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Objective: To examine the efficacy of an intervention, Training to Reconnect with Emotional Awareness Therapy (TREAT) at improving alexithymia, emotion dysregulation, anxiety, depression, anger, and global positive and negative affect in participants with traumatic brain injury (TBI)., Design: Randomized, waitlist control (WLC) trial with 3-month follow-up., Setting: Outpatient brain injury rehabilitation center., Participants: Adult participants, who were on average 11.37 years postcomplicated mild-to-severe TBI and also had elevated alexithymia (n=44), who were randomized to immediate treatment (TREAT; n=20) or WLC (WLC=24)., Interventions: Eight sessions, structured training program that teaches emotional awareness and discrete labeling of emotions., Main Outcome Measures: Toronto Alexithymia Scale-20, Levels of Emotional Awareness Scale, Difficulty with Emotion Regulation Scale, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9; State-Trait Anger Expression Inventory (STAXI), Positive and Negative Affect Schedule (PANAS); and Patient Global Impression of Change., Results: Thirty-four participants completed the study per protocol. Compared with WLC participants (n=16) who had not yet received the intervention, TREAT participants (n=18) had significantly less alexithymia, emotion dysregulation, anxiety, and depression (all P's<.05) within approximately 1 week of completing the intervention. Before/after results from the pooled sample (n=34) showed significant improvements, immediately and 3 months after the intervention, on all outcomes except the STAXI and the Positive Affect subscale of the PANAS. On the Patient Global Impression of Change, a noticeable change in global emotional function and quality of life was reported by 80%. Intent-to-treat analyses (n=38) revealed similar results to the per protocol sample., Conclusions: Findings support the efficacy of TREAT for reducing alexithymia and emotion dysregulation in individuals with chronic TBI. Although outcomes were also promising for anxiety and depression, more research using attention-control designs are warranted to control for the attention received during treatment., (Copyright © 2024 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Individuals recovering from stroke often experience cognitive and emotional impairments, but rehab programs tend to focus on motor skills. The aim of this investigation is to systematically assess the change of magnitude of cognitive and emotional function subsequent to a conventional rehabilitative protocol administered to stroke survivors within a defined locale in China., Methods: This is a multicenter study; a total of 1884 stroke survivors who received in-hospital rehabilitation therapy were assessed on admission (T0) and discharge (T1). The tool of InterRAI was used to assess cognitive, emotional, and behavioral abnormality., Results: The patients aged >60 years, with a history of hypertension, and long stroke onset duration were more exposed to functional impairment (all p  < 0.05). Both cognitive and emotional sections were significantly improved at T1 compared to T0 ( p  < 0.001). Initially, 64.97% and 46.55% of patients had cognitive or emotional impairment at T0, respectively; this percentage was 58.55% and 37.15% at T1., Conclusion: Many stroke survivors have ongoing cognitive and emotional problems that require attention. It is essential to focus on rehabilitating these areas during the hospital stay, especially for older patients, those with a longer recovery, and those with hypertension history.

Clinical psychologists are interested in studying factors that interfere with the behavioral regulation of perpetrators of intimate partner violence against women (IPVAW), as well as the way these factors affect the risk of future recidivism after interventions that are designed for them are completed. Although several variables have been proposed as risk factors for IPVAW, the role of alexithymia and its relationships with other cognitive and empathic variables in IPVAW perpetrators has been neglected. Thus, the main aim of this study was to compare the alexithymic and cognitive and empathic traits in a carefully selected sample of IPVAW perpetrators ( n  = 47; mean age = 39) with a control group matched on sociodemographic characteristics ( n  = 41; mean age = 42). Moreover, we also aimed to study whether alexithymic traits are related to cognitive and empathic alterations in IPVAW perpetrators. Compared to controls, IPVAW perpetrators had higher alexithymic and self-reported impulsivity traits and worse attention and executive functioning (e.g., verbal fluency and cognitive flexibility) performance than controls. Moreover, they also presented greater personal distress, compared to controls. Notably, we observed that higher alexithymia was associated with high self-reported impulsivity, worse cognitive and empathic performance in both groups. Our study identifies different cognitive targets for specific neuropsychological rehabilitation interventions designed to prevent violence recidivism in the long term through their effects on emotional information processing and behavioral regulation.

Aim: Borderline personality disorder and severe emotion dysregulation in adolescence is a major public health concern. Dialectical Behaviour Therapy is a promising treatment for suicidality in adolescents. The aim of this work is to present an adaptation of this intervention to the Spanish national health system, Actions for the Treatment of Adolescent Personality (ATraPA)., Method: Data consists of a description of the different ATraPA subprogrammes, including interventions for adolescents aged 13 to 17 and their families. Participants were referred to ATraPA from different hospitals within the region of Madrid, Spain., Results: ATraPA has been developed as an intensive outpatient treatment and it comprises different subprogrammes. ATraPA-TAI is an intensive outpatient treatment, including a skills-based group, individual therapy and email therapy. ATraPA-FAL is a psychoeducational intervention for families, including emotion regulation strategies for parents themselves. Finally, the Alternatives Group is offered to adolescents during the hospital admission, with the aim of promoting alternative coping skills. The group of therapists provides a support network to the professionals involved in ATraPA., Conclusions: ATraPA has been successfully implemented in a Child and Adolescent Psychiatry Service within the Spanish national health system. Future studies should address the efficacy of ATraPA using a controlled design., (© 2020 John Wiley & Sons Australia, Ltd.)

Traumatic brain injury (TBI) is common among Veterans, and sequelae frequently include deficits in attention and executive function and problems with emotional regulation. Although rehabilitation has been shown to be effective, it is not clear how patient characteristics such as baseline cognitive status may impact response to rehabilitation in this sample. Explore the relationship between baseline neuropsychological status and postintervention functional outcomes in Veterans with chronic TBI. Thirty-three Veterans with chronic mild-severe TBI completed a neuropsychological evaluation, a functional assessment of executive function (EF), and measures of emotional and everyday functioning pre- and post-EF training or control training. Performance on baseline neuropsychological measures was used to cluster participants. Participants' performance at baseline and postintervention assessments was compared by cluster using multivariate analyses of variance (MANOVAs). Cognitive Difficulty (CD; n  = 19) and Cognitively Normal (CN; n  = 14) clusters were identified. CD was characterized by z ≤ -.75 on neuropsychological measures of overall attention/EF, working memory, and memory. CD participants performed worse on functional EF assessment and endorsed more PTSD symptoms and community integration problems, at baseline. CD participants improved post-EF training, but not control training, on neuropsychological and functional measures. CN participants did not show statistically significant improvement. For Veterans with chronic TBI, cognitive assessment can aid in identifying functional impairment and assist treatment planning. Cognitive rehabilitation training appears to be a beneficial treatment option for TBI patients with cognitive, emotional, and daily living difficulties.

The aim of the current review is to advance the hypothesis that change in self-referential processing is a key but under-examined mechanism through which mindfulness training confers its therapeutic benefits for individuals with internalizing disorders. Consequently, we integrated neuroscientific studies on aberrant self-referential processing in internalizing disorders with contemplative science scholarship examining the effects of mindfulness training on the self-referential system. Reviewing these literatures yielded four major conclusions: (1) internalizing disorders can be characterized by excessive self-referential processing and emotion dysregulation; (2) mindfulness training has moderate effects on reducing internalizing symptoms; (3) mindfulness training promotes the shifting from narrative self-focus to present-centered experiential awareness; (4) such mindfulness-induced changes in self-reference is accompanied by reduced activation in overactive self-referential brain regions that have been implicated in internalizing disorders. Clinical and research implications related to delineating the role of self-referential processing in producing the therapeutic effects of mindfulness training are discussed., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: To examine the acceptability and initial efficacy of an emotional self-awareness treatment at reducing alexithymia and emotion dysregulation in participants with traumatic brain injury (TBI)., Setting: An outpatient rehabilitation hospital., Participants: Seventeen adults with moderate to severe TBI and alexithymia. Time postinjury ranged 1 to 33 years., Design: Within subject design, with 3 assessment times: baseline, posttest, and 2-month follow-up., Intervention: Eight lessons incorporated psychoeducational information and skill-building exercises teaching emotional vocabulary, labeling, and differentiating self-emotions; interoceptive awareness; and distinguishing emotions from thoughts, actions, and sensations., Measures: Toronto Alexithymia Scale-20 (TAS-20); Levels of Emotional Awareness Scale (LEAS); Trait Anxiety Inventory (TAI); Patient Health Questionnaire-9 (PHQ-9); State-Trait Anger Expression Inventory (STAXI); Difficulty With Emotion Regulation Scale (DERS); and Positive and Negative Affect Scale (PANAS)., Results: Thirteen participants completed the treatment. Repeated-measures analysis of variance revealed changes on the TAS-20 (P = .003), LEAS (P < .001), TAI (P = .014), STAXI (P = .015), DERS (P = .020), and positive affect (P < .005). Paired t tests indicated significant baseline to posttest improvements on these measures. Gains were maintained at follow-up for the TAS, LEAS, and positive affect. Treatment satisfaction was high., Conclusion: This is the first study published on treating alexithymia post-TBI. Positive changes were identified for emotional self-awareness and emotion regulation; some changes were maintained several months posttreatment. Findings justify advancing to the next investigational phase for this novel intervention.

Introduction: Stroke is a recognized cause of disability among adults. However the impact that the deficits that occur after a moderate/severe stroke have on long-term disability, as well as the response of the resultant deficits to rehabilitation, are not completely understood., Patients and Methods: A total of 396 patients with a modified Rankin score >= 3 after an ischemic (n = 221) or hemorrhagic (n = 175) stroke were included in this study. All patients were assessed with cognitive, behavior, emotional, motor and functional domains. All patients were assessed at baseline and six months after inclusion in a multidisciplinary rehabilitation program., Results: Risk of falling (Berg Balance Scale < 45 in 83.1% of the sample at baseline and 49.5% at follow-up) and functional problems (82.8% with a Barthel Index < 75 at baseline and 53% at follow-up) were the most prevalent deficits. Emotional disturbances were those that most improved while behavioral problems were those that did less. Although global disability improved during treatment among most patients, only 11% of our patients, especially those with preserved cognitive function at baseline, could be classified as patients with mild disability at follow-up., Conclusions: Stroke consequences are multidimensional. The symptoms that the stroke can cause in multiple domains, as well as the pattern of recovery are widely diverse, with prevalence of behavioral long-term disturbances.

Purpose: To describe the experience of family caregivers providing care to veterans with traumatic brain injury (TBI)., Design/methods: Using a qualitative design, interviews were conducted with a purposeful sample of women caregivers. Data were analyzed using content analysis procedures., Findings: Findings resulted in the key concept phrased by participants as "He looks normal but." This phrase conceptualizes the participants' description of their experience caring for a brain injured veteran who could appear normal to others but the caregiver's description revealed substantial cognitive, social, and emotional deficits. Concepts include (a) Becoming aware of his disabilities, (b) Observing his troubling symptoms, (c) Dealing with his memory loss, (d) Being fearful of his anger, (e) Sensing his loneliness, (f) Acknowledging the effects on the children, and (g) Managing the best I can., Conclusions/clinical Relevance: A better understanding of the needs of caregivers of veterans with TBI may allow clinicians to better support caregivers., (© 2014 Association of Rehabilitation Nurses.)

Objective: The present study examines the academic well-being of students with and without special educational needs (SEN) in inclusive classes compared to students from regular classes in which no child with SEN is taught. In addition, the relationships between the school well-being and emotional problems, conduct problems, hyperactivity/inattention, peer relationship problems and prosocial behavior are analyzed., Method: A total of 1115 students from the 4th and 7th grade (37 % 4th graders, 63 % 7th graders) participated in the survey, 126 of whom had been diagnosed as having SEN. The subscale Well-Being at School taken from the FEESS 3–4 (Rauer & Schuck, 2004) and the SDQ (Goodman, 1997) were used for measurement., Results: Results indicate high reliabilities for the subscale Well-Being in School for students both with and without SEN for both grades 4 and 7. Furthermore, it could be shown that the variance explained for school well-being can be connected to elements on the students’ individual level as well as on the class-specific level. Significant predictors of school well-being were sex, behavioral difficulties and strengths as well as the school grade. The SEN status (no SEN vs. SEN) and the class setting (regular vs. inclusive class) did not influence the school well-being significantly.

The welcomed coeducation of children and adolescents with and without disabilities is going into dangerous territory since it has become burdened with a number of illusionary expectations. The constraints applied by real-life and meaningful circumstances should be taken into account, especially for children with emotional and social behavior disorders. Practicable prevention and intervention measurements cannot be generated without profound knowledge about disorders among this heterogeneous group of people. Abandoning all previously relevant terminology («noncategorization»), demanded by some radical inclusion advocates, leads to a situation that is helplessly confronted with its duties but lacks the basic skills and the necessary support stemming from an interdisciplinary dialogue. The contact with child and adolescent psychiatry is threatened to the disadvantage of the profession.

Objectives: Little is known about the moderators and mediators of change in online pain interventions based on cognitive-behavior therapy (CBT). We hypothesized that the effects of painACTION.com, an online pain self-management program, on pain-related outcomes would be mediated by changes in depression, anxiety, and stress, as well as the use of coping strategies. We also examined potential moderators of change., Methods: First, the efficacy of painACTION.com and moderators of the intervention effects were evaluated using a pooled sample from previous back, neuropathic, and arthritis pain studies. Next, we explored whether the intervention effect on the primary outcomes, pain severity, and patient global impression of change (PGIC), was mediated by coping strategies or emotional functioning., Results: Compared with controls, experimental participants evidenced significant improvement in pain, emotional functioning, and coping strategies from baseline to follow-up. There were no clear moderators of intervention effects. Changes in emotional factors, particularly stress levels, mediated the relationship between the intervention and outcome (pain severity) over time., Discussion: This study supports the effectiveness of online interventions when CBT and self-management targets pain levels, emotional factors, and wellness-focused coping. The importance of stress as a mediator of pain severity is discussed. The absence of moderators may indicate that the intervention is effective for a wide variety of patients with chronic pain.

Many students with emotional and behavioral disorders (EBD) experience learning problems in reading at the middle and secondary school levels. Yet, the academic performance of students with EBD is often overlooked in the research literature. The purpose of this article was to provide a quantitative synthesis of the published, peer-reviewed, single-case research literature on reading interventions for students with or at-risk for EBD. An omnibus nonoverlap effect size of .59 with a 95% confidence interval (CI) = [.54, .64] was found consisting of 219 phase contrasts and 44 participants across the 11 studies included in the review. The findings are discussed in the context of improving the academic and behavioral outcomes of middle and secondary students with EBD., (© The Author(s) 2014.)

We reviewed studies utilizing task sequencing to improve academic outcomes for children with emotional and/or behavioral disorders (EBD) in educational settings. Task sequencing interventions included high-probability, high-preference, and task interspersal interventions. Although task sequencing is commonly used in research, a synthesis of recent applications in educational settings for students with EBD is absent. Systematic searches of electronic databases and ancestral references identified 11 studies meeting inclusion criteria. These 11 studies were reviewed and analyzed for (a) participant characteristics, (b) experimental design, (c) type of academic outcome as the dependent variable, (d) intervention description, (e) certainty of evidence and research quality, and (f) reported student academic outcomes. Implications for continued applied practice and future research are discussed., (© The Author(s) 2014.)

Introduction: Persons who have suffered brain damage can experience a wide range of cognitive, behavioural and emotional disorders. However, neuropsychological rehabilitation usually focuses, almost exclusively, on the cognitive deficits and pays very little attention to the emotional challenges associated with the psychological impact of the lesion. It is in this more personal side of brain damage where neuropsychotherapy can be of great aid to facilitate the process of acceptance and adaptation following a neurological lesion., Development: In this article, we describe the theoretical and conceptual aspects of psychotherapy oriented towards persons with brain damage, the implications of cognitive deficits in the practice of neuropsychotherapy and the evidence regarding its effectiveness., Conclusions: In the past, neuropsychotherapy was considered to be of little use in the rehabilitation of brain damage. Today, however, a growing number of professionals are acknowledging its importance in the management of the psychological/emotional suffering associated with brain damage. The aim of neuropsychological rehabilitation is not just to promote the recovery of the altered brain functions, but also to improve the individual's functional capacity, deal with his or her experiences of loss and help him or her to again find a meaning to life.

Objectives: To determine (1) alexithymia, affect recognition, and empathy differences in participants with and without traumatic brain injury (TBI); (2) the amount of affect recognition variance explained by alexithymia; and (3) the amount of empathy variance explained by alexithymia and affect recognition., Participants: Sixty adults with moderate-to-severe TBI; 60 age and gender-matched controls., Procedures: Participants were evaluated for alexithymia (difficulty identifying feelings, difficulty describing feelings, and externally-oriented thinking); facial and vocal affect recognition; and affective and cognitive empathy (empathic concern and perspective-taking, respectively)., Results: Participants with TBI had significantly higher alexithymia; poorer facial and vocal affect recognition; and lower empathy scores. For TBI participants, facial and vocal affect recognition variances were significantly explained by alexithymia (12% and 8%, respectively); however, the majority of the variances were accounted for by externally-oriented thinking alone. Affect recognition and alexithymia significantly accounted for 16.5% of cognitive empathy. Again, the majority of the variance was primarily explained by externally-oriented thinking. Affect recognition and alexithymia did not explain affective empathy., Conclusions: Results suggest that people who have a tendency to avoid thinking about emotions (externally-oriented thinking) are more likely to have problems recognizing others' emotions and assuming others' points of view. Clinical implications are discussed.

We have developed the method for the treatment of the patients presenting with arterial hypertension and concomitant chronic psychoemothional overtension. The method consists of the application of the baths containing the Siberian Stag velvet antler extracts in combination with exercise therapy and massage. A total of 35 patients with arterial hypertension and concomitant chronic psychoemothional overtension were enrolled in the study. It was shown that inclusion of the baths containing the Siberian Stag velvet antler extracts in the combined treatment of arterial hypertension and concomitant chronic psychoemothional overtension has positive effect on the parameters of the main homeostatic systems, enhances the working capacity of the patients, promotes their psychological stability, and increases the adaptive potential of the organism.

We examined whether the combined indices of respiratory sinus arrhythmia at rest (resting RSA) and in response to a sad film (RSA reactivity) predict effective and ineffective responses to reduce sadness (adaptive vs. maladaptive mood repair) in women with histories of juvenile-onset depression (n=74) and no history of major mental disorders (n=75). Structural equation models were used to estimate latent resting RSA, depression, and adaptive and maladaptive mood repair and to test the study hypotheses. Results indicated that combinations of resting RSA+RSA reactivity (RSA patterns) predicted maladaptive mood repair, which in turn, mediated the effects of RSA pattern on depression. Further, RSA patterns moderated the depressogenic effects of maladaptive mood repair. RSA patterns were unrelated to adaptive mood repair. Our findings suggest that mood repair is one mechanism through which physiological vulnerabilities adversely affect mental health., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Objective: We examined postsecondary employment experiences of young adults with an autism spectrum disorder (ASD) and compared these outcomes with those of young adults with different disabilities., Method: Data were from Wave 5 of the National Longitudinal Transition Study-2 (NLTS2), a nationally representative survey of young adults who had received special education services during high school. We examined the prevalence of ever having had, and currently having, a paid job at 21 to 25 years of age. We analyzed rates of full-time employment, wages earned, number of jobs held since high school, and job types., Results: Approximately one-half (53.4%) of young adults with an ASD had ever worked for pay outside the home since leaving high school, the lowest rate among disability groups. Young adults with an ASD earned an average of $8.10 per hour, significantly lower than average wages for young adults in the comparison groups, and held jobs that clustered within fewer occupational types. Odds of ever having had a paid job were higher for those who were older, from higher-income households, and with better conversational abilities or functional skills., Conclusions: Findings of worse employment outcomes for young adults with an ASD suggest that this population is experiencing particular difficulty in successfully transitioning into employment. Research is needed to determine strategies for improving outcomes as these young adults transition into adulthood., (Copyright © 2013 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

In this study the authors examine the individual and family characteristics of youth (N = 105) admitted over a five year period to a day school treatment program in a western New York community. All had exhausted alternative school placements within their home school districts and had a history of severe emotional or behavioral problems. Consistent with national patterns, more males (78%) than females were admitted, but in contrast to national trends, more Caucasians (63.8%) than students of color (36.2%) were admitted. Most lived in female headed single-parent households (51.4%). A few were foster children living with relatives or in non-relative foster homes (14.3%). Poverty was common with 45.7% of these youth eligible for free lunches. Most were on psychotropic medications (57.1%) and had histories of outpatient (62.9%) and inpatient hospitalizations (23.6%) at admission. Involvement in the juvenile justice system was common with nearly a quarter involved in the juvenile justice system (n = 25; 23.8%).

In this article we situate empirical research into women's problematic experiences of anti-depressant medication within broader debates about pharmaceuticalization and the rise of the neurochemical self. We explore how women interpreted and problematized anti-depressant medication as it impeded their recovery in a number of ways. Drawing upon Foucauldian and feminist work we conceptualize anti-depressants as biotechnologies of the self that shaped how women thought about and acted upon their embodied (and hence gendered) subjectivities. Through the interplay of biochemical, emotional and socio-cultural effects medication worked to shape women's self-in-recovery in ways that both reinscribed and undermined a neurochemical construction of depression. Our analysis outlines two key discursive constructions that focused on women's problematization of the neurochemical self in response to the side-effects of anti-depressant use. We identified how the failure of medication to alleviate depression contributed to women's reinterpretation of recovery as a process of 'working' on the emotional self. We argue that women's stories act as a form of subjugated knowledge about the material and discursive forces shaping depression and recovery. These findings offer a gendered critique of scientific and market orientated rationalities underpinning neurochemical recovery that obscure the embodied relations of affect and the social conditions that enable the self to change.

Objective: Two perspectives are offered on the transition outcomes of youth with emotional disturbances (ED) using data from the National Longitudinal Transition Study (NLTS) and the National Longitudinal Transition Study-2 (NLTS2). The first perspective compares two cohorts of youth ages 18-21 who were out of high school up to 4 years in 1990 and 2005 on their rates of high school completion, postsecondary education enrollment, employment, independent living, and criminal justice system involvement. The second perspective provides similar information from the final wave of NLTS2 data collection (2009), when young adults were ages 21-25., Methods: Using nationally representative interview and survey data, descriptive statistics are provided for outcomes at each time point., Results: Significant increases over time are apparent in rates of high school completion, postsecondary education, and arrest, and there was a significant decline in employment. Analyses of young adults with ED in 2009 show that 82.5 percent had completed high school, and 53 percent had had some postsecondary education. Although 91.2 percent had been employed at some time since high school, 49.6 percent were employed when interviewed; 63.1 percent had lived independently, 60.5 percent had been arrested, and 44.2 percent had been on probation or parole., Conclusions and Implications for Practice: Youth with emotional disturbances trail the general population in positive transition outcomes, and high rates of criminal justice system involvement suggest more effort is needed, including early intervening with response to intervention (RtI) strategies and self-determination training, to help these young adults succeed after high school.

Objective: Treatment adherence, defined as the degree to which practitioners implemented prescribed program principles and activities and avoided proscribed activities, has been an area of growing interest in mental health services for children with severe emotional and behavioral disorders. This study evaluated the reliability and validity of a treatment adherence measure for child psychiatric rehabilitation (CPSR)., Methods: Parents of children receiving CPSR (n = 79) or psychotherapy (n = 27) completed the Children's Psychosocial Rehabilitation Treatment Adherence Measure (CTAM) and a measure of 2-week session impact. Psychiatric rehabilitation (PSR) supervisors identified PSR practitioners with reputations for high or low adherence to the model. The CTAM's discriminant validity was assessed by using known-groups procedures and predictive validity by examining its relationship to 2-week session impact., Results: The CTAM demonstrated excellent internal consistency (α = .92), discriminant validity (p = .002, d = .72; p = .021, d = .59), and predictive validity (B = 2.24, SE = .31, p < .001), accounting for 28% of the child-level variance in 2-week session impact., Conclusions and Implications for Practice: Findings suggest the CTAM is a reliable and valid measure of treatment adherence for CPSR programs with a skill-teaching focus. Providers and agencies should take steps to enhance treatment adherence because it may be an important predictor of children's short-term response to CPSR., ((PsycINFO Database Record (c) 2012 APA, all rights reserved).)

The Schwartz Outcome Scale-10 (SOS-10) is a 10-item self-report that measures quality of life and psychological well-being. It is easy to administer and score, and past research has revealed its utility, validity, and reliability with different samples (i.e., clinical and nonclinical) and in different clinical settings (i.e., inpatient, outpatient, nonpsychiatry medical settings). The present study looks to investigate the utility of the SOS-10 in measuring psychological well-being and quality of life with the 28-day inpatient chemical dependency sample. In addition, the current study looks to investigate its ability to be used as a treatment outcome measure for chemical-dependent inpatients. The results revealed that the SOS-10 was associated with aspects of interpersonal dependency and alexithymia in predicted ways. The SOS-10 was positively associated to "Healthy Dependence" and negatively related to alexithymia and "Destructive Overdependence" and "Dysfunctional Detachment." The results also showed that the SOS-10 showed healthy change from admission to discharge and that this change was paralleled by healthy change in interpersonal dependency and alexithymia.

Background: Alcoholism during pregnancy is one of the most common factors in western societies causing persisting congenital and multiple physical as well as neurological impairments. Finding the diagnosis at first sight puts medical professionals into a demanding situation. Therefore the objective of this study was to detect patients' developmental characteristics with the main focus on the necessity of the diagnosis itself., Patients: 125 young patients, whose diagnosis of fetal alcohol syndrome (FAS) was made at the Muenster University Hospital, were followed up., Methods: Biographic details such as living conditions, health, developmental problems and educational career were gathered using a structured interview. The diagnosis itself and the impact of this on the patients were also explored., Results: Patients displayed characteristics of a less mature trait of character. The majority were looked after by foster parents. High rates of social and developmental problems could be found. The diagnosis was identified as a protective factor, with significantly better outcomes for patients being diagnosed in early childhood. A diagnosis established later in life was particularly helpful for the families and caregivers. Feelings of failure and self-blame could be diminished., Conclusions: The early detection of affected children has to be improved as receiving the correct diagnosis, despite the persistent impairments, is of major benefit for both patients and their families., (© Georg Thieme Verlag KG Stuttgart · New York.)

A considerable number of children are exposed to extreme stressors such as the sudden loss of a loved one, serious traffic accidents, violence, and disaster. In order to facilitate school psychologists' assistance of teachers working with traumatized children, this study aimed to explore elementary school teachers' perspectives. Using a qualitative design, the study explored the perspectives of a purposively varied sample of 21 elementary school teachers (ages 22-55 years; with 0.5-30 years of teaching experience; 5 men). The teachers participated in semistructured interviews, which were transcribed and analyzed in line with the method of "summative analysis" by F. Rapport. Even though some teachers expressed confidence in working with children after traumatic exposure and many referred to a supportive atmosphere within the school, the most prominent themes in the participants' narratives reflected uncertainty about, or a struggle with, providing optimal support to children. They searched for a clear role definition as well as a good balance in answering conflicting needs of the exposed children and classmates, wished for better knowledge and skills, and experienced difficulties related to the emotional burden of their work. The findings suggest a need for further research into this understudied topic. In addition, the identified themes can be used by school psychologists to systematically explore individual teachers' strengths and difficulties and to provide them with tailored advice and training., ((c) 2012 APA, all rights reserved.)

Context: Palliative care rehabilitation aims to maximize physical and psychological functioning, but negative thoughts can hinder patients from attempting this approach. Acceptance and commitment therapy (ACT), a modified form of cognitive behavioral therapy, encourages individuals to experience and manage negative emotions by focusing on changing individual behavior and so improve functioning. ACT has been used in many health-related behavioral interventions but not in palliative care rehabilitation., Objectives: To investigate the relationship between acceptance (often called experiential acceptance in ACT) and psychological and physical status., Methods: Cross-sectional study in which a consecutive sample of patients attending a specialist palliative care day therapy unit for rehabilitation completed the Acceptance and Action Questionnaire-II to measure acceptance and the Kessler-10 questionnaire to measure psychological morbidity. Physical function was assessed by a timed two-minute walking test and one-minute sit-to-stand test. Correlation statistics and multivariable regression analyses were used to explore the strength of relationships between acceptance and psychological morbidity and physical function., Results: One hundred one patients were recruited, mainly white women with a mean age of 64 years. Correlation analysis showed a negative association between acceptance and psychological morbidity (r=-0.59) and a positive association between acceptance and sit to stand (r=0.27) and distance walked (r=0.21). All three of these relationships were statistically significant after adjustment., Conclusion: These associations suggest that it may be possible to reduce psychological morbidity and improve physical mobility by increasing patients' acceptance using an ACT-based intervention. Future work is now needed to develop an ACT-based intervention in palliative care rehabilitation and test its acceptability and feasibility., (Copyright © 2012 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.)

Long-term foster care (LTFC) is an enduring problem that lacks evidence of effective strategies for practice or policy. This article describes initial activities of a statewide project of the national Permanency Innovations Initiative. The authors sought to: (1) verify the relevance of children's mental health as a predictor of LTFC, (2) describe critical barriers encountered by parents of children with serious emotional disturbances, and (3) identify systems barriers that hinder permanency for this target population.

Background: Children with Epidermolysis bullosa (EB) suffer from an intractable, burdensome skin disease that may result in cognitive as well as social and emotional problems., Patients: To assess cognitive problems in patients with EB, we investigated 20 affected children and adolescents, 6-17 years of age (mean: 10.8 years; SD: 3.4 years), and 24 healthy controls (6-15 years, mean: 10.9 years; SD: 3.0 years) for cognitive abilities. Additionally, parents were asked to assess social and emotional problems of their children., Methods: Patients and controls were assessed using the Wechsler Intelligence Scales. Parents completed Achenbach's Child Behaviour Checklist (CBCL), a parent-report measure on emotional and behavioural symptoms in children., Results: The mean scores of the young patients tested with WISC-R and WAIS-R showed no significant left shift if compared to healthy controls. Analyzing the subtypes of EB, however, considerable cognitive deficits were associated with recessive dystrophic EB (RDEB), severe generalized. Less social competence and more social and emotional problems were reported for the entire patient group., Conclusions: Functional rehabilitation is required to increase not only the physical but the cognitive development of the severely affected children with RDEB. Children and adolescents with all subtypes of EB require therapeutic support regarding their social and emotional life., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Recent researches on pathological gambling indicate that the various gambling activities are heterogeneous by nature. Indeed, some findings support the view that gambling cannot be seen as a homogeneous activity. Therefore, pathological gamblers do not represent a homogeneous population. However, treatment does not appear to take into account this heterogeneity and studies in the field have assessed the efficacy of the various types of treatment. Furthermore, recent empirical data emphasize the need for delineating distinct subtypes of pathological gambling presenting similar symptoms but which, at the same time, differ on certain variables. These subtypes will be essential in the management, treatment, and prognosis of pathological gambling., Literature Findings: Blaszczynski and Nower (2002) identified three subtypes of gamblers. The first subtype, referred to as the "emotionally vulnerable problem gamblers", includes gamblers who mainly gamble to escape painful emotional experiences. The second includes "antisocial impulsivist problem gamblers" who are mainly driven by impulsivity and sensation seeking. The last one, referred to as the "behaviourally conditioned problem gamblers", includes gamblers who gamble because of behavioural contingencies offered by the game, rather than psychological difficulties. Each group is characterized by specific psychological variables, and each may require a different treatment approach. Hence, these subgroups should be used and taken into account in the choice of the treatment., Aim of the Paper: The purpose of this article is to provide an integrative model of treatment of this disorder based on the typology of pathological gamblers. Many studies have tried to understand this pathological behaviour by exploring motivational, psychological, biological and ecological correlates of gambling to explain the aetiology. An approach integrating various orientations, at the same time cognitive-behavioural, motivational, psychoanalytical and bodily-centred is the most relevant for this behavioural disorder. On the one hand, treatment should focus on the similarities displayed by the gambler. On the other hand, treatment should evaluate and focus on the specificities of each subtype of pathological gamblers. This last point refers to the question of the role played by the game for the gambler. All pathological gamblers present similar symptoms. Concerning those common points, professionals should evaluate and treat comorbidities, wrong perceptions/cognitions, motivation to change, gambling behaviour and social aspects of the gambling behaviour. Concerning the specificities, professionals should evaluate to which subtype or pathway the gambler corresponds, and then adapt the treatment. For example, for emotionally vulnerable problem gamblers gambling to escape painful emotional experiences and presenting alexithymia components, specific psychotherapeutic techniques improving affect identification and differentiation should be applied. Thus, add-on individual psychoanalytical oriented sessions and relaxation sessions should be included in the treatment., (Copyright © 2011 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Objective: The state-trait nature of alexithymia is not fully resolved. The aim of this article was to evaluate the temporal stability of alexithymia in cancer patients after psychological intervention., Design: Absolute and relative stability of alexithymia was evaluated in 104 cancer patients who received multicomponent psychological treatment or usual medical care., Results: Alexithymia scores significantly decreased in treated patients and increased in the control group, thus showing that the lack of absolute stability (i.e., the change of personality scores over time) likely was because of the effect of the treatment versus the control condition. The relative stability (i.e., the extent to which the inter-individual differences remain the same over time) of alexithymia after 6 months was, however, demonstrated with multiple regressions, after controlling for anxiety, depression, and cancer-related pain., Conclusions: This study confirms the relative stability of alexithymia and that the lack of absolute stability of the construct is influenced by psychological intervention in cancer patients., (© 2011 Wiley Periodicals, Inc.)

Objective: To examine changes in behavioral and emotional problems among opioid-dependent adolescents during a 4-week combined behavioral and pharmacological treatment., Methods: We examined scales of behavioral and emotional problems in youth using the Youth Self-Report measure at the time of substance abuse treatment intake and changes in scale scores during treatment participants were 36 adolescents (aged 13-18 years, eligible) who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for opioid dependence. Participants received a 28-day outpatient, medication-assisted withdrawal with either buprenorphine, or clonidine, as part of a double-blind, double dummy comparison of these medications. All participants received a common behavioral intervention, composed of 3 individual counseling sessions per week, and incentives contingent on opioid-negative urine samples (collected 3 times/week) attendance and completion of weekly assessments., Results: Although a markedly greater number of youth who received buprenorphine remained in treatment relative to those who received clonidine, youth who remained in treatment showed significant reductions during treatment on 2 Youth Self-Report grouping scales (internalizing problems and total problems) and 4 of the empirically based syndrome scales (somatic, social, attention, and thought). On Youth Self-Report competence and adaptive scales, no significant changes were observed. There was no evidence that changes in any scales differed across medication condition., Conclusions: Youth who were retained demonstrated substantive improvements in a number of clinically meaningful behavioral and emotional problems, irrespective of pharmacotherapy provided to them.

Posterior fossa syndrome can occur after neurosurgical resections of childhood posterior fossa tumors, such as medulloblastomas. Posterior fossa syndrome is characterized by transient mutism, emotional lability, cognitive deficits, weakness, ataxia, and cranial nerve dysfunction. Symptoms generally appear 1 to 3 days after surgery and persist for months to years. Neuroscience nurses play an integral role in helping affected children and their families through the diagnosis, treatment, and sequelae of this frightening syndrome.

Background: Adolescents with a chronic somatic disease often show comorbid mental health problems which interfere with adherence and disease management. As adolescents often pass their rehabilitation treatment without their parents and therapists frequently lack resources necessary for assessing information from both the patients and their parents, the question arises what conclusions can be drawn on the basis of self report data only and how general agreement between parent and adolescents can be rated., Methods: Parent-child-agreement of chronically ill adolescents and their families are analyzed using intra-class-correlation (ICC). Data of 367 adolescents with obesity, chronic respiratory disease, skin disease and diabetes between the age of 12.0 and 16.11 years were collected at the beginning of rehabilitation treatment. Parents received their questionnaire via post. Psychological symptoms were identified using the German version of the Strength and Difficulties Questionnaire (SDQ-Deu)., Results: There was medium to high agreement between parent and child ratings regarding "emotional problems", "peer relationship problems" and "total difficulty score" for all diagnoses., Conclusions: Therapists of chronically ill adolescents can act on the assumption that parent-child-agreement is medium to high. Consequently, self-ratings appear a useful diagnostic indicator for rehabilitation treatment., (© Georg Thieme Verlag KG Stuttgart · New York.)

Aims: Our general objective was to assess the psychological symptoms and the types of causal attributions linked to the symptoms among women chronic pain., Methods: 70 fibromyalgia (FM) patients, 56 chronic low back pain (CLBP) patients and 72 healthy controls were assessed within a general hospital setting, using the Toronto Alexithymia Scale, Brief Symptom Inventory and Symptom Interpretation Questionnaire. Three-way analysis of variance and chi-square tests were used for inter-group comparisons, followed by multivariate correlation, covariate analysis and linear regression., Results: Alexithymia, somatization, depression, anxiety and hostility scores were significantly higher in FM patients relative to CLBP patients and healthy controls (P < 0.05). Alexithymia was linked to psychological attributions in FM patients and to somatic attributions in CLBP patients. Psychological attributions, the number of symptoms and difficulty in describing emotions were related to increased anxiety in FM patients. Depression, anxiety and somatization were significantly increased in subjects with high alexithymia scores in the FM group. There was no difference between groups regarding causal attributions., Conclusions: Causal attributions do not seem to have distinctive features between functional somatic syndromes like FM and CLBP, though differences might exist between groups as to the effects of coexisting psychological distress symptoms like anxiety and depression.

Objective: To investigate the change of psychological symptoms and quality of life in children and adolescents with congenital heart disease, cancer, or cystic fibrosis after a family-oriented inpatient rehabilitation program., Methods: 302 participants in the intervention (aged 4-17 years, mean=8.7) were assessed using standard questionnaires at admission to the rehabilitation program, at discharge, and 6 months post discharge. Parent-reported behavioral and emotional symptoms were compared to a healthy control group from the National Health Interview and Examination Survey for Children and Adolescents (n=903)., Results: At admission, 27.5% of patients showed abnormal levels on the total difficulties score of the Strengths and Difficulties Questionnaire - parent version (SDQ), while an additional 16.9% had slightly elevated symptoms (relative risk=2.16). Patients' psychological symptoms were negatively correlated with their quality of life (QoL) and with parental QoL. After rehabilitation, the patients' symptoms improved significantly, and the improvement persisted for 6 months in those patients who could be followed., Conclusions: The rehabilitation program can be considered a promising strategy to improve the patients' psychological adaptation., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Maternal alcohol abuse during pregnancy causes physical, cognitive and behavioural impairments in the child. Deficits are irreversible and persist into adulthood. It was the objective of this study to investigate the specific problems and challenges faced by young adults with Fetal Alcohol Syndrome (FAS)., Patients: We examined the biographical development and living situation of 60 adult patients with FAS. In their childhood, all the patients had been diagnosed with FAS in the Muenster University hospital., Methods: Using a structured interview, we asked for the occupational career, health and social problems as well as the current living conditions of the patients., Results: Most patients lived in dependent circumstances. The occupational development was characterized by disruption and failure, and severe social problems were common in patients. 3 in 4 patients were victims of physical and sexual abuse., Conclusions: Due to the variety of impairments caused by prenatal alcohol exposure and the persisting inability to live independently, adults with FAS need intense care, support and assistance., (© Georg Thieme Verlag KG Stuttgart · New York.)

The aim of this study was to compare a range of individual, life events, family and socio-economic factors associated with young people with intellectual disabilities and with and without behavioural/emotional problems. Teachers in 16 schools in one region of the UK completed a postal questionnaire on 249 young people with intellectual disabilities aged between 11 and 19 years. There were two groups: 155 young people with behavioural/emotional issues, and 94 without. Using a binary logistic regression analysis, a number of individual, life events, family and socio-economic risk factors were found to be significantly associated with emotional/behavioural problems. The results are discussed alongside findings from other studies. The importance of a multidimensional assessment is highlighted, as well as the interdependent nature of the risk factors.

Objective: This study concerns the long-term effects of ambulant and outpatient youth provisions. Progress was examined regarding the impact of stress, extensive conduct problems, emotional problems, as well as available resources. In addition, we included data on adolescents' educational status, legal problems, and substance use in the analysis., Method: Using quantitative data from three surveys, we analysed the development in children and adolescents and their families, all of whom were engaged in youth welfare services (N = 59)., Results: At the onset of youth welfare services involvement, there were three groups that different significantly regarding the stress impact (low, moderate, high). It was hypothesized that children with low stress impact would benefit most from youth welfare services. Even 3 years after the welfare service had come to an end children and adolescents with a high level of problems at service onset still showed significantly higher impact levels and more familial problems. However, there were no significant differences between the groups regarding behavioral problems., Conclusions: The study indicates the long-term effects of youth welfare services, independent of the initial extent of general impact.

Periods of recovery were examined in patients with and without deficit syndrome schizophrenia. Fifty-six patients with schizophrenia were studied, 39 of whom were divided into deficit and nondeficit syndrome schizophrenia subtypes using a proxy method. We also studied 39 nonpsychotic depressive comparison patients. Patients were evaluated as part of the Chicago Follow-up Study, which prospectively examined patients at regular intervals over a 20-year period. Using standardized instruments, patients were evaluated for the deficit syndrome, global recovery, rehospitalization, social dysfunction, occupational disability, and symptom presentation. Recovery was examined at 6 time points measured at 2-, 4.5-, 7.5-, 10-, 15-, and 20-year postindex hospitalization. Cumulatively, over the 20-year period, 13% of patients classified as meeting criteria for the deficit syndrome showed 1 or more 1-year periods of global recovery, in comparison to 63% of nondeficit schizophrenia patients and 77% of depressed patient controls. Results indicate that the deficit syndrome represents a persistently impaired subsample of schizophrenia patients, with continuous social, occupational, and symptom impairment. In contrast, nondeficit syndrome schizophrenia patients showed at least some periods of remission or recovery, with the likelihood of these periods increasing as they became older. Findings provide further support for the validity of the deficit syndrome concept and suggest that deficit status is characterized by a more persistently impaired course of illness and particularly poor long-term prognosis.

Background: Dialectic behaviour therapy (DBT) has been widely used with individuals diagnosed with borderline personality disorder who exhibit severe emotional and behavioural dysregulation. There is a paucity of research in assessing the effectiveness of DBT with forensic clients with intellectual disability (ID)., Methods: This pilot study aims to evaluate the effectiveness of the DBT group skills training programme adapted particularly for offenders with ID. Six participants completed the 13-week adapted DBT group skills training programme. All participants exhibited challenging behaviours and have a history of prior charges or convictions for violent crimes. The study conducted pre- and post-tests using instruments that measured dynamic risks, relative strengths, coping skills and global functioning., Results: The study result showed improvement across all measures. A decrease in the level of risks, increase in relative strengths and general improvement in overall functioning were found significant. The results were promising particularly as a stand-alone adapted DBT group skills training programme for this client group.

With this study the suitability of two instruments for assessing changes in the quality of life was examined. Data were collected in mother-child rehabilitation centres. The Kiddy-KINDL (n=727), a parent-based instrument for assessing health related quality of life in children (age 4 to 7 years) and the Kid-KINDL (n=716), a self-report questionnaire for children (age 8-12 years) were used at the beginning and the end of rehabilitation. In addition in a subgroup of n=420 children the Child Behavior Checklist was used in order to identify behavioral and emotional problems. The psychometric analyses revealed that both instruments were well accepted by mothers and children. The reliabilities of the sum scores as well as the convert validity were sufficient. The results of the Kid-KINDL were affected by low reliabilities and ceiling effects on subscales. Thus, in repeated measurements only changes of sum scores can be interpreted with sufficient accuracy. However, the use of the self-report questionnaires can be recommended because the known-group validity was high. Both versions of the KINDL are suitable for assessing treatment effects of preventive measures in rehabilitation clinics, considering the low reliabilities of subscales for the Kid-KINDL., (Georg Thieme Verlag KG Stuttgart.New York.)

This commentary presents data about the emotional, behavioral, and substance abuse disorders of youth in foster care and former recipients of foster care ("alumni") in the United States to underscore the reasons why high quality mental health services are essential.

The identification of schizophrenia's negative symptoms dates back to the earliest descriptions of Kraepelin and Bleuler, who each highlighted the central role of avolition in the phenomenology and course of this illness. Since, there have been numerous advances in our understanding of schizophrenia, and the present review tracks the changes that have taken place in our understanding of negative symptoms, their description and measurement. That these symptoms represent a distinct domain of the illness is discussed in the context of their ties to other symptoms and functional outcome. The underlying structure of the negative symptom construct is explored, including several lines of investigation that point towards diminished expression and amotivation as key underlying subdomains. We also discuss findings of intact emotional experience and consummatory pleasure in individuals with schizophrenia, calling into question the presence of anhedonia in this illness. We conclude with a reconceptualization of the negative symptoms, suggesting amotivation (ie, avolition) represents the critical component, particularly in regard to functional outcome. Further exploration and clarification of this core deficit will ultimately enhance our neurobiological understanding of schizophrenia, as well as strategies that may improve outcome.

Objectives: To increase understanding regarding precipitating and preventative factors of suicidal behavior and to highlight past experiences and recommendations regarding services aimed at suicide prevention among Veterans with a history of traumatic brain injury (TBI)., Study Design: Qualitative., Participants: Sample of 13 Veterans with a history of TBI, and a history of clinically significant suicidal ideation or behavior., Method: In-person interviews were conducted and data were analyzed using a hermeneutic approach., Results: Shared precipitants noted included loss-of-self post-TBI, cognitive sequelae, and psychiatric and emotional disturbances. Common protective factors noted included social supports, a sense of purpose regarding the future, religion and spirituality, and mental health care. Means of improving care were also identified (e.g., increasing the availability of services and mental health professionals' knowledge regarding TBI, providing more structured treatment)., Conclusions: Findings highlight potential areas of importance in the assessment and treatment of suicidal Veterans with a history of TBI. Recommendations regarding means of improving care are also presented.