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Communication deviance (CD) reflects features of the content or manner of a person's speech that may confuse the listener and inhibit the establishment of a shared focus of attention. The construct was developed in the context of the study of familial risks for psychosis based on hypotheses regarding its effects during childhood. It is not known whether parental CD is associated with nonverbal parental behaviors that may be important in early development. This study explored the association between CD in a cohort of mothers (n = 287) at 32 weeks gestation and maternal sensitivity with infants at 29 weeks in a standard play procedure. Maternal CD predicted lower overall maternal sensitivity (B = –.385; p < .001), and the effect was somewhat greater for sensitivity to infant distress (B = –.514; p < .001) than for sensitivity to nondistress (B = –.311; p < .01). After controlling for maternal age, IQ and depression, and for socioeconomic deprivation, the associations with overall sensitivity and sensitivity to distress remained significant. The findings provide new pointers to intergenerational transmission of vulnerability involving processes implicated in both verbal and nonverbal parental behaviors.
The experience of paediatric asthma is associated with increased stress and emotional difficulties for both the child and family. The current study aimed to qualitatively explore parents’ views of their child's asthma experience, from initial diagnosis onwards, to enhance our understanding of how families emotionally adjust and adapt to the diagnosis and management of asthma. Semi-structured interviews were conducted with 17 parents of children (<18 years) with physician-diagnosed asthma. Questionnaires were used to capture demographic information and anxiety symptom status of parents (State Trait Anxiety Inventory — Form Y [STAI-Y1/Y2]) and children (Spence Children's Anxiety Scale — Parent reported [SCAS-P]). Grounded theory was used to analyse the results. Analysis saw three themes emerge as important in understanding the impact of asthma on the family: (1) the experience of obtaining an asthma diagnosis, (2) parents’ belief in their competence to manage asthma, and (3) parents’ behaviour in response to the asthma. A model was developed that posits adaptive parental adjustment to asthma is determined in part by the circumstances around the time of diagnosis, the level of knowledge and skills, and the controllability of the asthma. This model can guide medical and allied health professionals to specific areas where intervention may reduce stress and emotional difficulties associated with asthma and its management for affected families.
Anxiety disorders occur at an increased rate in children with asthma; however, there is only a small evidence base to support specific psychological treatments for these children. The current study evaluated the efficacy of a pilot cognitive behavioural treatment (CBT) group intervention for children with asthma and a comorbid anxiety disorder in a case series design. Five children (aged 8–11 years old) with asthma and a comorbid anxiety disorder and their mothers took part in eight 1-hour group treatment sessions. Primary outcomes measures were anxiety diagnosis and asthma-related quality of life. Secondary outcome measures were asthma symptom control and parent quality of life associated with caring for a child with asthma. Three of the participants no longer met diagnostic criteria for an anxiety disorder following treatment and three different participants reported a reliable improvement in asthma-related quality of life. Two participants reported a reliable improvement in asthma symptom control. Three mothers reported an improvement in caregiver quality of life. The findings provide preliminary proof of concept evidence for the efficacy of a CBT intervention for children with asthma and clinical anxiety.
Anxiety symptoms and panic disorder are common sequelae of chronic obstructive pulmonary disease, an illness that primarily affects older adults. The aim of this paper is to describe the application of cognitive behavioural treatment for two patients with chronic obstructive pulmonary disease and co-morbid panic disorder. The patients attended for eight to twelve sessions of cognitive behaviour therapy. Both improved on a range of indices of anxiety and quality of life. Neither patient met criteria for panic disorder at the end of treatment or over the following year. These two cases provide evidence that interventions of proven efficacy for treating panic disorder in healthy individuals can be adapted to treat patients with chronic obstructive pulmonary disease.
A considerable literature has developed over the past two decades that has investigated the utility of cognitive
behavioural treatments for a variety of medical disorders, including rheumatoid arthritis. Research has consistently
found that psychological variables affect the course of the illness and that cognitive behavioural approaches can
improve psychological and physical function. However, the literature has focused almost exclusively on chronic illness.
There is little literature that has investigated the role of cognitive behavioural therapy in facilitating the adjustment
early in the disease course to diagnosis and subsequent illness. The diagnosis of any potentially chronic illness has
enormous ramifications for a person's life and it is well documented that many people become depressed even early
in the disease course. Theoretical accounts have been put forward that allow a model for understanding the process of
adaptation and offer a foundation for the use of cognitive and behavioural strategies with a recently diagnosed group
of patients. The present paper reports the use of a cognitive and behavioural intervention to facilitate coping and
adjustment to illness.
Recent advances have been made in the treatment of post-traumatic stress disorder (PTSD). Cognitive behavioural techniques have been reported in controlled trials to be very effective in reducing arousal symptoms associated with post-traumatic stress disorder, such as sleep disturbance, hypervigilance, intrusive thoughts and flashbacks. It remains unclear from the literature, however, how well these treatment modalities can alleviate post-traumatic stress disorder where the predominant clinical features are associated with depersonalization and dissociative states. Depersonalization is evident in a significant proportion of individuals presenting with PTSD and yet does not appear to be amenable to exposure based therapies. A case study presented suggests methods through which depersonalization may be addressed within the therapeutic context.
The present study evaluated the effectiveness of a self-help, cognitive-behavioural programme in the rehabilitation of a sample of chronic pain patients. The results demonstrated significant benefits for subjects who completed the self-help treatment on measures of depression, anxiety, coping strategies, impact on daily living, pain beliefs and self-monitored pain. These benefits were generally maintained at 6 month follow-up and no differences were found in outcome between subjects who completed the self-programme compared to those who completed the same treatment in a traditional clinic-based format. Unfortunately, a very high drop-out rate was found for the self-help condition, indicating the approach to be unsuitable for many clients. Attempts to identify the characteristics of subjects who completed the self-help programme versus those who dropped-out revealed only one predictor, namely pretreatment ratings of the credibility of the programme.
A heuristic model to account for the development and maintenance of problem gambling is provided with the aim of directing clinical management and future research. Previous explanations of problem gambling have been limited in two main ways. Firstly, the models have been primarily descriptive, and secondly they have generally lacked clinical value. Most explanations have ignored the mechanisms through which this behaviour becomes problematic, and have not identified the relationships between different variables.
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