Older Adults’ Psychosocial Responses to a Fear of Falling: A Scoping Review to Inform Occupational Therapy Practice

Abstract

Falls in older adults are a major health concern, yet the “fear of falling”, a common psychosocial response that can occur post-fall, has seldom been investigated. A scoping review was conducted to identify and map interventions that occupational therapists can use to manage the fear of falling psychosocial response (FoFPR) among older adults. Thirteen electronic databases were searched and 22 studies were retrieved. Cognitive behavioral therapy, guided imagery, and Tai Chi were interventions found to help older adults deal with their FoFPRs. Occupational therapists assisting older adults in this area can play a significant role.     

Clinical Implications for Multi-Racial Individuals

Abstract

Multi- racial individuals experience distinctive struggles and challenges that can impact their mental health. However, despite the growing population and unique presenting issues there remains a scarcity of literature to effectively support them. In addition, there is a lack of research exploring the unique experience of the multiple heritage population. The article offers implications for effectively working with individuals of multi-racial decent as well as a call to action for MFTs to develop multicultural competencies for the profession.     

Individual differences in visual acuity and face matching ability

The visual acuity of the eyes varies outside the range of normal vision, requiring corrective lenses, but also within the normal range. This study investigated whether both types of variation relate to individual differences in face-identity matching, considering this applied task requires perception of detail. Across two experiments, face-matching accuracy correlated with variation in acuity when this fell outside the normal range of vision and was uncorrected with glasses or contact lenses. In contrast, variation in visual acuity within the normal range did not affect face-matching accuracy, whereas matching accuracy at a given level of acuity could vary substantially. These results indicate that visual acuity is only a problem for occupations performing face-identity matching when below-normal acuity is not diagnosed or adequately corrected. In turn, these findings suggest that variation in acuity within the normal range is not a contributing factor to individual differences in face matching accuracy.     

How representations of number and numeracy predict decision paradoxes: A fuzzy-trace theory approach

Higher numeracy has been associated with decision biases in some numerical judgment-and-decision problems. According to fuzzy-trace theory, understanding such paradoxes involves broadening the concept of numeracy to include processing the gist of numbers—their categorical and ordinal relations—in addition to objective (verbatim) knowledge about numbers. We assess multiple representations of gist, as well as numeracy, and use them to better understand and predict systematic paradoxes in judgment and decision-making. In two samples (Ns = 978 and 957), we assessed categorical (some vs. none) and ordinal gist representations of numbers (higher vs. lower, as in relative magnitude judgment, estimation, approximation, and simple ratio comparison), objective numeracy, and a nonverbal, nonnumeric measure of fluid intelligence in predicting: (a) decision preferences exhibiting the Allais paradox and (b) attractiveness ratings of bets with and without a small loss in which the loss bet is rated higher than the objectively superior no-loss bet. Categorical and ordinal gist tasks predicted unique variance in paradoxical decisions and judgments, beyond objective numeracy and intelligence. Whereas objective numeracy predicted choosing or rating according to literal numerical superiority, appreciating the categorical and ordinal gist of numbers was pivotal in predicting paradoxes. These results bring important paradoxes under the same explanatory umbrella, which assumes three types of representations of numbers—categorical gist, ordinal gist, and objective (verbatim)—that vary in their strength across individuals.     

Mapping differential responses to cognitive training using machine learning

We used two simple unsupervised machine learning techniques to identify differential trajectories of change in children who undergo intensive working memory (WM) training. We used self‐organizing maps (SOMs)—a type of simple artificial neural network—to represent multivariate cognitive training data, and then tested whether the way tasks are represented changed as a result of training. The patterns of change we observed in the SOM weight matrices implied that the processes drawn upon to perform WM tasks changed following training. This was then combined with K‐means clustering to identify distinct groups of children who respond to the training in different ways. Firstly, the K‐means clustering was applied to an independent large sample (N = 616, M_age = 9.16 years, range = 5.16–17.91 years) to identify subgroups. We then allocated children who had been through cognitive training (N = 179, M_age = 9.00 years, range = 7.08–11.50 years) to these same four subgroups, both before and after their training. In doing so, we were able to map their improvement trajectories. Scores on a separate measure of fluid intelligence were predictive of a child's improvement trajectory. This paper provides an alternative approach to analysing cognitive training data that go beyond considering changes in individual tasks. This proof‐of‐principle demonstrates a potentially powerful way of distinguishing task‐specific from domain‐general changes following training and of establishing different profiles of response to training.     

“A definite feel‐it moment”: Embodiment,externalisation and emotion during chair‐work in compassion‐focused therapy

Chair‐work is an experiential method used within compassion‐focused therapy (CFT) to apply compassion to various aspects of the self. This is the first study of CFT chair‐work and is focused on clients' lived experiences of a chair‐work intervention for self‐criticism. Twelve participants with depression were interviewed following the chair‐work intervention and the resulting data were examined using interpretative phenomenological analysis. Three superordinate themes were identified: “embodiment and enactment,” “externalising the self in physical form” and “emotional intensity.” The findings suggest the importance of accessing and expressing various emotions connected with self‐criticism, whilst highlighting the potential for client distress and avoidance during the intervention. The role of embodying, enacting and physically situating aspects of the self in different chairs is also suggested to be an important mechanism of change in CFT chair‐work. The findings are discussed in terms of clinical implications, emphasising how core CFT concepts and practices are facilitated by the chair‐work process.     

Resistance and outcome expectations in cognitive‐behavioural therapy for generalised anxiety disorder

Greater client resistance has been consistently found to be negatively associated with outcome in psychotherapy. However, the pathways through which resistance impacts such outcomes are underexplored. Given that client outcome expectation (OE) has been identified as an important common factor in psychotherapy, the goals of the present study were to examine: (a) the impact of resistance on subsequent client and therapist OE (COE & TOE, respectively); and (b) whether COE and/or TOE mediate the relationship between resistance and outcome. These relationships were tested among 44 clients with severe generalised anxiety disorder treated with cognitive‐behavioural therapy in the context of a randomised controlled trial (Westra, Constantino, & Antony, 2016). Resistance was measured at a mid‐treatment session, and COE and TOE were assessed at baseline and immediately after the resistance session. Treatment outcome was measured via client‐rated worry severity at post‐treatment. As predicted, higher resistance was associated with lower subsequent COE and TOE; B = ?.73, p < .001 and B = ?.46, p < .001, respectively. In turn, lower post‐resistance COE predicted higher post‐treatment worry (B = ?.5, p < .001), indicating mediation. In contrast, TOE did not mediate the relationship between resistance and outcome (B = ?.02, p = .876). These results suggest that resistance can be demoralising to both clients and therapists. However, only lower client morale may be detrimental to therapy outcome. This study contributes to understanding outcome pathways through two common therapy processes.     

Barriers and facilitators affecting the sustainability of dialectical behaviour therapy programmes: A qualitative study of clinician perspectives

Dialectical behaviour therapy (DBT) is a psychological treatment developed for individuals experiencing chronic suicidality and high‐risk behaviours. Despite the substantial evidence supporting the effectiveness of DBT, many programmes have problems with its sustainability. The goals of the current qualitative study were to identify factors that impact the sustainability of DBT programmes within a publicly funded mental health system and identify factors that are particularly relevant for youth DBT programmes. Interviews with trained adult and youth DBT clinicians (N = 31) were conducted to explore their experiences providing DBT. Three major themes that emerged as barriers to the sustainability of DBT programmes included the following: systemic challenges, conflicts within the consultation teams and clinician burnout. Factors influencing the success of DBT programmes included the following: systemic support, clinician commitment and “buy in”, and team cohesion. Factors specific to providing DBT with youth (i.e. level of commitment, simplifying the language, and parental investment) and recommendations for sustainability for adults and youth programmes were also identified. Findings of this study provide valuable information on factors impacting DBT programmes within the unique context of a Canadian mental health service system, where community‐based services are publicly funded. These findings have clear clinical utility and can be used to generate solutions to clinicians' perceived barriers and to foster perceived facilitators within similar contexts.