Childhood Maltreatment,Emotional Response Inhibition,and Suicide in Psychiatric Inpatients

Childhood abuse and/or neglect adversely influences development of neurocognitive systems that regulate affect and behavior. Poor inhibitory control over emotional reactions is thus one potential pathway from maltreatment to suicide. Adult psychiatric inpatients completed the Childhood Trauma Questionnaire and an emotional stop-signal task indexing negative emotional action termination (NEAT): the ability to inhibit ongoing motor reactions to aversive stimuli triggered by negative affect. Clinical interviews assessed suicidal thoughts and behaviors during hospitalization (n = 131) and at follow-up assessments 6 months later (n = 87). Our primary aim was to examine whether maltreatment history and NEAT explain overlapping variance in suicidal behaviors (1) retrospectively and (2) 6 months following hospital discharge. Contrary to prediction, childhood maltreatment was unrelated to history of suicidal behaviors. However, NEAT was consistently associated with prior suicidal acts, even controlling for suicidal ideation and demographic covariates. NEAT similarly contributed to the prediction of post-discharge suicidal behaviors, whereas we found no effect of maltreatment history. The present study suggests that NEAT captures suicide risk independently of childhood maltreatment. Results implicated NEAT impairment specifically, rather than broader response inhibition deficits (e.g., to positive stimuli), in past and future suicidal behaviors. These findings provide preliminary support for NEAT as a behavioral vulnerability marker for suicide, with implications for understanding links between maltreatment history and suicidal acts.     

Brief Cognitive-Behavioral Therapy for Suicidal Inpatients

Suicide risk is elevated in psychiatric patients following discharge from inpatient care. Despite this vulnerability, there has been limited research investigating suicide prevention protocols that take into account the unique system characteristics of this setting (e.g., short lengths of stay, crisis stabilization treatment model, multidisciplinary team coordination). Cognitive-behavioral therapy (CBT) has demonstrated efficacy for improving suicide risk in outpatients, but has not been validated with inpatients. The current study was a treatment development and pilot feasibility open trial that modified brief cognitive-behavioral therapy (BCBT) for an inpatient setting (BCBT-I). Key treatment modifications included administering up to 10 sessions (depending on patient length of stay), daily, and in a standardized order, with core crisis management skills introduced during the first three sessions. In addition, coordination with the inpatient treatment team was included in BCBT-I implementation. Six adult inpatients with a recent suicide attempt enrolled and completed an average of 4.67 BCBT-I sessions (SD = 1.36). The treatment was highly acceptable (Client Satisfaction Questionnaire total score M = 3.49, SD = 0.73). Pre- to posttreatment effect sizes demonstrated improvements in suicidal ideation (d = 0.97), depression (d = 1.33), and suicidal implicit associations (d = 1.28). All but one of the participants (83%) completed follow-up assessments 1-, 2-, and 3-months postdischarge. Over follow-up, two participants reported suicidal ideation (both without intent), and none reported suicide attempts, preparatory acts or behaviors, or nonsuicidal self-injury. This study provided preliminary evidence supporting the feasibility of CBT to treat suicidal inpatients. Future research is needed to validate BCBT-I in a larger, randomized controlled trial to determine whether BCBT-I reduces suicide risk beyond that afforded by inpatient treatment alone.     

The social dynamics involved in recovery and return to sport following a sport-related concussion: A study of three athlete-teammate-coach triads

An athlete's connection to their team and team members is an important part of their sport experience. However, researchers currently know little about the nature of these social dynamics with respect to concussed athletes. Our study explored athletes' recovery and reintegration into the team environment following a sport-related concussion. We conducted semi-structured interviews with each member of three athlete-teammate-coach triads (N = 9). We analysed the data using thematic narrative analysis and present the results as three stories that focused on each athlete's experience. For Cassie, we found two major plot points in her story: the transition in her role (and shift in identity) from athlete to student assistant coach/team manager and, once recovered, back to an athlete on the team. For Jess, we found that the main plot in her story was “pressure”. Specifically, the interplay between internal (placed on herself) and external (perceived from teammates and coaches) pressures to return to sport. In the third and final story, the main plot point was the tensions that arose from Jaden's preferences for social support and the type of support that his teammates and coaches believed he needed during his recovery. Our results highlight the interplay between athlete's personal and social identities, feelings of pressure to return and readiness, and the challenges of providing the right amount and type of social support. This research contributes to our limited understanding of the social dynamics involved in athletes' return to sport following a concussion.     

EDITORIAL Building bridges with mixed methods research?

Mixed methods refers to the use of both qualitative and quantitative approaches and methods in one study or sequentially in two or more studies. Without a mixed methods approach there is – to our minds ‐ a risk that only part of a phenomenon or experience is being explored. Our own involvement in mixed methods research has grown out of a shared interest in the concept ‘research‐practitioner’. Psychotherapy is a notoriously complex and ever‐developing field, and our growing sense has been that mixed methods research can contribute to a more complete – both broad and deep ‐ sense of knowledge and understanding.     

Generating interior search directions for multiobjective linear programming

A new multiobjective linear programming (MOLP) algorithm is presented. The algorithm uses a variant of Karmarkar's interior-point algorithm known as the affine-scaling primal algorithm. Using this single-objective algorithm, interior search directions are generated and used to provide an approximation to the gradient of the (implicitly known) utility function. The approximation is guided by assessing locally relevant preference information for the various interior directions through interaction with a decision maker (DM). The resulting algorithm is an interactive approach that makes its progress towards the solution through the interior of the constraints polytope.     

The Nature of Client Agency Prior to Therapy: A Qualitative Study on Clients’ Narratives

Client agency is considered a crucial contributor to good treatment outcome. Recent studies, however, differ strongly in how they conceptualise and investigate agency. The current study explores the nature of client agency in ten clients’ pre-treatment interviews. Applying Consensual Qualitative Research, we constructed three overarching categories, subdivided into 14 sub-categories capturing both between- and within-person differences in agency before therapy. We found that all participants oscillated between the experience of a lack of grip on problems on the one hand and noticing their involvement in the problem and taking action on the other. These results present a dynamic conceptualisation of client agency. This allows us to ask pertinent questions for both future research and clinical practice.     

Subjectifying the Personality State: Theoretical Underpinnings and an Empirical Example

Recent developments in personality research highlight the value of modelling dynamic state-like manifestations of personality. The present work integrates these developments with prominent clinical models addressing within-person multiplicity and promotes the exploration of models centred on state-like manifestations of personality that function as cohesive organizational units. Such units possess distinct subjective qualities and are characterized by specific affects, behaviours, cognitions, and desires that tend to be co-activated. As background, we review both theory and research from the fields of social cognition, psychotherapy, and psychopathology that serve as the foundation for such models. We then illustrate our ideas in greater detail with one well-supported clinical model—the schema therapy mode model, chosen because it provides a finite and definite set of modes (i.e. cohesive personality states). We assessed these modes using a newly developed experience-sampling measure administered to 52 individuals (four times daily for 15 days). We estimated intraindividual and group-level temporal and contemporaneous networks based on the within-person variance as well as between-person network. We discuss findings from exemplar participants and from group-level networks and address cross-model particularities and consistencies. In conclusion, we consider potential idiographic and nomothetic applications of subjective states dynamic personality research based on intensive longitudinal methods. © 2020 European Association of Personality Psychology     

Integrated mindfulness-based intervention: Effects on mindfulness skills,cognitive interference and performance satisfaction of young elite badminton players

ObjectivesMindfulness- and acceptance-based interventions (MABI) in sport settings need further development and validation to fulfil the desired outcomes related to sport performance. The current study aimed to design and implement a MABI integrated into the badminton training of young elite players (MBI programme), and to investigate its impact on sport performance-related outcomes.DesignTwo stages: (a) design and implementation of the MBI programme, and (b) evaluation using a mixed methods approach.MethodParticipants were young elite badminton players, assigned either to the 8-week MBI programme (n = 18; M_age = 16.22), or the 8-week placebo programme (n = 11; M_age = 16.64). Participants completed pre- and post-intervention measures of mindfulness skills, cognitive interference, and performance satisfaction. Social validation interviews were conducted with MBI participants to collect their overall perceptions of the programme.ResultsMANCOVA indicated a large intervention effect on the main outcome variables (partial η² = 0.58). The results of univariate ANCOVAs showed that post-intervention awareness, performance worries and task-irrelevant thoughts differed significantly across the groups. In addition, follow-up t-tests provided additional information regarding changes from pre- to post-intervention among the MBI and control groups separately. Social validation data gave further insights into what athletes had retained and applied from the MBI programme.ConclusionsContrasting results highlighted the need to better explore mindfulness mechanisms in MABI and the way they are inter-related, in order to strengthen changes in sport performance-related outcomes.