The Responses of Health Systems to Marital Sexual Violence – A Perspective from Southern India

ABSTRACT

Marital sexual violence is a serious problem in India. However, marital rape and most other forms of marital sexual violence are not criminalized in the country. This qualitative study with healthcare providers (physicians and nurses), lawyers, members of a non-profit organization that offers domestic violence support services out of a hospital, a journalist and two lawyers suggest that the majority of care providers recognize that marital sexual violence is a serious concern, and agree that health systems can play a vital role in addressing both the immediate biomedical concerns of survivors, and also overall well-being. The study reveals several systemic and internal factors that hinder responsiveness of Indian health institutions. These include, the absence of a protocol or uniform internal guidelines in most hospitals, a lack of screening programs to capture the presence of violence occurring when patients visit hospitals for other reasons, a large patient load, a lack of gender sensitivity in providers’ education, an absence of domestic violence shelters, and poor interlinkages between support services such as counseling and legal services. Notwithstanding these challenges, some exemplar physicians and nurses assist survivors of sexual violence, sometimes risking their own safety. The Indian health system can be made more responsive, provided these factors are addressed, and crucially budgets are allocated for interventions.     

Physical and Psychological Health Predict Adherence to an Online Mindfulness Program for College Students

We examined predictors of students' adherence to a 10-session online mindfulness program. Undergraduates naive to meditation (N = 169) were recruited from an introductory psychology subject pool. Students completed assessments examining physical and psychological health and were asked to complete a 10-session online mindfulness activity. More than half (53%) of the sample was fully adherent to the program. Better physical health and lower levels of anxiety predicted adherence. We present recommendations for increasing adherence in the clinical use of mindfulness with college students.     

A systematic review of internet-delivered cognitive behavior therapy for alcohol misuse: study characteristics,program content and outcomes

ABSTRACT

Alcohol misuse is a common, disabling and costly issue worldwide. Internet-delivered cognitive behavior therapy (ICBT) has the potential to reduce the harms of alcohol misuse, particularly for individuals who are unable or unwilling to access face-to-face therapy. A systematic review was conducted using Medline, CINAHL, EMBASE and PsycINFO databases for all relevant articles published from 1980 to January 2019. Randomized controlled trials (RCTs) were included if (i) an ICBT intervention targeting alcohol misuse was delivered; (ii) participants were aged 18 years or older; and (iii) primary outcomes were quantity of drinking. A qualitative analysis was conducted on the content of the ICBT programs. Fourteen studies met inclusion criteria. Most studies included participants from the general population, while studies conducted within clinic settings with diagnosed individuals were rare. The programs were similar in terms of included modules. Small effects were seen in studies on self-guided ICBT, while therapist-guided ICBT rendered small to large effects. The current review indicates that ICBT has a significant effect in reducing alcohol consumption. Larger studies evaluating ICBT compared to active control groups especially within clinic settings are warranted.     

Obstetrics at odds with evolution: The consequences of interrupting adaptive birthing consciousness

“Birthing consciousness” is a psycho-physical state of focus and retreat into which a woman sometimes enters during physiological birth. When this state is initiated and continues uninterrupted, the probability of a natural birthing process increases. Adversely, interruptions to the state of birthing consciousness slow down or even stop the birth from progressing. In this theoretical examination, I claim that birthing consciousness was a useful adaptation in human evolutionary time. However, in current hospital settings there are various interruptions to birthing consciousness. I offer a critical insight: obstetrics has neglected to exploit evolutionary advantages. Moreover, attention to evolutionary adaptation in the hospital generally, or obstetrics specifically, will advance best medical practices, thus public health in general. The suggested evolutionary approach offers a new perspective concerning the cascade of interventions in the birth process. It also suggests a path for future research concerning the reduction in the rate of unscheduled cesarean births, on the rise in current obstetrical care.     

Implementing Trauma-Informed Care in Primary Medical Settings: Evidence-Based Rationale and Approaches

ABSTRACT

Chronic stress stemming from trauma exposure and posttraumatic stress disorder (PTSD) leads to many health problems that are typically seen by primary care providers. Unfortunately, providers rarely identify trauma as the root cause of patient difficulties. The present paper provides an evidence-based rationale for implementing trauma-informed care principles and processes into medical primary care systems. Beginning with a review of prevalence of trauma exposure and PTSD in primary care clinics, this article elucidates relationships between trauma exposure and behavioral and medical health problems, as well as clinical and physiological pathways that lead from trauma exposure to illness. The article concludes with exposition of trauma-informed interventions that can be implemented in primary care clinics, and discussion of future directions.     

Family systems psychiatry in an acute in‐patient setting: the implementation and sustainability 5 years after its introduction

From 2003 to 2008 a multicentre research project, systems therapy methods in acute psychiatry (SYMPA), attempted to establish structured in‐patient treatment based on systemic interventions in German non‐university psychiatric hospitals. Utilising multi‐professional family systems training for team members in six in‐patient wards, its main goal was to improve the involvement of familial and non‐familial important others. This follow‐up study explores the sustainability of family systems psychiatry by evaluating the frequency of the utilisation of four core systemic interventions; elements of a systemic organizational culture in psychiatry; and institutional barriers to this new approach. The degree of implementation was high to moderate, depending on the intervention. More intense communication developed among staff of different professions and the status of nursing staff improved. Organizational barriers to implementation included the ambiguous role of junior doctors in teams, continuously understaffed wards and frequent over‐occupancy.     

Family Therapy for Substance Use among Sexual Minority Youth: A Review of Treatment Options

Abstract

Substance use disorders are nearly twice as common among sexual minority youth (SMY) as among their heterosexual peers. Most applied literature about this population suggests interventions on either the individual or community level, and the benefits of family therapy for this population are often overlooked. The present literature review (a) outlines clinical knowledge related to sexual minority youth and substance use (e.g., prevalence rates, contributing factors), (b) discusses the importance of clinical self-awareness around these topics, and (c) outlines clinical behaviors and interventions from literature that may be employed when working with substance-using SMY and their families.     

Supportive and interpretative interventions in fostering mentalisation during counselling

ABSTRACT

This work analysed which profiles of counsellors’ supportive and interpretative actions emerged in two group counselling interventions designed to promote mentalisation in underachieving university students. The Psychodynamic Intervention Rating Scale was used to analyse this and the level of depth of defence interpretations. Two outcome measures were administered to analyse student mentalisation and their academic achievements. Process findings showed that supportive actions were used for the most part in both counselling interventions; however, only one group improved in terms of mentalisation and academic performance. In the good-outcome group, there were more defence interpretations, especially during the early sessions, and with a deeper level of elaboration. The innovative relevance of these findings and their implications for practice among counsellors are discussed.     

Causal Information-Seeking Strategies Change Across Childhood and Adolescence

Intervening on causal systems can illuminate their underlying structures. Past work has shown that, relative to adults, young children often make intervention decisions that appear to confirm a single hypothesis rather than those that optimally discriminate alternative hypotheses. Here, we investigated how the ability to make informative causal interventions changes across development. Ninety participants between the ages of 7 and 25 completed 40 different puzzles in which they had to intervene on various causal systems to determine their underlying structures. Each puzzle comprised a three- or four-node computer chip with hidden wires. On each trial, participants viewed two possible arrangements of the chip's hidden wires and had to select a single node to activate. After observing the outcome of their intervention, participants selected a wire configuration and rated their confidence in their selection. We characterized participant choices with a Bayesian measurement model that indexed the extent to which participants selected nodes that would best disambiguate the two possible causal structures versus those that had high causal centrality in one of the two causal hypotheses but did not necessarily discriminate between them. Our model estimates revealed that the use of a discriminatory strategy increased through early adolescence. Further, developmental improvements in intervention strategy were related to changes in the ability to accurately judge the strength of evidence that interventions revealed, as indexed by participants' confidence in their selections. Our results suggest that improvements in causal information-seeking extend into adolescence and may be driven by metacognitive sensitivity to the efficacy of previous interventions in discriminating competing ideas.