Parental Reflective Functioning on the Parent Development Interview: A narrative review of measurement, association, and future directions.

A caregiver's capacity to mentalize is thought to be one of the most important features of secure parent-child relationships. Parental mentalizing can be measured using the Reflective Functioning (RF) coding system applied to the Parent Development Interview (PDI). In this narrative review, we summarize the research using this measure and synthesize what has been learnt about the predictors, correlates and sequelae of parental RF. Studies have consistently shown that PRF on the PDI is associated with both parent and child attachment and is an important factor in the intergenerational transmission of attachment. It is also related to the quality of parental representations, parent-child interactions, and child outcomes. While a number of social and clinical risk factors are associated with lower PRF, it is difficult to disentangle the unique contribution of each of these. We discuss these findings and present the direction of future work that is planned to expand and refine the PRF scale for the PDI.

Se piensa que la capacidad que tiene una persona que presta el cuidado para mentalizarse es una de las más importantes características de una segura relación entre progenitor y niño. La mentalización del progenitor se puede medir usando el sistema de codificación del Funcionamiento con Reflexión (RF) aplicado a la Entrevista de Desarrollo al Progenitor (PDI; Slade et al., 2004a; 2004b). En esta revisión narrativa, resumimos la investigación usando esta medida y sintetizamos lo que se ha aprendido acerca de los factores de predicción, las correlaciones y secuelas del RF del progenitor. Los estudios han mostrado consistentemente que el RF del progenitor (PRF) en la PDI se asocia tanto con la afectividad del progenitor como con la del niño y es un factor importante en la transmisión intergeneracional de la afectividad. También está relacionado con la calidad de las representaciones del progenitor, las interacciones progenitor­niño y los resultados en el niño. Mientras que un número de factores de riesgo sociales y clínicos se asocia con un PRF más bajo, es difícil desentrañar las contribuciones únicas de cada uno de estos aspectos. Discutimos estos resultados y presentamos la dirección del trabajo futuro que se planea para expandir y refinar la escala del PRF para la PDI.

Examining the relationship between parents' self-reported mindfulness and observed language use in attachment-relevant communication.

Parents' language use is an important context for early socialization. We examined the relationship between parents' self-reported mindfulness and observed language use in two forms of attachment-relevant communication. Sixty-three parents of 6-18-month-old infants from Australia (n = 32) and New Zealand (n = 31) completed the five facets of mindfulness-short form (FFMQ-SF) questionnaire, the adult attachment interview (AAI), and a 10-min play session with their infant. We examined parents' frequency of word usage within the categories of the linguistic inquiry word count (LIWC) text analysis program to explore the relationship between mindfulness and language use. Mindfulness was associated with cognitive, affective, perceptual, and time orientation language use in the AAI. However, fewer associations were identified between mindfulness and language use in the parent-infant play session. Results are discussed in terms of their relevance to mindfulness and attachment.

El uso del lenguaje por parte de los padres es un contexto importante para la temprana socialización. Examinamos la relación entre la auto reportada atención consciente de los padres y el observado uso del lenguaje en dos formas de comunicación relevantes a la unión afectiva. Sesenta y tres progenitores de infantes entre 6 y 18 meses de edad de Australia (n = 32) y Nueva Zelanda (n = 31) completaron el cuestionario de Cinco Facetas de la Atención Consciente en su formato corto (FFMQ­SF), la Entrevista de la Afectividad Adulta (AAI), así como una sesión de juego de diez minutos con sus infantes. Examinamos la frecuencia del uso de palabras por parte de los padres dentro de las categorías del programa de análisis de texto Investigación Lingüística del Conteo de Palabras (LIWC) para explorar la relación entre la atención consciente y el uso del lenguaje. Se asoció la atención consciente con el uso del lenguaje cognitivo, afectivo, perceptivo y con orientación del tiempo de la AAI. Sin embargo, menos asociaciones se identificaron entre la atención consciente y el uso del lenguaje en la sesión de juego entre progenitor e infante. Los resultados se discuten en términos de su relevancia para la atención consciente y la afectividad.

Effectiveness of a training program for the management of risky alcohol use in primary care professionals based on motivational interviewing.

OBJECTIVE: To assess the effectiveness of a training program for Primary Care (PC) professionals developed to increase knowledge, attitudes, and skills for managing patients with risky alcohol use and in the motivational interview. DESIGN: Multicenter, two-arm parallel, randomized, open-label controlled clinical trial. SETTING: PC of the Andalusian Health Service. PARTICIPANTS: The study was completed by 80 healthcare professionals from 31 PC centers. INTERVENTIONS: In both experimental and control groups, a workshop on managing patients with risky alcohol consumption and the resolution of two videotaped clinical cases with standardized patients were conducted. The experimental group attended a workshop on motivational interviewing. MAIN MEASUREMENTS: Knowledge about managing risky alcohol use, clinical performance in patients with this health problem, and assessment of the motivational interview. RESULTS: Mean age was 39.50±13.06 - SD - (95% CI: 36.59-42.41); 71.3% (95% CI: 61.1-80.9%) were women. The average score of both groups in the knowledge questionnaire before the training program was 15.10±4.66, becoming 21.99±3.93 points after the training (95% CI: 5.70-7.92; p<0.001). The experimental group showed an average score of 18.53±13.23 before the intervention with the motivational interview and 28.33±11.86 after this intervention (p=0.002). In contrast, no significant variation was found in the score of the control group. CONCLUSIONS: A training program aimed at PC professionals designed to increase knowledge on how to manage risky alcohol use and acquire communication skills in motivational interviewing is effective.

Hostile-helpless states of mind: A scoping review of risk factors, correlates, and consequences.

Chronic relational trauma can lead to the formation of pervasively unintegrated attachment representations in adulthood, referred to as Hostile-Helpless (HH) states of mind. Individuals with this type of attachment disorganization evidence conflicting evaluations of caregivers and have difficulty reflecting on their traumatic childhood experiences. This scoping review is the first to systematically integrate the results of all empirical studies on HH states of mind in an effort to highlight the scientific and clinical contributions of the concept and guide future research. Following Arksey and O'Malley's (2005) Methodological Framework, cross-reference keywords were searched in three databases (PsycArticles, Psychology and Behavioral Sciences Collection, ProQuest). In total, 19 studies met inclusion criteria and were included in the synthesis. Results suggest that prevalence rates of HH states of mind increase as a function of adults' psychosocial risk status. Findings also reveal that the long-term consequences of early trauma are greater in the presence of a HH state of mind, whereas the absence of a HH state of mind acts as a protective factor against the intergenerational transmission of maladaptation. Finally, results support the discriminant validity of the HH classification against other forms of attachment disorganization in adulthood. Research gaps and future research directions are discussed.

El trauma crónico de la relación puede llevar a la formación de representaciones de afectividad profundamente desintegradas en la edad adulta, conocidas como estados mentales Hostiles-Sin Ayuda. Los individuos con este tipo de afectividad desorganizada demuestran evaluaciones conflictivas de quienes les cuidan y tienen dificultades para reflexionar acerca de sus experiencias traumáticas de niñez. Este estudio de alcance comprensivo es el primero en integrar sistemáticamente los resultados de todos los estudios empíricos acerca de los estados mentales Hostiles-Sin Ayuda como un esfuerzo para subrayar las contribuciones científicas y clínicas del concepto y guiar la investigación futura. Siguiendo el Marco de Trabajo Metodológico de Arksey y O'Malley's (2005), se investigaron palabras claves con enlaces de referencia en tres bases de datos (PsycArticles, Colección de Psicología y Ciencias del Comportamiento, ProQuest). En total, 19 estudios reunieron los criterios de inclusión y se les incluyó en la síntesis. Los resultados indican que los puntajes prevalentes de los estados mentales Hostiles-Sin Ayuda aumentan como una función del riesgo sicosocial de los adultos. Los resultados también revelan que las consecuencias a largo plazo del trauma temprano son mayores en presencia de un estado mental Hostil-Sin Ayuda, mientras que la ausencia de un estado mental Hostil-Sin Ayuda actúa como un factor de protección contra la transmisión intergeneracional de mal adaptación. Finalmente, los resultados apoyan la validez discriminante de la clasificación Hostil-Sin Ayuda contra otras formas de desorganización de la afectividad en la edad adulta. Se discuten los vacíos y el futuro de la investigación.

Le trauma relationnel chronique peut mener à la formation de représentations de l'attachement non intégré omniprésent à l'âge adulte, auquel on fait référence en tant qu'états d'esprit Hostile-Impuissant. Les individus avec de type de désorganisation d'attachement font état d'évaluations contradictoires des personnes prenant soin d'eux et ont des difficultés à réfléchir à leurs expériences traumatiques durant l'enfance. Ce passage en revue est le premier à systématiquement intégrer les résultats de toutes les études empiriques sur les états d'esprit Hostile-Impuissant pour essayer de mettre en évidence les contributions scientifiques et cliniques du concept et guider les recherches futures. En suivant la structure méthodologique de Arksey et O'Malley (2005) les mots clés de référence croisée ont fait l'objet d'une recherche dans trois bases de données (PsycArticles, Psychology and Behavioral Sciences Collection, ProQuest). Au total 19 études ont rempli les critères d'inclusion et ont été inclues dans la synthèse. Les résultats suggèrent que les taux de prévalence d'états d'esprit Hostile-Impuissant augmentent en tant que fonction du statut de risque psychologique des adultes. Les résultats révèlent aussi que les conséquences à long terme du trauma précoce sont plus grandes en présence d'un état d'esprit Hostile-Impuissant, alors que l'absence d'état d'esprit hostile-Impuissance agit en tant que facteur protecteur contre la transmission intergénérationnel de mal-adaptation. Enfin, les résultats soutiennent la validité discriminante de la classification Hostile-Impuissant par rapport à d'autres formes de désorganisation de l'attachement à l'âge adulte. Les écarts dans les recherches et des directions futures de recherches sont discutés.

Measuring mothers' representations of their infants: Psychometric properties of the clinical scales of the working model of the child interview in a low- to moderate-risk sample.

The Working Model of the Child Interview (WMCI) is frequently used to measure parents' representations. Beyond the global categories (balanced, disengaged, distorted), the reliability, factor structure, and validity of all the 15 clinical scales have not previously been studied. The WMCI was administered to 152 Norwegian mothers of infants (mean age = 7.3 months) recruited from community well-baby clinics. Interrater reliability was adequate for the global categories and moderate for the clinical scales. Exploratory factor analysis and confirmatory factor analysis yielded three factors with evidence of factorial validity: Factor 1 balanced; factor 2 resentful; factor 3 apprehensive. Factor 1 corresponded with the original category balanced, while factor 2 and factor 3 corresponded with the original category distorted. Concurrent validity was supported as mothers with balanced representation (factor 1) were less stressed and the mother-infant interaction was more positive than that of mothers with resentful representation. Mothers with resentful or apprehensive representations (factor 2 and factor 3) reported more stress. The extracted factors and demographic variables correlated weakly or not at all, confirming discriminant validity. Our findings show that the clinical scales of the WMCI can be used in research with low- to moderate-risk samples.

El Modelo de Trabajo de la Entrevista del Niño (WMCI) se usa frecuentemente para medir las representaciones de los progenitores. Más allá de las categorías globales (equilibradas, desconectadas, distorsionadas), la confiabilidad, la estructura de factores y la validez de todas las 15 escalas clínicas no han sido previamente estudiadas. Se les administró el WMCI a 152 madres noruegas de infantes (edad media = 7.3 meses) reclutadas de clínicas comunitarias para el bienestar del bebé. La confiabilidad entre los evaluadores fue adecuada para las categorías globales y moderada para las escalas clínicas. Los análisis exploratorios de factores (EFA) y los análisis confirmatorios de factores (CFA) produjeron tres factores con evidencia de validez factorial: Factor 1) equilibradas; factor 2) resentidas; factor 3) aprensivas. El factor 1 se correspondió con la categoría original de equilibradas, mientras que el factor 2 y el factor 3 se correspondieron con la categoría original de distorsionadas. La validez concurrente encontró apoyo en que las madres con una representación equilibrada (factor 1) estaban menos estresadas y la interacción madre-infante fue más positiva que la de las madres con representaciones resentidas. Las madres con representaciones resentidas o aprensivas (factor 2 y factor 3) reportaron más estrés. Los factores extraídos y las variables demográficas se correlacionaron débilmente o no se correlacionaron del todo, lo cual confirma la validez discriminante. Nuestros resultados muestran que las escalas clínicas del WMCI pueden usarse en la investigación con grupos muestras de bajo a moderado riesgo.

Le Modèle Fonctionnel de l'Entretien de l'Enfant (WMCI en anglais) est fréquemment utilisé pour mesurer les représentations des parents. Au-delà des catégories globales (équilibré, désengagé, déformé), la fiabilité, la structure de facteur et la validité de toutes les 15 échelles cliniques n'ont pas été étudiées jusqu'à présent. Le WMCI a été donné à 152 mères de nourrissons norvégiennes (âge moyen = 7,3 mois) recrutées dans des cliniques de bien-être du bébé communautaires. La fiabilité entre les évaluateurs était adéquate pour les catégories globales et modérée pour les échelles cliniques. L'Analyse Factorielle Exploratoire (AFE) et l'Analyse Factorielle de Confirmation (AFC) ont produit trois facteurs avec une preuve de validité factorielle: Facteur 1) équilibré; facteur 2) rancunier; facteur 3) appréhensif. Le facteur 1 correspondait à la catégorie originale balancé, alors que le facteur 2 et le facteur 3 correspondaient à la catégorie originale déformé. La validité simultanée a été confirmée puisque les mères avec une représentation équilibrée (facteur 1) étaient moins stressées et l'interaction mère-bébé était plus positive que celle des mères avec une représentation rancunière. Les mères avec des représentations rancunières ou appréhensives (facteur 2 et facteur 3) ont fait état de plus de stress. Les facteurs extraits et les variables démographiques se sont faiblement corrélés ou pas du tout, confirmant une validité discriminante. Nos résultats montrent que les échelles cliniques du WMCI peut être utilisée dans les recherches avec des échantillons à risque faible à modéré.

The assessment of representational risk (ARR): Development and psychometric properties of a new coding system for assessing risk in the parent-infant relationship.

There are few clinically valid tools that can be used to assess potential parent-infant relational risk. This study describes the development and initial validation of the assessment of representational risk (ARR) coding system to be applied to the parent development interview (Slade, A., Aber, J. L., Bresgi, I., Berger, B., & Kaplan, M. (2004). The Parent Development Interview - Revised. Unpublished protocol. New York, NY: The City University of New York.) for assessing potential risk in caregivers' representations of their infant, themselves as parents, and their relationship. The ARR was developed and validated in three samples in England. A review of the literature informed the selection of 10 items. It had a three-factor structure that was used to inform subscales: hostile, helpless, and narcissistic caregiving representations. The subscales and total risk scores showed good criterion validity for discriminating between high and low risk samples and good concurrent validity with measures of parental psychopathology and parent-infant interaction. The ARR is a potentially valuable coding system for identifying risk in early attachment relationships.

Hay pocas herramientas clínicamente válidas que pueden usarse para evaluar los posibles riesgos en la relación progenitor-infante. Este estudio describe el desarrollo y la convalidación inicial de la Evaluación del Riesgo Representacional (ARR), un sistema de codificación para aplicarse a la Entrevista del Desarrollo del Progenitor (PDI; Slade et al., 2004) para evaluar el posible riesgo en las representaciones que los cuidadores tienen de sus infantes, de ellos mismos como padres y de sus relaciones. La ARR se desarrolló y se convalidó en tres grupos muestras en Inglaterra. Una revisión de la información disponible sirvió de base para la selección de 10 puntos. La misma tenía una estructura de tres factores que se usó como base en las subescalas: representaciones para prestar cuidado de tipo Hostil, Desesperanzado y Narcisista. Los puntajes de las subescalas y los totales mostraron buen criterio de validez para diferenciar entre los grupos muestras de alto y bajo riesgo, así como una buena validez concurrente con las medidas de sicopatología de progenitores y la interacción progenitor-infante. La ARR es un sistema de codificación de valor potencial para identificar el riesgo en las tempranas relaciones de afectividad.

Il existe peu d'outils cliniquement valables qui peuvent être utilisés pour évaluer le risque relationnel potentiel parent-nourrisson. Cette étude décrit le développement et la validation initiale du système de codage Evaluation du Risque Représentationnel (abrégé ici ERR en français) destiné à être appliqué à l'Entretien du Développement du Parent (PDI; Slade et al., 2004) pour évaluer le risque potentiel dans les représentations que les parents se font de leur nourrisson, d'elles-mêmes ou d'eux-mêmes en tant que parents, et de leur relation. L'ERR a été développé et validé dans trois échantillons en Angleterre. Une revue des recherches a éclairé la sélection de 10 éléments. Celle-ci a suivi une structure de 3 facteurs qui ont été utilisés pour éclairer les sous-échelles: représentations des parents de l'enfant Hostiles, Impuissantes, Narcissiques. Les Sous-échelles et les scores de risque total ont fait preuve d'une bonne validité du critère pour séparer les échantillons à risque élevé et à faible risque, et d'une bonne validité concurrente avec des mesures de psychopathologie parentale et d'interaction parent-nourrisson. L'ERR s'avère pouvoir être un système de codage utile pour l'identification du risque dans les relations d'attachement précoce.

[Impact of training on Motivational Interviewing (MI) for Family Physicians: Design and assessment of a Training Program (MOTIVA)]. / Impacto de la formación en entrevista motivacional para médicos: diseño y evaluación de un Programa Formativo (MOTIVA).

AIM: To develop a training program in Motivational Interviewing for Family Physicians and assess the impact. STUDY DESIGN: Multicenter, double blind and randomized clinical essay, with 2arms, Experimental (EG) and Control (CG) of Family Physicians with a follow up of 12 months. LOCATION: 32 Primary Healthcare Centers. SAMPLE DESCRIPTION: 54 physicians (CG=28, EG=26). INTERVENTIONS: Training Program MOTIVA in ME with an initial presential course (16h), followed by online activities during 12months, and presential meetings (Problem BasedInterviewing with expert feedback). MAIN MEASUREMENTS: Communicative skills in MI were assessed based on video-recordings (VR) with the EVEM 2.0 scale by peer reviewers. 236 VR with standardized patients and 96 VR with real patients. RESULTS: Average results in EVEM scale (up to 56 points) at the beginning of the study were EG=21.27 (CI 95% 15.8-26.7) and CG=20.23 (CI95% 16.4-23.9) with no differences between both groups (P=.79). After the training, EG punctuation increased by 13.89 points (P<.001), average 35.16 (CI 95% 29.8-40.6). Real patients' VR in EG over a 12 month period keep their MI skills with an average of 36.9 points (CI 95% 30.3-43.6) versus CG 15.9 points (CI 95% 9.8-22.0). Once ended the MOTIVA Training Program, the EG maintains the acquired skills: final average EG=37.6 (CI 95% 33.2-41.1) versus CG=24.3 (CI95% 19.0-29.2) (P<.001). CONCLUSIONS: The MOTIVA Training Program improves Motivational Interviewing skills, significatively improving after a presential course and sequential keep-alive activities. The effectiveness of the Program has been proven in the Third and Fourth steps of Miller's Pyramid.

[Do COPD patients lie about their smoking habit?] / ¿Mienten los pacientes con EPOC sobre su hábito tabáquico?

OBJECTIVE: To determine the deception rate or concordance between the interview on smoking and cooximetry in COPD patients from a monographic consultation. DESIGN: Prospective observational study to evaluate the concordance between the values of cooximetry and the response to a clinical interview on smoking. SETTING: COPD monographic consultation, Pneumology, Seville. PARTICIPANTS: Patients with a confirmed diagnosis of COPD in any degree. INTERVENTIONS: Clinical interview and measurement of carbon monoxide by cooximetry. MAIN MEASUREMENTS: Cooximetry values, responses on smoking, sociodemographic variables. RESULTS: n: 169. 107 patients presented values less than or equal to 6 ppm compared to 62 with values greater than 6 ppm, determining a prevalence of active smoking of 36.7%. The deception rate was 19.5% of the total sample (24.3% of all those who claimed not to smoke), with a Cohen kappa of 0.48 and p < 0.000. 40% of patients confessed not having told the truth. No relationship of this data was found with age, accumulated tobacco consumption or FEV1. A significant relationship with sex was found (deception rate: 31.8% in women vs. 15.2% in men, p 0.017). CONCLUSIONS: In spite of our attempts to make patients stop smoking, a considerable deception rate was found in our consultation; higher among women, recent ex-smokers or in the process of abandonment, so it would be essential to incorporate objective measures such as the cooximeter in the approach of this type of patient.

Specific and common processes as mediators of the long-term effects of cognitive-behavioral therapy integrated with motivational interviewing for generalized anxiety disorder.

OBJECTIVE: A trial of psychotherapy for generalized anxiety disorder (GAD) demonstrated that motivational interviewing (MI) integrated with cognitive-behavioral therapy (CBT) outperformed CBT alone on clients' worry reduction across a 12-month follow-up. In the present study, we hypothesized and tested that less client resistance and greater client-perceived therapist empathy (specific foci of MI) would account for MI's additive effect. Exploratory analyses assessed whether the common processes of homework completion and therapeutic alliance quality mediated the treatment effect. METHOD: Clients with GAD were randomized to 15 sessions of MI-CBT (n = 42) or CBT alone (n = 43). Worry was assessed throughout treatment and follow-up. Observers rated resistance at midtreatment, and clients reported on perceived therapist empathy, alliance, and homework completion throughout treatment. Mediation was tested with bootstrapping methods. RESULTS: Expectedly, MI-CBT clients evidenced less resistance and perceived greater therapist empathy, each of which related to lower 12-month worry. However, when both variables were tested simultaneously, only resistance remained a significant mediator of treatment. No indirect effects through homework completion or alliance emerged. CONCLUSIONS: Reducing client resistance may be a theory-consistent mechanism through which integrative MI-CBT promotes superior long-term improvement than traditional CBT when treating GAD. Clinical or methodological significance of this article: This study further supports the long-term clinical benefit of integrating MI into CBT when treating the highly prevalent and historically difficult-to-treat condition of GAD. In particular, it points to the theory-specific mechanism of MI (helping to reduce/resolve patients' in-treatment resistance) as accounting for the integrative treatment's additive effect on worry reduction across a follow-up period. Therapists using CBT to treat patients with GAD should be trained to incorporate MI principles (e.g., empathy, collaboration, autonomy support) in general and in response to explicit markers of resistance.

Do what you say and say what you are going to do: A preliminary meta-analysis of client change and sustain talk subtypes in motivational interviewing.

Objective: This meta-analysis examines the predictive validity of client change language subtypes in motivational interviewing (MI) sessions addressing addictive behavior change. Method: A systematic review identified k = 13 primary studies, contributing 16 MI conditions (N = 1556). The pooled correlation coefficient was used to assess the significance, direction, and strength of seven language subtypes (i.e., reason, desire, need, ability, commitment, taking steps, and other) by three valences (i.e., frequency positive or change talk, frequency negative or sustain talk, and proportion change talk) and their relationship to subsequent engagement in addictive behavior. Results: For frequency measures, more sustain talk related to reason, desire, ability, and other were associated with more addictive behavior at follow up. Other change talk was associated with MI outcomes but in an unexpected direction (i.e., more addictive behavior). Proportion measures showed more proportion change talk-reason and -other statements were associated with less addictive behavior at follow up. Sensitivity analyses indicated some heterogeneity and instability of effect sizes, but no evidence of publication bias. Conclusions: This preliminary meta-analysis suggests that aggregate measures of change and sustain talk are comprised of statement subtypes that are not equally meaningful in predicting outcome following MI for addictive behavior change.

[Is the individual motivational interviewing effective in overweight and obesity treatment? A systematic review]. / ¿Es efectiva la entrevista motivacional individual en la malnutrición por exceso? Una revisión sistemática de la literatura.

OBJECTIVE: To analyze the effectiveness of individual motivational interviewing (MI) in the ambulatory treatment of the overweight and obese. DESIGN: The protocol of this systematic review is registered in PROSPERO N° CDR42017058814. DATABASES: EBSCO-CINAHL, Pubmed, Scielo, PsycoINFO from 2010 to 2017. STUDY SELECTION: We included studies with overweight and obese adult participants, randomized trial and case control studies, with MI being applied individually and face to face, with primary or secondary results in changes in body composition (weight or BMI), published in English or Spanish, with available text and in peer-reviewed journals. DATA EXTRACTION: We obtained anthropometric, behavioral, psychosocial, and other variables as effects of MI. In addition, we collected descriptive variables of the interventions. RESULTS: Eleven articles were included in this revision. There is a great variability between the studies in terms of population, kind of intervention, and time of follow-up. In most of them, some effect was observed in reducing bodyweight, reaching a maximum of 7kg in the group that received the MI. There are positive variations in psychosocial and metabolic variables in the studies. CONCLUSIONS: Individual MI interventions have a modest effect on the variation of bodyweight, and could have a positive impact on behavioral, psychosocial, and other variables. More studies are needed to elucidate the best form of MI application with regard to effectiveness on different variables. The primary healthcare system is in an advantageous position for generating fruitful research on this motivational strategy.

[Promoting Health Promotion: Medical students perceptions about an educational program on behavioral change in primary care]. / Promocionando la Promoción de la Salud: percepciones de estudiantes de medicina sobre un programa educativo para cambio de conductas en atención primaria.

OBJECTIVE: To evaluate whether a training program offered by family physicians in the official medical curriculum on principles and strategies to help patients change risk behaviours (HPCRB), produces changes in perceptions, opinions, and attitudes regarding this type of intervention. DESIGN: Quasi-experimental before-after study. SETTING: A School of Medicine. PARTICIPANTS: All students in their 4th year (n=110). INTERVENTIONS: Experiential training course on communicative strategies for HPCRB. MEASUREMENTS: Opinions and perceptions were evaluated before and after the course using an ad hoc survey. RESULTS: After the course, students (n=103) changed their ideas about motivation as an 'internal' (15, 13%) to 'internal-external' factor (71, 61%) (P=.003), reinforcing their opinions about the clinician's ability for HPCRB (high: 72, 62%; low: 10, 12%; P=.008). They considered themselves more capable to respect patient autonomy when they make decisions or follow harmful behaviours (easy: 58, 50%; difficult: 28, 24%; P=.001), and increased their perception of their ability to cope with this type of interview (83, 72% vs. 1, 1%; P<.001). CONCLUSIONS: This training course seems to contribute to creating positive perceptions and attitudes in students, as regards key aspects when conducting an interview for HPCRB. This is a key preliminary aspect to implement this type of strategy.

EARLY REGULATION IN CHILDREN WHO ARE LATER DIAGNOSED WITH AUTISM SPECTRUM DISORDER. A LONGITUDINAL STUDY WITHIN THE DANISH NATIONAL BIRTH COHORT.

Studies have shown that children later diagnosed with autism spectrum disorders (ASD) in their first years of life might show symptoms in main developmental areas and that these signs might be sensed by the parents. The present study investigated in a large birth cohort if children later diagnosed with ASD had deviations at 6 and 18 months in areas such as the ability to self-regulate emotions, feeding, and sleeping. The study was based on prospective information collected from 76,322 mothers who participated in the Danish National Birth Cohort. When the children reached an average age of 11 years, 973 children with ASD and a control group of 300 children with intellectual disability (IDnoASD) were identified via Danish health registries. Associations were found between short periods of breast-feeding and the children later diagnosed with ASD and IDnoASD as well as associations at 18 months to deviations in regulation of emotions and activity. The similarities in these associations emphasize how difficult it is to distinguish between diagnoses early in life.

CAN ATTACHMENT INFORM DECISION-MAKING IN CHILD PROTECTION AND FORENSIC SETTINGS?

The historic publication of the "consensus statement" on not using the "D/disorganized" category in the infant Strange Situation (M. Ainsworth, M. Blehar, E. Waters, & S. Wall, 1978) for case-specific child protection work (P. Granqvist et al., 2017) opens the door for a broader discussion of different branches of attachment theory and different attachment classificatory systems applied to infants, young children, and their parents. We agree with the consensus authors that Strange Situation classifications alone, regardless of coding method, are insufficient for decision-making. The authors, however, have acknowledged that the Dynamic-Maturational Model of Attachment and Adaptation (DMM; Crittenden, 2016) offers a different perspective on classifying Strange Situations. The DMM is a branch of attachment theory that expands the Ainsworth A and C classifications across the life span to reflect the complex attachment strategies that some individuals use in dangerous contexts. We contrast the DMM to the D classification, both for the Strange Situation for infants and its adaptation for young children and also for the Adult Attachment Interview (AAI; C. George, N. Kaplan, & M. Main, 1984-1996) for their parents. We initiate a scientific dialogue by addressing three points: (a) "Attachment" does not imply or require a model that includes a D/disorganization category nor is the D/disorganized category the only clinical expansion of Mary Ainsworth's (1978) original work; (b) the DMM method for classifying Strange Situations may be better attuned to parental inadequacy and child protection than is the D/disorganized category; and (c) with attention to guidelines, DMM classifications from the Strange Situation with both infants and preschool-aged children can be used in a case-specific manner in both treatment and forensic settings. The same is true for other DMM assessments of attachment, including the AAI. We close by suggesting steps that could further understanding and application of Ainsworth's great accomplishment: individual differences in attachment relationships.

Admission to Intensive Care for a trauma related to alcohol or drugs, a 'teachable moment' for the beginning of a change. / Ingreso en cuidados intensivos por un traumatismo relacionado con el consumo de alcohol o drogas, un «momento propicio de enseñanza¼ para el inicio del cambio.

OBJECTIVES: To estimate how many of the trauma patients admitted to ICU would be candidates for a secondary prevention programme for trauma related to alcohol or drug use by brief motivational intervention and to define what factors prevent that intervention being performed. METHODS: All 16-70year old trauma patients (n=242) admitted to ICU in 32 non-consecutive months (November 2011 to March 2015) were included in the study, coinciding with the implementation of a screening and brief motivational intervention programme for trauma patients related to substance consumption. The programme includes screening for exposure to substances at admission. Sociodemographic and clinical variables were collected prospectively. RESULTS: The screening for substances was not performed in 38 (15.7%) of all admitted patients. Of the patients screened, 101 (49.5%) were negative. The variables that in greater proportion impeded intervention between screening positive patients were neurological damage due to the trauma with 23 patients (37.1%) and prior psychiatric disorder with 18 (29%). Both variables were associated with substance consumption: negatives 9.9% vs positive 22.3% (P=.001) and negatives 3% vs positive 17.5% (P=.016) respectively. The number of candidates for motivational intervention was 41, 16.9% of all admitted patients. CONCLUSIONS: Almost 2 out of 10 patients were potential candidates. The factors that in a greater proportion precluded the intervention were the same as those associated with consumption. Mortality in ICU was associated with non-compliance with the screening protocol.

Thinking and working relationally: interviewing and constructing hypotheses to create compassionate understanding.

In the initial interviews of family therapy sessions, the therapist faces the challenge of obtaining and organizing the information that is most relevant toward understanding the essential concerns that families and couples bring to therapy. This article describes the process of clinical interviewing and case conceptualization used in training family therapists at the Ackerman Institute for the Family. This approach helps the therapist bring forward, and organize, specific information into relational hypotheses, or systemic-relational conceptualizations, that allow both family members and the therapist to understand presenting problems within their relational contexts. While always provisional, relational hypotheses help anchor the therapist in a systemic-relational frame and provide a conceptual through-line to guide the ongoing work of the therapy. The process of interviewing and the construction of clear and complex conceptualizations of presenting problems are illustrated through case examples.

Conducting a multi family member interview study.

Family researchers have long recognized the utility of incorporating interview data from multiple family members. Yet, relatively few contemporary scholars utilize such an approach due to methodological underdevelopment. This article contributes to family scholarship by providing a roadmap for developing and executing in-depth interview studies that include more than one family member. Specifically, it outlines the epistemological frames that most commonly underlie this approach, illustrates thematic research questions that it best addresses, and critically reviews the best methodological practices of conducting research with this approach. The three most common approaches are addressed in depth: separate interviews with each family member, dyadic or group interviews with multiple family members, and a combined approach that uses separate and dyadic or group interviews. This article speaks to family scholars who are at the beginning stages of their research project but are unsure of the best qualitative approach to answer a given research question.

Perception of patients with retinal pathology on aspects of visual function and their management.

BACKGROUND AND OBJECTIVE: Age-related macular degeneration (AMD) and diabetic retinopathy (DR) are highly prevalent. OBJECTIVE: To explore perceptions of patients with AMD or DR about the impact of the disease and treatment on their daily living activities. MATERIALS AND METHODS: Semi-structured interviews with a questionnaire developed from validated patient reported outcomes questionnaires. The questionnaire consisted of 19 questions about the disease and 9 about the treatment. The questions (items) were answered on a scale from 1 to 9. In addition, the patient interviewed was invited to make free comments on each question. Nine patients with AMD and 9 with DR were interviewed by videoconference or telephone call. A quantitative analysis of the responses and a qualitative analysis of the comments were carried out. RESULTS: The most relevant item for patients with AMD or DR is "Recognize people when they are nearby", and "Read text in normal size font in a newspaper or book", followed, in patients with AMD, by "Do things what you would like" and, in patients with DR, "Feeling frustrated by the vision problems." Regarding the treatment, the most relevant aspects for both groups is that the treatment works and receiving appropriate information before and after the treatment. The qualitative comments were focused to the disease, the treatment, and to the role of doctors and the health system. CONCLUSION: Quantitative responses and free comments can be useful to improve the care of patients with AMD or DR by physicians and the health system.

Assessing complex PTSD and PTSD: validation of the German version of the International Trauma Interview (ITI).

Background: With the introduction of the ICD-11 into clinical practice, the reliable distinction between Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) becomes paramount. The semi-structured clinician-administered International Trauma Interview (ITI) aims to close this gap in clinical and research settings.Objective: This study investigated the psychometric properties of the German version of the ITI among trauma-exposed clinical samples from Switzerland and Germany.Method: Participants were 143 civilian and 100 military participants, aged M = 40.3 years, of whom 53.5% were male. Indicators of reliability and validity (latent structure, internal reliability, inter-rater agreement, convergent and discriminant validity) were evaluated. Confirmatory factor analysis (CFA) and partial correlation analysis were conducted separately for civilian and military participants.Results: Prevalence of PTSD was 30% (civilian) and 33% (military) and prevalence of CPTSD was 53% (civilians) and 21% (military). Satisfactory internal consistency and inter-rater agreement were found. In the military sample, a parsimonious first-order six-factor model was preferred over a second-order two-factor CFA model of ITI PTSD and Disturbances in Self-Organization (DSO). Model fit was excellent among military participants but no solution was supported among civilian participants. Overall, convergent validity was supported by positive correlations of ITI PTSD and DSO with DSM-5 PTSD. Discriminant validity for PTSD symptoms was confirmed among civilians but low in the military sample.Conclusions: The German ITI has shown potential as a clinician-administered diagnostic tool for assessing ICD-11 PTSD and CPTSD in primary care. However, further exploration of its latent structure and discriminant validity are indicated.

This study validated the German International Trauma Interview (ITI), a semi-structured clinician-administered diagnostic interview for ICD-11 Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder.Internal reliability, inter-rater agreement, latent structure, and convergent validity were explored in trauma-exposed clinical and military samples from five different in- and outpatient centres in Germany and German-speaking Switzerland.The findings supported the German ITI's reliability, inter-rater agreement, convergent validity and usefulness from a patient perspective. Future research should explore its factor structure and discriminant validity, for which differences between the samples were found.

[Current evidence on the motivational interview in the approach to health care problems in primary care]. / Evidencia actual de la entrevista motivacional en el abordaje de los problemas de salud en atención primaria.

The motivational interview has been widely used as a clinical method to promote behavioural changes in patients, helping them to resolve their ambivalence to obtain their own motivations. In the present article, a review is made of the main meta-analyses and systematic and narrative reviews on the efficacy of the motivational interview in the primary health care environment.