The nature space. A reflexive thematic analysis of therapists' experiences of 1:1 nature-based counselling and psychotherapy with children and young people: Exploring perspectives on the influence of nature within the therapeutic process

Nature-based therapy is an emerging and rapidly developing field within counselling and psychotherapy, yet there is little published empirical research, or integrated models relating to its practice with Children and Young People (CYP). The present study aimed to explore therapists’ experiences of one-to-one nature-based counselling and psychotherapy with CYP, eliciting perspectives on the interaction between nature and the therapeutic process. A reflexive thematic analysis provides preliminary insights into possible mechanisms of action with the potential to inform a longer-term exploration of whether nature-based therapy is effective, for whom and why. The study highlights the need to better explore and understand how nature-based therapy supports relational and intrapsychic change in interaction with developmental processes, to inform construction of coherent and consolidated theory and models for practice.     

Can we predict non-response in developmental tasks? Assessing the longitudinal relation between toddlers' non-response and early academic skills

To date, virtually no studies have examined toddlers' non-response in developmental tasks. This study investigates data from 3667 toddlers to address (1) whether two aspects of non-response (completion and engagement) are separable, (2) how stable these aspects are from ages two to three, (3) how non-response relates to background characteristics, and (4) whether non-response at ages two and three predicts early academic skills at age six. Structural equation modelling shows that completion and engagement are separable constructs, relatively stable across age, and related to several background characteristics. Especially engagement predicts later academic performance. Results show that non-response in behavioural tasks in toddlers is not random, increasing the likelihood of sampling bias and lack of generalizability in developmental studies.     

The effect of the two-chair dialogue intervention on self-compassion - adding an emotional evocative component to a basic Rogerian condition

Objective

How people relate to themselves when facing distress or failure influences general psychological well-being and vulnerability to psychological disorders. The aim of the present study was to explore the effect of an emotionally evocative intervention on self-compassion.

Methods

The data were retrieved from a larger study of Emotion-Focused Therapy (EFT) utilising a multiple baseline design comparing two treatment phases. The baseline phase consisted of 5, 7 or 9 therapy sessions where the therapist solely adhered to Rogerian relational conditions, as prescribed in EFT. A two-chair dialogue intervention was then added for five sessions. The sample consisted of 18 self-critical clients with clinically significant symptoms of depression and/or anxiety. The “Self-Compassion Scale” (SCS) was administered pre, mid and post therapy.

Results

The baseline phase did not lead to significant changes in self-compassion. However, the addition of the two-chair dialogue was associated with a significant increase in self-compassion. This increase was due to reductions in the negative subscales, especially the isolation subscale.

Conclusion

The emotionally evocative two-chair dialogue was associated with a significant change in self-to-self relating, compared to relational conditions alone. The two-chair dialogue, thus, seems to be a promising intervention for promoting healthier self-to-self relating.     

Effect of Daily Life Reward Loop Functioning on the Course of Depression

Engagement in activities increases positive affect (Reward Path 1), which subsequently reinforces motivation (Reward Path 2), and hence future engagement in activities (Reward Path 3). Strong connections between these three reward loop components are considered adaptive, and might be disturbed in depression. Although some ecological nomentary assessment (EMA) studies have investigated the cross-sectional association between separate reward paths and individuals’ level of depression, no EMA study has looked into the association between individuals’ reward loop strength and depressive symptom course. The present EMA study assessed reward loop functioning (5x/day, 28 days) of 46 outpatients starting depression treatment at secondary mental health services and monitored with the Inventory of Depressive Symptomatology—Self-Report (IDS-SR) during a 7-month period. Results of multilevel regression analyses showed significant within-person associations for Reward Path 1 (b = 0.21, p < .001), Reward Path 2 (b = 0.43, p < .001), and Reward Path 3 (b = 0.20, p < .001). Stronger average reward loops (i.e., within-person mean of all reward paths) did not relate to participants’ improvement in depressive symptoms over time. Path-specific results revealed that Reward Paths 1 and 2 may have partly opposite effects on depressive symptom course. Together, our findings suggest that reward processes in daily life might be best studied separately and that further investigation is warranted to explore under what circumstances strong paths are adaptive or not.     

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.