Prospective Associations Between Peer Victimization and Internalizing Symptoms in Adolescence: The Protective Role of Hope

Youth who experience aggression at the hands of peers are at an increased risk for a variety of adjustment difficulties, including depressive and anxiety symptoms and lower self-esteem. The links between peer victimization and internalizing problems are robust, but less work has been done to identify individual-level protective factors that might mitigate these outcomes. The current study investigated whether hope served as a moderator of the prospective links from peer victimization to depressive and anxiety symptoms and self-esteem during adolescence. Participants included 166 high school students (64% female; 88% Black/African American). Youth completed self-report measures at three different time points across the Spring semester of an academic year. As predicted, hope interacted with peer victimization to predict changes in depressive and anxiety symptoms over the course of the semester. That is, for youth with low levels of hope, peer victimization predicted more stable patterns of depressive and anxiety symptoms. For adolescents with average levels of hope, however, peer victimization did not influence anxiety and depressive symptoms over time. Finally, for adolescents with high levels of hope, peer victimization predicted greater decreases in anxiety symptoms over time. Hope did not interact with peer victimization to predict self-esteem. Rather, hope uniquely predicted higher levels of self-esteem, whereas peer victimization uniquely predicted lower levels of self-esteem. The current study provides initial support for the notion that hope can serve as a protective factor among youth who are victims of peer aggression.

     

Ethics, Cultural Competence, and the Changing Face of America

The population in the United States is increasingly multicultural. So, too, is the U.S. physician workforce. The combination of these diversity dynamics sets up the potential for various types of cultural conflict in the nation’s examining rooms, including the relationship between religion and medicine. To address the changing patient-physician landscape, we argue for a broad scale intervention: interdisciplinary bioethics training for physicians and other health professionals. This approach seeks to promote a common procedural expectation and language which can lead to an improved, patient-centered approach resulting in better patient-physician relationships that contribute to better health outcomes across the U.S. population. The authors illustrate their thesis and solution using a well-known case of cross-cultural dynamics taken from religion and medicine—Anne Fadiman’s The Spirit Catches You And You Fall Down.     

Understanding adolescent type 1 diabetes self-management as an adaptive process: A grounded theory approach

Objective: To develop a conceptual understanding of the process of adapting to the self-management of type 1 diabetes during adolescence.

Design: Participants were recruited from a National Health Service paediatric diabetes service within the south-west of England which runs six countywide diabetes clinics. Thirteen interviews were conducted using a social constructivist grounded theory approach.

Results: The findings illustrate how self-management can be understood in terms of a continuum-based framework, ranging from difficulties with, to successful self-management. Adaptation within the continuum can further be understood by specific transitional phases and process mechanisms, providing further depth to individuals’ experiences of adaptation.

Conclusion: This investigation provides a conceptual understanding of the complex issues adolescents encounter while adapting to and integrating a diabetes self-management regime into their lives. It provides an invaluable framework for exploring psychological mechanisms and contextualising them within a self-management continuum. Implications for healthcare professionals are discussed and further research proposes whether the model could be applicable to other chronic illnesses.     

Resisting self-compassion: Why are some people opposed to being kind to themselves?

Although self-compassion is associated with positive emotions, resilience, and well-being, some people resist recommendations to treat themselves with kindness and compassion. This study investigated how people’s personal values and evaluations of self-compassionate behaviors relate to their level of self-compassion. After completing measures of trait self-compassion and values, participants rated how they would view themselves after behaving in a self-compassionate and self-critical way. Overall, participants associated self-compassion with positive attributes that connote emotional well-being, yet only those who were low in trait self-compassion associated self-compassionate responding with negative attributes that involve low motivation, self-indulgence, low conscientiousness, and poor performance. Participants’ endorsement of basic values was not meaningfully related to their evaluations of self-compassionate vs. self-critical behaviors or to self-compassion scores. We propose that self-compassion might operate as an instrumental value insofar as those high vs. low in self-compassion differ in their beliefs about whether self-compassion affects performance-related outcomes positively or negatively.     

A systematic review of motivational interviewing within musculoskeletal health

Motivational interviewing (MI) has been investigated within a range of healthcare environments though to date no studies have systematically assessed its application and effectiveness within musculoskeletal health. The aim of this study is to identify interventions that have utilised MI to create change within musculoskeletal healthcare, evaluate quality and effectiveness, as well as identify the level of training received by those utilising the approach. The search strategy identified both published and unpublished or grey literature through electronic resources, reference list and content searches. Five studies were identified for quality assessment. Due to variations in delivery modality, musculoskeletal condition and type of MI application it was not possible to provide direct comparative interpretations for these factors. A data synthesis was used to provide a summary of study characteristics, a narrative overview and conduct a quality assessment as well as considering authors comments on study limitations. The results of the quality assessment highlighted a number of methodological issues which supported and expanded upon those expressed by the studies authors. None of the studies contained children or young people and in terms of training there were variations in training provider, duration and competency, as well as variation in the fidelity of MI. The findings have highlighted the need for well designed randomised controlled trials that are suitability powered to measure the effectiveness of MI within musculoskeletal health. Future studies may consider the application of MI within musculoskeletal conditions in terms of self-management and its application to creating lifestyle changes (e.g., diet, exercise) for adults, as well as children and young people. Research currently being conducted may expand upon the evidence, feasibility and validity of MI within areas such as fibromyalgia, osteoporosis, arthritis, understanding of knee replacement and rehabilitation.     

REFLECTIVE BORDERLINE GROUP THERAPY: THE PATIENTS' EXPERIENCE OF BEING BORDERLINE

This paper describes a novel 20-week psycho-educational group therapy for borderline patients. The therapy aims to stabilize the disorganized and chaotic presenting behaviours of the patients when they enter the borderline treatment service by providing a group psycho-educational programme based upon a psychodynamic appreciation of symptoms, causes, defences and affects. We think that borderline patients will only take in such understandings if they feel listened to and understood in a way that may not have been available to them as children. To do this, the therapists need to create a reflective space underpinned by psychodynamic thought and respecting the patient's experience of being borderline. The paper illustrates the difficulties encountered and discusses the importance of containing or modifying the counter-transference stresses felt by the therapists.

The authors also report on some recent outcome data collected from the running of the group programme over the last 4 years. Twenty borderline patients were able to complete the pre- and post-treatment self-report questionnaires. The results indicate some positive signs in extra-punitive symptom control and levels of impulsivity. Significant levels of improvement were noted in the BSI total scores (p=0.048) with particular reduction in interpersonal sensitivity (p=0.007) and the hostility (p=0.008) sub scores. Patients also reported a reduction in ‘feeling like’ scores on the Multi Impulsivity Scale – reflecting an improvement in internal affect triggers that might result in impulsive behaviours.

The authors discuss the potential value of this pragmatic model of care that is underpinned by psychoanalytic thinking, and its application to managing long waiting lists in psychotherapy services for borderline patients.