"Virtual reality fixed me": A case report of the use of virtual reality during intensive interdisciplinary pain treatment.

Virtual reality (VR) is an innovative technology with the potential to enhance treatment for children with chronic pain and functional symptoms. Currently, little is known about patients' experiences of VR in the setting of intensive interdisciplinary pain treatment (IIPT). This study aimed to better understand how patients engage with and benefit from VR. This case report focuses on a 12-year-old female with amplified musculoskeletal pain syndrome and comorbid functional neurological disorder receiving treatment in inpatient IIPT. VR was incorporated into physical/occupational and recreational therapy sessions. A semi-structured interview was completed one-month post-discharge. Qualitative analysis revealed three major themes: Process of Change (VR was unique/immersive, reduced pain focus, challenged skepticism, and changed pain perception), Efficacy (VR increased movement, supported transitioning from a wheelchair to walking independently, and increased confidence, excitement, and surprise), and Engagement (VR aided in acknowledging progress, increased camaraderie, was fun, and challenged patient to extend treatment goals made in VR to real life). Therapist observations of the benefits and barriers to using VR in treatment are described. Overall, this report indicates that VR may be a helpful tool to use with existing IIPT interventions to enhance patient engagement in treatment and improve functionaloutcomes.

Predictors of improvement in a family-based partial hospitalization/intensive outpatient program for eating disorders.

The efficacy of family-based treatment (FBT) in outpatient settings has led to efforts to incorporate FBT principles into higher levels of care. The present study examined predictors of improvement in an FBT-based partial hospitalization program/intensive outpatient program (PHP/IOP) as measured by the Eating Disorder Examination-Questionnaire. Participants were 113 patients with anorexia nervosa (AN) or eating disorder not otherwise specified (EDNOS) consecutively participating in an FBT-based PHP/IOP. Multilevel modeling was used to investigate predictors for adolescents and young adults separately. Predictors considered included illness duration, previous hospitalization, hospitalization immediately prior to treatment, previous outpatient therapy, hospitalization during treatment, diagnosis, gaining 4 pounds in 4 weeks, and family status as time-invariant variables. Time-varying variables considered included depression symptoms and mothers'/fathers' ratings of parental self-efficacy and expressed emotion. For adolescents, depression by time and diagnosis by time interactions were statistically significant. At all levels of depression, adolescent patients with AN demonstrated greater reductions in eating disorder symptoms compared to patients with EDNOS. For young adults, depression and gaining 4 pounds in 4 weeks were significant predictors. The relationships for young adults were curvilinear such that, while lower eating disorder symptoms were found during treatment, these gains were not maintained at follow up.

The Impact of Spatial Distribution of Pain on Long-Term Trajectories for Chronic Pain Outcomes After Intensive Interdisciplinary Pain Treatment.

OBJECTIVES: Evidence for the effectiveness of intensive interdisciplinary pain treatment (IIPT) for pediatric chronic pain is growing; however, little research has considered factors that contribute to differences in patients' treatment response. The present study utilized multilevel modeling to examine trajectory of change over time in functional disability from clinic assessment to 6-month follow-up in pediatric patients participating in IIPT, considering spatial distribution of pain, coping efficacy, and pain intensity. MATERIALS AND METHODS: Participants included 110 pediatric patients (Mage=14.65, SD=2.37; localized pain, 27.3%; widespread pain, 72.7%) consecutively admitted into IIPT. Patients completed self-report measures of functional disability, pain intensity, and coping efficacy at pretreatment assessment, admission, weekly during IIPT, discharge, and several follow-ups. RESULTS: Analysis identified a model with 3 three-way interactions, including time, time squared, pain intensity, coping efficacy, and pain distribution, on functional disability. The spatial distribution of pain had the greatest impact on treatment trajectory in patients with widespread pain, high pain intensity, and poor coping efficacy; these patients demonstrated greater functional disability compared with patients with localized pain. In addition, patients with widespread pain and poor coping efficacy had the most functional disability across all levels of pain intensity. Patients with localized pain and poor coping efficacy demonstrated initial treatment gains, but evidenced an increase in functional disability at follow-up. DISCUSSION: Overall, spatial distribution of pain, coping efficacy, and pain intensity played an important role in patients' response to treatment. Better understanding of these variables could improve treatment response, particularly for the most severely disabled chronic pain patients.

Measurement of leadership skills development among veterinary students and veterinary professionals participating in an experiential leadership program (the Veterinary Leadership Experience).

OBJECTIVE: To evaluate outcomes associated with an experiential leadership program (the Veterinary Leadership Experience [VLE]) among participants 1 year after program completion. SAMPLE: 157 veterinary students and 61 veterinary professionals who participated in the 2015 or 2016 VLE. PROCEDURES: Participants completed various instruments to assess emotional intelligence, psychological flexibility, resilience, and client-communication skills prior to (pretest) and 1 year after (posttest) attending the VLE; pretest and posttest findings were compared for all but client-communication skills, for which only posttest responses were analyzed. An additional posttest instrument assessed the impact that the VLE had on key knowledge areas (ie, self-awareness, self-management, social awareness, relational competence, communication skills, and conflict management skills) and overall impact. RESULTS: 1 year after completing the VLE, participants reported that the program had a high impact on all key knowledge areas; the impact on social awareness and overall impact was significantly higher for veterinary students than for veterinary professionals. Veterinary professionals reported a greater increase in emotional intelligence after program completion than did veterinary students. For each assessed client-communication skill, the percentage of veterinary professionals who reported increased confidence in that skill after program completion was lower than the corresponding percentage of veterinary students. Resilience and psychological flexibility scores did not increase after program completion. CONCLUSIONS AND CLINICAL RELEVANCE: Assessment of the effectiveness and long-term outcomes of experiential leadership programs is important to understanding whether such programs are having the intended effect. Veterinary students and veterinary professionals who were assessed 1 year after completing the VLE reported improvements in leadership skills foundational to the program.

Medical Assessment and Triage of Pediatric Patients with Anorexia Nervosa in Primary Care.

OBJECTIVE: To examine the medical assessment and triage of pediatric patients with anorexia nervosa (AN) initially seen in primary care. METHODS: A retrospective cohort study was conducted for all pediatric patients with AN who had eating/weight concerns and initially identified symptoms in primary care in a single health care system between January 1, 2010, and December 31, 2016. Information on presenting concern, medical assessment/laboratory tests, clinical diagnoses, treatment recommendations, and referrals were abstracted from the medical record. RESULTS: Forty-one (mean age = 13.7 years; SD = 2.2) pediatric patients with AN had eating/weight concerns and initially identified symptoms in a primary care. Overall, only 5% (n = 2/41) of patients received an AN diagnosis during the index visit; a minority were assessed for electrolyte disturbance (n = 20), electrocardiogram abnormality (n = 18), hypothermia (n = 13), binge/purge behaviors (n = 13), orthostatic hypotension (n = 2), or dehydration (n = 1), and only 56% (n = 23) received triage consistent with practice recommendations. Although 61% (n = 25) met criteria for inpatient admission, inpatient hospitalization was recommended for only 2 patients. Patients who received triage consistent with practice recommendations received AN diagnosis and treatment significantly earlier than those who did not (p < 0.01 and p = 0.001, respectively). CONCLUSION: Findings suggest that pediatric patients with AN may not be receiving medical assessment and triage per practice recommendations in the primary care setting. Understanding barriers to evidence-based care for pediatric eating disorders may inform provider education and system-wide changes to enhance outcomes in these patients.

Motivation for sport participation and eating disorder risk among female collegiate athletes.

In light of conflicting research regarding eating disorder risk and sports participation, the current study examined the relationship between specific aspects of sports participation (i.e., level of competition, leanness requirements, and physical/cardiovascular intensity level), an individual's motivation for sports participation, and eating disorder symptomatology/risk. Participants included 319 female collegiate athletes (M age = 19.88; SD = 1.62) representing a variety of sports and competition levels. Multilevel modeling found that level of competition, receiving a scholarship, age, and years of collegiate sport played did not predict eating disorder risk. In the final model, there was a significant interaction between intrinsic motivation and sport intensity. For high intensity sports, higher levels of intrinsic motivation were associated with lower eating disorder risk. For low intensity sports, the level of intrinsic motivation did not impact eating disorder risk. For all sport intensities, extrinsic motivation was associated with a higher eating disorder risk. Results suggest that it is not the specific sport but athletes' motivation for those sports with high physical/cardiovascular intensity and leanness requirements that is associated with untoward consequences. The results clarify conflicting results previously reported in the literature that have primarily employed univariate analyses and have implications for athletic development programs.

Assessment of sleep problems in preschool aged children: an adaptation of the children's sleep habits questionnaire.

The purpose of the present study was to evaluate the factor structure of the children's sleep habits questionnaire (CSHQ) when used with preschool and toddler age children. Mothers of 105 children ages 2-5 completed the CSHQ, the child behavior checklist (CBCL), and a sleep diary. Internal consistency for the original subscales on the CSHQ ranged from .55 to .82 and factor analysis resulted in four factors that tap into critical aspects of sleep. The concurrent validity of the revised scales of the CSHQ was adequate. Overall the results from this study suggest a revised factor structure may be more appropriate for use with preschool and toddler age children.

Parenting styles in a cultural context: observations of "protective parenting" in first-generation Latinos.

Current literature presents four primary parenting styles: authoritative, authoritarian, permissive, and neglectful. These styles provide an important shortcut for a constellation of parenting behaviors that have been characterized as consisting of warmth, demandingness, and autonomy granting. Empirically, only warmth and demandingness are typically measured. Research reporting on parenting styles in Latino samples has been equivocal leading to questions about conceptualization and measurement of parenting styles in this ethnic/cultural group. This lack of consensus may result from the chasm between concepts (e.g., authoritarian parenting) and observable parenting behaviors (e.g., warmth) in this ethnic group. The present research aimed to examine parenting styles and dimensions in a sample of Latino parents using the two usual dimensions (warmth, demandingness) and adding autonomy granting. Traditional parenting styles categories were examined, as well as additional categorizations that resulted from adding autonomy granting. Fifty first-generation Latino parents and their child (aged 4-9) participated. Parent-child interactions were coded with the Parenting Style Observation Rating Scale (P-SOS). In this sample, the four traditional parenting categories did not capture Latino families well. The combination of characteristics resulted in eight possible parenting styles. Our data showed the majority (61%) of Latino parents as "protective parents." Further, while mothers and fathers were similar in their parenting styles, expectations were different for male and female children. The additional dimensions and implications are discussed. The importance of considering the cultural context in understanding parenting in Latino families is emphasized, along with directions for future research.

Beyond consensus: a summary of the special series and future of the Combined-Integrated model.

The articles that comprise this Special Series offer a comprehensive examination of the results and implications of the Consensus Conference and Combined-Integrated (C-I) model of doctoral training in professional psychology (see Shealy, Cobb, Crowley, Nelson, & Peterson, 2004). Given the scope of this effort, it may be helpful to provide a summary of the 12 preceding articles. Such a presentation should illustrate the complementarity of the diverse perspectives presented in this series, the essential coherence of this innovative and compelling model of education and training, and its timely relevance for the future of professional psychology. Following a summary of these articles, eight "future topics for discussion" also are presented.

Voices of the five doctoral training councils in psychology: seeking common ground on Combined-Integrated doctoral training in psychology.

Doctoral training programs in psychology are accredited by the American Psychological Association in four areas: Clinical, Counseling, School, and Combined-Integrated (C-I) psychology. Each area of doctoral preparation in psychology has its own council, which represents its interests within the field and to external constituents. Despite the fact that Combined-Integrated training programs have existed since the mid-1970s, the Consortium representing this area's interests only formed in the past two years. The purpose of this article was to obtain input from representatives of all five training councils regarding the role of the newly formed council in relation to the other councils and the role of Combined-Integrated training. We begin with a brief description of each of the five councils. We then summarize the representatives' responses to narrative questions regarding advantages and disadvantages associated with meeting to discuss the combined model. Finally, common and divergent themes across the councils in training psychologists are presented, and the future role for Combined-Integrated programs is discussed.

From the horse's mouth: a case for Combined-Integrated doctoral training in professional psychology.

Although new to many members of the psychological community, the notion of a "combined" model of training has been in existence for nearly 30 years (Beutler & Fisher, 1994). The present article is intended to outline the benefits and advantages of the Combined-Integrated (C-I) model. Following a brief discussion of the terms "combined" and "integrated," the advantages of C-I training are discussed across five key themes: (a) the high overlap across traditional practice area training, (b) the advantages of the breadth of training offered, (c) the advantages of C-I training for the professional of psychology, (d) the pragmatic advantages of C-I training to faculty and students, and (e) the benefits of C-I training for salient constituency groups.

Back to our future? The Consensus Conference and Combined-Integrated model of doctoral training in professional psychology.

Is it possible and advisable for the profession of psychology to articulate and endorse a common, generalist, and integrative framework for the education and training of its students? At the Consensus Conference on Combined and Integrated Doctoral Training in Psychology, held at James Madison University in Harrisonburg, VA (USA), May 2 to 4, 2003, participants from across the spectrum of education and training in professional psychology ultimately answered "yes." This article, the first in this special series on the Consensus Conference and Combined-Integrated (C-I) model of doctoral training in professional psychology, essentially provides an overview of the conference rationale, participants, goals, proceedings, and results. Because the other 12 articles in this series all reference the Consensus Conference and C-I model, this overview provides a good starting point for understanding what occurred at the conference, what it means to educate and train from a C-I perspective, and what the potential implications of such a model might be for the profession of psychology.

A measure of traditionalism for American Indian children and families: psychometric properties and factor structure.

Factor analytic findings from culturally specific instruments measuring traditionalism as one aspect of cultural identity are described, based on the self-reports of American Indian children and parents. Findings indicate that traditionalism is a multidimensional construct that can be measured reliably. Results are important because few psychometrically adequate instruments exist to assess either traditionalism or acculturation among American Indian families. Implications for refinements in measuring child and family acculturation and examining the relationship with the social/emotional development of American Indian children are discussed.

How effective are treatments for child and adolescent depression? A meta-analytic review.

We located a comprehensive sample of studies (1980-1999) on the psychosocial and pharmacological treatment of child and adolescent depression through an extensive literature search. Articles that met the inclusionary criteria were subsequently analyzed. The outcome data from 38 studies were extracted and converted into effect sizes (ESs). Comparisons of main effects, demographic, and quality of study variables were conducted. The overall findings of this meta-analysis indicate that several different psychosocial interventions for child and adolescent depression produced moderate to large treatment gains that were clinically meaningful for many afflicted youth. However, in general, the vast majority of pharmacological interventions were not effective in treating depressed children and adolescents. Nonetheless, there is recent evidence that selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine are efficacious, and will likely play an increased role in the management of affective illness in youngsters. The clinical implications and limitations of these data are discussed and suggestions for future research are provided.