different aspects of anxiety, and may represent environmentally and genetically mediated components of this phenotype. Furthermore their relationship, where trait anxiety is expressed through levels of state anxiety under threatening circumstances, may represent a process of interplay between a genetic vulnerability factor and an environmental stressor. To test these hypotheses, we explored genetic and environmental influences on measures of state and trait anxiety in a sample of 1058 twins (521 males and 537 females) aged 8–16. The results were consistent with these hypotheses. State anxiety is largely influenced by environmental factors in males and females whereas trait anxiety shows moderate genetic effects and substantial non-shared environment effects. Their association was accounted for by non-shared environmental effects, with modest genetic and shared environmental inputs. The implications of these results for vulnerability mechanisms involving stress reactivity on anxiety are discussed.     

Training play behavior in a 5-year-old boy with developmental disabilities

The purpose of the current study was twofold: (a) to investigate if it was possible to train three different games (both as a leader and as a participant) to a child with developmental disabilities through interaction with 4 typically developing peers, and (b) to examine if correct responding would be maintained after the training was faded. A multiple probe design across three games was used. The results showed that the child learned both skills as a leader and as a participant in all three games, and that skills were maintained for a period of 3 weeks after the training had stopped.     

Enhancing tolerance to delayed reinforcers: the role of intervening activities

Three participants with moderate to profound mental retardation were exposed to choices between an immediate small amount and a delayed larger amount of a preferred reinforcer. All participants initially showed a relatively high preference for the smaller reinforcer, suggesting impulsive choice making. However this preference reversed, suggesting self-control, when the larger reinforcer was available immediately and, over time, its delay was gradually increased. Results highlight the potential utility of incorporating concurrent activities into self-control training paradigms.     

Attitudes of Health Care Trainees About Genetics and Disability: Issues of Access, Health Care Communication, and Decision Making

Prior studies suggest that knowledge and attitudes of health care professionals influence patient communication and medical decision making. To study this dynamic in the context of genetic disability, we developed a survey on health professionals' attitudes regarding disability and genetic screening and pilot-tested it on a sample of medical students, residents, and genetic counseling students (N = 85). Despite minimal experience with disability or genetics, most respondents reported feeling comfortable dealing with genetics (59%) and disability (75%). The majority felt that disability caused significant suffering for both the person (51%) and family (64%), and that research should be directed toward preventing genetic disability (62%). Similar to prior literature, perceived Quality of Life was most often based on degrees of physical and cognitive functioning, pain, and social support. However, differences were found between genetic counseling trainees and other medical trainees in their relative emphasis of social versus medical issues in questions of disability and genetic testing, and these response patterns were associated with differences in the groups' priorities for offering information about social resources. Respondents agreed that access to genetic testing and information is personal and that testing should be available upon request for oneself (68%) and to a lesser degree for one's fetus (55%) or child (41%). However, the same individuals frequently stated that society should regulate access to such technologies. Although most felt that the patient and professional should jointly make such decisions on a case-by-case basis, it was also seen as appropriate for the health care professional to occasionally decline genetic testing. It seems apparent that training and experience influence knowledge and attitudes. Therefore, it is critical to document knowledge and attitudes of various health care providers and trainees, including differences between various specialties, to improve educational interventions geared to this area.     

Bioethics, theology, and social change

Recent years have witnessed a concern among theological bioethicists that secular debate has grown increasingly "thin," and that "thick" religious traditions and their spokespersons have been correspondingly excluded. This essay disputes that analysis. First, religious and theological voices compete for public attention and effectiveness with the equally "thick" cultural traditions of modern science and market capitalism. The distinctive contribution of religion should be to emphasize social justice in access to the benefits of health care, challenging the for-profit global marketing of research and biotechnology to wealthy consumers. Second, religion and theology have been and are still socially effective in sponsoring activism for practical change, both locally and globally. This claim will be supported with specific examples; with familiar concepts like subsidiarity and "middle axioms"; and with recent analyses of "participatory democracy" and of emerging, decentralized forms of global governance.