Binge eating in bariatric surgery candidates: The role of insecure attachment and emotion regulation.

Binge eating has a high prevalence among bariatric patients and is associated with post-surgical weight gain. This study examined the potential mediating role of emotion regulation difficulties in the relation between attachment insecurity and binge eating among this population. Participants were 1388 adult pre-bariatric surgery candidates from an accredited bariatric surgery assessment centre in Toronto, Ontario. Participants completed measures of psychological functioning, including attachment style and emotion regulation. Mediation analyses revealed that difficulties with emotion regulation mediated a positive association between insecure-anxious attachment and binge eating. An insecure-avoidant attachment was found to have a non-significant association with binge eating when examining the total effect. However, when difficulties with emotion regulation were controlled for in the model to examine its role as a mediator, this association became significant, and emotion regulation difficulties also mediated the relationship between attachment avoidance and binge eating. These findings suggest that difficulties in emotion regulation may be an important clinical issue to address in order to reduce binge eating in adult bariatric surgery candidates.

Development of a universal psycho-educational intervention to prevent common postpartum mental disorders in primiparous women: a multiple method approach.

BACKGROUND: Prevention of postnatal mental disorders in women is an important component of comprehensive health service delivery because of the substantial potential benefits for population health. However, diverse approaches to prevention of postnatal depression have had limited success, possibly because anxiety and adjustment disorders are also problematic, mental health problems are multifactorially determined, and because relationships amongst psychosocial risk factors are complex and difficult to modify. The aim of this paper is to describe the development of a novel psycho-educational intervention to prevent postnatal mental disorders in mothers of firstborn infants. METHODS: Data from a variety of sources were synthesised: a literature review summarised epidemiological evidence about neglected modifiable risk factors; clinical research evidence identified successful psychosocial treatments for postnatal mental health problems; consultations with clinicians, health professionals, policy makers and consumers informed the proposed program and psychological and health promotion theories underpinned the proposed mechanisms of effect. The intervention was pilot-tested with small groups of mothers and fathers and their first newborn infants. RESULTS: What Were We Thinking! is a psycho-educational intervention, designed for universal implementation, that addresses heightened learning needs of parents of first newborns. It re-conceptualises mental health problems in mothers of infants as reflecting unmet needs for adaptations in the intimate partner relationship after the birth of a baby, and skills to promote settled infant behaviour. It addresses these two risk factors in half-day seminars, facilitated by trained maternal and child health nurses using non-psychiatric language, in groups of up to five couples and their four-week old infants in primary care. It is designed to promote confidence and reduce mental disorders by providing skills in sustainable sleep and settling strategies, and the re-negotiation of the unpaid household workload in non-confrontational ways. Materials include a Facilitators' Handbook, creatively designed worksheets for use in seminars, and a book for couples to take home for reference. A website provides an alternative means of access to the intervention. CONCLUSIONS: What Were We Thinking! is a postnatal mental health intervention which has the potential to contribute to psychologically-informed routine primary postnatal health care and prevent common mental disorders in women.

The Mediating Effects of Academic Performance between Screen Time, Executive Function Difficulty and School Adjustment.

The purpose of this study was to verify the mediating effects of academic performance on the relationship between screen time, executive function difficulty, and school adjustment. This study analyzed secondary data of the 8th Panel Survey on Korean Children. The 8th Panel Survey was the first measurement of children's academic performance, executive function difficulty, and school adjustment through large sampling. Accordingly, it is possible to provide a large amount of data that can verify the relationship between them. The respondents were parents and teachers of students. The total number was 1,031. Data were analyzed by descriptive, t-test, analysis of variance, Pearson correlation, and three-steps multiple regression statistics. As a result, screen time has a full mediating effect on school adjustment through academic performance. The executive function difficulty has a partial mediating effect on school adjustment through academic performance. The results of this study will contribute to the development of the school adjustment improvement program.

Outcomes from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) program for bereaved caregivers.

Although preventive efforts for bereaved individuals have not been shown to be particularly effective in past studies, it has been suggested that intervention effects might be underestimated due to methodological issues such as short follow-up assessments. Thus, the present study aimed to assess the efficacy (as whole intervention packages and as component parts) of the Resources for Enhancing Alzheimer's Caregiver Health (REACH) interventions in preventing complicated grief, normal grief, and depressive symptoms at a longer term follow-up assessment among bereaved caregivers (N = 224). On average, active interventions showed a statistically significant effect on normal grief symptoms (d = 0.28), exhibited a trend toward improvement on complicated grief symptoms (d = 0.25), and demonstrated little impact on depressive symptoms (d = 0.09). Interestingly, the examination of intervention components revealed differential effects, whereby cognitive and behavioral strategies were most effective at reducing levels of complicated grief, information and emotional support were most effective for addressing normal grief, and environmental modifications were most effective for ameliorating depressive symptoms. These findings suggest that different preloss interventions might be warranted depending on a caregiver's unique clinical presentation and combination of risk factors.

A preliminary assessment of adjustment disorder among first-year college students.

Using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (American Psychiatric Association, 2000) criteria, we investigated whether the diagnosis adjustment disorder (AD) described first-year college students' adjustment problems. We found that a substantial portion of students experienced a set of adjustment symptoms meeting the AD criteria. Another portion of students reported adjustment concerns that were problematic but did not meet the AD diagnosis threshold. Female students tended to report more symptoms than do male students. College counseling implications are presented.

Trastornos adaptativos y su manejo desde atención primaria / Adaptive disorders and their management in primary care

Introducción: El trastorno de adaptación describe una respuesta emocional y conductual desproporcionada a uno o más estresores psicosociales identificables. Existen múltiples situaciones capaces de generarnos una situación de estrés agudo. Sin embargo, uno de los requisitos necesarios para poder hablar de trastorno adaptativo es que ese o esos factores estresantes supongan un deterioro en el funcionamiento normal del individuo. Objetivos: El objetivo principal de este trabajo es analizar, mediante una revisión bibliográfica, el diagnóstico y abordaje de los trastornos adaptativos dentro del ámbito de Atención Primaria. El objetivo secundario es destacar la importancia de la detección y el tratamiento precoces, así como de la gestión multidisciplinar y la promoción de la salud mental. Resultados: Los principales factores de riesgo de los trastornos adaptativos son el desempleo, los bajos ingresos,el escaso apoyo social, las enfermedades físicas y la salud mental. La prevalencia es mayor en jóvenes,especialmente entre las mujeres, y existe un riesgo aumentado de suicidio en el subtipo de estado de ánimo depresivo. El Cuestionario Internacional de Trastornos Adaptativos es actualmente la principal herramienta diagnóstica, por establecer sus criterios diagnósticos en base a la definición teórica establecida por la CIE-11. El manejo de estos trastornos se realiza principalmente mediante terapia cognitivo-conductual. Conclusiones: Los trastornos de adaptación surgen como respuestas anormales ante ciertas situaciones estresantes. El papel de los médicos de Atención Primaria en el abordaje de este trastorno es primordial, siendo necesaria su detección y manejo precoz para disminuir los niveles de ansiedad disfuncionales que presentan los pacientes.(AU)

Introduction: Adjustment disorder describes a disproportionate emotional and behavioral response to one or more identifiable psychosocial stressors. There are multiple situations capable of generating an acute stressful situation. However, one of the requirements to be able to speak of an adaptive disorder is that the stressor(s) in question should lead to an impairment of the individual's normal functioning.Objectives: The main objective of this work is to analyze , through a literature review, the diagnosis and approach to the diagnosis and management of adaptive disorders in the Primary Care setting. The secondary objective is toemphasize the importance of early detection and treatment, as well as multidisciplinary management and mentalhealth promotion. Results: The main risk factors for adjustment disorders are unemployment, low income, low social support, physical illness, and personal history of mental health. The International Questionnaire of Adaptive Disorders is currently the principal diagnostic tool, as it establishes its diagnostic criteria based on the theoretical definition established by the ICD-11. The management of these disorders is mainly through cognitive behavioural therapy.Conclusions: Adjustment disorders arise as abnormal responses to certain stressful situations. The role of primary care physicians in dealing with this disorder is essential, and early detection and management are necessary to reduce the levels of dysfunctional anxiety that patients present.(AU)

Laying the foundations of well being: a creative psycho-educational program for young children.

Dysfunctional cognitive schemata and pessimistic explanatory styles are usually held responsible for some of the commonest features of depressed mood such as feelings of meaninglessness, resignation, and underachievement which seem to affect even young children. This pilot study investigates the applicability and efficacy of an interactive, creative psycho-educational program for preschoolers that aims at enhancing mastery and shaping optimistic explanatory styles. Twenty preschoolers participated in once-a-week hourly sessions which took place in their school and lasted for one school year. The intervention consisted of several playful tasks and novel creative activities specially designed to meet the needs and abilities of preschoolers, while satisfying the objectives of the school curriculum. The tasks were based on the principles of cognitive behaviour theory. Qualitative and quantitative analyses of our results support the efficacy of the intervention for preschoolers.

Postshelter adjustment of children from violent families.

Few studies have examined the adjustment of battered women and their children after exiting domestic violence shelters. Participants were 62 women who had endured severe partner abuse, completed a shelter program with their children, and resided in the community for at least 6 months. Field interviews concerned mothers' and children's abuse histories and included measures of maternal depression, maternal trauma, and child behavior problems. Nearly all women had lived violence free since shelter exit. Child internalizing behaviors were associated with direct abuse, maternal depression, and shelter program. Externalizing behaviors were related to maternal depression and shelter program. Neither severity of interparental violence nor maternal trauma symptoms was related to child behavior problems. Mothers' family of-origin abuse predicted current satisfaction with child functioning, beyond the effects of maternal depression and child behavioral problems. Findings suggest a need for postshelter therapeutic services and further research addressing the adjustment of such families.

Development of a music group psychotherapy intervention for the primary prevention of adjustment difficulties in Korean adolescent girls.

PROBLEM: Traditionally, adolescent mental health in Korea has not been a prime focus for educators, health workers, and politicians, yet a majority of sampled adolescents report interpersonal sensitivity (Kim, 2003). METHOD: Thirty-five adolescent girls took part in a six-session school-based music group psychotherapy pilot intervention designed to promote relationships and improve self-control skills. FINDING: Participants identified several outcome benefits that may serve as protective factors in their continued social and emotional development. CONCLUSIONS: Music is a medium that promotes interpersonal relatedness among Korean adolescent girls. More research is necessary to identify long-term benefits of preventive music group psychotherapy interventions among the adolescent population.

Theory of psychological adaptive modes.

When an individual is facing a stressor and normal stress-response mechanism cannot guarantee sufficient adaptation, special emotional states, adaptive modes, are activated (for example a depressive reaction). Adaptive modes are involuntary states of mind, they are of comprehensive nature, they interfere with normal functioning, and they cannot be repressed or controlled the same way as many emotions. Their transformational nature differentiates them from other emotional states. The object of the adaptive mode is to optimize the problem-solving abilities according to the situation that has provoked the mode. Cognitions and emotions during the adaptive mode are different than in a normal mental state. These altered cognitions and emotional reactions guide the individual to use the correct coping skills in order to deal with the stressor. Successful adaptation will cause the adaptive mode to fade off since the adaptive mode is no longer necessary, and the process as a whole will lead to raised well-being. However, if the adaptation process is inadequate, then the transformation period is prolonged, and the adaptive mode will turn into a dysfunctional state. Many psychiatric disorders are such maladaptive processes. The maladaptive processes can be turned into functional ones by using adaptive skills that are used in functional adaptive processes.

Prevention of adjustment disorders and anticipatory nausea secondary to adjuvant chemotherapy: a double-blind, placebo-controlled study assessing the usefulness of alprazolam.

PURPOSE AND METHODS: Although a high prevalence of adjustment disorders and anticipatory nausea secondary to adjuvant chemotherapy (CT) has been reported, little has been done to develop strategies to prevent these problems. A double-blind, placebo-controlled study was therefore designed to assess the usefulness of adding low-dose alprazolam (0.5 mg to 2 mg per day) to a psychologic support program including progressive relaxation training designed to prevent the aforementioned conditions. Fifty-seven women undergoing adjuvant CT for stage II primary breast cancer agreed to participate in the assessment, which was conducted at four time points: before starting CT, 6 weeks after CT, before the fourth CT, and after the fourth CT. The Hospital Anxiety and Depression Scale (HADS), Montgomery and Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Scale (HAS), Revised Symptom Checklist (SCL-90-R), Morrow Assessment of Nausea and Emesis (MANE), and World Health Organization (WHO) grading of acute and subacute toxicities were used to compare the alprazolam (AA) and placebo (PA) arms of the study. RESULTS: At the second evaluation, the results showed a higher rate of anticipatory nausea (18% v 0%) in the PA compared with the AA arm (P = .038). These differences were no more significant at each of the further assessments. Significant differences were found for the intake of hypnotics at each assessment visit, with the rate of hypnotic users being significantly higher in the PA (19%) compared with the AA (0%) arm at the fourth assessment (P < .05). Anxiety and depression scores of self- and observer-report were similar in the two arms. A significant relationship was found between the development of anticipatory nausea and the self-report of anxiety and depression score measured by HADS at baseline. The average HADS total score at baseline was 15.33 (SD = 6.56) for patients who developed anticipatory nausea and 11.23 (SD = 6.67) for other patients. CONCLUSION: The adjunct of alprazolam to a psychologic support program delays the occurrence of anticipatory nausea and controls sleeping problems secondary to adjunct CT. Although studies are needed to improve the efficacy reported here, physicians may already consider the use of alprazolam for cancer patients undergoing CT.

A randomized trial of a nursing intervention to promote the adjustment of children with chronic physical disorders.

OBJECTIVE: This study was conducted to determine whether a specialized form of nursing could help prevent or reduce psychosocial maladjustment among children, aged 4 to 16 years, with chronic physical disorders. In contrast to other studies, nurses were chosen to provide the intervention based on their central role in health care and the appropriateness of their training for this task. METHODOLOGY: A clinical trial was conducted in which 332 children and their families were randomly assigned either to receive this specialized nursing for a 1-year period, or to remain in the control condition. The children were all active outpatients in nine clinics at the Montreal Children's Hospital. Three measures of psychosocial functioning administered before and after the intervention were the basis for assessing its efficacy. The measures included the behavior problems profile of the Achenbach Child Behavior Checklist, the Personal Adjustment and Role Skills, completed by the parents, and two versions of the Self-Perception Profile (Harter) for children aged 4 to 7 years and 8 to 16 years. RESULTS: Differences between groups were examined both categorically and quantitatively. In the former, the percent of children with clinical scores (those above or below a cut-off indicative of maladjustment) at baseline and postintervention were compared. In the latter, the mean scores at the end of the trial were analyzed using analysis of covariance with the baseline scores as covariates. Statistically significant positive differences were found in the domain of anxiety/depression on the Personal Adjustment and Role Skills, and in the areas of scholastic competence, behavior, and global self-worth on the Harter. CONCLUSION: The results indicate that this intervention helps children with chronic disorders by preventing or reducing maladjustment. Most university-prepared nurses already have the basic skills required to achieve these results; only a modest investment in reorientation may be needed. Thus, other pediatric centers should be able to replicate these findings and thereby take a major step toward improving the lives of children with chronic disorders.

Perceived social support from family, school, and peers: relationship with emotional and behavioral problems among adolescents.

OBJECTIVE: To examine (1) the extent to which negative perceptions of support from family, school, and peers differ with regard to their impact on emotional and behavioral problems and (2) the extent to which negative perceptions of multiple social support systems are related to the presence of multiple emotional and behavioral problems in adolescence. METHOD: The sample comprised 476 high school students, aged 16 to 18 years: 119 without any emotional and behavioral problems, 119 with emotional problems only, 119 with behavioral problems only, and 119 with emotional and behavioral problems. Possible differences between the subgroups were tested with regard to the perceived social support from family, school, and peers, and with regard to the number of negatively perceived support systems. RESULTS: Whereas a negative perception of school was shown to be specifically related to behavioral problems and a negative perception of peers specifically to emotional problems, a negative perception of the family appeared to be strongly related both to emotional and behavioral dysfunction. A strong accumulating effect was found for multiple negatively perceived social environments. CONCLUSIONS: The results suggest a dominant role of negatively perceived family support. Therefore, to prevent emotional and behavioral problems in adolescence it is of paramount importance to identify families at risk at the earliest possible stage and to provide training and support for the parents involved.

Preventive psychosocial intervention with newly diagnosed cancer patients.

To study the effectiveness of preventive intervention in lowering emotional distress and improving coping, 381 newly diagnosed cancer patients were assessed shortly after the time of initial diagnosis. Subjects predicted by a screening instrument to be at risk for high levels of emotional distress and poor coping during the second through sixth months of their illness were randomly allocated to one of two short-term intervention programs (N = 59). Specific techniques to lower distress and improve coping were given during the four weeks following diagnosis. A control group (N = 58) received no intervention. All were followed at two-month to 6-month intervals by interview and testing. There was a significant lowering of emotional distress in the intervention group as compared to the control group (p less than 0.05). There was also a significant increase in the level of problem resolution in the intervention groups (p less than 0.01), although the numbers of problems experienced by both groups were no different.

Impact of a preventive job search intervention on the likelihood of depression among the unemployed.

Drawing on coping resources theory, we evaluate the impact of a job search intervention on depressive symptoms in a randomized field experiment at three follow-up periods covering two and one-half years. Baseline depressive symptoms, low social assertiveness, and financial hardship were identified as significant risk variables predicting depressive symptoms at follow-up. These variables then were used to identify high- and low-risk individuals in both experimental and control groups. Results indicated that the job search intervention had its primary impact on persons identified as being at higher risk for depression. Furthermore, the intervention had an impact on both the incidence and prevalence of more severe depressive symptoms among high-risk individuals.