Emotion regulation in children (ERiC): A protocol for a randomised clinical trial to evaluate the clinical and cost effectiveness of Mentalization Based Treatment (MBT) vs Treatment as Usual for school-age children with mixed emotional and behavioural difficulties.

BACKGROUND: The majority of children referred to Child and Adolescent Mental Health Services (CAMHS) in the UK will present with mixed emotional and behavioural difficulties, but most mental health treatments are developed for single disorders. There is a need for research on treatments that are helpful for these mixed difficulties, especially for school-age children. Emotion Regulation (ER) difficulties present across a wide range of mental health disorders and mentalizing may help with regulation. The ability to mentalize one's own experiences and those of others plays a key role in coping with stress, regulation of emotions, and the formation of stable relationships. Mentalization Based Therapy (MBT) is a well-evidenced therapy that aims to promote mentalization, which in turn increases ER capacities, leading to decreased emotional and behavioural difficulties. The aim of this study is to test the clinical- and cost-effectiveness of MBT compared to treatment as usual for school age children with emotional and behavioural difficulties. If effective, we hope this approach can become available to the growing number of children presenting to mental health services with a mix of emotional and behavioural difficulties. MATERIALS AND METHODS: Children referred to CAMHS aged 6-12 with mixed mental health problems (emotional and behavioural) as primary problem can take part with their parent/carers. Children will be randomly allocated to receive either MBT or treatment as usual (TAU) within the CAMHS clinic they have been referred to. MBT will be 6-8 sessions offered fortnightly and can flexibly include different family members. TAU is likely to include CBT, parenting groups, and/or children's social skills groups. Parent/carers and children will be asked to complete outcome assessments (questionnaires and tasks) online at the start of treatment, mid treatment (8 weeks), end of treatment (16 weeks) and at follow up (40 weeks). TRIAL REGISTRATION: Clinical trial registration: ISRCTN 11620914.

A typology for the interpersonal affective focus in dynamic interpersonal therapy based on a contemporary interpersonal approach.

Dynamic Interpersonal Therapy (DIT) is a brief, time-limited psychodynamic individual therapy in which depressive and anxious symptoms are understood as responses to interpersonal difficulties. Problematic interpersonal representations of the self and others are conceptualized in DIT as the interpersonal affective focus (IPAF), a predominant and recurring interpersonal pattern that is connected to the symptoms and becomes the foundation of treatment. This article reports the development of a typology for classifying IPAFs, which characterizes the predominant style based on contemporary interpersonal approaches. If such a typology can be shown to have validity in a clinical setting, it could have multiple uses that would improve understanding of how DIT works and for whom it might be effective, for example, assisting the therapist in formulating the IPAF, allowing investigations of treatment outcome and process research, and informing training. An IPAF typology was developed by means of a hybrid method of qualitative analysis of transcriptions of audio recordings of DIT sessions using data from a randomized control and feasibility trial. Results revealed four themes, that is, patterns of relating, which could be described as hostile-dominant, hostile-submissive, friendly-dominant, or friendly-submissive. Limitations include the sample size and diversity, the impact of the inclusion and exclusion criteria of the pilot feasibility trial, and the clinical need to titrate the IPAF. Future research should focus on the reliability and validity of the typology and whether it can be employed in outcome and process research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Changes in interpersonal problems in the psychotherapeutic treatment of depression as measured by the Inventory of Interpersonal Problems: A systematic review and meta-analysis.

BACKGROUND: Interpersonal problems are commonly reported by depressed patients, but the effect of psychotherapeutic treatment on them remains unclear. This paper reviews the effectiveness of psychotherapeutic interventions for depression on interpersonal problems as measured by the Inventory of Interpersonal Problems (IIP). METHODS: An electronic database search identified articles reporting IIP outcome scores for individual adult psychotherapy for depression. A systematic review and, where possible, meta-analysis was conducted. RESULTS: Twenty-eight studies met inclusion criteria, 10 of which could be included in a meta-analysis investigating changes in the IIP after brief psychotherapy. Reasons for exclusion from the meta-analysis were too few participants with a diagnosis of depression (n=13), IIP means and SDs unobtainable (n=3) and long-term therapy (n=2). A large effect size (g=0.74, 95% CI=0.56-0.93) was found for improvement in IIP scores after brief treatment. LIMITATIONS: Paucity of IIP reporting and treatment type variability mean results are preliminary. Heterogeneity for improvement in IIP after brief psychotherapy was high (I2=75%). CONCLUSIONS: Despite being central to theories of depression, interpersonal problems are infrequently included in outcome studies. Brief psychotherapy was associated with moderate to large effect sizes in reduction in interpersonal problems. Of the dimensions underlying interpersonal behaviour, the dominance dimension may be more amenable to change than the affiliation dimension. Yet, high pre-treatment affiliation appeared to be associated with better outcomes than low affiliation, supporting the theory that more affiliative patients may develop a better therapeutic relationship with the therapist and consequently respond more positively than more hostile patients.

Take your mind off it: Coping style, serotonin transporter linked polymorphic region genotype (5-HTTLPR), and children's internalizing and externalizing problems.

Individuals with the short variant of the serotonin transporter linked polymorphic region gene are more susceptible than individuals homozygous for the long allele to the effects of stressful life events on risk for internalizing and externalizing problems. We tested whether individual differences in coping style explained this increased risk for problem behavior among youth who were at both genetic and environmental risk. Participants included 279 children, ages 8-11, from the Children's Experiences and Development Study. Caregivers and teachers reported on children's internalizing and externalizing symptoms, and caregivers and children on children's exposure to harsh parenting and parental warmth in middle childhood, and traumatic events. Children reported how frequently they used various coping strategies. Results revealed that short/short homozygotes had higher levels of internalizing problems compared with long allele carriers and that short allele carriers had higher levels of externalizing problems compared with long/long homozygotes under conditions of high cumulative risk. Moreover, among children who were homozygous for the short allele, those who had more cumulative risk indicators less frequently used distraction coping strategies, which partly explained why they had higher levels of internalizing problems. Coping strategies did not significantly mediate Gene × Environment effects on externalizing symptoms.

Interactive effects of early and recent exposure to stressful contexts on cortisol reactivity in middle childhood.

BACKGROUND: Given mixed findings as to whether stressful experiences and relationships are associated with increases or decreases in children's cortisol reactivity, we tested whether a child's developmental history of risk exposure explained variation in cortisol reactivity to an experimentally induced task. We also tested whether the relationship between cortisol reactivity and children's internalizing and externalizing problems varied as a function of their developmental history of stressful experiences and relationships. METHOD: Participants included 400 children (M = 9.99 years, SD = 0.74 years) from the Children's Experiences and Development Study. Early risk exposure was measured by children's experiences of harsh, nonresponsive parenting at 3 years. Recent risk exposure was measured by children's exposure to traumatic events in the past year. Children's cortisol reactivity was measured in response to a social provocation task and parents and teachers described children's internalizing and externalizing problems. RESULTS: The effect of recent exposure to traumatic events was partially dependent upon a child's early experiences of harsh, nonresponsive parenting: the more traumatic events children had recently experienced, the greater their cortisol reactivity if they had experienced lower (but not higher) levels of harsh, nonresponsive parenting at age 3. The lowest levels of cortisol reactivity were observed among children who had experienced the most traumatic events in the past year and higher (vs. lower) levels of harsh, nonresponsive parenting in early childhood. Among youth who experienced harsh, nonresponsive parent-child relationships in early childhood and later traumatic events, lower levels of cortisol reactivity were associated with higher levels of internalizing and externalizing problems. CONCLUSIONS: Hypothalamic-pituitary-adrenal (HPA) axis reactivity to psychological stressors and the relationship between HPA axis reactivity and children's internalizing and externalizing problems vary as a function of a child's developmental history of exposure to stressful relationships and experiences.

Older people and 'active ageing': Subjective aspects of ageing actively.

Following a critical overview of the active ageing concept, a thematic decomposition of 42 transcribed interviews with British people aged 72 years and over indicates that active ageing is understood in relation to physical, cognitive, psychological and social factors, but that these co-exist in complex combinations. The notion of activity in active ageing is grasped in relation to an active/passive distinction which emphasizes the enhancement or diminishment of concrete powers of activity. A 'challenge and response' framework is suggested for future research on active ageing.

Knowledge and attitudes regarding electroconvulsive therapy among medical students and the general public.

OBJECTIVE: To explore the state of knowledge and attitudes toward electroconvulsive therapy (ECT) among a sample of the adult British general public (n = 70) in comparison with a sample of medical students (n = 70) and MRCPsych students (n = 20). Despite documented efficacy, an uncritical anti-ECT stance is often adopted by the media. It has been suggested that medical students are relatively unfamiliar with ECT. If they do hold the same misconceptions as the general public, there are implications for the future use of ECT. METHOD: Participants were opportunistically recruited for a Likert scale questionnaire developed for this study and designed to investigate the source of ideas about ECT, extent of knowledge, and lasting impressions of ECT as portrayed in films. RESULTS: The lay sample was significantly less knowledgeable and had less positive attitudes and greater fear of ECT than the medical students. The aspects of ECT that medical students were least knowledgeable about were the potential risks and side effects involved. Popular films portraying ECT still seem to have a negative impact on their audiences. CONCLUSIONS: The targets for education both in the public forum and in medical schools should be the procedure of administering ECT and explanation of the associated risks. Outdated and inaccurate depictions of ECT in films are still a frequently reported source of knowledge of ECT for both the general public and medical students.

A review of the safety of repetitive transcranial magnetic stimulation as a clinical treatment for depression.

There is growing interest worldwide in rTMS as a clinical treatment for depression. Apart from efficacy, its safety as a clinical treatment must be considered before its widespread use can be advocated. All published, sham-controlled rTMS depression trials were reviewed for reported side-effects and outcomes of formal neuropsychological testing. In addition, all reports of seizures occurring with rTMS were reviewed. Other safety concerns (effects on hearing; headache, pain, induced currents in electrical circuits, histotoxicity, electromagnetic field exposure, psychiatric complications, safety in pregnancy) are discussed. Common side-effects were of a minor nature, e.g. headache. There was a low incidence of accidental seizures and induced hypomania, both of which were associated with identified risk factors for which subjects should be screened. Long-term effects of repeated rTMS sessions are as yet unknown. When given within recommended guidelines, the overall safety profile of rTMS is good, and supports its further development as a clinical treatment.

Repetitive transcranial magnetic stimulation for the treatment of obsessive compulsive disorder: a double-blind controlled investigation.

BACKGROUND: To determine the efficacy and tolerability of repetitive transcranial magnetic stimulation (rTMS) as a treatment for obsessive compulsive disorder (OCD) in a double-blind placebo-controlled study. METHOD: Subjects with treatment-resistant OCD were randomized to rTMS (n = 10) or sham rTMS (n = 8) for 10 sessions of daily stimulation over the left dorsolateral prefrontal cortex (DLPFC), with subjects and raters being blind to the treatment. Subjects were offered an open extension of up to 20 sessions of rTMS. RESULTS: The two groups did not differ on change in Yale-Brown Obsessive Compulsive Scale (YBOCS) or Maudsley Obsessive-Compulsive Inventory scores over 10 sessions, with or without correction for depression ratings. Over 20 sessions, there was a significant reduction in total YBOCS scores, but not after controlling for depression. rTMS over 20 sessions was well tolerated. CONCLUSION: Two weeks of rTMS over the left DLPFC is ineffective for treatment-resistant OCD.

A sham-controlled trial of the efficacy and safety of twice-daily rTMS in major depression.

BACKGROUND: Studies of repetitive transcranial magnetic stimulation (rTMS) in depression have mostly involved once-daily treatment, with positive but modest clinical results. This study tested the efficacy and safety of twice-daily rTMS over 2 weeks. METHOD: Thirty-eight depressed subjects enrolled in a double-blind, sham-controlled trial of twice-daily rTMS (left prefrontal cortex, 10 Hz, 110% intensity, 1500 stimuli per session) over 2 weeks. Mood and neuropsychological functioning were assessed weekly by blind raters, using the Montgomery-Asberg Depression Rating Scale (MADRS) as the primary outcome measure, plus the Hamilton Rating Scale for Depression (HRSD) and self-report measures. After the blind period, 22 subjects continued with once-daily rTMS to receive a total of 6 weeks of active rTMS. RESULTS: Subjects were moderately treatment resistant. Active treatment resulted in significantly greater improvement than sham over the 2-week blind period on one outcome measure only (MADRS p<0.05). Subjects showed further improvement over the 6 weeks of active rTMS. Neuropsychological test scores did not change significantly. CONCLUSIONS: rTMS given twice daily was effective and safe, with no adverse neuropsychological effects.

Transcranial magnetic stimulation in adolescent depression.

OBJECTIVE: There are few safe and effective biological treatments for major depression in adolescents. We aimed to report the use of repetitive transcranial magnetic stimulation (rTMS) as a treatment for adolescents with this condition. METHODS: The first two subjects in a double-blind, sham-controlled trial of rTMS that is evaluating the efficacy and safety of rTMS in depressed adolescents are described. Clinical response was assessed at baseline and at the end of each week. The following scales were used: Montgomery-Asberg Depression Rating Scale, Clinical Global Impression-Severity Scale, Beck Depression Inventory and Centre for Epidemiological Studies - Depression - Child Scale. A battery of cognitive tests was also used at several intervals to measure potential change in neuropsychological functioning. RESULTS: Random allocation of both subjects was to active treatment. Both subjects improved to a clinically significant degree with rTMS treatment and reported no adverse effects. Neuropsychological testing did not demonstrate any deterioration in the domains of functioning tested. CONCLUSIONS: Repetitive transcranial magnetic stimulation shows early promise as a treatment for major depression in adolescents. Well-designed, sham-controlled studies are now indicated to test the efficacy and safety of rTMS in these patients.