Existential Therapy of Panic Disorder: A Single System Study

Recently there has been an emphasis on biomedical and behavioral aspects of the treatment panic disorder. The symptom-based nature of these treatments may cause elements of the life context, such as systems of meaningfulness and symbolism, to be overlooked in some cases. In this paper, the successful treatment of a case of panic disorder of three years duration is presented, in which complete remission of symptoms occurred within the third week of existential psychotherapy. Prior to this therapy, the client had exhibited a deteriorating course while following a purely psychopharmacological treatment plan. Implications are discussed.     

Scared to Death: Reflections on Panic and Anxiety in the Field

This paper examines reflections about researcher emotions and the experience of having panic attacks and panic disorder as a result of fieldwork. Anxiety and panic are sparsely discussed in methodological appendices and handbooks about qualitative research, and the embodiment of mental health in the field has received even less attention. I have two aims in the paper: to describe the experience of panic attacks and to open a discussion about panic and anxiety attacks in the field. The failure to address mental health problems as a result of fieldwork can negatively impact expert and fledgling ethnographers, and should be remedied.     

Life Stress and Depression in University Students: Clinical Illustrations of Recent Research

Abstract

Through the use of case vignettes, this paper demonstrates the clinical relevance of findings from previously reported research conducted at the University of Toronto. These published studies link life stress to depression in university students. Three psychosocial factors—a family history of psychiatric illness, stressful life events, and lack of social support—are found to be significantly related to depressive symptoms. A fourth psychosocial factor, childhood or adolescent loss of a nurturing person, was not significantly related to the occurrence of depression. However, that factor remains an important therapeutic focus for a number of depressed students. In addition, the absence of at least a single confidant and certain life events (recent loss of a significant person, changes in living arrangements or academic situation, and financial problems) were identified as specific risk factors for depression. Although depression experienced by students is often serious enough to warrant professional intervention, only a minority seek professional help. The majority of those who do seek help are women; male students are less likely to associate somatic symptoms with emotional problems and are less willing to seek psychiatric help. The four case studies presented illustrate the clinical relevance of these research findings.     

Schizotypal Personality Disorder: A Clinical Social Work Perspective

Schizotypal personality disorder (SPD) is considered to be a “schizophrenia spectrum disorder” as evidenced in part by its cross-listing in that chapter of the DSM-5. SPD is considered to be a condition with limited potential for positive change because one of its major features is the presence of a biologically based cognitive deficit. This assumption, however, is an example of the medical model’s creating a bias against psychosocial features that are always involved in character development. The social work profession’s bio-psycho-social perspectives focus more comprehensively on all features of the condition and promote a more optimistic view of clients’ change potentials. The purposes of this paper are to examine SPD from a social work perspective and to demonstrate, with a case example, how effective intervention can be organized and delivered.     

Clinical Pilot Experiences Using the Marijuana Screening Inventory (MSI-X): Screening Guidelines and Case Illustrations

ABSTRACT

A review of the literature indicates that there is a need for marijuana specific screening. The Marijuana Screening Inventory (MSI-X) was developed as a psychometrically reliable and valid tool for clinical use in general health and primary care settings. This paper describes the MSI-X, its potential assessment benefits, and clinical screening guidelines. It discusses the pilot application of the MSI-X with four clients to illustrate its clinical usefulness.     

An Integrative Group Treatment Model for Women with Binge Eating Disorder: Mind,Body and Self in Connection

Binge eating disorder (BED) is the most prevalent eating disorder reported among women, and its recent diagnostic recognition in the DSM-5 (APA 2013) calls for further discussion on effective treatment. Women with BED commonly report a diet/binge cycle that can exacerbate a disconnection between mind and body and reinforce feelings of shame and isolation. This article presents an integrative group treatment model for women with BED that has shown positive outcomes in clinical practice. The group model addresses key biopsychosocial factors associated with BED and incorporates mindfulness principles tailored to problems of the disorder. A core foundation of the group model is the relational context that fosters connections between women members and promotes self-efficacy. The discussion includes etiology of BED and current empirical support for integrating mindfulness skills in treatment for binge eating problems, as well as the author’s clinical experience in formulating a short-term group model. The eight-session semi-structured group format integrates evidence-based treatments in resonance with treatment-based evidence that reflects the distinct clinical needs of women with BED. Clinical vignettes illustrate how the group model can provide an anchoring therapeutic support to women with BED for linking experiences of mind, body, and self.     

A Hybrid Model of Moral Panics: Synthesizing the Theory and Practice of Moral Panic Research

We seek to address criticisms of the concept of moral panics (MPs) by offering a hybrid model of MPs that synthesizes theory and practice of MPs research. A review of the literature on MPs from sociology, media studies and related fields shows a wide variety of usage and lack of conceptual clarity of the term ‘moral panic’. Yet there are few articles explaining how to analyze MPs. We present a theoretical clarification of MPs by addressing elements of scope, intensity and reception, to create distinction from other related theoretical concepts. To develop a working method for researching MPs, one must have an understanding of social conditions that give rise to, sustain and result in the success or failure of MPs, as well as possible lasting effects. We synthesize Cohen’s process-oriented model of MPs and Goode & Ben-Yehuda’s attribution-oriented model of MPs, creating a critical hybrid model of MPs that integrates processes and attributes. We then utilize the hybrid model to offer practical suggestions for researching and analyzing the conditions, processes and effects of MPs, in the hopes of encouraging a more rigorous research agenda for scholars of MPs.     

Review Essay: Up Close and Personal: Locating the Self in Qualitative Research

Qualitative Sociology -     

Gendering the Research Self: Social Practice and Corporeal Multiplicity in the Writing of Organizational Research

This article examines the problems inherent in taking a reflexively gendered position in writing research accounts. Such socially constructed accounts typically require researchers to do one of two things: to suppress the feminine and write implicitly as male, or to adopt a textual position as ‘woman’ that fails to do justice to the complex and unstable multiplicity that underpins the research self. It is argued that this shifting multiplicity is stabilized by the relationship between self and research text being corporeally grounded and gendered in practice. Three possible approaches to gender are considered: the discursive/textual approach (as developed by Foucault); the performance/social practice approach (as developed by Judith Butler) and the corporeal multiplicity approach (as developed by Elizabeth Grosz and Dorothea Olkowski). The article concludes by suggesting a tripartite approach to writing self‐multiplicity in research to extend the possibilities opened up by the social practice approach: re‐citing (redeploying discursive resources in intertextuality); re‐siting (changing the positioning of the self in power relations by reinscribing) and re‐sighting (opening up new, virtual visions of possibility).     

Differentiation of Self and the Process of Forgiveness: A Clinical Perspective for Couple and Family Therapy

In this article we explore the role of differentiation of self in facilitating forgiveness in the context of couple and family relationships. Differentiation is defined from the Bowen perspective as the ability to connect with others without being excessively emotionally reactive to the ebb and flow inherent in all significant relationships (being able to connect to others yet also being able to self‐regulate). Forgiveness is described as the releasing of an emotional injury via a complex psychological and relational process that is less an act of will than a discovery or possibility through understanding and empathy. Differentiation of self is related to emotional intelligence and empathy. The developmental and relational benefits of such are illustrated and discussed. A rationale for viewing differentiation and forgiveness in a contextual, historical, and relational attachment paradigm is suggested. Relevant clinical cases illustrate the dynamics of differentiation and forgiveness as discovery in the context of an understanding and empathic relational environment.     

Microaggressions and Islamophobia: Experiences of Muslims Across the United States and Clinical Implications

This mixed methods exploratory study illustrates the influence of pervasive misconceptions about Islam on the experiences of 314 adult Muslims across the United States. Quantitative results suggest that Muslim stress levels are comparable to the stress levels of other marginalized groups in the United States. Qualitative analysis revealed four themes that highlight the challenges faced by Muslims as well as their resiliency in the face of microaggressions and marginalization. Family therapists may utilize these personal accounts to expand their understanding of Muslim experiences, and to reflect on their own implicit biases toward Muslims in order to reduce chances of premature termination. Clinical implications include using resiliency‐based models and creating collaborative partnerships with community leaders when working with this religious minority group.     

Autism Spectrum Disorder: The Impact of Stressful and Traumatic Life Events and Implications for Clinical Practice

Research findings suggest that behavioral interventions are effective in improving educational outcomes and fostering skill development in people with autism spectrum disorder (ASD). However, high rates of comorbidity between ASD and other psychological disorders, including depression and anxiety, indicate that standard behavioral approaches are not adequately addressing issues related to mental health in this population. Research emerging since the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is advancing our understanding of the nature of childhood stress and trauma in people with ASD and its subsequent impact on mental health and wellbeing. Mounting evidence for stress and trauma as a risk factor for comorbidity and the worsening of core ASD symptoms may intimate a shift in the way clinical social workers and other clinical practitioners conceptualize and approach work with this population to include trauma-focused assessment strategies and clinical interventions. Future directions for research to better understand the nature of childhood stress and trauma and improve mental health in this population are also discussed.     

Asylum Discourse in New Zealand: Moral Panic and a Culture of Indifference

Recent law changes in New Zealand allowing for the detention of a “mass arrival” of asylum seekers reflect a concerning international rhetoric and associated policy trend in Australia and the United Kingdom towards those seeking asylum. This paper argues that, although the New Zealand public has not (yet) reached a “moral panic” that is prevalent within international contexts, there are concerns about a “culture of indifference” in relation to asylum seekers. By providing a policy analysis about asylum seekers and an examination on the associated discourses utilised in international contexts, this discussion presents the New Zealand context through the process of risk signification. The paper discusses how the social work profession can respond to this culture of indifference through addressing collusion (often through silence) with oppressive asylum policies, the need for stronger advocacy and action, and the associated role of social work education.     

Complexities in Assessing Marital Beliefs: Illustrations Across College and Non-College Emerging Adults

ABSTRACT

Although research on marital beliefs has been increasing in recent years due to cultural and behavioral shifts regarding marital transitions, scholarly work dedicated to the measurement of marital beliefs has been limited. Using a sample of 571 college students, the Criteria for Marriage Readiness Scale (CMRS) was assessed to see if results from a previous validation study could be replicated. Results largely replicated previous findings but suggested a shorter and slightly revised version of the CMRS. A sample of 102 individuals with no college experience were then also administered the CMRS to see if measurement remained valid across a noncollege population. Results suggested that the CMRS may not be a valid measurement in this population, and further tests revealed that the college and noncollege samples were not invariant in regards to the factor structure of the CMRS. Implications for the assessment of marital beliefs given the lack of research on noncollege samples is discussed.     

Homelessness and Mental Disorder: Policy Considerations

Abstract

‘Photovoice’ is a photographic method that is used for several purposes (e.g. storytelling, building awareness, enhancing personal discovery), including conducting community-based participatory research (CBPR). Since its creation, photovoice has been used as a method for implementing health-related CBPR projects with people experiencing homelessness. As such, this article presents an overview of seven peer-reviewed publications regarding photovoice projects that were conducted with participants who are homeless. The goal of the review is to provide health professionals with a practical summary of the lessons learned from each photovoice project's methods and findings. Based on the literature, the review's major suggestion is that health professionals should plan and implement future projects according to the fundamental aspects of photovoice (e.g. empowerment of participants to document their community, facilitation of group discussions of photos, concerted efforts to reach policymakers).     

Gambling Disorder in Veterans: A Review of the Literature and Implications for Future Research

To review the scientific literature examining gambling behavior in military veterans in order to summarize factors associated with gambling behavior in this population. Database searches were employed to identify articles specifically examining gambling behavior in military veterans. Cumulative search results identified 52 articles (1983–2017) examining gambling behavior in veteran populations. Articles generally fell into one or more of the following categories: prevalence, psychological profiles and psychiatric comorbidities, treatment evaluations, measurement, and genetic contributions to gambling disorder. Results from reviewed articles are presented and implications for future research discussed. Research to date has provided an excellent foundation to inform potential screening, intervention and research activities going forward. The authors suggest that a public health approach to future research endeavors would strengthen the evidence base regarding gambling in veteran populations and better inform strategies for screening, prevention and treatment.