Is schema therapy effective for adults with eating disorders? A systematic review into the evidence.

Commonly developing in adolescence and following a chronic course, eating disorders are life-threatening psychological disorders and typically very difficult to treat despite the body of research exploring treatment options. Due to the high levels of severity and the enduring nature of eating disorders, schema therapy has been proposed as a more effective treatment than cognitive behaviour therapy. To assess the effectiveness of schema therapy in adults with eating disorders, the present systematic review was designed in accordance with PRISMA guidelines. A structured search of electronic databases and grey literature was conducted, and the Mixed Methods Assessment Tool was used to assess the quality of each article. Four articles including 151 participants were found which demonstrated that schema therapy is effective at reducing eating disorder symptoms and behaviour and general psychopathology. Despite the limitations of this study, including the scarcity of research available and varying methodologies used, the present systematic review found evidence supporting the use of schema therapy in patients with eating disorders, particularly those experiencing severe and enduring forms.

What role do early life experiences play in eating disorders? The impact of parenting style, temperament and early maladaptive schemas.

OBJECTIVE: Given that most eating disorders develop in adolescence and early adulthood, early life experiences are said to play a key role in the aetiology of eating disorders. There are well-documented relationships between early maladaptive schemas and eating disorders, early maladaptive schemas and temperament and temperament and perceived parenting style. The present study aimed to test a hypothesis that perceived parenting style predicts temperament, which predicts early maladaptive schemas, which predict eating disorder symptoms in young people. METHOD: An online survey measured perceived parenting style, temperament, early maladaptive schemas and eating disorder symptoms in 397 people with disordered eating between the ages of 18 and 29. Path analysis was used to investigate the relationship between these elements. RESULTS: The results found support for this hypothesis. Perceived maladaptive parenting ratings for mothers were a stronger predictor of temperament, and only two temperament factors were adequate predictors of early maladaptive schemas. CONCLUSIONS: Overall, the present study found preliminary support for a linear relationship where perceived parenting style predicts temperament, which predicts early maladaptive schema levels, which predicts eating disorder symptoms. The present study was the first to propose and test this model; however, further research is required to confirm the nature and extent of this relationship.

Fantasy-Driven Versus Contact-Driven Users of Child Sexual Exploitation Material: Offender Classification and Implications for Their Risk Assessment.

Since the advent of the Internet, convictions for the possession, display, trading, and distribution of child sexual exploitation material (CSEM) have risen steadily, but little is known about their appropriate assessment and treatment, especially concerning their risk of reoffending. It has been suggested that a conceptual distinction of fantasy- versus contact-driven CSEM users might be of merit. Sixty-eight offenders recruited from sex offender treatment providers were assessed via an anonymous computer survey including a variety of clinical and risk-related variables; the findings showed differences in the psychological profiles between CSEM users and contact child sex offenders. Numerical and spatial methods of data analysis were used to identify subgroups of CSEM users; these confirmed the twofold distinction of fantasy- versus contact-driven offending. The spatial representation of participants identified three dimensions as crucial in the classification of these subgroups: direct sexual contact with a minor, possession of fantasy-generating material, and social contact with other users with a sexual interest in minors; potentially differentiating distinct offender subgroups with different risks and needs. The current study informed the development of an empirical model of CSEM users that could aid in the assessment of risk of reoffending and cross-over to contact sex offending.

Prospective dynamic assessment of risk of sexual reoffending in individuals with an intellectual disability and a history of sexual offending behaviour.

BACKGROUND: The purpose of the present study was to add to the literature on the predictive accuracy of a dynamic intellectual disability specific risk assessment tool. METHOD: A dynamic risk assessment for sexual reoffending (ARMIDILO-S), a static risk assessment for sexual offending (STATIC-99), and a static risk assessment for violence (Violence Risk Appraisal Guide [VRAG]) were completed for a sample of 64 adult males with an intellectual disability. RESULTS: The dynamic risk assessment for sexual offenders with an intellectual disability resulted in the best prediction of sexual reoffending (ARMIDILO-S area under the curve (AUC) = 0.92) this was better than an established sexual offending static risk assessment (STATIC-99 AUC = 0.75). A static tool for violent reoffending, did not perform as well in this group (VRAG AUC = 0.58). CONCLUSIONS: Results suggest that dynamic variables are useful in predicting sexual reoffending with individuals with an intellectual disability, confirming previous findings. The ARMIDILO-S is a promising dynamic risk assessment for individuals with an intellectual disability.

The bereavement experiences of families of potential organ donors: a qualitative longitudinal case study illuminating opportunities for family care.

OBJECTIVES: To illuminate opportunities for care in the context of deceased organ donation by exploring pre-existing family and healthcare professional characteristics, in-hospital experiences, and ongoing adjustment through the lenses of grief theory, systems theory, meaning-making, narrative, and organ donation literature. METHOD: Qualitative longitudinal case studies explored individual and family change in five Australian families who had consented to Donation after Circulatory Determination of Death at a single centre. Participants attended semi-structured interviews at four, eight, and twelve months after the death. FINDINGS: Family values, pre-existing relationships, and in-hospital experiences influenced first responses to their changed lives, understanding of the patient's death, and ongoing family adjustment. Novel behaviour that was conguent with family values was required at the hospital, especially if the patient had previously played a key role in family decision-making. This behaviour and emerging interactional patterns were drawn into family life over the first year of their bereavement. RECOMMENDATIONS: Training that includes lenses introduced in this study will enable healthcare professionals to confidently respond to individual and family psychosocial needs. CONCLUSION: The lenses of grief theory and systems thinking highlight opportunities for care tailored to the unique in-hospital context and needs that emerge in the months that follow.

Grief, Stress, Trauma, and Support During the Organ Donation Process.

The organ donation process is complex and stressful for the family of the potential donor and members of the multidisciplinary team who may experience grief, ethical dilemmas, vicarious trauma, or compassion fatigue. Several studies each explore the role of a specific healthcare group and the impact of inhospital processes on group members. We conducted a systematic literature search to identify such studies and a qualitative synthesis to consolidate findings and highlight features of the interaction and relationships between role players. Our results suggest that, while healthcare professionals have different roles, attitudes, and views, the experience of stressors and interdisciplinary tension is common. Nevertheless, staff are united by the goal of caring for the patient and family. We therefore propose that, while focusing on bereavement care and other aspects of the family's experience, staff can find other shared goals and develop understanding, trust, empathy, and respect for each other's positions, thereby improving functioning in the complex adaptive system that forms at this time. Education and training can equip staff to facilitate anticipatory mourning, family-led activities, and a meaningful parting from their relative, assisting families with their grief and increasing staff members' efficacy, confidence, and interdisciplinary teamwork. Knowledge of systems thinking and opportunities to share ideas and experiences will enable staff to appreciate each other's roles, while supportive mentors, self-care strategies, and meaningful feedback between role players will foster healthy adjustment and shared learning. A focus on psychosocial outcomes such as family satisfaction with the process, collaboration within the multidisciplinary team, and reduction in the role stress of healthcare professionals will contribute to family well-being as well as personal and professional growth for staff.

An exploration of the relationship between families of deceased organ donors and transplant recipients: A systematic review and qualitative synthesis.

Following deceased organ donation and transplantation, the narratives of families of donors and organ recipients become connected. This is acknowledged when parties receive anonymous information from donation agencies and transplant centres, when they exchange correspondence or when they meet in person. This article reviews literature describing the experience from the points of view of donor families, recipients, and other stakeholders to explore the dynamic system that evolves around this relationship. Findings highlight a link between identity development and ongoing adjustment and will assist those supporting donor families and recipients to make decisions that fit meaningfully.

A novel approach to studying co-evolution of understanding and research: Family bereavement and the potential for organ donation as a case study.

A novel approach to data extraction and synthesis was used to explore the connections between research priorities, understanding and practice improvement associated with family bereavement in the context of the potential for organ donation. Conducting the review as a qualitative longitudinal study highlighted changes over time, and extraction of citation-related data facilitated an analysis of the interaction in this field. It was found that lack of 'communication' between researchers contributes to information being 'lost' and then later 'rediscovered'. It is recommended that researchers should plan early for dissemination and practice improvement to ensure that research contributes to change.

The Personality Assessment Inventory as a proxy for the Psychopathy Checklist Revised: testing the incremental validity and cross-sample robustness of the Antisocial Features Scale.

The Personality Assessment Inventory's (PAI's) ability to predict psychopathic personality features, as assessed by the Psychopathy Checklist-Revised (PCL-R), was examined. To investigate whether the PAI Antisocial Features (ANT) Scale and subscales possessed incremental validity beyond other theoretically relevant PAI scales, optimized regression equations were derived in a sample of 281 Canadian federal offenders. ANT, or ANT-Antisocial Behavior (ANT-A), demonstrated unique variance in regression analyses predicting PCL-R total and Factor 2 (Lifestyle Impulsivity and Social Deviance) scores, but only the Dominance (DOM) Scale was retained in models predicting Factor 1 (Interpersonal and Affective Deficits). Attempts to cross-validate the regression equations derived from the first sample on a sample of 85 U.S. sex offenders resulted in considerable validity shrinkage, with the ANT Scale in isolation performing comparably to or better than the statistical models for PCL-R total and Factor 2 scores. Results offer limited evidence of convergent validity between the PAI and the PCL-R.

In-hospital experiences of families of potential organ donors: A systematic review and qualitative synthesis.

Information and compassion assist families of potential organ donors to make informed decisions. However, psychological implications of the in-hospital process are not well described with past research focusing on decision-making. To enhance understanding and improve service delivery, a systematic review was conducted. Inductive analysis and synthesis utilised Grounded Theory Methodology within a systems theory framework and contributed to a model proposing that family and staff form a System of Systems with shared responsibility for process outcomes. This model can guide evaluation and improvement of care and will be tested by means of a longitudinal study of family experiences.

The development of a narrative describing the bereavement of families of potential organ donors: A systematic review.

Families of potential post-mortem organ donors face various challenges in the unfamiliar hospital context and after returning home. This review of sources published between 1968 and 2017 seeks to understand their journey as a bereavement experience with a number of unique features. Grief theory was used to identify ways that staff can assist family members to tolerate ambiguities and vulnerabilities while contributing to an environment characterised by compassion and social inclusion. Staff can guide families and create opportunities for meaningful participation, building resilience and developing bereavement-related skills that could assist them in the months that follow.

Two clusters of child molesters based on impulsiveness.

OBJECTIVE: High impulsiveness is a general problem that affects most criminal offenders and is associated with greater recidivism risk. A cluster analysis of impulsiveness measured by the Barratt Impulsiveness Scale - Version 11 (BIS-11) was performed on a sample of hands-on child molesters. METHODS: The sample consisted of 208 child molesters enrolled in two different sectional studies carried out in São Paulo, Brazil. Using three factors from the BIS-11, a k-means cluster analysis was performed using the average silhouette width to determine cluster number. Direct logistic regression was performed to analyze the association of criminological and clinical features with the resulting clusters. RESULTS: Two clusters were delineated. The cluster characterized by higher impulsiveness showed higher scores on the Sexual Screening for Pedophilic Interests (SSPI), Static-99, and Sexual Addiction Screening Test. CONCLUSIONS: Given that child molesters are an extremely heterogeneous population, the "number of victims" item of the SSPI should call attention to those offenders with the highest motor, attentional, and non-planning impulsiveness. Our findings could have implications in terms of differences in therapeutic management for these two groups, with the most impulsive cluster benefitting from psychosocial strategies combined with pharmacological interventions.

Did Freud mislead patients to confabulate memories of abuse? A reply to Gleaves and Hernandez (1999).

Gleaves and Hernandez have argued that skepticism about the validity of Freud's seduction theory, including by Powell and Boer, is largely unjustified. This paper contends that their analysis is in many ways both inaccurate and misleading. For example, we did not, as they implied, reject the possibility that some of Freud's early patients were victims of childhood sexual abuse. We also maintain that the weight of the available evidence indicates that false memories of traumatic events probably can be implanted, and that Freud's (1896/1962a) original evidence for the validity of his patients' recovered memories remains lacking in several respects-particularly in view of the extremely suggestive procedures he often used to elicit such memories.

Psychosocial pathways to inconsistent condom use among male sex workers: personality, drug misuse and criminality.

BACKGROUND: This research compared street male sex workers in Santo André, Brazil, that reported consistent condom use with those that revealed inconsistent condom use with their clients, concerning personality aspects, impulsiveness, alcohol and drug consumption, depressive symptoms, sociodemographic data and criminal involvement. METHODS: Eighty-six male sex workers were evaluated in face-to-face interviews at their place of work. A 'snowball' sampling procedure was used to access this hard-to-reach population. FINDINGS: Male sex workers with inconsistent condom use showed greater involvement with criminal activities, higher reward dependence level and more frequent self-report of being HIV-positive. CONCLUSIONS: Conceptualisation of male sex workers' psychological characteristics may be required where HIV risk is not only attributed to sex work per se, but to other aspects such as personality-related factors and negative identity.

Two clusters of child molesters based on impulsiveness

Objective: High impulsiveness is a general problem that affects most criminal offenders and is associated with greater recidivism risk. A cluster analysis of impulsiveness measured by the Barratt Impulsiveness Scale - Version 11 (BIS-11) was performed on a sample of hands-on child molesters. Methods: The sample consisted of 208 child molesters enrolled in two different sectional studies carried out in São Paulo, Brazil. Using three factors from the BIS-11, a k-means cluster analysis was performed using the average silhouette width to determine cluster number. Direct logistic regression was performed to analyze the association of criminological and clinical features with the resulting clusters. Results: Two clusters were delineated. The cluster characterized by higher impulsiveness showed higher scores on the Sexual Screening for Pedophilic Interests (SSPI), Static-99, and Sexual Addiction Screening Test. Conclusions: Given that child molesters are an extremely heterogeneous population, the “number of victims” item of the SSPI should call attention to those offenders with the highest motor, attentional, and non-planning impulsiveness. Our findings could have implications in terms of differences in therapeutic management for these two groups, with the most impulsive cluster benefitting from psychosocial strategies combined with pharmacological interventions. .

Prospective actuarial risk assessment: a comparison of five risk assessment instruments in different sexual offender subtypes.

This study examines the predictive validity of the most commonly used risk assessment instruments for sexual offenders: Static-99, Rapid Risk Assessment for Sexual Offense Recidivism, Sex Offender Risk Appraisal Guide, Sexual Violence Risk-20, and Psychopathy Checklist-Revised in a prospective research design. Although risk assessment is part of a regime leading to various efforts to reduce risk by treatment and aftercare, all instruments show good predictive validity. However, depending on the instrument, recidivism category, and subgroup, the predictive accuracy varies markedly. Furthermore, the authors fail to demonstrate predictive validity for sexual violent reoffences-for the whole sample and for all subgroups. The results, nevertheless, support the utility and predictive validity of actuarial risk assessment complementary to treatment efforts to reduce risk. On the other hand, forensic practitioners have to be aware of the limitations of actuarial risk assessment methods, in particular as regards to variable predictive accuracy for different sexual offender subgroups and reoffence categories.