Deep brain stimulation for psychiatric disorders: From focal brain targets to cognitive networks.

Deep brain stimulation (DBS) is a promising intervention for treatment-resistant psychiatric disorders, particularly major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). Up to 90% of patients who have not recovered with therapy or medication have reported benefit from DBS in open-label studies. Response rates in randomized controlled trials (RCTs), however, have been much lower. This has been argued to arise from surgical variability between sites, and recent psychiatric DBS research has focused on refining targeting through personalized imaging. Much less attention has been given to the fact that psychiatric disorders arise from dysfunction in distributed brain networks, and that DBS likely acts by altering communication within those networks. This is in part because psychiatric DBS research relies on subjective rating scales that make it difficult to identify network biomarkers. Here, we overview recent DBS RCT results in OCD and MDD, as well as the follow-on imaging studies. We present evidence for a new approach to studying DBS' mechanisms of action, focused on measuring objective cognitive/emotional deficits that underpin these and many other mental disorders. Further, we suggest that a focus on cognition could lead to reliable network biomarkers at an electrophysiologic level, especially those related to inter-regional synchrony of the local field potential (LFP). Developing the network neuroscience of DBS has the potential to finally unlock the potential of this highly specific therapy.

Channeling Jane Austen: how it helped me become a better psychotherapist.

The influences on a therapist are many. This article illustrates how a 19th-century novelist, Jane Austen, informs the work of a nurse therapist in the 21st century. The characters in a Jane Austen novel provide perspectives from setting boundaries to handling feelings. Austen's characters promote an acceptance of less attractive qualities in others and in oneself that can benefit the therapy.

"Extremely toxic and evil" reflections on gender identity change efforts by Christian religious leaders: Implications for therapy with transgender and nonbinary clients.

Given the religious groundings that support the practice of gender identity change efforts (GICE), we sought to explore the beliefs of Christian religious leaders about this practice and their understanding of marginalized gender identities. Nineteen religious leaders mainly from diverse Mainline Christian Protestant traditions were interviewed. Queer theory-informed thematic analysis revealed two themes related to participants' beliefs about transgender and nonbinary identities: (1) Transgender and nonbinary identities are normative and authentic and (2) God created gender diversity. The analyses also highlighted two themes reflecting the pastors' beliefs about GICE: (1) GICE is harmful and (2) Therapy should affirm transgender and nonbinary identities. Finally, the thematic analysis exploring participants' messages for couple and family therapists could be organized into two themes: (1) Christian religious beliefs do not justify the use of GICE and (2) Therapists should be helpful and not harmful. Implications for couple and family therapists are also discussed.

"It's like a happy little affirmation circle": a grounded theory study of nonbinary peoples' internal processes for navigating binary gender norms.

Background: Nonbinary people experience marginalization through discrimination, rejection, microaggressions, and stigma as a result of not always conforming to societal gender norms embedded in the gender binary. There is limited research about how nonbinary Black, Indigenous, and People of Color (BIPOC) living in the United States navigate societally enforced binary gender norms, which is especially important to understand given how racism and Euro-colonization have enforced the gender binary. Better understanding the internal strategies nonbinary people use to cope, embody affirmation, and regulate emotions in response to marginalizing experiences could increase understanding of how to best prevent and address the health disparities experienced by nonbinary people. Aim: Drawing on the practices of interrogating norms central to queer theory with a sensitization to racism and settler colonialism, this study aimed to identify a framework to understand nonbinary peoples' processes of navigating gender norms internally through their lived experiences with an awareness of how context impacts these processes. Method: This qualitative interview study utilized construcitivist grounded theory methodology, guided by queer theory. Twenty-one nonbinary individuals were interviewed over Zoom with 15 being BIPOC. Results: Participants navigated binary gender norms internally by self-defining affirmative nonbinary ways of being, noticing affirmation in a chosen community that allowed them to experience existing authentically outside of binary gender norms, and internally connecting to an embodied, authentic sense of gender within themselves and in community with other nonbinary people. These internal processes were influenced by two contextual factors: societal and cultural expectations of gender; and the contextual impacts of holding multiple marginalized identities. Discussion: Understanding the contexts of the gender binary, racism, and cissexism that impact nonbinary people on a daily basis is crucial for mental health professionals, researchers, policy makers, and creators of gender inclusive education and support programs to support and affirm nonbinary people.

Trajectory Modeling and Response Prediction in Transcranial Magnetic Stimulation for Depression.

Background: Repetitive transcranial magnetic stimulation (rTMS) therapy could be improved by more accurate and earlier prediction of response. Latent class mixture (LCMM) and non-linear mixed effects (NLME) modeling have been applied to model the trajectories of antidepressant response (or non-response) to TMS, but it is not known whether such models are useful in predicting clinically meaningful change in symptom severity, i.e. categorical (non)response as opposed to continuous scores. Methods: We compared LCMM and NLME approaches to model the antidepressant response to TMS in a naturalistic sample of 238 patients receiving rTMS for treatment resistant depression, across multiple coils and protocols. We then compared the predictive power of those models. Results: LCMM trajectories were influenced largely by baseline symptom severity, but baseline symptoms provided little predictive power for later antidepressant response. Rather, the optimal LCMM model was a nonlinear two-class model that accounted for baseline symptoms. This model accurately predicted patient response at 4 weeks of treatment (AUC = 0.70, 95% CI = [0.52 - 0.87]), but not before. NLME offered slightly improved predictive performance at 4 weeks of treatment (AUC = 0.76, 95% CI = [0.58 - 0.94], but likewise, not before. Conclusions: In showing the predictive validity of these approaches to model response trajectories to rTMS, we provided preliminary evidence that trajectory modeling could be used to guide future treatment decisions.

Trajectory Modeling and Response Prediction in Transcranial Magnetic Stimulation for Depression.

Repetitive transcranial magnetic stimulation (rTMS) therapy could be improved by better and earlier prediction of response. Latent class mixture (LCMM) and non-linear mixed effects (NLME) modelling have been applied to model the trajectories of antidepressant response (or non-response) to TMS, but it is not known whether such models can predict clinical outcomes. We compared LCMM and NLME approaches to model the antidepressant response to TMS in a naturalistic sample of 238 patients receiving rTMS for treatment resistant depression (TRD), across multiple coils and protocols. We then compared the predictive power of those models. LCMM trajectories were influenced largely by baseline symptom severity, but baseline symptoms provided little predictive power for later antidepressant response. Rather, the optimal LCMM model was a nonlinear two-class model that accounted for baseline symptoms. This model accurately predicted patient response at 4 weeks of treatment (AUC = 0.70, 95% CI = [0.52-0.87]), but not before. NLME offered slightly improved predictive performance at 4 weeks of treatment (AUC = 0.76, 95% CI = [0.58 - 0.94], but likewise, not before. In showing the predictive validity of these approaches to model response trajectories to rTMS, we provided preliminary evidence that trajectory modeling could be used to guide future treatment decisions.

Measuring Allyship: Development and Validation of Two Measures to Assess Collegiate Athlete Department Staff Engagement in LGBTQ Allyship and Ally Behaviors.

This pilot quantitative study sought to explore lesbian, gay, bisexual, transgender, and queer (LGBTQ) ally engagement by collegiate coaches and athletic department staff. In particular, this study sought to investigate the psychometric properties for two adapted measures: the Ally Identity Scale-Athletic Staff Version and the Engagement in LGBTQ Ally Actions in Sports Scale-Athletic Staff Version. These measures could provide a means to assess the degree to which coaches and athletic department staff identify as allies and engage in actions that support a welcoming and inclusive climate for LGBTQ student-athletes and athletic department staff. The sample for this study was 87 coaches and athletic department staff who completed an online survey. The results of this study provide preliminary psychometric support for two adapted measures and provide insights into the next steps scholars can take in exploring the intersection of LGBTQ identities and collegiate athletics.

Psychometric validation and clinical correlates of an experiential foraging task.

Measuring the function of decision-making systems is a central goal of computational psychiatry. Individual measures of decisional function could be used to describe neurocognitive profiles that underpin psychopathology and offer insights into deficits that are shared across traditional diagnostic classes. However, there are few demonstrably reliable and mechanistically relevant metrics of decision making that can accurately capture the complex overlapping domains of cognition whilst also quantifying the heterogeneity of function between individuals. The WebSurf task is a reverse-translational human experiential foraging paradigm which indexes naturalistic and clinically relevant decision-making. To determine its potential clinical utility, we examined the psychometric properties and clinical correlates of behavioural parameters extracted from WebSurf in an initial exploratory experiment and a pre-registered validation experiment. Behaviour was stable over repeated administrations of the task, as were individual differences. The ability to measure decision making consistently supports the potential utility of the task in predicting an individual's propensity for response to psychiatric treatment, in evaluating clinical change during treatment, and in defining neurocognitive profiles that relate to psychopathology. Specific aspects of WebSurf behaviour also correlate with anhedonic and externalising symptoms. Importantly, these behavioural parameters may measure dimensions of psychological variance that are not captured by traditional rating scales. WebSurf and related paradigms might therefore be useful platforms for computational approaches to precision psychiatry.

Structural Racism in Psychiatric Research Careers: Eradicating Barriers to a More Diverse Workforce.

Investigators from minoritized backgrounds are underrepresented in psychiatric research. That underrepresentation contributes to disparities in outcomes of access to mental health care. Drawing on lived experience, scholarly qualitative reports, and empirical data, the authors review how the underrepresentation of minoritized researchers arises from interlocking, self-reinforcing effects of structural biases in our research training and funding institutions. Minoritized researchers experience diminished early access to advanced training and opportunities, stereotype threats and microaggressions, isolation due to lack of peers and senior mentors, decreased access to early funding, and unique community and personal financial pressures. These represent structural racism-a system of institutional assumptions and practices that perpetuates race-based disparities, in spite of those institutions' efforts to increase diversity and in contradiction to the values that academic leaders outwardly espouse. The authors further review potential approaches to reversing these structural biases, including undergraduate-focused research experiences, financial support for faculty who lead training/mentoring programs, targeted mentoring through scholarly societies, better use of federal diversity supplement funding, support for scientific reentry, cohort building, diversity efforts targeting senior leadership, and rigorous examination of hiring, compensation, and promotion practices. Several of these approaches have empirically proven best practices and models for dissemination. If implemented alongside outcome measurement, they have the potential to reverse decades of structural bias in psychiatry and psychiatric research.

The effects of gender identity change efforts on Black, Latinx, and White transgender and gender nonbinary adults: Implications for ethical clinical practice.

Gender identity change efforts (GICE) and sexual orientation change efforts (SOCE) continue to be practiced by mental health professionals and religious organizations. It is frequently sought out by families who are rejecting loved ones with marginalized sexual orientations and gender identities. This study explored the impact of religious and nonreligious GICE on the mental health of transgender and nonbinary adults through a secondary data analysis of the U.S. Transgender Survey. Results found that both nonreligious and religious GICE were associated with increased odds of suicidal ideation and attempts. Only nonreligious GICE was associated with severe psychological distress. Black individuals showed increased odds of binge alcohol consumption when exposed to nonreligious change efforts, while White individuals showed decreased odds with both nonreligious and religious GICE. This study supports ethical and legal bans on GICE.

Genetic variants associated with the occurrence and progression of adolescent idiopathic scoliosis: a systematic review protocol.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) is a structural lateral spinal curvature of ≥ 10° with rotation. Approximately 2-3% of children in most populations are affected with AIS, and this condition is responsible for approximately $1.1 billion in surgical costs to the US healthcare system. Although a genetic factor for AIS has been demonstrated for decades, with multiple potentially contributory loci identified across populations, treatment options have remained limited to bracing and surgery. METHODS: The databases MEDLINE (via PubMed), Embase, Google Scholar, and Ovid MEDLINE will be searched and limited to articles in English. We will conduct title and abstract, full-text, and data extraction screening through Covidence, followed by data transfer to a custom REDCap database. Quality assessment will be confirmed by multiple reviewers. Studies containing variant-level data (i.e., GWAS, exome sequencing) for AIS subjects and controls will be considered. Outcomes of interest will include presence/absence of AIS, scoliosis curve severity, scoliosis curve progression, and presence/absence of nucleotide-level variants. Analyses will include odds ratios and relative risk assessments, and subgroup analysis (i.e., males vs. females, age groups) may be applied. Quality assessment tools will include GRADE and Q-Genie for genetic studies. DISCUSSION: In this systematic review, we seek to evaluate the quality of genetic evidence for AIS to better inform research efforts, to ultimately improve the quality of patient care and diagnosis. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration #CRD42021243253.

Deconstructing cissexism: The journey of becoming an affirmative family therapist for transgender and nonbinary clients.

This article proposes a model for family therapists to become more competent, inclusive, and affirmative in their clinical work with transgender and nonbinary clients. In particular, this article details: (1) barriers to transgender and nonbinary affirmative therapy, (2) impacts of these barriers on transgender and nonbinary people's mental health, (3) a three-step model for becoming an affirmative therapist for transgender and nonbinary clients, and (4) strategies for deconstructing cissexism in therapy. This goal of this article is to invite family therapists to join in on a lifelong journey of "becoming" an affirmative therapist for transgender and nonbinary clients, a journey on which none of us will ever "arrive". We can, however, take continual action to minimize the negative impacts of cissexism on therapists and clients; this article offers ideas for a place to start.

Christian Mainline Protestant Pastors' Beliefs About the Practice of Conversion Therapy: Reflections for Family Therapists.

Efforts to change the sexual orientation of lesbian, gay, and bisexual (LGB) individuals to heterosexual are referred to as conversion therapy. Given the religious groundings that support the practice of conversion therapy, we sought to explore the beliefs of Christian religious leaders about this practice and what they want family therapists to know about the practice of conversion therapy. Twenty-one pastors from diverse Mainline Christian Protestant traditions were interviewed. Queer theory-informed thematic analysis revealed four themes that reflect the participants' perspectives on conversion therapy: (a) Conversion Therapy Is an Abomination, (b) Conversion Therapy Is Similar to Other Abusive Practices, (c) Conversion Therapy Represents A Misuse of Religion, and (d) Ethical Concerns About Therapists Who Practice Conversion Therapy. Implications of this study include a need for self-of-the-therapist work to address religious biases and heteronormative assumptions in order to examine beliefs that support practicing conversion therapy.

Firefighters Are More Physically Active On-Duty Compared to Off-Duty.

Physical inactivity, coupled with increasing obesity levels, in firefighters plays a key role in aggregated cardiovascular events. The purpose of this study was to investigate device-measured physical activity (PA) for firefighters while on- and off-duty to have a clearer understanding of their overall PA level. METHODS: Twenty-nine career firefighters participated in this non-experimental, within-subjects study by wearing an accelerometer to assess PA intensities and step-count. Obesity was classified using body mass index (BMI). Dependent t-tests were used to examine mean differences in PA intensities when on- and off-duty. Pearson product-moment correlations were used to assess the association between PA intensities when on and off-duty. RESULTS: According to the World Health Organization BMI categorizations, 20 firefighters were overweight, 9 were obese, and, thus, none were normal weight. Only light PA (LPA) was statistically significant (p = 0.026) for on- and off-duty days with a small-to-medium effect size (d = 0.47), meaning that on average, firefighters performed more minutes of LPA when on-duty compared to off. There was a significant difference between on- (9060.2 ± 2636.4) and off-duty (7495.3 ± 2835.8) daily step counts (p = 0.011). CONCLUSION: As the results demonstrate, there is a dire need for increased PA levels in firefighters while on- and off-duty.

Firefighters' Physical Activity and Waist Circumference as Predictors of VO2max.

OBJECTIVE: To examine associations among objectively measured physical activity (PA), body mass index (BMI), waist circumference (WC), and cardiorespiratory fitness (CRF) in firefighters. METHODS: Career firefighters (n = 29; male = 100%) wore accelerometers to assess PA. BMI and WC classified obesity. Each participant completed a stage-graded exercise test to determine maximal oxygen uptake ((Equation is included in full-text article.)). RESULTS: Two linear regression models were used to investigate whether PA intensities, step count, BMI, or WC were predictive of "true" (Equation is included in full-text article.). Vigorous physical activity (VPA) was predictive of "true" (Equation is included in full-text article.)(F[1,27] = 7.89, R = 0.23, P < 0.01). Additionally, when BMI and WC were added, only WC was predictive of "true" (Equation is included in full-text article.)(F[1,27] = 11.76, R = 0.30, P < 0.01). CONCLUSION: Fire departments should be cognizent of ways to increase PA levels, decrease excess weight gain, and maintain CRF to adequately perform job-specific tasks.

Are we there yet? Faculty Members' Beliefs and Teaching Practices Related to the Ethical Treatment of Lesbian, Gay, and Bisexual Clients.

The purpose of this study was to explore (a) faculty members' beliefs about the ethics of reparative therapy and referring lesbian, gay, and bisexual (LGB) clients, (b) course content related to reparative therapy and referral of LGB clients, and (c) positions taken by programs associated with reparative therapy and referral of LGB clients. A total of 117 faculty members from accredited family therapy programs completed an online survey for this study. While the vast majority of faculty members reported that reparative therapy is unethical, there was less agreement related to the ethics of referring LGB clients, which may highlight the need for clearer ethical guidelines to regulate this potentially harmful practice. Implications for clinical training and future research are discussed.

The State of Lesbian, Gay, and Bisexual Affirmative Training: A Survey of Faculty from Accredited Couple and Family Therapy Programs.

This study explored the state of lesbian, gay, and bisexual (LGB) affirmative training in the couple and family therapy field. LGB affirmative refers to holding positive views of LGB identities and relationships. A total of 117 faculty members completed the online survey for this study. Participants were asked to respond to items on the following topics: LGB affirmative stances, LGB affirmative program environment, LGB affirmative course content, self-of-the-therapist work, and professional opportunities to work with LGB topics and clients. The findings of this study were encouraging as participants reported holding positive beliefs about LGB individuals, that their training programs had fairly affirmative program environments, and that LGB affirmative course content was included in their program curriculum.

To Refer or Not to Refer: Exploring Family Therapists' Beliefs and Practices Related to the Referral of Lesbian, Gay, and Bisexual Clients.

This study explored how negative beliefs toward lesbian, gay, and bisexual (LGB) individuals and LGB clinical competence influenced family therapists' beliefs and practices regarding referring based on the sexual orientation of the client. The sample consisted of 741 experienced clinicians. The results of this study indicated that the majority of the participants believe it is ethical to refer LGB clients; however, most had never made such a referral. Furthermore, participants who had referred based solely on the client's sexual orientation reported higher levels of negative beliefs toward LGB individuals and lower levels of LGB clinical competence. Finally, negative beliefs toward LGB persons not only predicted the practice of referring, but also the belief that it is ethical to refer an LGB client.

An exploration of family therapists' beliefs about the ethics of conversion therapy: the influence of negative beliefs and clinical competence with lesbian, gay, and bisexual clients.

The majority of the literature on conversion therapy has focused on clients' experiences and rationales for seeking such therapy. This study sought to explore differences in the beliefs and clinical competence of therapists who practice and believe in the ethics of conversion therapy and those who do not. The sample for this study included 762 family therapists who were members of the American Association of Marriage and Family Therapy. Data were collected using electronic surveys that assessed participants' negative beliefs about and perceived clinical competence with lesbian, gay, and bisexual (LGB) individuals. Results indicate that those who believe in the ethics of and/or practice conversion therapy report statistically higher levels of negative beliefs about LGB individuals and lower levels of clinical competence working with LGB clients. Implications for clinical practice and organizational policy are discussed.

Assessing lesbian, gay, and bisexual affirmative training in couple and family therapy: establishing the validity of the Faculty Version of the Affirmative Training Inventory.

This study established the validity and factor structure of the Faculty Version of the Affirmative Training Inventory (ATI-F), which assesses faculty members' perceptions of the level of lesbian, gay, and bisexual (LGB) affirmative training that occurs in clinical programs. Additionally, this study examined the latent associations among the subscales of the ATI-F and three convergent validity items utilizing a sample of 117 faculty members from accredited family therapy programs. The findings provide empirical support for the relationship between including classroom content on LGB affirmative therapy and faculty members' beliefs about LGB individuals and relationships. Specifically, faculty members who report more positive beliefs about LGB clients appear to be more likely to include LGB affirmative therapy content in the courses they teach.