Towards the Development of an Effective Working Alliance: The Application of DBT Validation and Stylistic Strategies in the Adaptation of a Manualized Complex Trauma Group Treatment Program for Adolescents in Long-Term Detention.

The current paper details a case of adapting a manualized group therapy treatment for youths experiencing chronic stress. It was used for use with a highly traumatized and behaviorally disordered group of adolescents (ages 14 to 17 years) in long-term juvenile detention. The authors argue for a phasic approach to treatment for this population, with the goal of the essential, initial phase being the development of an authentic therapeutic alliance before other treatment goals are pursued. The authors provide clinical examples of liberally and patiently utilizing dialectical behavior therapy-framed acceptance-based strategies to achieve this therapeutic alliance, and only then naturally weaving in more traditional cognitive behavioral, change-oriented psychoeducational approaches successfully. Clinical and research implications for effective treatment of traumatized, detained youths are also discussed.

Space re-exploration in hemispatial neglect.

Exploration of the space around us is a fundamental part of human behaviour. When it breaks down there is an important opportunity to understand its underlying mechanisms. Here we show that many right-hemisphere patients with left neglect re-explore rightward locations, failing to keep track of them during search. Importantly, such re-exploration occurred despite leftward stimuli being indistinguishable in peripheral vision, so it is unlikely to result from implicit processing of neglected targets. Revisits generally occurred after visits to other targets and are therefore not immediate perseverations. Finally, manipulating the visual salience of found targets altered the degree of neglect, but not revisit rates. Space exploration appears to be modulated both by the ability to keep track of spatial locations and by stimulus salience.

Theta burst stimulation in the rehabilitation of the upper limb: a semirandomized, placebo-controlled trial in chronic stroke patients.

BACKGROUND: Noninvasive cortical stimulation could represent an add-on treatment to enhance motor recovery after stroke. However, its clinical value, including anticipated size and duration of the treatment effects, remains largely unknown. OBJECTIVE: The authors designed a small semi-randomized clinical trial to explore whether long-lasting clinically important gains can be achieved by adding theta burst stimulation (TBS), a form of repetitive transcranial magnetic stimulation (TMS), to a rehabilitation program for the hand. METHODS: A total of 41 chronic stroke patients received excitatory TBS to the ipsilesional hemisphere or inhibitory TBS to the contralesional hemisphere in 2 centers; each active group was compared with a group receiving sham TBS. TBS was followed by physical therapy for 10 working days. Patients and therapists were blinded to the type of TBS. Primary outcome measures (9-hole Peg Test [9HPT], Jebsen Taylor Test [JTT], and grip and pinch-grip dynamometry) were assessed 4, 30, and 90 days post treatment. The clinically important difference was defined as 10% of the maximum score. RESULTS: There were no differences between the active treatment and sham groups in any of the outcome measures. All patients achieved small sustainable improvements--9HPT, 5% of maximum (confidence interval [CI] = 3%-7%); JTT, 5.7% (CI = 3%-8%); and grip strength, 6% (CI = 2%-10%)--all below the defined clinically important level. CONCLUSIONS: Cortical stimulation did not augment the gains from a late rehabilitation program. The effect size anticipated by the authors was overestimated. These results can improve the design of future work on therapeutic uses of TMS.

Copper deficiency myeloneuropathy in a patient with haemachromatosis: a case report.

A 64-year-old British Caucasian man presented with red skin wheals and breathlessness and then developed a progressive neurological syndrome. Investigation revealed hereditary haemachromatosis, porphyria, and a myelodysplastic syndrome. No unifying diagnosis was made, and his neurological symptoms remained unexplained, until further studies revealed an underlying copper deficiency.

The relationship between religiosity and adjustment among African-American, female, urban adolescents.

African-American female adolescents living in urban environments are at risk for adverse adjustment outcomes, and thus it is imperative to identify protective factors. Religion has been found to be a significant protective resource against many types of maladaptive adjustment outcomes among adolescent samples. The present study accomplishes the following: (1) Provides a description of religiosity in a sample of African-American female teens; (2) examines religion as a resource for these adolescents by focusing on the association between religiosity and sexual activity, self-esteem, and general psychological functioning. Four-hundred ninety-two African-American females, ages 12-19, completed measures on religiosity, sexual activity, self-esteem, and psychological functioning. Most of the adolescents identified as Christian, reported a belief in God, and attended religious services. Greater overall religiosity was associated with greater self-esteem and better psychological functioning. Adolescents at different levels of self-religiosity, as well as family religiosity, evidenced significantly different self-esteem but not psychological distress or sexual activity. Adolescents with varying levels of church attendance demonstrated differences on all three outcomes. By identifying the ways in which religion may exert a positive impact on African-American female teens, mental health professionals can design interventions that have the potential to help improve the quality of life for these adolescents.

Coping and HIV infection in African-American women.

HIV is impacting African-American women at alarming rates. Many of these women are poor and socially disadvantaged, resulting in a combination of stressors that impacts the quality of their lives. This study investigated whether coping style (i.e., problem-focused, emotion-focused) varies as a function of HIV status or stage of HIV-related illness. Secondly, we examined whether the use of a particular style is associated with three areas of functioning among HIV-infected women: general psychological distress, depressive symptomatology, and physical symptomatology. Ninety-nine HIV-infected women and 143 noninfected women completed measures assessing coping styles and functioning. No significant differences emerged in coping styles between the HIV-infected and noninfected women or for the groups when symptomatic women were examined separate from asymptomatic women. Greater emotion-focused coping was associated with less general psychological distress and depression specifically. Problem-focused coping interacted with illness stage to predict all areas of functioning. By identifying effective coping strategies among African-American women with HIV, mental health professionals can design empirical interventions that can help improve quality of life for these women.