Making Lemonade out of Lemons: Dialectical Behavior Therapy via Telehealth During a Pandemic

The COVID-19 pandemic has created a burden on healthcare systems and increased demand for mental healthcare at a time when in-person services are limited. Many programs offering dialectical behavior therapy (DBT) for complex clients have pivoted to telehealth in order to increase access to critical mental healthcare. There is, however, limited research on the provision of telehealth treatment for clients with complex psychopathology more broadly, or the telehealth implementation of DBT more specifically. The aim of this study was to examine the use of telehealth services and related clinician attitudes and experiences in the context of DBT. We examined the degree of telehealth platform adoption among DBT clinicians, as well as changes in stress and self-care strategies. A supplemental aim was to gather clinicians’ recommendations for providing DBT via telehealth. Participants included N = 99 DBT practitioners (79.8% female; 20.2% male). Qualitative and quantitative methods were used for data analysis. Findings show that telehealth DBT has been widely adopted among DBT clinicians, and that clinicians’ attitudes to telehealth DBT are cautiously optimistic. Participants described three main areas of stress associated with DBT via telehealth provision, as well as lost and novel self-care strategies.     

Behavioral Parent Training Engagement Among Young Children With Autism Spectrum Disorder

The purpose of the current study was to examine engagement with Behavioral Parent Training (BPT) for families of children with Autism Spectrum Disorder (ASD) and assess openness to novel delivery formats for BPT (e.g., telehealth, group). Participants were caregivers of 501 children with ASD (ages 2–6) enrolled in the SPARK (Simons Foundation Powering Autism Research for Knowledge) online national registry. The study assessed: (1) rates of child disruptive behavior diagnoses, (2) engagement and satisfaction with BPT, (3) parent and child factors (e.g., diagnostic history), and (4) openness to novel delivery formats. Almost 25% of young children with ASD in this sample had disruptive behavior problems rising to the level of a diagnosis of ADHD or ODD and thus would benefit from BPT. However, only one third of these families had actually been referred to BPT. Families indicated high level of interest in participating in BPT, with a particular interest in Parent Child Interaction Therapy (PCIT) as well as novel delivery formats such as telehealth and group. Specific components of the therapy and delivery formats were indicative of parent satisfaction (e.g. groups, longer treatment sessions, longer treatment length). Specific parent and child characteristics were predictive of openness to novel formats (e.g. parental depression, more severe behavioral challenges, lower verbal skills). Results underscore the need for increased referrals and access to BPT programs the ASD population. Both parent and child characteristics are important for determining appropriate delivery formats.     

Treating Young Adult Depression With Text-Delivered Cognitive Behavioral Therapy: A Pilot Randomized Clinical Trial

Young adults (ages 18 to 25) in the U.S. suffer from the highest rates of past-year major depressive episode and are the least likely to receive treatment compared to other age groups. As such, we examined the feasibility, acceptability, and efficacy of a text-message delivered cognitive behavioral therapy: CBT-txt with young adults. The study was a 2-month pilot RCT to test a 4-week intervention for depression that contained 197 text messages (average 12 texts every other day). The sample, recruited via Facebook and Instagram, was 102 U.S. young adults who presented with at least moderate depressive symptomatology. Assessments occurred at baseline prior to randomization and at 1 and 2 months post enrollment. The primary outcome, severity of depressive symptoms, was assessed using the Beck Depression Inventory II. Feasibility benchmarks were met and participants reported high levels of engagement with and acceptability of the intervention. Logistic regression indicated that treatment participants were three times as likely to have minimal or mild depression symptoms at 2 months compared to waitlist control participants. Latent change score modeling found that the strongest significant treatment effect appeared at the 1-month follow-up period, particularly for participants who began with severe depressive symptoms. Mediation analysis revealed significant indirect treatment effects of increases in behavioral activation on reducing depressive symptoms, suggesting a mechanism of change. Limitations were that the sample was relatively small and consisted of primarily women. These results provide initial evidence for the feasibility, acceptability, and efficacy of a text-delivered treatment for young adult depression.     

Behavioral case formulation: An experimental assessment study of transient tic disorder

A nine-year-old male, who met DSM III-R criteria for transient tic disorder, participated in an experimental assessment strategy to generate support for a case formulation. In addition to presenting motor disturbance, assessment procedures revealed six problem areas. All problems were formulated as manifestations of a hypersensitivity to evaluation, etiologically related to the boy's relationship with an insecure and critical father. It was hypothesized that the patient's tic disorder was a consequence of his hypersensitivity to father's excessive criticism, which then generalized to other evaluative situations. Using a controlled single-subject design, predictions derived from the formulation were tested by exposing the child to a planned combination of evaluative observers (e.g., father, mother, therapist, etc.) who watched him as he worked on a series of puzzles. The dependent measures included (1) behavioral recordings of tic frequency and (2) frontalis EMG responses. The results indicated significant differences in tic rate and EMG as a function of the type of observer. Consistent with the formulation, the patient displayed the highest levels of tic behavior and EMG response when his father was the observer and lowest in the presence of the mother. Predictions regarding other stimulus conditions were also confirmed. These results provided support for the case formulation that was used to design an effective treatment intervention. Findings suggest that the case formulation model offers a method whereby novel case hypotheses can be generated for poorly understood psychopathology and tested later in the experimental situation.     

Cognitive habilitation in schizophrenia: A theoretical review and model of treatment

Evidence has accumulated for information processing deficits in schizophrenia. The functional significance of these deficits is only beginning to be understood. There are indications that these deficits may respond to intervention. Training on deficient functions has been demonstrated to relate to improvements in performance. A treatment program of cognitive rehabilitation is deduced from the literature and induced from clinical experience. The treatment is designed to impact directly on the information processing deficits of schizophrenic patients and indirectly to ameliorate functional deficits.     

Schizophrenia and indeterminacy: The problem of validity

The paper attempts to account for the confusion over the validity of the concept of schizophrenia in terms of two closely related aspects of conceptual indeterminacy. Firstly, it is identified on the basis of a breakdown in intelligibility, but what constitutes such a breakdown is indeterminate. Secondly, the concept sits between the categories of natural disease or illness on the one hand, and character trait or moral failing or gift on the other. This entails an indeterminacy in attempting to define the role that physiological explanation could have. Light may be thrown on the concept by exploring a distinction between a life story in which the schizophrenic condition emerges as the conclusion of the story and a causal process in which the condition is the end result or final consequence.     

Aging families: The personal, permanent group

Later life families present a very special instance of group psychotherapy with older adults. This paper describes the challenges faced by later life families, including major life events to which multiple family members must adapt, and the increasing dependency of some elderly members. A developmental framework for later life problems is offered as a therapy frame useful to families. Key aspects of therapy process with later life families are also presented. Goals, strategies, structures of therapy, and the therapist’s role are all shaped by the long and intimate history of the members of this special form of group.     

Relationship Satisfaction: Impact and Consequences for Women's Emotional Health and Treatment

This study uses feminist theory to examine the variables of relationship length and relationship satisfaction as predicators of both self-esteem and emotional functioning for women. Using a national sample of data gathered from 1,257 female survey respondents this study found significant relationships between emotional functioning, self-esteem, and self-reported relationship satisfaction which was supported by regression testing and path analysis. In addition, a significant negative relationship was noted between a woman's self-esteem and her with-holding of verbalized displeasure or disagreement with her partner. Implications for women in therapy were discussed.     

Family Secrets: The Case of the Patient Kept in the Dark

The author examines the position of a child from whom important matters in his or her own life or key events in the family have been kept secret, outlines criteria by which the decision whether or not to unveil the secret should be made, and urges colleagues to gather more data and examine further family secrets.