A conversation analysis of therapist repeats in open dialogue network meetings.

Writings on Open Dialogue approaches to working with families experiencing mental distress emphasize the importance of the therapist repeating the family's words back to them verbatim. Repeats are theorized to display the therapist's listening and to encourage elaboration without imposing the therapist's own interpretations or conclusions on the family. These recommendations have not been subjected to rigorous interactional investigation. In this study, we used conversation analysis to analyze 160 examples of therapists repeating the prior talk of the family from 14 h of video-recorded Open Dialogue sessions. We found that these repeats had similar functions to those previously described in conversation analysis research such as initiating repair, marking receipt, and requesting elaboration as well as examples of therapist repeats occurring in overlap with the talk of the client. Open Dialogue writings thus present an oversimplified account of how repeats are utilized in clinical Open Dialogue sessions. Consistent with dialogical writings, repeats can elicit elaboration with limited input from the therapist, however repeats reflect selectivity and function to direct and guide the conversation to some extent. So, while therapist authority can be mitigated by repeating clients' words, when a therapist chooses to employ a repeat actively shapes the direction of the interaction.

Open dialogue trainees' perspectives on learning processes and psychotherapeutic practice: A prospective focus group study.

Open Dialogue is a collaborative approach to mental health care emphasizing integrated services and a dialogical psychotherapy approach. Open Dialogue training programs eschew traditional didactic teaching of technical therapeutic skills in favor of more experiential learning processes. It is unclear how these training programs affect trainees and shape their perspectives on Open Dialogue. Our aim was to follow up a group of Australian Open Dialogue trainees and explore their perspectives on learning processes and psychotherapeutic practice. We utilized a prospective focus group design with data from audio-recorded focus groups convened before (n = 2) and after (n = 3) participants completing an advanced Open Dialogue training program. Data were subjected to reflective thematic analysis. We identified the theme "Extending possibilities by holding ideas lightly," which represented a universal principle that participants applied to multiple aspects of their practice, for example, favoring multiple perspectives and approaches to therapy, including those other than Open Dialogue. This theme had two sub-themes: (1) "Allowing intimacy by being aware of personal biographies" and (2) "Learning by joining others," which reflected an increased willingness by participants to reflect on and share their inner experiences and an emphasis on joint experiential exercises in the training program. "Extending possibilities by holding ideas lightly" facilitated a means of incorporating a dialogical perspective into existing practices thus avoiding the potential barriers to a wholesale implementation of Open Dialogue. Findings indicated that the participants were not learning how to practice a therapeutic technique or propositional knowledge, but were socialized into a dialogical way of being.

Power and dialogue: A review of discursive research.

Collaborative-dialogic approaches to family therapy advise therapists to take a position of client-as-expert and promote an equality of multiple perspectives. This has led to debates about how to conceptualize power in dialogical therapies with scholars theorizing and researching power as social and negotiated through interaction. We aimed to understand power in dialogical therapy through reviewing discursive research on therapeutic conversations. We performed a systematic search of bibliographical databases PsycINFO, PubMed, and CINAHL. We reviewed the findings from 18 studies utilizing discursive analyses of collaborative-dialogical therapy sessions and examined their findings in relation to power within interactions. We found a strong focus on the practices of the therapist rather than on those of the client. The therapist was presented as a catalyst of dialogue using minimal and active responses to promote dialogical conversations. Therapists also utilized power in response to broader institutional and social demands that may not be consistent with some interpretations of dialogical therapy. We consider practice implications where the exercise of power to direct a session facilitates dialogical interactions.

The relatives of people with depression: A systematic review and methodological critique of qualitative studies.

Being a close relative of a person with depression can take a heavy toll on the former, but these relatives are increasingly made responsible for taking on extensive carer roles. Research on relatives of people with depression is currently dominated by a focus on "carer burden" and although such a focus can explain many relatives' experiences and daily lives, it provides very limited insight into the everyday life of a person living with someone with depression. Therefore, we scoped qualitative research on people who are relatives of people living with depression and identified knowledge gaps caused by explicit or implicit theoretical or methodological assumptions. We conducted an exhaustive literature search in CINAHL, PubMed, PsycINFO, Sociological Abstracts, and Eric. In total, 34 publications were included, their quality evaluated and their findings mapped and summarized. We identified four interrelated and overlapping themes that dominated the findings of the publications: (a) recognition of "depression", (b) emotional responses, (c) interruptions of relationships, and (d) a staged psychosocial process. The vast majority of studies presented de-contextualized and underinterpreted analyses assuming a homogeneity of (illness) experiences and disregarded the important influence of social contributors to social relationships, connectedness, and mental health problems.

Downgrading Deontic Authority in Open Dialogue Reflection Proposals: A Conversation Analysis.

The Open Dialogue approach promotes collaboration with clients and families in decisions about the direction of therapy. This creates potential problems for Open Dialogue therapists who seek collaboration but also have responsibility for managing the session. Using conversation analysis, we examined 14 hours of video recordings of Open Dialogue sessions, and specifically how therapists proposed the transition to a reflecting conversation. We found that, when making proposals to reflect, therapists routinely downgrade their deontic authority (i.e., adopt a less powerful, more collaborative position). They did this through framing proposals as interrogatives, providing accounts, and by prefacing their proposals with "I'm wondering". More heavily downgraded proposals made acceptance less salient, potentially risking transition to the reflection. These findings provide more detail on how theoretical concepts such as "collaboration" and "power" are actually displayed and negotiated in practice and can contribute to a more nuanced understanding of what constitutes Open Dialogue.

El método de diálogo abierto promueve la colaboración con los pacientes y las familias en las decisiones acerca del rumbo de la terapia. Esto genera posibles problemas para los terapeutas que implementan el diálogo abierto y que buscan colaboración, pero que también tienen la responsabilidad de manejar la sesión. Utilizando el análisis de la conversación, analizamos 14 horas de videograbaciones de sesiones de diálogo abierto y, específicamente, cómo los terapeutas propusieron la transición a una conversación reflexiva. Descubrimos que, cuando los terapeutas hacen una propuesta de reflexionar, habitualmente rebajan su autoridad deóntica (p. ej.: adoptan una postura menos poderosa y más colaborativa). Para esto, los terapeutas plantearon las propuestas como interrogaciones, ofrecieron explicaciones e introdujeron sus propuestas con la frase: "Me pregunto". Las propuestas más rebajadas hicieron que la aceptación se destacara menos, arriesgando potencialmente la transición a la reflexión. Estos hallazgos ofrecen mas detalles sobre cómo los conceptos teóricos, como la "colaboración" y el "poder", en realidad se muestran y se negocian en la práctica, y pueden contribuir a una comprensión más matizada de lo que constituye el diálogo abierto.

Implementing Open Dialogue approaches: A scoping review.

Open Dialogue approaches fall broadly into the area of systemic psychotherapeutic practices. They encourage active participation of families and social networks, and emphasize genuine collaboration within highly integrated systems of health-care service delivery. These approaches are currently being implemented in a growing number of services across the globe, and in this review, we summarize and discuss insights from papers concerned with the implementation of Open Dialogue. We used a scoping review method, which included systematic literature searches and summarizing data extraction as well as consultation with eight Open Dialogue implementation stakeholders who were invited to comment on preliminary review findings and a draft paper. We included 18 studies in the review and present their content under four thematic headings: 1. Training, 2. Family and network experiences, 3. Staff members' experiences, and 4. Structural and organizational barriers and resistance to implementation. In general, the studies did not include rich descriptions of the implementation contexts, which made it difficult to draw conclusions across studies about effective implementation practices. The discussion draws on Jamous and Peloille's (Professions and professionalisation, 1970, Cambridge University Press, 109-152) concepts of "indeterminacy" and "technicality," and we argue that the indeterminacy that dominates Open Dialogue is a challenge to implementation efforts that favor specific and standardized practices. We conclude by encouraging the development of implementation initiatives that theorize Open Dialogue practices with higher levels of technicality without corrupting the fundamental spirit of the approach.

Los métodos de diálogo abierto (Open Dialogue) pertenecen ampliamente al área de las prácticas psicoterapéuticas sistémicas. Estos fomentan la participación activa de las familias y los contactos sociales, y enfatizan la colaboración genuina dentro de los sistemas sumamente integrados de prestación de servicios de asistencia sanitaria. Estos métodos se están implementando actualmente en un número cada vez mayor de servicios en todo el mundo y, en esta revisión, resumimos y debatimos los conocimientos obtenidos de artículos relativos a la implementación del diálogo abierto. Utilizamos un método de revisión exploratoria, que incluyó búsquedas sistemáticas de publicaciones y resúmenes de extracción de datos, así como consultas con ocho partes interesadas en la implementación del diálogo abierto, a quienes se las invitó a comentar sobre los resultados preliminares de la revisión y sobre un borrador del artículo. Incluimos 18 estudios en la revisión y presentamos su contenido en cuatro títulos temáticos: 1. Capacitación, 2. La familia y las experiencias de contacto social, 3. Las experiencias de los miembros del personal, y 4. Los obstáculos estructurales y organizativos y la resistencia a la implementación. En general, los estudios no incluyeron descripciones valiosas de los contextos de implementación, lo cual dificultó la posibilidad de sacar conclusiones entre los estudios con respecto a las prácticas eficaces de implementación. En el debate se utilizan los conceptos de "indeterminación" y "tecnicidad" de Jamous y Peloille's (1970), y argumentamos que la indeterminación que domina el diálogo abierto supone un desafío para los esfuerzos de implementación que favorecen prácticas específicas y estandarizadas. Finalizamos fomentando el desarrollo de iniciativas de implementación que teorizan las prácticas de diálogo abierto con niveles más altos de tecnicidad sin alterar el espíritu fundamental del método.

Physical activity and cognition in young-onset Parkinson's disease.

BACKGROUND: A relationship has been observed between physical activity and cognition in older-onset Parkinson's disease, as well as improvements in cognition after a physical activity intervention. To date, this has not been investigated in young-onset Parkinson's disease (YOPD). OBJECTIVES: To examine the baseline relationship between physical activity and cognition in YOPD; and to examine whether a physical activity intervention can improve cognition in YOPD. METHODS: Two interrelated online studies were conducted. In the first study, 132 participants with YOPD completed self-reported measures of physical activity, and objective and subjective measures of cognition. A subset of 38 participants was then randomly allocated to either a six-week physical activity intervention or control condition. Following the intervention, participants repeated the objective and subjective cognitive measures. RESULTS: No relationship was found between self-reported physical activity and objective cognition; however, there was a relationship between physical activity and subjective cognition. Similarly, following the intervention subjective improvements were found for concentration, attention, and processing speed, but not for memory. Furthermore, medium effect sizes were evident for objective measures of processing speed and small-medium effect sizes for planning and cognitive flexibility, although statistical significance was not reached. CONCLUSIONS: In this first study investigating physical activity and cognition in YOPD, the results suggest that increased physical activity relates to improved processing speed and attention. Replication is recommended with a larger sample size. A longer, more intense physical activity manipulation and utilizing the study's strengths of online recruitment and intervention delivery are also recommended.

Conversation Analysis and Family Therapy: A Critical Review of Methodology.

This article critiques the use of conversation analysis (CA) as applied to the study of family therapy. Searches of relevant databases and journals as well as citation searches were conducted in April 2018 for relevant articles. Inclusion criteria included the explicit use of CA either solely or in combination with discourse analysis and discursive psychology. This resulted in the inclusion of 25 articles that were reviewed against a guideline for the evaluation of qualitative research to which five items specific to CA were added to ensure a specific and balanced evaluation of the studies. Articles generally had a good application of quality criteria although there was a variation in detail of transcription, application of sequence analysis, and a limited use of validity testing. CA has the potential to complement existing research on family therapy but requires a rigorous application of process and quality criteria. The article provides recommendations for future CA research into family therapy.

Este artículo analiza el uso del análisis de la conversación (CA) según se aplica al estudio de la terapia familiar. En abril de 2018 se realizaron búsquedas en bases de datos y revistas relevantes así como búsquedas de citas para artículos relevantes. Los criterios de inclusión incluyeron el uso explícito del análisis de la conversación, ya sea exclusivamente o combinado con el análisis del discurso y la psicología discursiva. Esto resultó en la inclusión de 25 artículos que se revisaron según una guía para la evaluación de la investigación cualitativa a la cual se agregaron cinco puntos específicos del análisis de la conversación para garantizar una evaluación específica y equilibrada de los estudios. Los artículos generalmente tuvieron una buena aplicación de los criterios de calidad, aunque hubo una variación en el detalle de la transcripción, la aplicación del análisis de secuencias y un uso limitado de la evaluación de la validez. El análisis de la conversación tiene el potencial de complementar las investigaciones existentes sobre terapia familiar, pero exige una aplicación rigurosa de los criterios de procesamiento y calidad. El artículo ofrece recomendaciones para futuras investigaciones sobre el análisis de la conversación en la terapia familiar.

Making sense of self in Alzheimer's disease: reflective function and memory.

OBJECTIVE: The current investigation examined the relationship between cognitive impairment and sense of self in Alzheimer's disease (AD). METHOD: Forty-nine participants with dementia associated with AD were recruited through memory clinics in Victoria, Australia. The 26 participants of the healthy control sample were recruited from a retirement village. Self was measured via the Reflective Self-Function Scale - a theory of mind indicator that provides personal and social self-reflection scores. Cognitive assessment included measures of new learning, executive function, and speed of information processing. RESULTS: A reduction in sense of self in mild AD was demonstrated in both personal and social domains, as compared to healthy adults of a similar age. With a focus on specific cognitive impairment relationships, new learning was found to predict personal self-reflection, whereas speed of information processing predicted social self-reflection capacity. CONCLUSION: Findings suggest that deficits in new learning ability contribute to a reduced ability of people with early AD to understand their mental world and interpret thoughts, feelings, and beliefs about themselves. This impaired capacity to self-reflect will be intrusive in daily activities that require monitoring of current self-performance. Furthermore, with reduced speed of information processing found to impact on ability to reflect on social relations, individuals with AD are placed at risk of reduced ability to understand their social world, including communicating and interacting with others. Notwithstanding the overall group findings, individual variability was evident which reinforces the need for person-centred care in dementia.

Naturalistic prospective memory in older adults: Predictors of performance on a habitual task.

Age-related difficulties in episodic prospective memory (PM) are common. However, little is known about habitual PM, which involves remembering to carry out intended actions that are regular and repeated. This is important for many health-related tasks and for maintaining independence in daily living activities. This study investigates, in older people, the predictors of habitual PM performance in a naturalistic setting. A group of 191 community-based, older adults (aged 65-89 years) wore an actigraph over two weeks. The habitual PM task involved pressing a button twice daily (Bed-time, Rise-time) on the actigraph. Accuracy of response was calculated for Bed-time and Rise-time, determined by light, movement, and diary data. The contribution of retrospective memory and executive function to PM performance was assessed. PM was more accurate at Bed-time compared to Rise-time (p < .01), and better in the first compared to the second week (p < .01). Retrospective memory contributed small but significant unique variance (ß = .24) to PM accuracy. For older adults living in the community, both contextual factors (e.g., time of day) and retrospective memory are important for individuals' ability to remember to perform daily tasks. This is relevant when planning interventions for maintaining independent living in ageing.

Objective but not subjective sleep predicts memory in community-dwelling older adults.

Research on the relationship between habitual sleep patterns and memory performance in older adults is limited. No previous study has used objective and subjective memory measures in a large, older-aged sample to examine the association between sleep and various domains of memory. The aim of this study was to examine the association between objective and subjective measures of sleep with memory performance in older adults, controlling for the effects of potential confounds. One-hundred and seventy-three community-dwelling older adults aged 65-89 years in Victoria, Australia completed the study. Objective sleep quality and length were ascertained using the Actiwatch 2 Mini-Mitter, while subjective sleep was measured using the Pittsburgh Sleep Quality Index. Memory was indexed by tests of retrospective memory (Hopkins Verbal Learning Test - Revised), working memory (n-back, 2-back accuracy) and prospective memory (a habitual button pressing task). Compared with normative data, overall performance on retrospective memory function was within the average range. Hierarchical regression was used to determine whether objective or subjective measures of sleep predicted memory performances after controlling for demographics, health and mood. After controlling for confounds, actigraphic sleep indices (greater wake after sleep onset, longer sleep-onset latency and longer total sleep time) predicted poorer retrospective (∆R(2)  = 0.05, P = 0.016) and working memory (∆R(2)  = 0.05, P = 0.047). In contrast, subjective sleep indices did not significantly predict memory performances. In community-based older adults, objectively-measured, habitual sleep indices predict poorer memory performances. It will be important to follow the sample longitudinally to determine trajectories of change over time.

Mild traumatic brain injury in older adults: early cognitive outcome.

Severe traumatic brain injury (TBI) in older age is associated with high rates of mortality. However, little is known about outcome following mild TBI (mTBI) in older age. We report on a prospective cohort study investigating 3 month outcome in older age patients admitted to hospital-based trauma services. First, 50 mTBI older age patients and 58 orthopedic controls were compared to 123 community control participants to evaluate predisposition and general trauma effects on cognition. Specific brain injury effects were subsequently evaluated by comparing the orthopedic control and mTBI groups. Both trauma groups had significantly lower performances than the community group on prospective memory (d=0.82 to 1.18), attention set-shifting (d=-0.61 to -0.69), and physical quality of life measures (d=0.67 to 0.84). However, there was only a small to moderate but non-significant difference in the orthopedic control and mTBI group performances on the most demanding task of prospective memory (d=0.37). These findings indicate that, at 3 months following mTBI, older adults are at risk of poor cognitive performance but this is substantially accounted for by predisposition to injury or general multi-system trauma.

The role of metacognitive beliefs in the proneness to hallucinations and delusions: an analysis across clinical and non-clinical populations.

OBJECTIVES: This study explored specific and differential effects of metacognitive beliefs on proneness to both hallucinations and delusions in a general population sample, including a control for the alternate symptom. The study then examined whether similar findings were reproduced in a sample of people with psychotic disorders. DESIGN: Linear and hierarchical regressions were used to determine the role of metacognitive beliefs in the proneness to symptoms, whilst ANCOVAs analysed group differences. METHODS: Participants were recruited to a non-clinical sample (N = 133) and a psychosis sample (N = 100). Both groups completed the Launay-Slade Hallucinations Scale-Revised (Laroi et al., ; Eur. Psychiatry, 19, 15), the Peters Delusions Inventory (Peters et al., ; Schizophr. Bull., 25, 553), and the Metacognitions Questionnaire-30 (Wells & Cartwright-Hatton, ; Behav. Res. Ther., 42, 385). RESULTS: Metacognitions were predictive of both hallucination- and delusion-proneness in the non-clinical sample. Controlled analyses in the non-clinical sample revealed specific effects: low cognitive confidence (CC) predicted hallucination-proneness, whilst negative beliefs about the uncontrollability and danger of thoughts (NBUD) predicted delusion-proneness. Mean ratings on NBUD, low CC, and need to control thoughts were elevated in the psychosis sample; however, after controlling for comorbid symptoms, no metacognitive belief predicted symptom-specific vulnerability in the clinical sample. CONCLUSIONS: The pattern of findings provided little support for Morrison's theoretical model of symptom-proneness. Metacognitive beliefs may be related to sub-acute vulnerability to psychosis symptoms; however, the specificity of the relationship between individual metacognitive beliefs and positive psychosis symptoms appeared no longer significant in psychosis patients. The possibility that these metacognitive beliefs are evoked by psychotic experiences, rather than primarily functioning as a driver of them, warrants greater attention. CLINICAL IMPLICATIONS: Metacognitive beliefs appear at least equally associated with delusion-proneness as hallucination-proneness. Negative metacognitive beliefs appear more central to delusion-proneness than hallucination-proneness in the general population. When controlling for alternate symptom, no individual metacognitive belief appears reliably able to predict symptom-proneness in psychosis patients. LIMITATIONS: Consistent with existing literature on metacognitions in psychosis, this study adopted a cross-sectional design, meaning we were unable to determine the causal direction of the observed associations between metacognitive beliefs and symptom-proneness. Although a strength of this study design was its control for alternate psychotic symptoms, we did not control for non-psychotic symptoms, particularly, anxiety and depression. The symptom measures used were developed primarily for assessment of psychosis-proneness within the general population; thus, their use by people with established psychosis may have been less sensitive to clinical manifestations of these phenomena.

Clinical measures of prospective memory in amnestic mild cognitive impairment.

Recent research has established that individuals with amnestic mild cognitive impairment (aMCI) have impaired prospective memory (PM); however, findings regarding differential deficits on time-based versus event-based PM have been less clear. Furthermore, the diagnostic utility of PM measures has received scant attention. Healthy older adults (n = 84) and individuals with aMCI (n = 84) were compared on the Cambridge Prospective Memory Test (CAMPROMPT) and two single-trial event-based PM tasks. The aMCI participants showed global impairment on all PM measures. Measures of retrospective memory and complex attention predicted both time and event PM performance for the aMCI group. Each of the PM measures was useful for discriminating aMCI from healthy older adults and the time- and event-based scales of the CAMPROMPT were equivalent in their discriminative ability. Surprisingly, the brief PM tasks were as good as more comprehensive measures of PM (CAMPROMPT) at predicting aMCI. Results indicate that single-trial PM measures, easily integrated into clinical practice, may be useful screening tools for identifying aMCI. As PM requires retrospective memory skills along with complex attention and executive skills, the interaction between these skills may explain the global PM deficits in aMCI and the good discriminative ability of PM for diagnosing aMCI.

Modelling the emergence of hallucinations: early acquired vulnerabilities, proximal life stressors and maladaptive psychological processes.

BACKGROUND: The study aimed to expand upon existing findings on the vulnerability to psychosis by examining synergistic models of hallucination emergence. Hypothesised vulnerability factors were separated into three stages of vulnerability; early acquired and enduring vulnerabilities (heredity, childhood trauma, early cannabis use), proximal life stressors (life hassles) and psychological appraisals/coping (metacognitions/experiential avoidance). METHODS: Participants were recruited to a non-clinical sample (N = 133) and a clinical sample of psychosis patients (N = 100). RESULTS: Path analyses in the non-clinical sample indicated that experiences of childhood emotional trauma, in combination with subsequent experiences of life hassles, best predicted vulnerability to both hallucinations in general and auditory hallucinations specifically. This pathway was partially mediated by negative metacognitions. The models were then replicated in the clinical sample, with two notable differences: (1) childhood sexual trauma replaced childhood emotional trauma as the best enduring predictor in the clinical model. (2) Experiential avoidance replaced metacognitions as the best cognitive predictor of hallucinations. CONCLUSIONS: The study's findings highlighted how vulnerability to hallucinations can occur developmentally across time, with early acquired vulnerability factors, combining additively with more proximal day-to-day factors and cognitive style, to propel a person further towards the formation of hallucinations.

Process modelling and techno economic analysis for optimal design of integrated electrocoagulation-membrane system for dye removal in wastewater.

Textile industry, one of the largest exporting industries in Malaysia, generates azo dyes wastewater which cannot be easily decomposed biologically due to its high stability and xenobiotic nature. Conventional electrocoagulation (EC) system requires high energy consumption, resulting in higher operating cost while membrane system suffers from fouling. To eliminate these drawbacks, an integrated electrocoagulation - membrane (ECM) system has been proposed as one of the emerging methods for treating dye wastewater. However, feasibility analysis of the proposed system is yet to be conducted. This study proposes a statistical technique to evaluate the techno-economic feasibility of the system via John's Macintosh Project (JMP) software. From JMP, an equation represents the whole model had been obtained for each of the system, EC standalone and ECM system. The models have been validated experimentally it is proven all the models can reach dye removal efficiency of 96%. Overall, the total cost for ECM system (1 V and 1.0 g of NaCl) was 40.44% cheaper than the conventional dye treatment method with total cost of 1.079 million MYR. EC standalone system at 1 V and 1.0 g however were found to be more economically feasible with 0.325 million MYR or 82.07% cheaper compared to conventional photocatalytic method. EC standalone system was also more economical than ECM system due to lower capital cost expended for installation of membrane tank and additional membrane purchase.

Eliciting Stance and Mitigating Therapist Authority in Open Dialogue Meetings.

Open Dialogue is a collaborative systemic approach to working with families in crisis. A core feature is the creation of dialogue through the elicitation of a multiplicity of voices. Using conversation analysis, we studied 14 hr of Open Dialogue sessions. We found that therapists recurrently produced utterances containing "I'm wondering." These utterances topicalized particular issues and invited stance positions from other participants while also allowing the therapist to mitigate their deontic authority and present potentially disaligning stances. Therapists thus exercised authority in eliciting stances, but provided recipients with multiple avenues for responding. These findings illustrate that therapist authority is not necessarily antithetical to dialogue and, in well-crafted forms, may even be necessary for the creation of polyphony through the elicitation of multiple stances.

Learning and memory in amnestic mild cognitive impairment: contribution of working memory.

In addition to deficits in delayed recall, recent research suggests that participants with amnestic mild cognitive impairment (aMCI) demonstrate diminished use of strategic encoding strategies during learning. Few studies have explored the cognitive mechanisms underlying this deficit. The aim of this study was to investigate in aMCI whether components of working memory (executive attention--attention set-shifting, dividing and focusing attention; and episodic buffer functions--strategic retrieval and manipulation of information) predict strategic encoding strategies during learning (semantic clustering). Thirty-three participants with aMCI and 33 healthy older adults (HOA) were administered neuropsychological tests assessing word-list learning and working memory. The aMCI group demonstrated significant impairment in acquisition, retrieval of information, and decreased use of semantic clustering strategies. Use of semantic clustering in the aMCI group was not predicted by measures of executive attention or phonemic verbal fluency, but was predicted by semantic verbal fluency performance. In the HOA group, semantic clustering was strongly related to semantic verbal fluency. These findings suggest that in aMCI, diminished strategic encoding strategies during learning (semantic clustering) is selectively related to the strategic function of the episodic buffer, but only when in interaction with the manipulation and retrieval of semantic associations.

Mediators of burden and depression in dementia family caregivers: Kinship differences.

OBJECTIVES: To investigate kinship differences in the caregiver stress process by developing multiple mediation models for two distinct caregiver subgroups (spouses and adult children of older adults living with dementia). The effect of four potential mediating variables (mastery, self-efficacy, satisfaction with social support, positive caregiving appraisals) on the relationship between perceived burden and depression was evaluated. METHOD: Family caregivers of a person living with dementia were recruited through national dementia and carer organisations. Participants completed a paper-based or electronic version of the study survey. A bias-corrected, accelerated bootstrapping method was used to test the effect of the four proposed mediating variables on the relationship between perceived burden and depression in each caregiver subgroup (spouses and adult children). RESULTS: Perceived burden was directly and significantly related to depression for both spouse caregivers and adult child caregivers. The mediation models explained approximately 50% of the variance in the burden-to-depression pathway for both caregiver subgroups. Mastery and social support (but not self-efficacy, nor positive caregiving appraisals) were found to individually significantly influence the impact of perceived burden on depression in spouse caregivers. All four proposed mediators failed to reach statistical significance as individual mediators of the burden-to-depression pathway in adult child caregivers. CONCLUSION: These findings demonstrate differences in the dementia caregiver experience according to kinship, and that certain mediating variables are more relevant for some subgroups of caregivers than others. Implications for the design of psychosocial interventions are discussed.

"Y, what do you think about what X just said?" Conversation analysis of stance-eliciting questions in open dialogue network meetings.

Open dialogue is a resource-oriented approach to mental health, which aims to help those involved in a crisis situation support each other and engage in dialogue. While language use in open dialogue is generally characterized as being open-ended, nondirective, and nonevaluating on the professionals' side, little is known about the specific conversational features. The aim of this study was to analyze the interactional functions of a stance-eliciting question of the form: "Y, what do you think about what X just said?" We used conversation analysis (CA) to examine this in eight video-recorded Danish open dialogue network meetings. In CA, stance involves expressions of attitude, affect, or judgments about people or events. We describe the interactional functions of these stance-eliciting questions and discuss how clinicians used them as a tool for accomplishing neutrality. The findings can be used to gain a more nuanced understanding of open dialogue psychotherapeutic practices.