Dissociative Collusion: Reconnecting Clients with Histories of Trauma in Couple Therapy

This paper introduces the concept of “dissociative collusion” as a helpful theoretical and clinical tool for understanding and working with clients with histories of trauma in couple therapy. The paper describes ways to diagnose and treat dissociative collusion based on the integration of an object relations approach, a relational approach, and a narrative approach. Dissociative collusion, a unique version of the well‐documented “couple collusion,” describes relational unconscious dynamics where split‐off aspects of one or both partners are mutually dissociated in a complementary fashion that becomes a part of the shared unconscious and is reenacted in destructive ways. The dissociative collusion concept is especially relevant to couple therapists who work with clients with histories of trauma, who frequently use dissociation as a primary defense mechanism. We suggest that the challenge and goal for couple therapy with this population are to help them reconnect and better oscillate between dissociated self‐other configurations. A case of couple therapy of a wife who had been a victim of childhood sexual abuse and her husband who displayed frequent use of dissociative defenses is presented.     

The influence of training task stimuli on transfer effects of working memory training in aging

IntroductionWorking memory (WM) training is known to produce benefits in older adults’ WM. Transfer effects to untrained abilities, however, remain controversial and several aspects are thought to influence the generalization of benefits, including the kind of stimuli used in the training tasks, an aspect rarely addressed in older adults.ObjectiveThe present study had two aims: (1) to test the efficacy of a visuospatial WM training procedure in older adults, in terms of specific and transfer effects; (2) to examine in two experiments whether the type of stimuli used in the training task influences the training's effectiveness. Experiment 1 adopted images with a neutral valence while experiment 2 used emotionally positive images based on evidence that older adults tend to remember positive stimuli better. In both experiments, specific training-related gains in a visuospatial WM task (the criterion task) and transfer effects on measures of verbal WM, visuospatial short-term memory, processing speed and reasoning were examined. Maintenance of training benefits was also assessed at an 8-month follow-up.MethodSeventy older adult (63–75 years old) volunteers (35 for experiment 1, and 35 for experiment 2) were randomly assigned to a training or active control group. The same visuospatial WM training procedure was used in both experiments, manipulating only the type of stimuli used (neutral in experiment 1 and emotionally positive in experiment 2).ResultsIn both experiments, only trained participants showed specific benefits in the WM criterion task. These gains were also maintained at the follow-up, but no transfer effects were identified.ConclusionOverall, our findings using the present visuospatial WM training paradigm suggest that it is less effective, in terms of transfer effects, than the same paradigm administered verbally in a previous study, regardless of the type of stimuli used in WM training tasks (neutral or emotionally positive stimuli).     

Do patients suffering from chronic diseases retrospectively overestimate how healthy they were before they fell ill?

Background/Objective: To examine the impact of a disease on a person's subjective health state, patients are often asked to assess their current health state and to retrospectively assess how healthy they were before they fell ill. The objective of this study was to test whether patients generally overestimated the quality of their pre-disease health. Method: Six samples of patients with chronic diseases (cancer patients, cardiovascular patients, and patients diagnosed with sarcoidosis, N between 197 and 1,197) were analyzed. The patients assessed their current health states and their health states at the time before diagnosis. The retrospective scores were compared with matched data from general population studies. Results: In three of the six studies, the retrospective health ratings of the patients were significantly higher than the general population norms (effect sizes between 0.24 and 0.46), two studies yielded nonsignificant effects, and in one study there was an opposite trend. The general overestimation of pre-disease health was more pronounced in older patients as compared with younger ones, and it was more pronounced when global health/quality of life was to be assessed. Conclusions: Retrospective assessments of pre-disease health states are not appropriate for assessing disease-related changes in a person's health state.     

Loneliness predicts suicidal ideation and anxiety symptoms in long-term childhood cancer survivors

Background/ObjectiveLong-term childhood cancer survivors (CCS) are at risk for adverse late effects. However, not all of them are well understood. The present study addressed loneliness, a previously under-researched mental health risk in cancer survivor populations. We assessed the prevalence of loneliness and its impact on psychological symptoms over time. Method: A registry-based sample of N = 633 adult long-term CCS underwent medical and psychological assessments and took part in a follow-up survey 2.5 years later. Psychological symptoms (somatic, anxiety, depression symptoms, and suicidal ideation) were measured using the Patient Health Questionnaire. We calculated linear regression models of symptoms at follow-up to investigate the impact of loneliness over time (controlling for symptoms at baseline and relevant confounders). Results: Loneliness was reported by 17.70% of CCS. In multivariate linear regression analyses, loneliness was still predictive of more severe anxiety symptoms and suicidal ideation over two years later. Loneliness did not predict somatic and depression symptoms at follow-up (which increased with age). Conclusions: Loneliness affected a significant number of CCS and was a risk factor for persistent anxiety symptoms and suicidal ideation. The extent to which young cancer patients’ re-integration into society is successful could thus have important implications for well-being in adulthood.     

A LONGITUDINAL,PERSON‐CENTERED ANALYSIS OF EARLY HEAD START MOTHERS’ PARENTING

This study used a person‐centered approach to examine stability and change in parenting typologies across early childhood. Profiles were associated within and across time with contextual covariates, including demographic characteristics, risk factors, and Early Head Start participation. Participants were drawn from the Early Head Start Research and Evaluation Project (N = 2, 876). Parenting profiles were identified based on observed parenting dimensions at 14, 24, and 36 months, and pre‐Kindergarten (pre‐K). Results suggested a four‐profile solution at each time point: Supportive, Lukewarm (14 & 24 months)/Sufficient (36 months and pre‐K), Harsh, and Detached. Supportive was the largest, most stable, and most likely transitioned into profile while Harsh and Detached represented rare profiles with moderate to low membership stability across time. Depression and family conflict emerged as important correlates of unsupportive parenting profiles both within and across time. Findings are discussed in terms of their relevance for both policy and implementation practices for low‐income mothers with young children.     

OBSERVATION AND COMPARISON OF MEALTIME BEHAVIORS IN A SAMPLE OF CHILDREN WITH AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDERS AND A CONTROL SAMPLE OF CHILDREN WITH TYPICAL DEVELOPMENT

Despite widespread use of behavioral observations to evaluate child feeding behaviors in research and clinical practice, few studies have comprehensively characterized mealtimes or identified features that differentiate children with and without disordered feeding; these were the aims of the current study. Mealtime observations were conducted for 18 children with avoidant restrictive food intake disorder (ARFID) and 21 typically developing children. Observations were coded inductively, and associations between disorder and observed mealtime actions were examined. Most behaviors were observed across both clinical and nonclinical mealtimes, and many did not differ in frequency between children with and without ARFID. However, significant group differences were observed in the frequencies of behaviors relating to food intake, visual and physical engagement with feeding, and movement during mealtimes. The comparability of behaviors across clinical and nonclinical groups suggests that eating behaviors exist on a continuum from “normal” to “abnormal,” with group differences relating to frequency rather than type of behavior. The behavioral differences observed in this study suggest that identification of children with ARFID should focus on child engagement with food and restlessness during mealtimes. Reliance on emotional and escape‐maintained behaviors will lead to underrecognition of families in need of clinical support.     

The link between stress,well-being,and psychological flexibility during an Acceptance and Commitment Therapy self-help intervention

Background/Objective: Prolonged stress can overwhelm coping resources, leading people to seek mental health care. Acceptance and commitment therapy (ACT) is an intervention that enhances well-being and reduces distress, assumedly by means of increasing psychological flexibility (PF). We examined the association between a total increase in PF during an intervention and decreases in stress and increases in well-being during and after the intervention. Method: The intervention was a randomized controlled trial of an ACT-based self-help intervention. Participants were 91 individuals reporting elevated levels of work-related stress. Measurements were completed at preintervention, postintervention, and 3-month follow-up. Results: Structural equation models revealed that the total increase in PF during the intervention was negatively associated with a decrease in stress (b = -0.63, SE = 0.14, p < .001) and positively associated with an increase in well-being during the intervention (b = 0.48, SE = 0.11, p < .001), but not with a decrease in stress (b = 0.03, SE = 0.27, p > .05) and well-being (b = -0.04, SE = 0.39, p > .05) following the intervention. Conclusions: Our study provides empirical support for decreasing stress and promoting well-being through ACT and emphasizes the potential of PF in promoting well-being.     

Psychometric properties of the Shared Decision-Making Questionnaire (SDM-Q-9) in oncology practicePropiedades psicométricas del Questionnaire Shared Decision-Making (SDM-Q-9) en oncología

Background/Objective: This study sought to assess the psychometric properties of the 9-item Shared Decision-Making Questionnaire (SDM-Q-9) in patients with resected, non-metastatic cancer and eligible for adjuvant chemotherapy. Method: A total of 568 patients were recruited from a multi-institutional, prospective, transversal study. Patients answered the SDM-Q-9 after visiting their medical oncologist who, in turn, completed the SDM-Q–Physician version. Reliability, factorial structures [exploratory factor analysis (EFA), confirmatory factor analysis (CFA)], and convergent validity of the SDM-Q-9 scores were explored. Results: SDM-Q-9 showed a clear factorial structure, compatible with a strong and replicable general factor and a secondary group factor, in patients with resected, non-metastatic cancer. Total sum scores derived from the general factor showed good reliability in terms of omega coefficient: .90. The association between patient and physician perception of SDM was weak and failed to reach statistical significance. Males and patients over 60 years of age displayed the greatest satisfaction with SDM. Conclusions: SDM-Q-9 can aid in evaluating SDM from the cancer patients’ perspective. SDM-Q-9 is helpful in studies examining patient perspectives of SDM and as an indicator of the degree of quality and satisfaction with health care and patient-physician relationship.     

Let's Talk About Race: Evaluating a College Interracial Discussion Group on Race

The authors evaluate Dialogues on Race, an interracial group intervention in which undergraduate student facilitators led conversations about race with their peers. The evaluation process is described, including developing collaborative relationships, identifying program goals, selecting measures, and analyzing and presenting results. The authors discuss lessons learned about evaluating an interracial dialogue intervention that did not originally include researchers in the hope that this examination will encourage others to evaluate similar campus interventions. Diálogos sobre Raza es una intervención de grupo interracial en la que estudiantes universitarios moderaron conversaciones sobre raza con sus compañeros. Se describe el proceso de evaluación, incluyendo el desarrollo de relaciones de colaboración, la identificación de objetivos del programa, la selección de medidas, y el análisis y presentación de los resultados. Los autores discuten las lecciones aprendidas sobre la evaluación de una intervención interracial dialogada que en principio no incluyó a investigadores con la esperanza de que este examen animará a otros a evaluar intervenciones similares en sus campus.