Aboriginal Practitioners Offer Culturally Safe and Responsive CBT: Response to Commentaries

We appreciate the valuable commentaries that have been provided for our paper “Can CBT be effective for Aboriginal Australians? Perspectives of Aboriginal practitioners trained in CBT.” The international authors identify how CBT, with adaptations by culturally responsive practitioners can be of value for non‐Western and Indigenous peoples. The commentary by Australian psychologists Dudgeon and Kelly questions the value of CBT for Indigenous Australians, terming it a “Western therapy” that is “culturally unresponsive” and “culturally blind.” They also critique the methodology of the study. We argue that CBT can be adapted by culturally competent practitioners to be culturally safe in Australia, as elsewhere. Cultural safety is mostly a function of the therapist, not the therapy. In the Bennett‐Levy et al. (2014) study, CBT was delivered in a culturally responsive way by Aboriginal counsellors within their own communities. CBT is a particularly adaptable and versatile therapy, and embodies principles of empowerment and self‐determination that are central to Indigenous social and emotional well‐being. We are concerned that CBT, which has strong empirical support and has been adapted elsewhere for a range of cultures, including Indigenous cultures, may be being denied to Indigenous Australian clients. There is considerable opportunity to evaluate the effectiveness and versatility of CBT, and variations of its mode of delivery, for all Australians.     

Extensions and Mechanisms of Mindfulness‐based Cognitive Therapy: A Review of the Evidence

Mindfulness‐based cognitive therapy (MBCT) was originally developed to prevent depressive relapse and recurrence and has also been widely extended to new patient populations and target problems over the last 14 years. We provide a comprehensive review of this literature, examining the strength of the evidence base for specific populations and target problems and identifying questions for future research to address. Specifically, we review studies addressing the use of MBCT for depressive disorders (prevention of depressive relapse and treatment of residual and current depressive symptoms), the use of MBCT in the treatment or management of other mental disorders (bipolar disorder, anxiety disorders, mixed anxiety and depression symptoms, disordered eating, personality disorders, and psychosis), and the use of MBCT in behavioural medicine contexts. Additionally, we discuss the extension of MBCT during specific developmental periods, like childhood, pregnancy and post‐partum, and adult caregiving, and, finally, we address the use of MBCT among clinical health‐care providers. In the second section, we review hypothesised mechanisms of change in MBCT and reflect on implications for theories of how MBCT works in the application to various patient populations and target problems. We also consider research addressing active ingredients and what is known about the “dosage” of meditation practice. We conclude with a summary of recommendations for future research.     

Evaluating Outcome Domains Assessing Caregivers of Individuals with Mental Illness: A Review

In this article, we describe the properties and consider the outcome dimensions of a collection of self‐administered questionnaires that assess caregivers of offspring with mental illness. To this end, we searched the MEDLINE, Web of Science, and PsycINFO databases, as well as reference lists of studies published between 1980 and 2012. We reviewed 43 instruments, and found multiple outcome domains, associated with either objective burden or subjective burden, or both. A number of tools captured additional negative aspects of caregiving (e.g., strain, stress, and worrying) as well as positive aspects (e.g., personal growth, strength, support, rewards, and satisfaction), supplemented by measures assessing caregivers' perceptions and attitudes toward their offspring with SMI (e.g., insight, stigma, and efficacy). This current review of existing measures and their specific domains contributes to a more comprehensive understanding of the caregiving experience and allows both clinicians and researchers to select the most appropriate measurement tools for their purposes.     

Wisdom won from illness: The psychoanalytic grasp of human being

From its inception psychoanalysis claimed not merely to be an effective therapy for psychological suffering, but to shed light on the human condition. But what kind of insight does psychoanalysis offer? This paper locates psychoanalysis in the western philosophical tradition, arguing that psychoanalysis provides not only theoretical wisdom about the human, but practical wisdom of a peculiar kind. The human mind, through its self‐conscious understanding can be immediately and directly efficacious in shaping its own structure.     

Jung's views on causes and treatments of schizophrenia in light of current trends in cognitive neuroscience and psychotherapy research I. Aetiology and phenomenology

Jung's writings on schizophrenia are almost completely ignored or forgotten today. The purpose of this paper, along with a follow‐up article, is to review the primary themes found in Jung's writings on schizophrenia, and to assess the validity of his theories about the disorder in light of our current knowledge base in the fields of psychopathology, cognitive neuroscience and psychotherapy research. In this article, five themes related to the aetiology and phenomenology of schizophrenia from Jung's writings are discussed:1) abaissement du niveau mental; 2) the complex; 3) mandala imagery; 4) constellation of archetypes and 5) psychological versus toxic aetiology. Reviews of the above areas suggest three conclusions. First, in many ways, Jung's ideas on schizophrenia anticipated much current thinking and data about the disorder. Second, with the recent (re)convergence of psychological and biological approaches to understanding and treating schizophrenia, the pioneering ideas of Jung regarding the importance of both factors and their interaction remain a useful and rich, but still underutilized resource. Finally, a more concerted effort to understand and evaluate the validity of Jung's concepts in terms of evidence from neuroscience could lead both to important advances in analytical psychology and to developments in therapeutic approaches that would extend beyond the treatment of schizophrenia.     

Pathways to adulthood and their precursors and outcomes

Norway has an extensive welfare system which may provide adolescents with many options and high levels of flexibility in terms of pathways to adulthood. This study aimed to describe Norwegian developmental pathways to adulthood, including changes in role statuses (such as living situations, education, work, marriage/cohabitation and parenthood) from 16 to 30 years of age, and their precursors and outcomes. Repeated measures latent class analysis of longitudinal data from 998 Norwegian individuals indicated three main pathways to adulthood among women and men. In both sexes, most individuals undertook a long period of education and postponed family formation. However, some individuals started working early, a group of women established families with partners and children early, and a group of men remained primarily single between 16 and 30 years of age. Furthermore, the results show that pathways to adulthood in Norway are surprisingly similar to pathways in other countries such as the US, UK and Finland. The results indicate that pathways to adulthood are influenced by social reproduction factors in a country with high levels of welfare benefits as well. In addition, the results suggest that pathways involving living with a partner and either higher education or work are associated with high life satisfaction at age 30.     

The mental health of unaccompanied refugee minors on arrival in the host country

Despite increasing numbers of unaccompanied refugee minors (UM) in Europe and heightened concerns for this group, research on their mental health has seldom included the factor “time since arrival.” As a result, our knowledge of the mental health statuses of UM at specific points in time and over periods in their resettlement trajectories in European host countries is limited. This study therefore examined the mental health of UM shortly after their arrival in Norway (n = 204) and Belgium (n = 103) through the use of self‐report questionnaires (HSCL‐37A, SLE, RATS, HTQ). High prevalence scores of anxiety, depression and posttraumatic stress disorder (PTSD) symptoms were found. In addition, particular associations were found with the number of traumatic events the UM reported. The results indicate that all UM have high support needs on arrival in the host country. Longitudinal studies following up patterns of continuity and change in their mental health during their trajectories in the host country are necessary.     

History of the Hospital Real y General de Nuestra Señora de Gracia in Saragossa: Occupational Therapy Pioneer in Neurology and Psychiatry in Spain

In this article the authors describe the program of the Hospital Real y General de Nuestra Señora de Gracia in Saragossa (Spain) and its importance in the history of occupational therapy. It is believed to be the first hospital in the world to use occupations as therapy for psychiatric patients. Pinel knew about this new trend through a report by Iberti and wrote about it in his book Medico-Philosophical Treatise on Mental Alienation.     

Behavioral Health Competence: An Exploration of Army Reserve Occupational Therapists

In this study the behavioral health competence of Army Reserve occupational therapists (OTs) was examined by the authors through electronic survey to determine current levels of competence and highlight pre-deployment training needs. Results indicated that while Army Reserve OTs report high levels of behavioral health competence, many questions regarding diagnosis, assessment, evaluation, treatment planning, intervention, and progress arose throughout deployment. OTs often relied on skills from Level II fieldwork education and entry-level didactic education for competency. Perceived competencies may be compromised by curriculum changes in entry-level education, available fieldwork settings, and a lack of adequate training currently available prior to deployment.