Compassionate mind training for ex-service personnel with PTSD and their partners.

Posttraumatic stress disorder (PTSD) is a significant issue for a substantial proportion of Australian ex-service personnel. In addition to the functional impact on individuals, PTSD can have a significant impact on intimate partner relationships. Research has demonstrated that practicing compassion and self-compassion may be an important component of psychological therapy for survivors of trauma, while also demonstrating benefits to intimate relationships. This pilot study aimed to investigate the utility of a Compassionate Mind Training intervention for ex-service personnel with PTSD and their partners. An uncontrolled, within-subjects, longitudinal design was utilized with assessment at pre-intervention, post-intervention and 3-month follow-up. Twenty-four participants attended 12 biweekly group sessions. Self-report measures of compassion, quality of life and psychological symptoms were administered at each time point. Findings demonstrated a significant reduction in fears of compassion and PTSD symptoms for ex-service personnel at 3-month follow-up and a reduction in depressive symptoms and increase in quality-of-life and social safeness at post-intervention. Additionally, significant reductions in anxiety, stress, external shame and self-criticism at 3-month follow-up were found, and couples reported significant increases in relationship satisfaction. Findings from this pilot study demonstrate promising outcomes, warranting further investigation in a larger randomized controlled trial of Compassionate Mind Training for ex-service personnel and their partners.

Assessing psychological adjustment and cultural reintegration after military service: development and psychometric evaluation of the post-separation Military-Civilian Adjustment and Reintegration Measure (M-CARM).

BACKGROUND: The transition out of military service and subsequent reintegration to civilian life has been established as a period associated with an increased risk of psychological adjustment difficulties, psychiatric disorders and suicide risk, yet no tool exists to measure cultural and psychological adjustment following permanent separation from the military. This study describes the two-phase mixed-methods development and validation of the self-report Military-Civilian Adjustment and Reintegration Measure (M-CARM). METHODS: In Phase I, four focus groups (n = 20) and semi-structured one-on-one interviews (n = 80) enabled thematic analysis and generation of 53 initial items that were reviewed by an expert multidisciplinary panel (n = 12) and piloted for clarity and relevance in an Australian service-veteran sample (n = 11). In Phase II, psychometric properties of the 47 items resulting from Phase I were evaluated with online assessment of a convenience sample of transitioned Australian Defence Force veterans (n = 725). Analyses included exploratory and confirmatory factor analyses, as well as evaluation of test-retest reliability, internal consistency, and convergent, divergent and discriminant validity. RESULTS: Exploratory factor analysis on a randomized split-half sample (n = 357), resulted in a 21-item, five-factor solution of Purpose and Connection, Help seeking, Beliefs about civilians, Resentment and regret, and Regimentation, explaining 53.22% of the variance. Confirmatory factor analysis (n = 368) verified this factor structure without modification (χ2 = 304.96, df = 160; CFI = .96, TLI = .94, NFI = .91, RMSEA = .05). Strong convergent, divergent and discriminant validity was demonstrated as M-CARM scores significantly correlated with related constructs assessed by standardised clinical measures as well as differentiated groups based on three binary reintegration items, with large effect sizes (d = > 1). Strong test-retest reliability for the total score (n = 186, r = .93) and excellent internal consistency (n = 725, a = .90) were also found. CONCLUSIONS: Results provide promising evidence the M-CARM is a valid, reliable measure of psychological and cultural reintegration to civilian life, with potential for considerable clinical and research application.

Motivational processes contributing to disturbances in women's body image and eating.

Reinforcement Sensitivity Theory (RST) provides a neurobiological personality framework for understanding approach and avoidance behavioural patterns. Recent research suggests an association between RST personality traits (reward interest and behavioural inhibition system [BIS]) and women's body image and eating behaviours. The current study aimed to extend this research by testing for indirect relationships between reward interest and BIS and eating disorder symptoms, as mediated through thin ideal internalisation. Adult female participants (N = 354, M = 22.06 years of age, SD = 6.78) completed self-report measures of reward interest, BIS, thin ideal internalisation, and eating disorder symptoms (i.e., restraint, eating concerns, weight and shape concerns). Indirect relationships were tested using bootstrapped mediation analyses. Results showed thin ideal internalisation mediated the pathways between the BIS and restraint, eating concern, and weight and shape concerns. Reward interest was not associated with thin ideal internalisation, or with eating disorder symptoms. Although the application of RST to women's body image is an emerging research area, these novel findings suggest BIS trait sensitivity may increase women's risk of body image concerns and restricted eating, via increased levels of thin ideal internalisation. Overall, these findings provide preliminary support for inclusion of individual differences in BIS sensitivity in risk factor models of body image and eating disturbances. Future research should aim to replicate these findings in more diverse samples, using longitudinal designs.

Integrating social media, body shame and psychological distress within the Elaborated Sociocultural Model.

The Elaborated Sociocultural Model proposes exposure to sociocultural appearance pressures increases women's internalisation of the thin ideal, their engagement in social comparison and body surveillance, and subsequent body dissatisfaction and disturbances in eating (Fitzsimmons-Craft et al., 2011). Although this model has received some empirical support, it is limited in that it does not currently account for social media as a contemporary source of appearance pressure, nor include additional known outcomes of thin ideal internalisation (i.e., body shame, psychological distress). The current study tested the integration of these variables within the Elaborated Sociocultural Model. Using structural equation modelling with latent variables, the extended model provided acceptable to good fit to the data in a sample of 271 female participants. A latent variable representing sociocultural appearance pressures originating from social media, traditional media, family and peers was found to significantly predict thin ideal internalisation and body image concerns. Furthermore, both social comparison and body surveillance emerged as indirect mediators of the relationship between thin ideal internalisation and body image concerns, which in turn, increased report of restrained eating and psychological distress. Aligning with previous research, this extended model offers a useful and comprehensive framework for investigating women's body image.

Thin Ideal Internalization Assessment (THIINA): Development and Psychometric Validation of a New Measure of Female Body Image.

Thin ideal internalization is widely implicated in women's body image and eating disturbances. A recently proposed multidimensional operationalization of internalization suggests the brevity and construct validity of existing questionnaires may limit the assessment of thin ideal internalization. Therefore, this research aimed to develop a new questionnaire (i.e., Thin Ideal Internalization Assessment; THIINA) to comprehensively assess thin ideal internalization. In Study 1, 301 female participants were administered the THIINA. Exploratory factor analyses revealed the 17-item THIINA had a stable 3-factor structure reflecting thin idealization, thin overvaluation, and thin behavioral drive. In Study 2, 337 female participants were administered the THIINA and validation measures. Confirmatory factor analysis confirmed stability of the 3-factor structure and findings supported convergent, discriminant, and incremental validity of the THIINA. Support for temporal stability was found within a sub-sample of participants (n = 132). The THIINA demonstrated strong psychometric properties, a stable three-factor structure representing theoretically-driven domains, and support for the creation of a composite score representing overall thin ideal internalization. These findings suggest the multidimensional operationalization and measurement of thin ideal internalization could improve theoretical and clinical understanding of the impact of thin ideal internalization on women's body image and eating.

Drug and alcohol practitioners' attitudes toward the use of standardized assessment.

Despite their importance to evidence-based assessment, standardized assessments remain underutilized by mental health practitioners in practice. The underutilization has been attributed to a lack of appreciation of the importance of standardized assessments, lack of knowledge of standardized assessments, and practical barriers to implementation. This study sought to gather the first descriptive data on alcohol and other drug (AOD) practitioners' attitudes toward, and knowledge and self-reported use of, standardized assessments. Practical barriers to implementation in initial assessment and progress monitoring were also assessed. Ninety-nine Australian AOD practitioners recruited via newsletters of national representative bodies and practitioner networks completed an online survey. While practitioners' attitudes towards using standardized assessments for initial assessment and progress monitoring were generally positive and consistent with other populations of health practitioners, assessments remained underutilized in practice. Most AOD practitioners did not consider standardized assessments to be feasible to implement. The current findings highlight the importance of practical barriers, particularly organization-level barriers, in the underutilization of standardized assessments in AOD practice. Findings support an extension of dialogue surrounding evidence-based practice beyond treatment selection to include assessment practices at a more general level. The present study offers a starting point from which efforts to improve practitioner compliance with evidence-based best practices can be conceived, designed, and implemented.

Improving assessment and progress monitoring in alcohol use disorder: An implementation evaluation of the instant assessment and personalised feedback system (iAx).

BACKGROUND: When treating patients with alcohol use disorder (AUD), best practice guidelines recommend the use of standardised assessment instruments to obtain reliable information about psychological symptoms and functioning to inform treatment. Due to time constraints and administrative burden, many mental health practitioners do not routinely use standardised assessments. To overcome these barriers, an instant assessment and feedback system (iAx) was developed that electronically administers standardised instruments. Responses are instantly scored and benchmarked against clinical norms for immediate interpretation. This allows for timely assessment and feedback. The aim of this study was to evaluate the implementation of the iAx system at a specialist alcohol and drug outpatient unit in a public hospital. METHODS: Baseline (pre-iAx implementation; paper-and-pencil assessments) and follow-up (post-iAx implementation) clinical audits collated records from 313 patients with AUD across 2,616 treatment sessions. Multilevel modelling was used to determine if use of standardised instruments increased post-iAx implementation. RESULTS: Post-iAx implementation, there was a significant increase in the probability of using standardised assessments during the initial assessment and throughout treatment (ps < 0.001). Specifically, the use of standardised assessments to inform initial assessment of patients increased from 51% to 89%, and progress monitoring of symptoms increased from 28% to 84%. A significant increase in treatment completion rates was also observed post-iAx implementation (from 15.6% to 32.4%). Psychologists and patients also provided feedback on iAx acceptability, appropriateness and feasibility. CONCLUSIONS: This study found support for the successful implementation of an electronic, theory-driven iAx system to improve assessment practices with patients with AUD in routine clinical settings.

A narrative review of reward sensitivity, rash impulsivity, and food addiction in adolescents.

Adolescence represents a neurodevelopmental period characterised by heightened reward drive and weaker inhibitory control that may increase vulnerability to compulsive overconsumption of highly-palatable foods and food addiction. This narrative review aimed to summarise research investigating the presence of food addiction in adolescents and establish the role that impulsivity traits (i.e., reward sensitivity and rash impulsivity), previously linked to substance and behavioural addictions, play in contributing to food addiction in this cohort. It was found that the prevalence of food addiction was typically higher in studies that recruited adolescents who were overweight/obese or from clinical populations. Overall, impulsivity was found to be more consistently associated with food addiction, while the relationships between measures of reward sensitivity and food addiction were mixed. Findings of this review suggest trait impulsivity may contribute to food addiction in adolescents, however, further longitudinal and prospective research is recommended to confirm these findings and to investigate the potential interactive effects of reward sensitivity and rash impulsivity.

Evaluation of an equine-assisted therapy program for veterans who identify as 'wounded, injured or ill' and their partners.

The aim of this study was to evaluate outcomes of an equine-assisted therapy program for Defence Force veterans and their partners across the psychological domains of depression, anxiety, stress, posttraumatic stress, happiness, and quality of life, as well as compare the outcomes of an Individual and Couples program. A non-controlled, within-subjects longitudinal design was utilized with assessment at three time points (pre-intervention, post-intervention, and three months follow-up). Between-subjects analysis with two groups was also conducted to compare the outcomes of the Individual and Couples programs. Participants were recruited from ten programs in 2016 with a total of 47 veterans and partners from both an Individual program (n = 25; veterans only) and a Couples program (n = 22). Outcome measures included the Depression Anxiety Stress Scale-21, Posttraumatic Stress Disorder Checklist for DSM-5, Oxford Happiness Questionnaire, and Quality-of-Life Enjoyment and Satisfaction Questionnaire-Short Form. Paired samples t-tests revealed that within both the Individual and Couples programs, there were significantly fewer psychological symptoms and significantly greater levels of happiness and quality of life at post-intervention compared to pre-intervention. Reduced psychological symptoms were maintained at the three months follow-up for participants of the Couples program only. Independent samples t-tests revealed participants in the Couples program reported significantly less symptoms of depression, stress, and posttraumatic stress disorder (PTSD) at follow-up compared to participants in the Individual program. These results indicate there may only be meaningful benefits for equine-assisted therapy in the reduction of depression, stress, and PTSD symptoms for veterans, if partners are integrated into the intervention.

Junk food advertising moderates the indirect effect of reward sensitivity and food consumption via the urge to eat.

The current study aimed to identify how underlying individual differences increases vulnerability to television food advertising. In particular, this study examined how reward sensitivity, a biologically-based predisposition to approach rewards (such as appetitive foods) in the environment, influenced participants' vulnerability to television food advertising and subsequent food consumption. Ninety-eight participants were randomly assigned to a cue condition (food cues versus non-food cues) and then viewed a 30 min documentary interrupted by advertising featuring a mix of food and neutral advertising (food cue condition) or only neutral advertising (non-food cue condition). Participants' reward sensitivity, approach motivation measured as urge to eat, and food consumption were recorded. Moderated mediation regression analyses revealed the positive association between reward sensitivity and food consumption was mediated by an increase in urge to eat, but only when participants were exposed to food advertising. These findings suggest heightened reward sensitivity, exposure to appetitive food cues, and approach motivation are key interacting mechanisms that may lead to maladaptive eating behaviours.