Enhanced Cognitive Behavior Therapy: A Single Treatment for All Eating Disorders

Eating disorders are serious mental illnesses affecting a significant proportion of women and a smaller number of men. Approximately half of those with an eating disorder (ED) will not meet the criteria for anorexia or bulimia nervosa, and will be diagnosed with an eating disorder not otherwise specified (EDNOS). Until recently, there were no recommended treatments for EDNOS. This article provides an overview of enhanced cognitive behavior therapy, a validated treatment for all forms of EDs.     

Assessment and Diagnosis of Eating Disorders: A Guide for Professional Counselors

Despite the prevalence of and risk associated with disordered eating, there are few guidelines for counselors on how to conduct an eating disorder assessment. Given the importance of the clinical interview, the purpose of this article is to provide recommendations for the assessment and diagnosis of eating disorders that (a) specifically focus on assessment in the context of a clinical interview and (b) can be used by counselors whether or not they specialize in eating disorder treatment.     

Disordered Eating in Women of Color: Some Counseling Considerations

There is little attention devoted to studying eating disorder symptoms in racially and ethnically diverse groups despite the fact that the prevalence rates among women of color for eating disorder symptoms are similar to those of European American women. This article reviews research related to eating disorders in women of color, including a discussion of sociocultural factors that could influence the manifestation of eating disorders in women of color. Considerations for counseling practice and research are provided.     

The Development of Internal State Language during the Third Year of Life: A Longitudinal Parent Report Study

Children's talk about the mind has been scarcely studied in non‐English speakers. For this reason, this longitudinal study documents age‐related changes in German‐speaking children's internal state language. At 24, 30 and 36 months, children were administered general language tests and their internal state vocabulary levels were obtained via parental report. The developmental transition from a vocabulary rich in physiological, perceptual and desire terms to a vocabulary rich in a wider range of mental concepts confirmed previous research with French‐speaking and English‐speaking children and research in children's internal state comprehension. Further, children's category scores proved to be developmentally stable. Finally, with increasing age, children's category scores became more specifically related to each other, independent of general language skills. The results are discussed in regard to the universality of children's talk about the mind. Copyright © 2012 John Wiley & Sons, Ltd.     

Mothers' and Fathers' Internal State Language with Their Young Children: An Examination of Gender Differences During an Emotions Task

The current study examined gender differences in mothers' and fathers' internal state language (ISL), children's use of ISL, and whether ISL was related to parents' ratings of the children's social skills. Fifty‐seven (28 boys, 29 girls) toddler/preschool children (M age = 32.5 months, SD = 5.38 months) were observed separately with their mothers and fathers in their homes while they discussed pictures of children's facial expressions of emotions. Parents completed a questionnaire concerning their child's social–emotional behaviours (i.e. BASC‐2). Parents used more ISL with sons compared with daughters, and sons used more ISL with mothers than with fathers. No overall differences were found between mothers' and fathers' ISL. Children's social skills as rated by mothers were predicted by mothers' ISL comments, whereas children's social skills as rated by fathers were predicted by children's age and fathers' ISL clarifications. Implications and limitations of the study are discussed. Copyright © 2012 John Wiley & Sons, Ltd.     

The gap that makes us desperate: Paths from language to mental health

Although past research provided some clues about the relation of language use with mental health, the mediatory functions of personality variables in this relationship have been ignored. This research examined the mediatory role of self‐concept clarity in the relationship between language use perceived by individuals and mental health indicators including anxiety, depression, and alexithymia. Based on the theoretical framework suggested by ?im?ek (2010), two studies sought to test two alternative structural equation models in data from university students in the first study (n = 250) and data from other groups in the second study (n = 331). The first model assumed that the relationship of language use with anxiety, depression, and alexithymia was mediated by self‐concept clarity. The second model tested the mediatory role of both anxiety and self‐concept clarity in this relationship. The results of the first study showed that the second model fitted better to the data than the first. Consistent with the first study, the results of the second study confirmed that the second model produced better goodness of fit statistics than the first model.     

THE EFFECTS OF THE QUESTION “WHAT IS THIS?” ON TACT-TRAINING OUTCOMES OF CHILDREN WITH AUTISM

Tact training is a common element of many habilitative programs for individuals with developmental disabilities. A commonly recommended practice is to include a supplemental question (e.g., “What is this?”) during training trials for tacts of objects. However, the supplemental question is not a defining feature of the tact relation, and prior research suggests that its inclusion might sometimes impede tact acquisition. The present study compared tact training with and without the supplemental question in terms of acquisition and maintenance. Two of 4 children with autism acquired tacts more efficiently in the object-only condition; the remaining 2 children acquired tacts more efficiently in the object + question condition. During maintenance tests in the absence of the supplemental question, all participants emitted tacts at end-of-training levels across conditions with no differential effect observed between training conditions.Key words: autism, language training, stimulus control, tacts, verbal behaviorSkinner (1957) defined the tact as a response “evoked by a particular object or event or property of an object or event” (p. 82) and considered it to be one of the most important verbal operants. Tacts are maintained by generalized social reinforcement and, thus, they are central to many social interactions. For example, the tact “That cloud looks like a horse” (under the control of a visual stimulus) could evoke a short verbal interaction about the sky or horses. The tact “My tummy hurts” (under the control of an interoceptive stimulus) could evoke soothing statements from a parent. A child who tacts “doggie” in the presence of a cat likely would evoke a correction statement from an adult, further refining two stimulus classes (i.e., dog and cat). These examples illustrate that, despite their topographical differences, the tact relations share antecedent control by a nonverbal discriminative stimulus (S^D) and are maintained by generalized social reinforcement.In habilitative programs for individuals with language impairments, autism, and intellectual disabilities, tacts often are taught for objects (e.g., ball), object features (e.g., color, size, shape), activities (e.g., jumping), prepositions (e.g., between), and emotions (e.g., sad) among others. Although conceptualized differently among therapeutic approaches, the tact relation occupies a central position in many early-intervention curricula. For example, Lovaas (2003) and Leaf and McEachin (1999) describe these relations as expressive labels and recommend that they be taught early in language training using three-dimensional objects accompanied by the supplemental questions “What is it?” or “What''s this?” Alternatively, Sundberg and Partington (1998) explicitly refer to the relation as a tact and recommend beginning instruction by including the question “What is it?” before eventually fading the question. In addition to these clinical manuals, the use of supplemental questions during tact training has appeared in some empirical studies on tact or expressive-label training (e.g., Braam & Sundberg, 1991; Coleman & Stedman, 1974), but not others (e.g., Williams & Greer, 1993). Regardless of whether tact training initially includes supplemental questions prior to response opportunities, tacts ultimately should be emitted readily under the sole control of the nonverbal S^D as well as when it happens to be accompanied by a question.Conceptually, at least four potential problems could arise from introducing supplemental questions early and consistently in tact training. First, the acquired responses might not be emitted unless the question is posed (i.e., prompt dependence). This problem would lead to few spontaneous tacts occurring outside the explicit stimulus control of the training environment. Williams and Greer (1993) compared comprehensive language training conducted under the stimulus control specified in Skinner''s (1957) taxonomy of verbal behavior to a more traditional psycholinguistic perspective with supplemental questions and instructions embedded within trials. For all three adolescents with developmental disabilities, the targets taught from the verbal behavior perspective were maintained better in natural contexts than those taught from the psycholinguistic perspective. However, because data were not reported for each individual verbal operant, it is unclear what specific impact their tact-training procedures had on the outcomes.The second potential problem is that the supplemental question might acquire intraverbal control over early responses and interfere with the acquisition of subsequent tact targets. For example, Partington, Sundberg, Newhouse, and Spengler (1994) showed that the tact repertoire of a child with autism had been hindered by prior instruction during which she was asked “What is this?” while being shown an object. The supplemental question subsequently evoked previously acquired responses and blocked the ability of new nonverbal S^Ds (i.e., objects) to evoke new responses. Partington et al. then showed that new tacts were acquired by eliminating the supplemental question from instructional trials.The third potential problem is that learners might imitate part of or the entire supplemental question prior to emitting the target response (e.g., “What is it” → “What is it … ball.”). For example, Coleman and Stedman (1974) demonstrated that a 10-year-old girl with autism imitated the question “What is this?” while being taught to label stimuli depicted in color photographs. Such an outcome results in a socially awkward tact repertoire and requires additional intervention to remedy the problem.Finally, including supplemental questions during tact training might impede skill acquisition, perhaps via a combination of the problems described earlier. Sundberg, Endicott, and Eigenheer (2000) taught sign tacts to two young children with autism who had prior difficulty acquiring tacts. In one condition, the experimenter held up an object and asked, “What is that?” In the comparison condition, the experimenter intraverbally prompted the participant to “sign [object name]” in the presence of the object. Sundberg et al. demonstrated substantially more efficient tact acquisition under the sign-prompt condition than when the question “What is that?” was included in trials; the latter condition sometimes failed to produce mastery-level responding.Teaching an entire tact repertoire while including supplemental questions (e.g., “What is it?”) during training trials could produce a learner who is able to talk about his or her environment only when asked to do so with similar questions. To the extent that this is not a therapist''s clinical goal, teaching the tact under its proper controlling variables may eliminate such problems. Of course, inclusion of supplemental questions during the early phases of language training could be faded over time such that the target tact relation is left intact prior to the end of training (Sundberg & Partington, 1998). However, the aforementioned studies have documented problems with using supplemental questions during tact training. Given the ubiquity of tact training in habilitation programs, the numerous problems that may arise when supplemental questions are included in training trials, and the limited research on the topic, further investigation is warranted. Thus, the purpose of the present study was to compare directly the rate of acquisition and subsequent maintenance of tacts taught using only a nonverbal S^D (i.e., object only) with tacts taught using a question (“What is this?”) in conjunction with the nonverbal S^D (i.e., object + question). The present study extends earlier research by examining both acquisition and maintenance and by including individuals with no prior history of formal tact training.     

The Relationships Between Japanese Interpersonal Conflict Styles and Their Language Expressions

ABSTRACT

The present study investigated the influence of interpersonal conflict management styles on language expressions and the differences in expressions in same-sex relational categories based on specific in-group-out-group classifications. Questionnaires were administered to 367 university students in Japan. After reading a scenario, participants reported on actual language use and gave ratings on an interpersonal conflict management scale. The results revealed that Japanese change their expressions, along with psychological styles, depending on the relational target. They also indicated psychological constructs were related to their equivalent expressions. The results suggested that future research should take into consideration the potential differences in behavior and interaction posture inherent in various relational and situational categories.     

Is there evidence for the use of art therapy in treatment of psychosomatic disorders,eating disorders and crisis? A comparative study of two different systems for evaluation

A comparative study of two different systems for evaluation. Scandinavian Journal of Psychology 53, 47-53. As with any type of treatment the requirement for evidence based practice (EBP) has also affected art therapy (AT) when used as an intervention. This review evaluates the available evidence for using AT for psychosomatic disorders, eating disorders and crisis. The search in Cochrane, Best Practice, AMED, CINAHL, PION, PsycINFO and PubMed from 1987 until now resulted in a huge number of articles but only 32 articles met our criteria for evaluations. The articles were assessed with two evaluation systems, the GRADE system used by the Swedish Council on Health Technology Assessment (SBU) and the US Preventive Services Task Force (USPSTF/Task Force). When comparing the results we found that the GRADE evaluation system rejected the quality in 84% of the 32 studies and the USPSTF/Task Force 41% of these studies. An evidence base for AT was found only according to the criteria of USPSTF/Task Force. Hence, the evidence concept is not explicit, which means that effective treatments run a risk of not being implemented in health care. We suggest a broader view of what constitutes evidence in order to make it possible to include different types of research designs and methods.