Relation between increasing attachment security and weight gain: a clinical study of adolescents and their parents at an outpatient ward.

PURPOSE: We wanted to evaluate the impact of a relational focus in the treatment of adolescent ED-patients and their parents at an intensive outpatient ward, based on attachment theory, combined with a family approach and psychodynamic principles. Our aim was to investigate the distribution of different attachment styles among the adolescent ED-patients and their parents, and to find out if they could change by the treatment. METHODS: Swedish adolescents (n = 33; 3 boys, 30 girls) and their parents (n = 60; 34 mothers, 26 fathers) participated. MEASURES: Attachment Style Questionnaire (ASQ), Body Mass Index (BMI) and Children's Global Assessment Scale (CGAS) before and after treatment. RESULTS: The adolescents were high on Need for Approval (ASQ4) of the Insecure/Anxious scale before treatment (in contrast to the parents). The patients had a significant decrease in ASQ4 after treatment, which correlated inversely to the increase in BMI but not to CGAS. The mothers showed features of the Secure/Confident style, fathers of the Insecure/Avoidant with elevated Relationships as Secondary (ASQ2). CONCLUSIONS: Treatment with a relational and a family focus has impact on attachment insecurity in adolescent ED-patients and outcomes in terms of BMI. It is important to engage the parents, who need to help the adolescents to separate at that developmental stage. A secure therapeutic context, which enables mentalizations and allows new relational experiences, is essential. The ASQ-instrument is useful in indicating how the treatment of ED-adolescents is proceeding. LEVEL OF EVIDENCE: Level IV: evidence obtained from multiple time series with the intervention.

Art therapy and self-image: A 5-year follow-up art therapy RCT study of women diagnosed with breast cancer.

OBJECTIVE: This follow-up study on perceived self-image and psychophysical distress/psychic symptoms was based on a ranomized contolled study of art therapy on women with breast cancer. METHOD: The aim was to examine the long-term effects of time-limited art therapy using the instruments of Structural Analysis of Social Behavior (SASB) and Symptom Check List-90 (SCL-90). RESULTS: Three attachment clusters of the SASB showed significant changes post therapy: Autonomous self (cluster 1), Accepting self (cluster 2), and Loving self (cluster 3). Clusters 2 and 3 continued to change in favor of the intervention group at the 5-year follow-up. There were no significant differences in the SCL-90 results between the intervention group and the control group in the follow-up study. SIGNIFICANCE OF RESULTS: The art therapy intervention was both therapeutic and psycho-educative. The conclusion of this study is that approaching emotions through time-limited art therapy seems to have a long-lasting effect on the attachment behavioral system shown in the SASB model post intervention, and this effect remained 5 years later.

Getting "Stuck" in the Future or the Past: Relationships between Dimensions of Time Perspective, Executive Functions, and Repetitive Negative Thinking in Anxiety.

BACKGROUND/AIM: Anxiety disorders are associated with impairments in several aspects of cognitive processing. In this study we investigated three such aspects, i.e., time perspective, repetitive negative thinking (worry and rumination), and executive functioning, in persons with anxiety disorders compared to healthy controls and examined the influence of negative past and negative future time perspective and executive functioning on worry and rumination. METHOD: Thirty-six psychiatric outpatients with anxiety disorders (mean age = 30.83, SD = 11.74; 30 females and 6 males) and 44 healthy controls (mean age = 28.89, SD = 9.54; 24 females and 20 males) completed inventories of time perspective and repetitive negative thinking, and tasks measuring executive functioning (shifting and inhibition). RESULTS: The groups (patient vs. control) differed significantly on all time perspective dimensions (past, present, and future), with largest effect sizes observed for negative past and negative future. Regression analyses with executive functioning, negative past, and negative future time perspectives as predictors, and worry and rumination as outcomes, showed that negative past time perspective was the best predictor for rumination, whereas negative future time perspective more strongly predicted worry. Executive functioning was not a significant predictor of either worry or rumination. CONCLUSIONS: Individuals with anxiety disorders demonstrated systematic biases in all time perspective dimensions, particularly negative past and negative future time perspective, which was further related to worry and rumination. Thus, interventions targeting temporal focus may be one way of reducing repetitive negative thinking. A major limitation of this study was the use of a cross-section design.

Adolescent patients with eating disorders and their parents: a study of self-image and outcome at an intensive outpatient program.

PURPOSE: The main aim of this clinical study was to explore how adolescent patients with eating disorders and their parents report their perceived self-image, using Structural Analysis of Social Behavior (SASB), before and after treatment at an intensive outpatient program. Another aim was to relate the self-image of the young patients to the outcome measures body mass index (BMI) and Children's Global Assessment Scale (C-GAS) score. METHODS: A total of 93 individuals (32 adolescents, 34 mothers, and 27 fathers) completed the SASB self-report questionnaire before and after family-based treatment combined with an individual approach at a child and youth psychiatry day care unit. The patients were also assessed using the C-GAS, and their BMI was calculated. RESULTS: The self-image (SASB) of the adolescent patients was negative before treatment and changed to positive after treatment, especially regarding the clusters self-love (higher) and self-blame (lower). A positive correlation between change in self-love and in C-GAS score was found, which rose significantly. Increased self-love was an important factor, explaining a variance of 26 %. BMI also increased significantly, but without any correlation to change in SASB. The patients' fathers exhibited low on the cluster self-protection. Mothers' profiles were in line with a non-clinical group. CONCLUSIONS: Results indicate that the self-image of adolescent patients change from negative to positive alongside with a mainly positive outcome of the ED after treatment. Low self-protection according to SASB among fathers suggests the need for greater focus on their involvement.

Time out of mind: temporal perspective in adults with ADHD.

OBJECTIVE: ADHD is often associated with difficulties in planning and time management. In this study, the authors examined the hypothesis that these functional problems in ADHD reflect systematic biases in temporal orientation. METHOD: To test this hypothesis, adults with ADHD (n = 30) and healthy controls (n = 60) completed the Swedish version of the Zimbardo Time Perspective Inventory (S-ZTPI). RESULTS: Although a majority of the ADHD participants were tested under stimulant medication, they showed significant differences in all the six subscales of the S-ZTPI. Logistic regression analysis, with age, education, depression, and response inhibition as covariates, showed that the Future Positive Scale was the primary predictor of ADHD status. CONCLUSION: These findings suggest that ADHD is associated with systematic biases in habitual time orientation and that these differences may contribute to functional problems in ADHD.

Individual brief art therapy can be helpful for women with breast cancer: a randomized controlled clinical study.

OBJECTIVE: Recent research shows that almost every second woman with breast cancer is depressed or has anxiety; the risk for younger women is even higher. Moreover, research shows that women are at risk for developing depression, also a threat for women with breast cancer. The aim of this randomized controlled clinical trial was to study the outcome of five sessions of art therapy given at a 5-week period of postoperative radiotherapy. METHODS: The participants were between 37 and 69 years old; six participants in each group were below 50 years of age. Half of the participants (n = 20) received art therapy and the other half (n = 21) were assigned to a control group. At the first measurement, at least 17% (n = 7) of the participants medicated with antidepressants. Data were collected before and after art therapy and at a 4-month follow-up using self-rating scales that measure self-image (the Structural Analysis of Social Behaviour) and psychiatric symptoms (the Symptom Check List-90). RESULTS: At follow-up, significant lower ratings of depression, anxiety, and somatic symptoms and less general symptoms were reported for the art therapy group compared to the control group. The regression analysis showed that art therapy relates to lower ratings of depression, anxiety, and general symptoms; chemotherapeutic treatment predicts lower depressive symptoms; in contrast to axillary surgery and hormonal treatment as well as being a parent predicts higher ratings of anxiety and general symptoms. SIGNIFICANCE OF RESULTS: The conclusion suggests that art therapy has a long-term effect on the crisis following the breast cancer and its consequences.

A pilot study of eye movement desensitisation and reprocessing treatment (EMDR) for post-traumatic stress after childbirth.

OBJECTIVE: to explore the possibility of using eye movement desensitisation and reprocessing (EMDR) to treat women who have experienced post-traumatic stress after childbirth. DESIGN: the pilot study consisted of a 'before and after' treatment design combined with follow-up measurements 1-3 years after EMDR treatment. Quantitative data from questionnaires (Traumatic Event Scale [TES]) were collected. In addition, qualitative data from individual interviews with the participants were collected as well as data from the psychotherapist's treatment notes of the EMDR treatment sessions. SETTING: the north of Sweden. PARTICIPANTS: four women with post-traumatic stress disorder (PTSD) after childbirth (one pregnant and three non-pregnant). FINDINGS: all participants reported reduction of post-traumatic stress after treatment. After 1-3 years, the beneficial effects of EMDR treatment remained for three of the four women. Symptoms of intrusive thoughts and avoidance seemed most sensitive for treatment. IMPLICATIONS FOR PRACTICE: EMDR might be a useful tool in the treatment of non-pregnant women severely traumatised by childbirth; however, further research is required.