FUNCTIONAL COMMUNICATION TRAINING WITH AND WITHOUT EXTINCTION AND PUNISHMENT

Functional communication training has been reported to be a promising treatment for severe behavior problems. In this study, functional communication training alone and combined with extinction and/or punishment was evaluated for 4 clients with severe retardation, behavior problems, and communication deficits. The participants were inpatients on a hospital unit for treatment of severe behavior disorders. They received individualized interventions based on functional assessment that included reinforcement of a communication response with the same function as their destructive behavior. Results showed that for some patients, functional communication training was not sufficient to produce clinically significant reductions in destructive behavior, and the combination of training plus punishment produced the largest and most consistent reductions.     

青少年早期抑郁和自伤的联合发展轨迹：人际因素的作用

通过对859名初中生历时3年的3次追踪测量, 考察了抑郁和自伤的独立与联合发展轨迹, 并对3种重要人际关系(亲子关系、同伴关系、师生关系)在二者联合发展中的作用进行检验。结果发现, 青少年早期抑郁和自伤分别呈现4条和3条异质性发展轨迹; 二者的联合发展轨迹包含“低抑郁-低自伤-稳定”、“低抑郁-低自伤-增长”、“中抑郁-中自伤-降低”三类; 父母心理控制和同伴接纳分别为青少年早期抑郁和自伤的风险与保护性因素。     

Implementing and Adapting the SAFETY Treatment for Suicidal Youth: The Incubator Model,Telehealth, and the Covid-19 Pandemic

The Safe Alternatives for Teens and Youth (SAFETY) treatment was developed to decrease the risk of repeat suicidal and self-harm behavior in youth presenting with elevated suicide risk. This paper uses case illustrations to demonstrate the SAFETY treatment, building upon the companion paper describing our “incubator” treatment development model and process (Asarnow et al., 2022). As illustrated in the second case illustration, the incubator model approach was particularly useful during the COVID-19 pandemic switch to telehealth. SAFETY specifically targets suicide and self-harm risk reduction using an individually tailored principle-guided approach, grounded in a case conceptualization that identifies cognitive-behavioral processes and reactions that contribute to increased suicide attempt risk and explains the youth’s suicidal/self-harm behavior within the context of his or her broader social systems. The SAFETY treatment has been tested in two treatment development trials, and results support the efficacy of SAFETY for preventing suicide attempts in adolescents presenting with recent self-harm.     

The Incubator Treatment Development Model: The SAFETY Treatment for Suicidal/Self-Harming Youth

Youths who make suicide attempts or engage in repetitive self-harm are at risk for future suicide attempts and death by suicide or self-harm. This treatment development report focuses on the Safe Alternatives for Teens and Youth (SAFETY) treatment. SAFETY is a 12-week outpatient child and family-centered cognitive-behavioral treatment, informed by dialectical-behavior therapy, and designed to promote safety following a suicide attempt or repeated episodes of self-harm. Previous reports have described results of small open and randomized treatment development trials. Here, we describe our “incubator” treatment development model. Combining scientific rigor with attention to the community context in which treatment is delivered, the incubator model emphasizes laboratory-based treatment development trials and quantitative and qualitative data generated through partnerships with community treatment sites and youth and parent consumers of care. Aims of this approach are to: (1) integrate information from our partners throughout the treatment development process; (2) create a more feasible and easily transportable “youth” and “family” centered treatment; and (3) accelerate the pace with which laboratory-based treatment advances can be incorporated into improvements in community care. We describe our incubator treatment development model and how data generated through our treatment development process and interactions between the laboratory and community teams contributed to the development of the SAFETY treatment.     

Emotional responding in NSSI: examinations of appraisals of positive and negative emotional stimuli,with and without acute stress

Non-suicidal self-injury (NSSI) is commonly used by young adults to regulate emotional responses. Yet, experimental examination of how people who self-injure appraise and respond to emotional stimuli is limited. We examined appraisals of, and responses to, emotive images in young adults who did and did not self-injure, and assessed whether these were impacted by exposure to a stressor. Study 1 (N?=?51) examined whether participants differed in their appraisals of emotional images. Study 2 (N?=?78) assessed whether appraisals of images changed after exposure to the Trier Social Stress Test. Ratings of emotional valence and arousal were collected in both studies; skin conductance was measured as an indicator of physiological arousal in Study 2. In Study 1 participants reporting NSSI rated positively valenced images as less pleasant than participants not reporting NSSI. In Study 2, after acute stress, participants reporting NSSI displayed dampened physiological reactions to positive images whereas participants who did not self-injure displayed heightened physiological reactions to these and rated them as more pleasant. Individuals who self-injure seem less able to engage in strategic mood repair after exposure to stress compared to people who do not self-injure.     

负性生活事件对初中生自我伤害行为的影响:有调节的中介效应

采用负性生活事件量表、自我批评量表、亲子关系量表和青少年自我伤害行为问卷对333名初中生进行测查,探讨负性生活事件对初中生自我伤害行为的影响及作用机制。结果表明:(1)负性生活事件对初中生的自我批评和自我伤害行为均有显著的正向预测作用;(2)自我批评在负性生活事件与初中生自我伤害行为之间起着部分中介作用;(3)负性生活事件和自我批评的关系(中介效应的前半段路径)受到亲子关系的调节,即负性生活事件对自我批评的正向影响随着父子关系和母子关系的增强而减弱。因此,负性生活事件和初中生自我伤害行为之间存在有调节的中介效应。     

Early maladaptive schemas and non-suicidal self-injury among young adults: A preliminary investigation

Non-suicidal self-injury (NSSI) represents a critical mental health issue among young adults. Accordingly, it is important to understand potentially modifiable processes involved in its enactment. The current investigation built on previous work to better understand the nature of early maladaptive schemas (EMS) in the context of NSSI. One hundred and thirty young adults completed questionnaires assessing NSSI history, EMS and depressive symptoms. Results indicate that EMS may play a role in NSSI engagement after controlling for depressive symptoms. Specifically, higher scores on social isolation and emotional inhibition and possibly lower scores on entitlement/grandiosity schemas may differentiate those who self-injure from those who do not. Furthermore, higher levels of dependence/incompetence schema may differentiate those who report a higher NSSI frequency and those who report a less frequent NSSI history. Although a nascent area of study, our findings suggest that it may be fruitful to consider conceptualizing NSSI within a schema therapy framework.     

It is never the right time: How to help a mother to separate from her young child

In this paper I have described a short-psychotherapy treatment with a mother, a 3-year-old girl, and occasionally a father, over the difficulty in separating and settling down at nursery. The mother's unresolved mourning for the early miscarriage of her second baby was one important factor. She held on to the company and comfort provided by the little girl, who had become the vessel of maternal projections. Filled with Poppy's projections, the mother had also felt unable to withstand and process them. Mr Green was a conflictual element in the family, rather than a supportive husband and father, and Poppy's care and problems were left with the mother. Nine sessions unblocked the situation and allowed Poppy to settle down at a private nursery.     

Continuous Access to Competing Stimulation as Intervention for Self-Injurious Skin Picking in a Child with Autism

Children with autism frequently display self-injurious behavior (SIB), but skin picking—a less severe topography of SIB—has not been the focus of much clinical research. The present study evaluated a home-based intervention that was implemented with a 9-year-old girl who had autism and picked her fingers with resulting tissue damage. The intervention allowed the girl to hold and manipulate preferred objects during play and leisure activities. Evaluated in an ABAB reversal design, intervention essentially eliminated skin picking. Clinical and research implications are discussed.