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This study aimed to demonstrate proof of concept and acceptability of a brief acceptance and commitment therapy (ACT)-based guided self-help intervention for improving quality of life (QoL) and mood for people with muscle disorders (MD). A case-series with an AB design was used to assess changes in primary (QoL) and secondary (depression and anxiety) outcome variables across the period of study. Change in the psychological process targeted by ACT – psychological flexibility – was also investigated, to allow insight into possible treatment mechanisms. Post-intervention, participants also completed a brief free-text evaluation. Relative to pre-intervention scores, four (of seven) participants showed varying degrees of improvement in all primary and secondary outcome variables and were thus considered responders. However, consistent concomitant improvements in psychological flexibility were not apparent. Participants reported a mostly positive experience of the intervention; all appeared to complete the intervention, and no adverse events were reported. Nonetheless, there was evidence that those with compromised concentration or who report good initial QoL and low levels of distress may derive less benefit. Although several methodological weaknesses limit the strength of our conclusions, this ACT-based guided self-help intervention shows encouraging utility for improving QoL and mood in MD.
Background: Interventions for anger represent the largest body of research on the adaptation of cognitive behavioural therapy (CBT) for people with intellectual disabilities. The extent to which the effectiveness of these interventions reflects the behavioural or cognitive components of CBT is uncertain. This arises in part because there are few measures of anger-related cognitions. Method: The Profile of Anger-related Cognitions (PAC) is built around interpersonal scenarios that the participant identifies as personally anger-provoking, and was designed as an extension of the Profile of Anger Coping Skills (PACS). A conversational presentational style is used to approach ratings of anger experienced in those situations and of four relevant cognitive dimensions: attribution of hostile intent, unfairness, victimhood, and helplessness. The PAC, and other measures, including the PACS, was administered to (i) people with ID identified as having problems with anger control (n = 12) and (ii) university students (n = 23); its psychometric properties were investigated and content analyses were conducted of participants’ verbal responses. In a third study, clinicians (n = 6) were surveyed for their impression of using the PAC in the assessment of clients referred for help with anger problems. Results: The PAC had good consistency and test-retest reliability, and the total score on the four cognitive dimensions correlated significantly with anger ratings but not with impersonal measures of anger disposition. The predominant cognitions reported were perceptions of unfairness and helplessness. People with ID and university students were in most respects very similar in both the psychometric analyses and the content analyses of their verbal responses. The PAC had high acceptability both to people with ID and to clinicians. Conclusions: The PAC may be a useful instrument for both clinical and research purposes. Personal relevance and the conversational mode of administration are particular strengths.
Social disability is a hallmark of severe mental illness yet individual
differences and factors predicting outcome are largely unknown.
To explore trajectories and predictors of social recovery following a
first episode of psychosis (FEP).
A sample of 764 individuals with FEP were assessed on entry into early
intervention in psychosis (EIP) services and followed up over 12 months.
Social recovery profiles were examined using latent class growth
Three types of social recovery profile were identified: Low Stable (66%),
Moderate-Increasing (27%), and High-Decreasing (7%). Poor social recovery
was predicted by male gender, ethnic minority status, younger age at
onset of psychosis, increased negative symptoms, and poor premorbid
Social disability is prevalent in FEP, although distinct recovery
profiles are evident. Where social disability is present on entry into
EIP services it can remain stable, highlighting a need for targeted
The PRODIGY trial (Prevention of long term social disability amongst
young people with emerging psychological difficulties, ISRCTN47998710) is
a pilot trial of social recovery cognitive–behavioural therapy
The PRODIGY qualitative substudy aimed to (a) explore individual
experiences of participating in the pilot randomised, controlled trial
(recruitment, randomisation, assessment) and initial views of therapy,
and (b) to explore perceived benefits of taking part in research
v. ethical concerns and potential risks.
Qualitative investigation using semi-structured interviews with thematic
Analysis revealed participant experiences around the key themes of
acceptability, disclosure, practicalities, altruism and engagement.
Participants in both trial arms perceived themselves as gaining benefits
from being involved in the study, above and beyond the intervention. This
has implications for the design of future research and services for this
client group, highlighting the importance of being flexible and an
individualised approach as key engagement tools.
Many people with intellectual disabilities find it hard to control their anger and this often leads to aggression which can have serious consequences, such as exclusion from mainstream services and the need for potentially more expensive emergency placements.
To evaluate the effectiveness of a cognitive–behavioural therapy (CBT) intervention for anger management in people with intellectual disabilities.
A cluster-randomised trial of group-based 12-week CBT, which took place in day services for people with intellectual disabilities and was delivered by care staff using a treatment manual. Participants were 179 service users identified as having problems with anger control randomly assigned to either anger management or treatment as usual. Assessments were conducted before the intervention, and at 16 weeks and 10 months after randomisation (trial registration: ISRCTN37509773).
The intervention had only a small, and non-significant, effect on participants' reports of anger on the Provocation Index, the primary outcome measure (mean difference 2.8, 95% Cl −1.7 to 7.4 at 10 months). However, keyworker Provocation Index ratings were significantly lower in both follow-up assessments, as were service-user ratings on another self-report anger measure based on personally salient triggers. Both service users and their keyworkers reported greater usage of anger coping skills at both follow-up assessments and keyworkers and home carers reported lower levels of challenging behaviour.
The intervention was effective in improving anger control by people with intellectual disabilities. It provides evidence of the effectiveness of a CBT intervention for this client group and demonstrates that the staff who work with them can be trained and supervised to deliver such an intervention with reasonable fidelity.
The use of deep brain stimulation has become increasingly common for the treatment of movement disorders, including Parkinson disease. Although deep brain stimulation is generally very successful in alleviating the extrapyramidal symptoms of Parkinson disease, side effects can occur. This case report describes a patient presenting to the emergency department in a state of extreme aggression 3 days after a change in the parameters of his bilateral subthalamic nucleus stimulator. We review the complications of deep brain stimulation relevant to the emergency physician and provide some practical information on stimulator adjustment in an emergency.
Titanium aluminide alloys with compositions slightly on the Ti-rich side of stoichiometry consist of the intermetallic phases α2 (Ti3Al) and γ(TiAl). The two phases form a lamellar microstructure with various types of coherent and semicoherent interfaces. The lattice mismatch occurring at the semicoherent interfaces is largely accommodated by networks of interfacial dislocations. Nevertheless, a significant homogeneous straining seems to remain at these interfaces, resulting in long-range residual stresses. The present paper reports an electron microscope study of the correlation between the misfit strain of adjacent lamellae and the atomic structure of the interfaces. The residual coherency stresses were determined by analyzing the curvature of dislocation loops which were emitted from the network of the interfacial dislocations. The estimated stresses are close to the shear stresses applied during macroscopic deformation experiments. The effects of these stresses on the deformation behaviour of the material are discussed.
The objective of this chapter is to provide an overview of biophysical models of marine fish populations, with a particular focus on those applied, or potentially applicable, for examining the consequences of climate change on small pelagic fish species. We focus on models that include physics and are therefore spatially explicit, and review models under the categories of those that include lower trophic level dynamics (NPZ), early life stages of fish (eggs and larvae), and juvenile and adult stages. We first give an overview of the methods that are used to represent transport, growth, mortality, and behavior in biophysical models of early life stages. Second, we detail several case studies of such models, focusing on those applied to anchovy and sardine in SPACC regions and those involving small pelagic fish in “non-SPACC” regions. Some questions related to climate change require models that include juveniles and adults. Models that include juveniles and adults differ from the early life stage models in the important role played by behavior in fish movement. We briefly discuss several approaches used for modeling behavioral movement of fish, and then summarize several case studies of biophysical models that include adults that are relevant, or potentially relevant, to small pelagic species. Finally, we conclude with a discussion of the potential use of biophysical models of early life stages and adults for investigating some of the issues associated with forecasting the effects of climate change on small pelagic fish species.