Barriers and facilitators affecting the sustainability of dialectical behaviour therapy programmes: A qualitative study of clinician perspectives

Dialectical behaviour therapy (DBT) is a psychological treatment developed for individuals experiencing chronic suicidality and high‐risk behaviours. Despite the substantial evidence supporting the effectiveness of DBT, many programmes have problems with its sustainability. The goals of the current qualitative study were to identify factors that impact the sustainability of DBT programmes within a publicly funded mental health system and identify factors that are particularly relevant for youth DBT programmes. Interviews with trained adult and youth DBT clinicians (N = 31) were conducted to explore their experiences providing DBT. Three major themes that emerged as barriers to the sustainability of DBT programmes included the following: systemic challenges, conflicts within the consultation teams and clinician burnout. Factors influencing the success of DBT programmes included the following: systemic support, clinician commitment and “buy in”, and team cohesion. Factors specific to providing DBT with youth (i.e. level of commitment, simplifying the language, and parental investment) and recommendations for sustainability for adults and youth programmes were also identified. Findings of this study provide valuable information on factors impacting DBT programmes within the unique context of a Canadian mental health service system, where community‐based services are publicly funded. These findings have clear clinical utility and can be used to generate solutions to clinicians' perceived barriers and to foster perceived facilitators within similar contexts.     

孤独感和手机成瘾的关系:一项元分析

孤独感与手机成瘾均是当下生活中较为常见的现象, 诸多研究基于不同的理论视角探讨了两者间的内在联系, 但研究结果却存在很大分歧。为明确两者之间的整体关系, 以及产生分歧的原因, 对检索后获得的121项研究(124个效应值)使用随机效应模型进行了元分析。结果发现:孤独感与手机成瘾存在中等程度的正相关(r = 0.25, 95% CI = [0.23, 0.27]); 两者的相关性受被试年龄群体的调节, 成年人群体中的相关系数显著高于青少年群体, 但两者的相关性不受性别、孤独感和手机成瘾测量工具的影响。结果表明孤独感与手机成瘾关系密切, 支持了补偿性网络使用理论和自我调节缺陷模型。未来应加强纵向研究或实验研究进一步揭示孤独感与手机成瘾的作用方向。     

人口统计学特征对公共服务动机有什么影响?来自元分析的证据

采用元分析方法探讨人口统计学特征与公共服务动机之间的关系。经筛选, 共纳入138篇492个独立样本(N = 1078442)。结果发现, 性别、年龄、教育程度、组织任期、工作任期、职位等级和收入与公共服务动机之间均呈显著的正相关关系, 且与公共服务动机不同维度之间的关系均存在差异, 婚姻状况与公共服务动机间不存在显著的相关关系。此外, 公共服务动机测量工具、测量时间点和文化背景对部分人口统计学特征与公共服务动机之间的关系有调节作用。研究结果为人口统计学特征如何影响公共服务动机提供了较为精确的估计, 对于发展公共服务动机理论, 激励员工工作积极性, 提高公共部门服务水平都有重要意义。     

Development of rules and strategies: balancing the old and the new

The experiments described in the lead articles replicate findings from previous studies of development of knowledge about balance scales, add several new findings, and raise four key questions: (a) How can rule use best be assessed? (b) How can we reconcile systematic use of rules with variable use of strategies? (c) When do children begin to use rules? and (d) How do children generate new rules? In this Reflection, we summarize current understanding of development of knowledge about balance scales and consider each of the four questions.     

From case management to prevention of scientific dishonesty in Denmark

In 1992, The Danish Medical Research Council established a national committee on scientific dishonesty with the twofold task of handling cases of scientific misconduct and taking preventive initiatives. Scientific dishonesty was proven in only five cases, but in another nine cases lesser degrees of deviations from good scientific practice were found. The experiences from a total of 24 treated cases indicated that three key areas were at the basis of most of the accusations and the deviations from good practice: uncertainty about 1) authorship, about 2) rights and duties to use scientific data and about 3) agreements at the initiation of joint studies. As a consequence guidelines on good practice have been issued on these key subjects. An earlier version of this paper was presented at a symposium, Scientific Misconduct. An International Perspective, organised by The Medical University of Warsaw, 16 November, 1998.     

Chimpanzee (Pan troglodytes) intentional communication is not contingent upon food

Studies of great apes have revealed that they use manual gestures and other signals to communicate about distal objects. There is also evidence that chimpanzees modify the types of communicative signals they use depending on the attentional state of a human communicative partner. The majority of previous studies have involved chimpanzees requesting food items from a human experimenter. Here, these same communicative behaviors are reported in chimpanzees requesting a tool from a human observer. In this study, captive chimpanzees were found to gesture, vocalize, and display more often when the experimenter had a tool than when she did not. It was also found that chimpanzees responded differentially based on the attentional state of a human experimenter, and when given the wrong tool persisted in their communicative efforts. Implications for the referential and intentional nature of chimpanzee communicative signaling are discussed.     

The Relative Contribution of Sibling Deviance and Peer Deviance in the Prediction of Substance Use Across Middle Childhood

This study investigated the quality of sibling relationships and sibling deviancy in a sample of children at-risk for substance use and antisocial behavior. Based on a history of empirical and theoretical models suggesting strong associations between children's development in the context of relationships and the emergence of delinquency and drug use, this research extends previous efforts by including sibling relationships in this developmental model, linking siblings with later substance use. Sibling relationship quality as well as peer deviance were examined using a multirater, multimethod assessment procedure. We tested 3 constructs (deviancy, warmth, and conflict) related to sibling behavior. Only sibling deviance and peer deviance directly predicted substance use. When both sibling deviance and peer deviance were examined as predictors of changes in substance use over time, only sibling deviance was significant. Implications for the development of substance use behavior in middle childhood are discussed.     

Religious Activity and Risk Behavior Among African American Adolescents: Concurrent and Developmental Effects

This study examines how religious activity is associated with risk behaviors, concurrently and developmentally among urban African American adolescents. Seven hundred and five African American youths were interviewed annually during high school. Retention rates for the study exceeded 90%. Frequency of religious activity, sexual intercourse, and alcohol, cigarette, and marijuana use were assessed at each wave. Growth curve analyses found negative concurrent associations between religious activity and each of the four risk behaviors. The developmental effects of religious activity varied by gender. Higher levels of religious activity in 9th grade predicted smaller increases in marijuana use among males and cigarette use among females. In addition, larger decreases in religious activity during high school were associated with greater increases in alcohol use among males and sexual intercourse among females. During high school, religious activity limits the development of certain types of risk behavior among African American youth, even after controlling for reciprocal effects.     

Looking on the One We Have Pierced: Repentance,Resurrection, and Winnicott's “Capacity for Concern”

This work presents a view of Christian repentance as a process analogous to the development of Winnicott's capacity for concern and illuminated by Rowan Williams' theology of the Resurrection. One begins with fear of forfeiting one's attachment to the divine good mother, confronts the evidence of one's destructiveness in the Passion of Christ, experiences the risen Christ's object survival and acceptance of reparations, and attains a desire to contribute-in to God and neighbor.     

Exploring dynamics of abusive lesbian relationships: preliminary analysis of a multisite,qualitative study

This paper presents preliminary results from a multisite, qualitative study on violence in lesbian relationships. A framework for conducting community-based, empowerment research that draws on theories of community psychology, feminism, and postmodernism is presented. The study was designed to understand the dynamics of abusive lesbian relationships and social service providers' responses to the abuse. Results from 80 in-depth interviews with lesbians who have experienced relationship violence are examined with a particular focus on a pattern of first relationships being abusive and a theme of shifting power dynamics. Analysis of focus group discussions with 45 feminist service providers (e.g., counselors, shelter workers, social workers, healthcare providers) reveals the difficulties in assessing the power dynamics of abusive same-sex relationships and in developing appropriate responses when relying on heterosexually gendered models developed to address men's violence against women. The preliminary results present implications both for how we theorize and research this form of violence, and for improving the practices and policies of social services that work with lesbian, gay, bisexual, and transgendered communities.