To Integrate or Not to Integrate Dialectical Behaviour Therapy with Other Therapy Approaches?

With mounting evidence for its efficacy in the treatment of borderline personality disorder and related problems and increasing dissemination nationally and internationally, front line clinicians in practice settings are increasingly aware of dialectical behavior therapy (DBT). Indeed, it is likely that this treatment is reaching individuals who practice from a variety of theoretical frameworks, such as psychodynamic, humanistic, cognitive, or some combination thereof. Therefore, this paper considers the ways in which DBT is an integrative approach, as well as the issues that may arise in the integration of DBT with other theoretical frameworks or with practices spawned by these alternative frameworks. We recommend that therapists practicing DBT adhere to the behavioral and dialectical theoretical foundations of the approach, in order to provide therapy that is effective, coherent, and consistent.     

Individual Differences in Infants’ Joint Attention Behaviors With Mother and a New Social Partner

Relations between infant–mother attachment security at 15 months and infants’ (N = 206) joint attention behaviors (a) with an experimenter at 8 and 15 months, and (b) with their mothers at 15 months were investigated. No concurrent or longitudinal relations were observed between attachment security and infants’ tendency to respond to an experimenter’s bids for joint attention. Higher levels of initiating joint attention with an experimenter at 15 months were associated with insecure‐avoidant attachment. Insecure‐avoidant attachment was also associated with lower scores for initiating high‐level joint attention behaviors (pointing, showing, and giving) with the mother at age 15 months. The fact that security‐related differences in initiating joint attention with an experimenter were observed only once the attachment relationship was consolidated suggests that (a) attachment security may influence infants’ active engagement with new social partners, and (b) insecure‐avoidant infants may compensate for reduced social contact with the caregiver by initiating more interaction with other social partners.     

Effects of Unemployment on Health in a Community Survey: Main, Modifying, and Mediating Effects

Results from a community survey in a sample of high-unemployment census tracts in southeastern Michigan showed significant elevations of depression, anxiety, somatization, and self-reported physical illness among the currently unemployed. These adverse effects were largely reversed by reemployment. Subsequent analyses documented modifying effects of social support, self-concept, and coping. We also found two mediating processes that account for the overall effects of current unemployment: (a) the intervening effects of financial strain, and (b) an influence of unemployment in creating heightened vulnerability to other stressful life events. The implications of these results for the design and implementation of preventive interventions are briefly discussed.     

Irish child sexual abuse victims attending a specialist centre

We profiled a cohort of CSA cases referred for assessment to a specialist child sexual abuse (CSA) centre in a national paediatric hospital in Ireland. Historical and clinical data were drawn from records of 171 cases. The majority of cases were referred by social workers following purposeful disclosure of CSA. Three quarters of the cases were female with a mean age of 9 years. They were from a wide spectrum of socioeconomic groups and many had suffered a range of family adversities. In most cases, the abuse involved masturbation of the child by the abuser. Almost all of the perpetrators were male with a mean age of 28 years and in 60% of cases extrafamilial abuse had occurred. In 23% of cases, the perpetrator had a history of previous sexual offending. Anxiety was the most common emotional problem before disclosure and after disclosure the most common emotional problem was guilt. Before disclosure school refusal was the most common behavioural problem and after disclosure fighting was the most prevalent behavioural difficulty. The most common factors supporting the credibility of CSA allegations were labile mood, the child's ability to differentiate fact from fantasy and a detailed disclosure of contextual details. More adolescents showed deterioration in schoolwork after disclosure and for more pre school children clinginess following disclosure was a significant emotional problem. More primary school aged children were abused by perpetrators who had abused a number of children. For children abused by such perpetrators, vaginal intercourse was less common. Vaginal intercourse was more common in 6–11‐year‐old victims and those who were abused on a daily basis. The threat that disclosure posed to the integrity of the family structure was more often a factor hindering disclosure in victims abused by father figures and abused very frequently. Copyright © 2003 John Wiley & Sons, Ltd.     

Innovations in the measurement of life stress: crisis theory and the significance of event resolution.

Further progress in understanding the significance of stress for psychological well-being requires improved strategies for controlling both inter- and intra-event variability across subjects studied. This paper reports on an innovation in stress measurement suggested by a proposition drawn from crisis theory that recognizes life events as representing opportunities as well as hazards. The crucial contingency is hypothesized to be the outcome of the event with respect to the extent of its resolution in emotional and practical terms. This paper examines the possibility that life events that have been resolved successfully may not contribute to individual stress. Data was gathered from community samples of physically limited individuals and of non-limited comparison subjects. Results from separate analyses of these data generally support this hypothesis.     

A comparison of two programmes for victims of child sexual abuse: a treatment outcome study

This study aimed to evaluate the comparative effectiveness of individual therapy and combined individual and group therapy in the treatment of the psychological sequelae of child sexual abuse. The Child Behaviour Checklist (CBCL), the Youth Self Report form (YSR), the Children's Depression Inventory (CDI) and the Trauma Symptom Checklist for Children (TSCC) were administered before treatment and 6 months later to a group of 20 young people who participated in individual therapy (IT) programmes and to a group of 18 young people who participated in programmes that involved combined individual and group therapy (IGT). For both types of programmes, statistically significant improvement occurred on the following scales: the total problems, internalizing problems, externalizing problems, withdrawn, somatic complaints, anxious/depressed, social problems, attention problems and aggressive behaviour problems CBCL scales; the total depression, interpersonal problems and anhedonia CDI scales; and the depression and anger TSCC scales. The only scale for which one therapy programme led to greater improvement than another was the CDI ineffectiveness scale. The IGT programme led to a reduction in the mean CDI ineffectiveness score, whereas a slight increase in the mean ineffectiveness score occurred in the IT group. There were no significant differences in the rates of clinically significant improvement associated with the two treatments and no major differences between cases who improved and those that did not improve over the course of therapy. From this study, it may be concluded that after 6 months, individual therapy and combined individual and group therapy were equally effective in the treatment of the psychological sequelae of child sexual abuse. Copyright © 2002 John Wiley & Sons, Ltd.     

Ethical questions in functional neuroimaging and cognitive enhancement

The new field of neuroethics has recently emerged following unprecedented developments in the neurosciences. Neuroimaging and cognitive enhancement in particular are demanding ethical debate. For example, neuroscientists are able to measure, with increasing accuracy, intimate personal biases and thoughts as they occur in the brain. “Smart drugs” are now available that can effectively and safely enhance mental functioning in both healthy and clinical populations. This article describes the scientific principles behind these technologies, and urges the development of ethical principles based on a clear understanding of them. Europe should take the United States’ lead in devoting resources specifically intended to examine neuroethical concerns within European healthcare and legal frameworks.

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Zusammenfassung Die zahlreichen Entwicklungen in den Neurowissenschaften haben kürzlich zur Entstehung des neuen Feldes der Neuroethik geführt. Vor allem die Möglichkeiten von Neuro-Bildgebung und kognitiver Leistungssteigerung machten eine ethische Debatte erforderlich. So sind Neurowissenschaftler heute in der Lage, mit zunehmender Genauigkeit intime persönliche Neigungen und Gedanken zu messen, sobald sie im Gehirn erscheinen. Zudem gibt es „Smart Drugs”, die mentale Funktionen sowohl in gesunden als auch in klinischen Populationen auf effektive und sichere Weise steigern können. In diesem Beitrag beschreiben wir die wissenschaftlichen Prinzipien hinter diesen Technologien und drängen auf die Entwicklung ethischer Prinzipien auf der Grundlage eines klaren Verständnisses besagter Technologien. Europa sollte dem Beispiel der Vereinigten Staaten folgen und Mittel zur Verfügung stellen, die spezifisch der Untersuchung neuroethischer Belange innerhalb des europäischen Gesundheitswesens und der Gesetzgebung in Europa dienen.

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Resume´ Des développements sans précédent dans les sciences neurologiques ont récemment débouché sur l’émergence du nouveau domaine de la neuro-éthique. La neuroimagerie et l’accroissement du rendement cognitif exigent en particulier un débat éthique. Par exemple, les neuroscientifiques sont en mesure aujourd’hui de mesurer avec une précision croissante les inclinaisons et les pensées intimes personnelles dès leur apparition dans le cerveau. Il existe à présent des « smart drugs », des molécules intelligentes, qui permettent de renforcer de manière efficace et sûre les fonctions mentales de populations saines comme cliniques. Le présent article décrit les principes scientifiques qui se cachent derrière ces technologies et considère qu’il est urgent de développer des principes éthiques fondés sur une compréhension claire de ces technologies. L’Europe devrait suivre l’exemple des États-Unis et consacrer des ressources spécialement destinées à étudier les questions de neuro-éthique au sein de la santé publique européenne et de ses cadres législatifs.