Digital Mental Health Interventions for Child and Adolescent Anxiety

Anxiety disorders are the most common mental health conditions in children, with approximately 13% of kids struggling with excessive anxiety. The vast majority do not have access to effective treatments and there continues to be a disjunction between treatments that are empirically supported and those that are available in the community. Digital mental health interventions (DMHI) can increase efficiency, reach, and standardization as well as reduce costs of providing of mental health care. Here we review the extant research on DMHI, including web- or cloud-based programs, mobile applications (apps), virtual reality (VR), and digital assessment methods such as ecological momentary assessment (EMA) for the delivery and/or support of evidence-based care in child anxiety. Preliminary research is promising for these tools to improve access and efficiency of evidence-based practice. However, ethics and practice guidelines are needed and questions remain regarding what level and quality of therapeutic involvement is needed to maximize treatment completion and outcomes in youth and whether DMHIs are contraindicated for certain populations or whether they are similarly effective with those with comorbid conditions is unclear.     

Profession Differences in Family Focused Practice in the Adult Mental Health System

There is a large gulf between what psychiatric services should (or could) provide and what they do in practice. This article sought to determine practice differences between the differing professions working in adult mental health services in terms of their family focused work. Three hundred and seven adult mental health professionals completed a cross‐sectional survey of family focused practices in adult mental health services. Findings highlight that social workers engaged in more family focused practice compared to psychiatric nurses, who performed consistently the lowest on direct family care, compared to both social workers and psychologists. Clear skill, knowledge, and confidence differences are indicated between the professions. The article concludes by offering direction for future profession education and training in family focused practices.     

ANALYTIC MIND USE AND INTERPSYCHIC COMMUNICATION: DRIVING FORCE IN ANALYTIC TECHNIQUE,PATHWAY TO UNCONSCIOUS MENTAL LIFE

Developed from established psychoanalytic knowledge among different psychoanalytic cultures concerning unconscious interpsychic communication, analysts' use of their receptive mental experience—their analytic mind use, including the somatic, unconscious, and less accessible derivatives—represents a significant investigative road to patients' unconscious mental life, particularly with poorly symbolized mental states. The author expands upon this tradition, exploring what happens when patients unconsciously experience and identify with the analyst's psychic functioning. The technical implications of the analyst's “instrument” are described, including the analyst's ego regression, creation of inner space, taking mind as object, bearing uncertainty and intense affect, and self‐analysis. Brief case vignettes illustrate the structure and obstacles to this work.     

Coping strategies: A prospective study of patterns,stability, and relationships with psychological distress

The aims of this article are: (1) to explore patterns (clusters) of coping strategies; (2) to examine the stability of individual coping strategies and patterns of coping over time; and (3) to establish long term associations between coping and psychological distress. Coping strategies were assessed with the Brief Cope questionnaire, whereas psychological distress was measured with the ten‐item version of the Hopkins Symptom Checklist, in a two‐year prospective sample comprising 3,738 employees. Based on TwoStep cluster analysis of the Brief Cope, three different coping patterns were identified: low coping, engagement coping, and disengagement coping. Analyses of long‐term stability indicated malleable properties for the individual coping strategies as well as the three clusters. Disengagement coping strategies in the form of self‐blame and self‐distraction were most strongly associated with distress at follow‐up, whereas baseline distress was related to increased use of these strategies two years later. Coping patterns at baseline had no main effects on later levels of distress, but levels of distress at baseline predicted subsequent use of engagement and disengagement coping patterns. The finding that specific coping strategies are malleable suggests that it is possible to modify and develop dysfunctional strategies. The associations between disengagement coping strategies and distress indicate that this kind of coping is especially problematic with regard to mental health problems. A main contribution of this study is that it establishes cluster analytic techniques as beneficial in the assessment of coping.     

Meaningfulness in Day Centers for People With Psychiatric Disabilities: Gender and Empowerment Aspects

This study investigated the experience of meaningfulness in occupations at day centers among people with psychiatric disabilities from an empowerment and gender perspective. One hundred eight participants, from eight day centers in Sweden, completed instruments measuring experienced meaning, empowerment, psychosocial functioning, and socio-demographic factors. Mixed methods were used, combining statistical analyses and content analysis. Gender differences were found concerning principal occupations performed. These confirmed traditional gender roles. The experience of meaning in day center occupations, particularly the domain of meaning pertaining to personal development, was significantly associated with empowerment. These results may be used in the future development of day centers.     

An internet survey of emotional health,treatment seeking and barriers to accessing mental health treatment among Chinese-speaking international students in Australia

The present internet survey examined the demographic characteristics of Chinese-speaking international students in Australia, psychological distress levels as measured by the Kessler-10 (K-10) Item scale, help-seeking history and preferences, as well as treatment barriers. Of the 144 respondents, 54% reported high psychological distress (mean K-10 score?=?23.96; SD?=?9.03). However, only 9% of those who were highly distressed reported they had sought mental health services in the past year. While the majority preferred help from informal social networks, they tended to favour mental health services over traditional culture-specific forms of help. Common barriers to accessing mental health services reported by respondents with high psychological distress included costs or transportation concerns, limited knowledge of available services, time constraints, the perception that symptoms were not severe enough to warrant treatment, language difficulties and lack of knowledge of symptoms of psychological distress. Although the majority preferred face-to-face treatments over internet treatments, a considerable percentage of respondents were willing to try either treatment modality. Chinese-speaking international students are a high risk group for developing psychological distress, yet they tend to underuse mental health services. Education about the effectiveness of face-to-face and online treatments may increase treatment seeking by this population.     

Is the Male Advantage in Mental-Rotation Performance Task Independent? On the Usability of Chronometric Tests and Paper-and-Pencil Tests in Children

This article presents a reanalysis of the data of 862 second and fourth graders collected in two previous studies, focusing on the influence of method (psychometric vs. chronometric) and stimulus type on the gender difference in mental-rotation accuracy. The children had to solve mental-rotation tasks with animal pictures, letters, or cube figures, either in a chronometric condition (computerized) or in a psychometric condition (paper-and-pencil). Results show a slight male advantage in mental-rotation accuracy, which is neither influenced by method nor by stimulus type. However, mental-rotation accuracy differed between the stimulus types, with the highest accuracy in animal pictures and the lowest accuracy in cube figures, and between age groups, with better performance in fourth graders than in second graders in both conditions. Results show that psychometric and chronometric mental-rotation tests with all the stimulus types are more or less similarly usable with children of that age.     

Adult Attachment Dimensions,World View Schemas,and the Psychological Health of Parents of Infants in a Neonatal Intensive Care Unit

This study reports the results of an exploration of the relationship of adult attachment dimensions (closeness, dependence, and anxiety) and world view assumptions (benevolence, meaningfulness, and worthiness) to psychological distress and psychological well-being in 142 parents (71 couples) of newborns recently hospitalized in a neonatal intensive care unit. The results of the Actor-Partner Interdependence Model, hierarchical multiple regression, and mediation analyses showed that parents who were more comfortable with attachment-dependence and parents who held more positive beliefs about benevolence and worthiness had less psychological distress and more well-being. In addition, parents with partners who were more comfortable with attachment-dependence had less psychological distress and more well-being. Attachment-dependence partially mediated the relationships of benevolence and worthiness with psychological distress and the relationship of benevolence with psychological well-being, whereas worthiness had a direct relationship with psychological well-being.     

A Single-Subject Evaluation of the Treatment of Morphing Fear

We present a single-subject prospective outcome study of a man with severe morphing fear and long history of OCD who was not helped by previous interventions, and who received an adapted form of cognitive behavior therapy (CBT) as part of this study. Treatment consisted of a cognitively focused approach tailored to address his fear of morphing and included developing a stronger sense of self-stability. We describe the details of the case, the treatment protocol, and the therapeutic outcomes as assessed over 36 weeks by questionnaires, rating scales, and semistructured interviews. The intervention was effective in eradicating the patient’s morphing fears and reducing other symptoms of OCD, anxiety, and depression. The presented case illustrates the need to appropriately conceptualize, assess, and address the specific nature of morphing fear symptoms in treatment.     

Factors related to life satisfaction among urban African American adults receiving care at a publicly-funded sexual health clinic

Life satisfaction is linked to premature morbidity and mortality and it may be compromised for individuals living in economically-disadvantaged, urban neighborhoods. The present study explores how behavioral and social-environmental health factors are associated with life satisfaction among a sample of African American young adults. Participants (N = 307, M_age = 26.6 years, 53% male) were recruited from a publicly-funded clinic for a randomized controlled trial (RCT). Data from the baseline assessment of the RCT, which included measures of sleep, depression, anxiety, social support, alcohol and drug use problems, city stress, and life satisfaction, were used for the current study. Correlation analyses assessed bivariate associations between life satisfaction and the demographic and health-related factors. Linear regression using backward elimination determined the best fitting model of factors associated with life satisfaction. Backward elimination resulted in the following variables remaining as significantly associated with life satisfaction: age (b = ?2.40, p = .017), anxiety (b = ?5.32, p < .001), and social support (b = 2.89, p = .004). Feeling rested upon waking also remained in the best fitting model, although this association did not achieve statistical significance (p = .099). The results suggest that African American adults who are younger, less anxious, and report adequate social support are more likely to report satisfaction with life. These findings add to the literature aimed at examining health and social factors impacting the well-being of African Americans living in low-income, urban communities.