The frequency of actions and thoughts scale: development and psychometric validation of a measure of adaptive behaviours and cognitions

This paper describes the development and preliminary psychometric evaluation of an instrument that measures the frequency of adaptive behaviours and cognitions related to therapeutic change during cognitive behavioural therapy (CBT), for symptoms of anxiety and depression. Two studies were conducted. In study one, 661 participants completed an online survey with 28 items targeting adaptive behaviours and cognitions. Exploratory factor analysis performed on part of the sample (n = 451) revealed that a four-factor solution ‘characterised’ the data. This led to the development of a 12-item instrument, the Frequency of Actions and Thoughts Scale (FATS). Confirmatory factor analysis was used to confirm the factor structure of the FATS using the remaining sample (n = 210), which revealed an acceptable model fit. In study two, 125 participants with clinically significant symptoms of anxiety, depression, or both were recruited to an Internet-delivered CBT (iCBT) treatment course. Participants completed the FATS and other measures throughout treatment, after treatment, and at three-month follow-up. Correlations and residual change scores of the FATS and its subscales with measures of anxiety, depression, behavioural activation, and CBT-related skills usage supported the construct validity of the FATS. A significant increase in FATS scores over treatment was also observed. The findings provide preliminary support for the psychometric properties of the FATS, which appears to have utility in research investigating mechanisms of change in CBT.     

Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review

The number of acceptance- and mindfulness-based interventions for chronic pain, such as acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT), increased in recent years. Therefore an update is warranted of our former systematic review and meta-analysis of studies that reported effects on the mental and physical health of chronic pain patients. Pubmed, EMBASE, PsycInfo and Cochrane were searched for eligible studies. Current meta-analysis only included randomized controlled trials (RCTs). Studies were rated for quality. Mean quality did not improve in recent years. Pooled standardized mean differences using the random-effect model were calculated to represent the average intervention effect and, to perform subgroup analyses. Outcome measures were pain intensity, depression, anxiety, pain interference, disability and quality of life. Included were twenty-five RCTs totaling 1285 patients with chronic pain, in which we compared acceptance- and mindfulness-based interventions to the waitlist, (medical) treatment-as-usual, and education or support control groups. Effect sizes ranged from small (on all outcome measures except anxiety and pain interference) to moderate (on anxiety and pain interference) at post-treatment and from small (on pain intensity and disability) to large (on pain interference) at follow-up. ACT showed significantly higher effects on depression and anxiety than MBSR and MBCT. Studies’ quality, attrition rate, type of pain and control group, did not moderate the effects of acceptance- and mindfulness-based interventions. Current acceptance- and mindfulness-based interventions, while not superior to traditional cognitive behavioral treatments, can be good alternatives.     

Career adaptability as a mediator between personality and career engagement

The current study examined the role of career adaptability as a mediator between personality dimensions and career engagement. This investigation was conducted using a sample of university students (N = 201) who completed the Zuckerman–Kuhlman–Aluja Personality Questionnaire, the Career Adapt-Abilities Scale-Persian Form, and the Career Engagement Scale. Career adaptability dimensions related positively with activity, negatively with neuroticism, and positively with career engagement. The results indicated that career adaptability dimensions partially mediated the relationships between activity (work compulsion, general activity, restlessness, and work energy) and career engagement, whereas they were a full mediator between neuroticism (anxiety, depression, dependency, and low self-esteem) and career engagement. Among career adaptability dimensions, curiosity fully mediated the effect of sensation seeking on career engagement. These findings suggest that career adaptability is a dynamic mechanism that helps to regulate the relationship between specific dispositional traits and career adapting behaviors.     

Experiences of Families Transmitting Values in a Rapidly Changing Society: Implications for Family Therapists

Intergenerational value transmission affects parent–child relationships and necessitates constant negotiation in families. Families with adolescents from rapidly changing societies face unique challenges in balancing the traditional collectivistic family values that promote harmony with emerging values that promote autonomy. Using modern Turkey as an example of such a culture, the authors examine the transmission process in families that hold more traditional and collectivistic values than their adolescent children. Special consideration is given to generational and cultural differences in the autonomy and relatedness dimensions.     

Delivering Intensive PTSD Treatment Virtually: The Development of a 2-Week Intensive Cognitive Processing Therapy–Based Program in Response to COVID-19

Of the many vulnerable groups affected by the spread of COVID-19, veterans have been especially impacted by the pandemic. Beginning in March 2020, nationwide shelter-in-place orders rapidly led to widespread job loss and economic upheaval; disruption and breakdown of multiple support systems; and increases in family stress, all of which may exacerbate underlying PTSD symptoms. Although telehealth has proven an effective means of delivering evidence-based psychotherapies for PTSD, little is known about the delivery of these treatments in an intensive, daily format over telehealth. There is growing need for intensive treatment options to reduce treatment-interfering barriers such as high dropout rates. In order to address this gap in the literature, this paper details several design considerations as well as patient selection procedures for a 2-week virtual intensive treatment program (vITP) for veterans with posttraumatic stress disorder (PTSD), consisting of daily individual Cognitive Processing Therapy (CPT) and other adjunctive interventions. We also describe two cases of veterans who successfully completed the vITP including their clinical outcomes, therapist reflections on the process, feedback regarding the program, as well as challenges patients encountered with the telehealth platform. Intensive evidence-based psychotherapy for PTSD delivered through a virtual format seems to show promise, but more systemic research is needed.     

Identifying when children with visual impairment share attention: A novel protocol and the impact of visual acuity

BackgroundIn Coordinated Joint Engagement (CJE), children acknowledge that they and their social partners are paying attention to the same object. The achievement of CJE, critical for healthy development, is at risk in infants with visual impairment (VI). Research on CJE in these children is limited because investigators use a child’s gaze switch between social partner and object to index CJE. Research is needed that identifies CJE in children with VI using behaviors that do not require normal vision and that explores the relationship between CJE and visual function. This study aimed to (a) develop a protocol for identifying CJE in children with VI, and (b) explore the relationship between CJE and infants’ visual acuity (VA) and contrast sensitivity (CS), measured with Preferential Looking (PL) techniques and Visual Evoked Potential (VEP).MethodsA protocol that included 9 indices of CJE that did not require normal vision was developed to code videos of 20 infants with VI (mean age =1 year, 6 months, 27 days) and their caregivers. The percentage of CJE episodes in which each index was observed was calculated. Inter-coder reliability was measured using Cohen’s Kappa. Linear regression analysis was used to examine the relationship between the infants’ visual function and CJE.ResultsInter-rater reliability between a first coder and each of two second coders were 0.98 and 0.90 for determining whether the child participated in CJE. The following indices were observed the most (in 43–62 % of CJE): child’s body orientation to caregiver, gaze switch between caregiver and object, and vocalization to caregiver. The only significant model included VA (measured with PL) as a single predictor and explained 26.8 % of the variance in CJE.ConclusionsThe novel protocol can be used to identify CJE in children with VI with good inter-coder reliability. The data suggest that children with lower VA exhibited less CJE.     

When bad gets worse: Negative wording amplifies negative recall in persons with the borderline personality trait

The emotional valence of memory recall strongly influences the extreme, and often self‐destructive behavioral response. Overall, 4427 people from the community filled out our screening questionnaire, of which 674 (mean age: 32.9 years, 64.7% women) passed the threshold for the likely presence of borderline personality disorder (BPD). Participants watched one of 9 possible video clips differing in valence (positive, negative or neutral). Results indicate support (ß = .151, p < .05) for a negative cognitive tendency in the evaluations proportionate to the severity of BPD but only when the impression is assessed with negatively‐worded items. This effect is detectable regardless of other factors such as negative mood, extremity of the answers or general impression of the character. These effects are unaffected by acute trauma. To conclude, different factors influence the recall of emotional stimuli, depending on the valence of the stimuli and the valence of the rating scale in persons with strong borderline tendencies.     

Women's Psychological Experiences in a Narrative Therapy-Based Group: An Analysis of Participants' Writings and Beck Depression Inventory–Second Edition

The purpose of this study was to explore women's experiences in a narrative therapy-based group conducted to help participants re-author their stories. Seven women who were either patients or individuals enrolled in Transition Support for Employment at a psychiatric clinic participated in the meetings, one every fortnight. Each session explored a theme based on narrative therapy techniques such as externalization. The participants wrote their reflections during each session, and completed the Beck Depression Inventory-Second Edition (BDI-II) during the initial and final sessions. An affinity diagram was developed to classify their written reflections into 22 lower categories (e.g., new understanding of self, forward-looking-understanding of life) and 4 upper categories (“Insight,” “Sharing with others,” “Changes with understanding of lives,” “Higher motivation”). The relationship among five lower categories comprising “Insight” was explored, and it became apparent that clarification of participants' own thoughts about social problems functioned as a mediator promoting the process. The largest portion of depressed feelings emerged during the initial session, and four participants had lower scores for BDI-II items such as self-criticism in the final session. The results suggest that the group's purpose was realized. However, future studies should examine participants' feelings more closely, especially during the initial session.     

Narrative of “Here-and-Now”: Cancer Survivors in a Group Psychotherapy Using SCT® (Systems-Centered Therapy)1,2

This study focused on “here-and-now” narrative and examined the process of group psychotherapy for cancer survivors using systems-centered therapy (SCT). In contemporary society, cancer survivors have a vital need for psychological support, and group psychotherapy and peer support are used as part of this need. In most of these interventions, participants are encouraged to speak freely and share their experience of cancer. This generally means speaking about “there-and-then” experience. It has been argued that one reason that narrative therapy produces a psychological effect is that the meaning of an experience changes when the experience is spoken about. SCT differs significantly from other group interventions in that it requires participants to talk about their here-and-now experience through the format of SCT's “functional subgrouping.” Functional subgrouping requires participants to listen, reflect, and build on similarities in their experience. In this study, we qualitatively examined how participants' experiences unfolded in the SCT group by directly addressing the group process. The study findings revealed that even though the participants did not directly share their cancer experiences in the group, they experienced an inexplicable sense of connectedness that had a positive psychological effect on them. They also experienced deep emotions through talking while using the SCT narrative style. In the process, the effects of the SCT narrative were discussed.