A case example of community-based supervision to overcome barriers and support the implementation of exposure therapy.

Supervision in community mental health (CMH) settings is critically important for supporting clinical competency and optimizing clinical outcomes. However, CMH supervision is hindered by numerous administrative and fiscal challenges, which makes aligning supervision practices with gold-standard recommendations notoriously difficult. This article describes a case example of one multicomponent supervision approach within a CMH clinic used to support the delivery of exposure therapy ("exposure") to youth with publicly funded insurance. We first review current recommendations for supervision and highlight the primary barriers to the use of these supervisory practices in CMH settings. We then present three low-burden supervisory approaches used to supplement traditional individual supervision. Each strategy presented aims to mitigate known barriers and maximize alignment with gold-standard supervision practices for exposure while being sustainable within a community setting. Finally, we review the strengths and limitations of each supervision strategy. The multicomponent strategies presented represent a creative approach to CMH supervision that maximizes the limited resources and infrastructure in CMH settings to support the delivery of gold-standard supervision. We conclude by offering insights into how these strategies could support supervision for a broader range of evidence-based practices (EBPs) and make recommendations for future research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Alexithymia in individuals maltreated as children and adolescents: a meta-analysis.

BACKGROUND: Children who are maltreated show deficits in emotion recognition, expression, and understanding. The goal of the current meta-analysis was to determine the degree to which maltreatment is associated with deficits in the ability to recognize one's own emotions - a phenomenon known as alexithymia. Alexithymia may be a mechanism explaining the association between childhood maltreatment and various psychological disorders. METHODS: This meta-analytic review (88 studies, n = 43,076) examined the association between the experience of childhood maltreatment and alexithymia, mainly in adulthood. Additional meta-analyses were run to examine if the strength of the association between maltreatment as a child and alexithymia varied as a function of the type of maltreatment individuals reported and other moderators. RESULTS: We found significant small effect sizes for all models, indicating higher levels of maltreatment in childhood or adolescence were associated with higher levels of alexithymia. Alexithymia was more strongly associated with forms of neglect than with physical or sexual abuse. The effect sizes also increased as the percentages of females in the sample increased. CONCLUSIONS: Results suggest that researchers should examine whether alexithymia is a transdiagnostic mechanism in the association between childhood maltreatment and psychopathology and whether targeting alexithymia in treatment could reduce a wide range of symptoms.

Treating Social Anxiety in an Era of Social Distancing: Adapting Exposure Therapy for Youth During COVID-19.

The novel coronavirus (COVID-19) pandemic has caused widespread disruption to our traditional way of life and mental health therapy has not been spared. A combination of increased anxiety, diminished social opportunities, and the shift to telehealth service provision presents particular challenges for the treatment of social anxiety in youth, which relies heavily on exposures to social situations with peers, adults, or other feared social stimuli. The objective of this commentary is to provide guidance to clinicians working with youth with social anxiety on how to maintain ethical, evidence-informed provision of exposure therapy in light of these unusual circumstances. We first present an overview of how COVID-19 may uniquely impact youth with social anxiety and highlight the importance of continuing to provide exposure-based treatments during this time. We then discuss guiding principles for delivering exposure therapy during COVID-19. We focus on providing practical examples of how common social anxiety exposures can be adapted and delivered successfully through telehealth while abiding by COVID-19 social distancing guidelines. Finally, we discuss key recommendations to assist clinicians in moving treatment forward while considering changing safety guidelines pertaining to COVID-19.