Principles for Designing Randomized Preventive Trials in Mental Health: An Emerging Developmental Epidemiology Paradigm

An emerging population-based paradigm is now being used to guide the design of preventive trials used to test developmental models. We discuss elements of the designs of several ongoing randomized preventive trials involving reduction of risk for children of divorce, for children who exhibit behavioral or learning problems, and for children whose parents are being treated for depression. To test developmental models using this paradigm, we introduce three classes of design issues: design for prerandomization, design for intervention, and design for postintervention. For each of these areas, we present quantitative results from power calculations. Both scientific and cost implications of these power calculations are discussed in terms of variation among subjects on preintervention measures, unit of intervention, assignment, balancing, number of pretest and posttest measures, and the examination of moderation effects.     

Problem drinking and psychological well-being: A five year follow-up study for adolescence to young adulthood

The psychological well-being of 651 Finnish adolescents (approximately age 17) was followed to young adulthood (age 22) and examined in terms of their drinking styles at age 22. The young adults were grouped into four categories delineating drinking style (non-users, non-problem drinkers, presumptive problem drinkers, and problem drinkers), and each group was examined for evolved paths of psychological well-being. The psychological profile of the participants was comprised of seven variables: self-esteem, trait anxiety, somatic symptoms, eating concerns, and mature, neurotic, and immature defense styles. The comparison of the drinking style categories revealed that future problem drinkers had lower states of psychological well-being already in adolescence and that the differences became more pronounced during the transition to young adulthood. Poor psychological well-being is a risk for the development of later problem drinking, although the profile of this poor psychological state is somewhat different in women and men.     

Positive Affect: A Neglected Group Treatment Outcome Measure in Assessing Efficacy of Psychosocial Group Interventions in Individuals with Heart Failure

Positive affect has been neglected in evaluation of group treatment efficacy. This pilot study for individuals with heart failure illustrates the contribution of positive affect to change processes. Assessment of positive affect pre- and post-group intervention can yield a better understanding of individuals' adjustment to heart failure, and provide additional information for selection of specific treatments for each individual. In an era characterized by standardized measures of outcome, inclusion of positive affect provides additional opportunity to document contributions in improving health related quality of life (psychosocial and physical functioning) of clients with heart failure.     

Going Beyond Certain Limits Together: How Ferenczi's Notion of Elasticity Informs Group Treatment of Traumatized Patients

This paper explores Ferenczi's elasticity techniques, ideas about mutuality, and analyst self-disclosure. It describes the application of Ferenczi's theory of working with traumatized patients to a group comprised of six patients. By exploring Ferenczi's techniques in working with his patients individually, the author hopes to guide clinicians in applying and recognizing the special value of Ferenczi's theory in a group setting. The author's emphasis on promoting an atmosphere of tenderness in the group led members to reveal their experiences of trauma after they had developed sufficient feelings of safety and freedom in the group.     

Michael Balint's Group Approach: The Boston Balint Group

Michael Balint was a physician/psychoanalyst who trained in Hungary and emigrated to England in 1939 when Nazi Germany began to dominate Europe. At the Tavistock Clinic, he and his wife met with social workers and physicians around case discussion seminars. With his strong interest in medicine and his curiosity about the patient-physician relationship, he initiated research/training groups with interested physicians, which ultimately led to publication of the now-classic The Doctor, His Patient, and the Illness, a rich text that has become a virtual staple of family practice residencies, along with Balint Groups for training. Balint refrained from considering his groups psychotherapy in order to minimize resistance of his physician-students. But because the groups lasted sometimes for years and explored transference and countertransference in patient-physician relationships, he acknowledged that the result was personal growth of the participants. His techniques are described and an example of a Balint Group (Boston Group) are presented here.     

Trauma, Regression, and the Intensive Group Experience

Ferenczi contributed a theory of trauma and regression that has application in the contemporary practice of group therapy. This article seeks to present an extension of these seminal ideas in the form of interventions based on therapist induced regression. The Intensive Group Experience (I.G.E.), a time extended group format found to be necessary for extensive emotional reliving and working through of trauma is described. A clinical case example is then discussed in detail and concludes this report.     

The Prophylactic Mastectomy Dilemma: A Support Group for Women at High Genetic Risk for Breast Cancer

The goal of this pilot study was to test the usefulness of a six session psychoeducational support group for women at high genetic risk for breast cancer who were considering prophylactic mastectomy. The themes of the group sessions included overestimation of and anxiety about risk; desire for hard data; the emotional impact of watching a mother die of breast cancer; concerns about spouse reactions; self- and body image; the decision-making process; and confusion over whom to trust in decision making. Both the participants and the multidisciplinary leaders concluded that as a supplement to individual counseling, a support group is a beneficial and cost-effective treatment modality. Recommendations for the optimal format for such a group are described.     

Engagement in Child and Adolescent Treatment: The Role of Parental Cognitions and Attributions

Parental engagement in the treatment process is influenced by parents' beliefs about the cause of their children's problems, perceptions about their ability to handle such problems, and expectations about the ability of therapy to help them. This paper examines the role of parental cognitions related to attributions and expectations in relation to engagement in child mental health treatment. Reviewed studies indicate that parental attributions and expectations influence three aspects of treatment: help seeking, engagement and retention, and outcome. This paper integrates findings from developmental and clinical research, highlights gaps in the literature, presents the beginnings of a model regarding the parental attributional process as it relates to engagement in treatment, recommends future research directions, and discusses clinical implications.     

The Future of Psychology in Academic Health Care Centers

A promising opportunity exists to continue psychology's move beyond its traditional mental health emphasis into a general health care discipline. Abundant empirical evidence supports that psychologists treat a wide array of physical disorders as well as psychological components of medical problems. The immediate issues confronting psychology's full emergence into the health care world are discussed and recommendations are offered to assure the success of this initiative. Office of the Senior Vice President and Provost     

Evaluating Environmental Arrangement as Setting Events: Review and Implications for Measurement

Environmental arrangement alters the physical, social, or programmatic aspects of classrooms to increase task engagement, facilitate prosocial behaviors, and reduce or prevent the challenging behaviors of children and youth. Research shows specific arrangements can affect student engagement and deportment, but this literature is not well integrated theoretically or empirically with other effective behavior change tactics. This article proposes that some environmental arrangements may serve as setting events for child behavior change. Setting events and environmental arrangement were defined and critically outlined. A total of 43 physical environmental arrangement articles were reviewed as to the specific type of arrangement and research methodology. Several methodological problems (e.g., lack of measurement or control of antecedents, consequences, or environmental arrangements, manipulation of more than one environmental arrangement) precluded conclusions about the setting event function of environmental arrangements. Suggestions for future research on setting events and environmental arrangements are proposed.