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Problematic and risk behaviours in psychosis : a shared formulation approach
\"In spite of improved access to psychosocial interventions, many people with psychosis continue to experience persistent problems which act as significant barriers to their recovery. This book investigates risk and problem behaviours in psychosis including staff and service factors that can impede the delivery of effective care. Working with Problematic Behaviour in Psychosis provides a new approach for assessment formulation and intervention with such problem behaviours in a team context. Of particular interest will be: an outline of the SAFE (Shared Assessment, Formulation and Education) approach an integrative model for understanding risk and problematic behaviour shared risk assessment and management processes the use of CBT in day-to-day interactions with clients a set of formulation driven strategies for managing problematic behaviours case studies and vignettes providing guidance and highlighting the benefits of the approach. This book will have particular appeal to professionals working in residential care for those with complex mental health problems as well as those working in intensive community based services. It is also an excellent resource for those training in psychological therapies for complex mental health problems, risk assessment and management\"--Provided by publisher.
Book
The Fast Track intervention’s impact on behaviors of despair in adolescence and young adulthood
How to mitigate the dramatic increase in the number of self-inflicted deaths from suicide, alcohol-related liver disease, and drug overdose among young adults has become a critical public health question. A promising area of study looks at interventions designed to address risk factors for the behaviors that precede these —often denoted—“deaths of despair.” This paper examines whether a childhood intervention can have persistent positive effects by reducing adolescent and young adulthood (age 25) behaviors that precede these deaths, including suicidal ideation, suicide attempts, hazardous drinking, and opioid use. These analyses test the impact and mechanisms of action of Fast Track (FT), a comprehensive childhood intervention designed to decrease aggression and delinquency in at-risk kindergarteners. We find that random assignment to FT significantly decreases the probability of exhibiting any behavior of despair in adolescence and young adulthood. In addition, the intervention decreases the probability of suicidal ideation and hazardous drinking in adolescence and young adulthood as well as opioid use in young adulthood. Additional analyses indicate that FT’s improvements to children’s interpersonal (e.g., prosocial behavior, authority acceptance), intrapersonal (e.g., emotional recognition and regulation, social problem solving), and academic skills in elementary and middle school partially mediate the intervention effect on adolescent and young adult behaviors of despair and self-destruction. FT’s improvements to interpersonal skills emerge as the strongest indirect pathway to reduce these harmful behaviors. This study provides evidence that childhood interventions designed to improve these skills can decrease the behaviors associated with premature mortality.
Journal Article
A cluster-randomized crossover trial of Montessori activities delivered by family carers to nursing home residents with behavioral and psychological symptoms of dementia
ABSTRACTObjectivesOne-on-one structured Montessori-based activities conducted with people with dementia can improve agitation and enhance engagement. These activities may however not always be implemented by nursing home staff. Family members may present an untapped resource for enabling these activities. This study aimed to evaluate the impact of the Montessori activities implemented by family members on visitation experiences with people who have dementia. DesignCluster-randomized crossover design. SettingGeneral and psychogeriatric nursing homes in the state of Victoria, Australia. ParticipantsForty participants (20 residents and 20 carers) were recruited. InterventionDuring visits, family members interacted with their relative either through engaging in Montessori-based activities or reading a newspaper (the control condition) for four 30-minute sessions over 2 weeks. MeasurementsResidents’ predominant affect and engagement were rated for each 30-second interval using the Philadelphia Geriatric Center Affect Rating Scale and the Menorah Park Engagement Scale. The Pearlin Mastery Scale was used to rate carers satisfaction with visits. The 15-item Mutuality Scale measured the carers quality of their relationship with the resident. Carers’ mood and overall quality of life were measured using the Center for Epidemiological Studies Depression Scale and Carer-QoL questionnaires, respectively. ResultsLinear regressions within the generalized estimating equations approach assessed residents’ and carers’ outcomes. Relative to the control condition, the Montessori condition resulted in more positive engagement ( b = 13.0, 95%CI 6.3–19.7, p < 0.001) and affect ( b = 0.4, 95%CI 0.2–0.6, p < 0.001) for the residents and higher satisfaction with visits for carers ( b = 1.7, 95%CI 0.45–3.00, p = 0.008). No correction was applied to p-values for multiple comparisons. ConclusionThis study strengthens the evidence base for the use of the Montessori programs in increasing well-being in nursing home residents. The findings also provide evidence that family members are an additional valuable resource in implementing structured activities such as the Montessori program with residents.
Journal Article
The skills training manual for Radically open dialectical behavior therapy : a clinician's guide for treating disorders of overcontrol
\"The Skills Training Manual for Radically Open Dialectical Behavior Therapy offers a groundbreaking, transdiagnostic approach for clients with difficult-to-treat overcontrol (OC) disorders, such as anorexia nervosa, treatment-resistant depression, and obsessive-compulsive disorder (OCD). Written by the founder of RO-DBT and published for the first time, this manual offers clinicians step-by-step guidance for implementing this evidence-based therapy in their practice\"-- Provided by publisher.
Book
Evaluation of a peer led parenting intervention for disruptive behaviour problems in children: community based randomised controlled trial
Objective To evaluate the effectiveness of a peer led parenting intervention delivered to socially disadvantaged families.Design Randomised controlled trial. Setting Schools and children’s centres in a socially deprived borough of inner London. Participants Parental caregivers seeking help with managing the problem behaviours of 116 index children, aged 2-11 years; 59 families were randomised to the intervention and 57 to a waitlist control condition. Intervention Empowering parents, empowering communities is an eight week (two hours each week), manualised programme delivered to groups of parents by trained peer facilitators from the local community. Main outcome measures Child problems (number and severity), parental stress, and parenting competencies were assessed before and after the intervention using standardised parent reported measures. Results Significantly greater improvements in positive parenting practices and child problems were observed in the intervention group compared with the waitlist group, with no difference in parental stress between the groups. An intention to treat analysis for the primary outcome measure, the intensity subscale of the Eyberg child behaviour inventory, showed an intervention effect size of 0.38 (95% confidence interval 0.01 to 0.75, P=0.01). The intervention group had high rates of treatment retention (91.5%) and user satisfaction. Conclusion The peer led parenting intervention significantly reduced child behaviour problems and improved parenting competencies. This is a promising method for providing effective and acceptable parenting support to families considered hard to reach by mainstream services.Trial registration Current Controlled Trials ISRCTN01962337.
Journal Article
A randomized crossover trial to study the effect of personalized, one-to-one interaction using Montessori-based activities on agitation, affect, and engagement in nursing home residents with Dementia
Background: Increasingly more attention has been paid to non-pharmacological interventions as treatment of agitated behaviors that accompany dementia. The aim of the current study is to test if personalized one-to-one interaction activities based on Montessori principles will improve agitation, affect, and engagement more than a relevant control condition. Methods: We conducted a randomized crossover trial in nine residential facilities in metropolitan Melbourne, Australia (n = 44). Personalized one-to-one activities that were delivered using Montessori principles were compared with a non-personalized activity to control for the non-specific benefits of one-to-one interaction. Participants were observed 30 minutes before, during, and after the sessions. The presence or absence of a selected physically non-aggressive behavior was noted in every minute, together with the predominant type of affect and engagement. Results: Behavior counts fell considerably during both the Montessori and control sessions relative to beforehand. During Montessori activities, the amount of time spend actively engaged was double compared to during the control condition and participants displayed more positive affect and interest as well. Participants with no fluency in English (all from non-English speaking backgrounds) showed a significantly larger reduction in agitation during the Montessori than control sessions. Conclusion: Our results show that even non-personalized social contact can assist in settling agitated residents. Tailoring activities to residents’ needs and capabilities elicit more positive interactions and are especially suitable for people who have lost fluency in the language spoken predominantly in their residential facility. Future studies could explore implementation by family members and volunteers to avoid demands on facilities’ resources. Trial Registration: Australian New Zealand Clinical Trials Registry – ACTRN12609000564257.
Journal Article
Motivational Interviewing to Increase Physical Activity Behavior in Cancer Patients: A Pilot Randomized Controlled Trials
Objective: This pilot randomized controlled trial (RCT) aimed at evaluating the feasibility and potential efficacy of a motivational interviewing (MI) intervention to increase physical activity (PA) behavior in cancer patients. Methods: Participants were randomly assigned to an experimental group with standard care plus 12 MI sessions within 12 weeks or a control group with standard care only. The number of recruited participants and the modality of recruitment were recorded to describe the reach of the study. The acceptability of the study was estimated using the attrition rate during the intervention phase. The potential efficacy of the intervention was evaluated by analyzing the PA behavior. Results: Twenty-five participants were recruited within the 16-month recruitment period (1.6 participants per month). Five participants (38.5%) from the experimental group (n = 13) and one participant (8.3%) from the control group (n = 12) dropped out of the study before the end of the intervention phase. No group by time interaction effect for PA behavior was observed at the end of the intervention. Conclusion: Due to the low recruitment rate and compliance, no conclusion can be drawn regarding the efficacy of MI to increase PA behavior in cancer patients. Moreover, the current literature cannot provide any evidence on the effectiveness of MI to increase PA in cancer survivors. Future RCTs should consider that the percentage of uninterested patients to join the study may be as high as 60%. Overrecruitment (30% to 40%) is also recommended to accommodate the elevated attrition rate.
Journal Article