Caring Together: Trajectories of Paid and Family Caregiving Support to Those Living in the Community With Dementia

OBJECTIVES

Paid caregivers (e.g., home health aides) often work with family caregivers to support persons living with dementia at home. We identify (a) unique trajectories of paid and family caregiving support among persons living with dementia with high care needs and (b) factors associated with these trajectories.

METHODS

We used group-based multiple trajectory modeling to identify distinct trajectories of paid and family caregiving hours among National Health and Aging Trends Study respondents with dementia who died or moved to a nursing home (n = 334, mean follow-up 5.5 years). We examined differences between trajectory groups and identified factors associated with group membership using generalized estimating equation modeling.

RESULTS

A 3-group model best fit our data: (a) "low/stable care" (61.3% of respondents) with stable, low/no paid care and moderate family care, (b) "increasing paid care" with increasing, moderate paid and family care, and (c) "high family care" with increasing, high family care and stable, low paid care. While both the "increasing paid care" and "high family care" groups were more functionally impaired than the "low/stable care" group, the "high family care" group was also more likely to be non-White and experience multiple medical comorbidities, depression, and social isolation.

DISCUSSION

Study findings highlight the importance of considering unique arrangements in dementia care. Receipt of paid care was not only determined by patient care needs. Creating equitable access to paid care may be a particularly important way to support both persons living with dementia and their family caregivers as care needs grow.

Cognitive skill training improves memory, function, and use of cognitive strategies in cancer survivors

BACKGROUND

Cancer survivors commonly report symptoms of impaired cognition. This project examined effectiveness of a behavioral skills training intervention to improve cognition and reduce cognitive dysfunction symptoms in cancer survivors.

METHODS

Participants were randomly assigned to group-based workshops focused on learning new cognitive skills (skills treatment-TX) or an active control of education workshops (education control-EC) or a passive control of wait list (WL). Participants were evaluated pre- and post intervention with subjective mood and symptom questionnaires and objective neurocognitive tests.

RESULTS

One hundred twenty-eight participants (mean age 59 years), average 4.6 years (+ / - 5.5 years) post cancer treatment with various cancer types (breast, bladder, prostate, colon, uterine), were enrolled. Analysis of all participants who attended workshop(s) revealed improvement in the TX workshop completers on all objective cognitive measures (attention, concentration, declarative, and working memory) save one test of selective attention, and improvement on a single measure (verbal memory) and decline (selective attention) in the EC group. TX workshop completers also improved on all symptom and mood measures, in contrast to EC group which improved on a single subscale of a symptom measure, but increased on an anxiety measure. TX group alone improved on a quantified measure of each participants' unique, "top three," self-described cognitive symptoms.

CONCLUSION

Improvement from behavioral skills training was evident from objective cognitive tests, subjective symptom measures, and quantified, individual patient-specific symptoms. Behavioral skill training is an effective treatment for cognitive dysfunction in cancer survivors, and should be considered as a treatment option by health care providers.

[Associations between group exercise and exercise adherence among older community-dwelling adults who attend a community sports club: Resol no Mori Wellness Age Club Longitudinal Study]

AIM

This study aimed to examine the relationship between group exercise and exercise adherence among older community-dwelling individuals who attended a community sports club and to discuss the exercise programs that promoted exercise habits.

METHODS

A total of 227 participants (117 women and 110 men), aged ≥ 65 years, who participated in the exercise programs (Wellness Age Club), provided by Resol no Mori, for at least 6 months from June 2017 to March 2019, were included in the analysis. Results obtained from the semi-annual questionnaire surveys, physical fitness tests, and annual medical check-ups were used, along with data on individual participation in programs and dates of participation. "Exercise adherence" was defined as participation in exercise programs for an average of ≥ 2 days per week for at least 24 weeks. "Group program participation" was defined as participation in group programs for an average of one or more times per week. The relationship between group program participation and exercise program adherence was analyzed using Poisson regression analysis.

RESULTS

Group program participants were more likely to continue attending exercise programs in comparison to non-participants (Prevalence ratio=3.63 [95% CI: 1.98-6.65], p< 0.01). There was also a significant positive association between group program participation and exercise adherence among women (8.08 [1.94-33.56], p< 0.01) and men (2.84 [1.39-5.78], p< 0.01).

CONCLUSIONS

Our results suggest that group exercise programs increased social interaction among participants and promoted exercise adherence. Encouraging older people to attend group exercise may increase the number of older people who regularly exercise.

We Hold Ourselves Accountable: A Relational View of Team Accountability

Accountability is of universal interest to the business ethics community, but the emphasis to date has been primarily at the level of the industry, organization, or key individuals. This paper unites concepts from relational and felt accountability and team dynamics to provide an initial explanatory framework that emphasizes the importance of social interactions to team accountability. We develop a measure of team accountability using participants in the USA and Europe and then use it to study a cohort of 65 teams of Irish business students over three months as they complete a complex simulation. Our hypotheses test the origins of team accountability and its effects on subsequent team performance and attitudinal states. Results indicate that initial team accountability is strongly related to team trust, commitment, efficacy, and identifying with the team emotionally. In established teams, accountability increases effort and willingness to continue to collaborate but did not significantly improve task performance in this investigation.

Bouldering psychotherapy is not inferior to cognitive behavioural therapy in the group treatment of depression: A randomized controlled trial

OBJECTIVES

Bouldering has shown promising results in the treatment of various health problems. In previous research, bouldering psychotherapy (BPT) was shown to be superior to a waitlist control group and to physical exercise with regard to reducing symptoms of depression. The primary aim of this study was to compare group BPT with group cognitive behavioural psychotherapy (CBT) to test the hypothesis that BPT would be equally as effective as CBT.

DESIGN

We conducted a randomized, controlled, assessor-blinded non-inferiority trial in which 156 outpatients meeting the criteria of a depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were randomly assigned to one of the two intervention groups (CBT: N = 77, BPT: N = 79).

METHODS

Intervention groups were manualized and treated for 10 weeks with a maximum of 11 participants and two therapists. The primary outcome was depressive symptom severity assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Patient Health questionnaire (PHQ-9) at the beginning and end of the treatment phase as well as one year after the end of treatment.

RESULT

In both groups, depressive symptoms improved significantly by an average of one severity level, moving from moderate to mild depressive symptoms after therapy (MADRS difference scores: BPT -8.06, 95% CI [-10.85, -5.27], p < .001; CBT -5.99, 95% CI [-8.55, -3.44], p < .001). The non-inferiority of BPT in comparison with CBT was established on the basis of the lower bound of the 95% confidence interval falling above all of the predefined margins. BPT was found to be effective in both the short (d = 0.89) and long term (d = 1.15).

CONCLUSION

Group BPT was found to be equally as effective as group CBT. Positive effects were maintained until at least 12 months after the end of therapy. Thus, BPT is a promising approach for broadening the therapeutic field of therapies for depression.

PRACTITIONER POINTS

Physical activity is effective in the treatment of depression and current guidelines explicitly recommend it as a complementary method for the treatment of depression. Nevertheless, body-related interventions are still underrepresented in current treatments for depression. Bouldering psychotherapy (BPT) combines physical activity with psychotherapeutic content. Its concept relies on proven effective factors from CBT such as exposure training, problem solving and practicing new functional behaviours and is thus an enrichment and implementation of CBT methods on the bouldering wall. The positive effect of group bouldering psychotherapy (BPT) in reducing depressive symptoms in outpatients with depression is not inferior to the effect of group cognitive behavioural therapy (CBT). Additionally the 10-weeks BPT-programme significantly improved symptoms of anxiety and interpersonal sensitivity as well as health-related quality of life, coping, body image, self-efficacy, and global self-esteem.

Efficacy of exposure in group settings for youth with posttraumatic stress symptoms

BACKGROUND

Exposure to traumatic experiences is a fundamental part of evidence-based trauma-focused cognitive behavioral treatment (CBT) but in group settings it is discussed controversially among researchers and practitioners. This study aims to examine the individual participants' stress level during group sessions with exposure and disclosure of traumatic events.

METHOD

N = 47 traumatized youth (M_age = 17.00, 94% male) participated in a group intervention comprising six 90-min group sessions (exposure in sessions 2-5). It is based on trauma-focused CBT principles. The individual stress level was assessed by the participants and group facilitators at the beginning, during, and at the end of every session.

RESULTS

During the sessions including exposure, the stress level of the participants was higher than during sessions without exposure (Z = - 3.79; p ≤ .001). During the exposure sessions, the participants showed significant changes in stress level (d = 0.34-0.87) following an inverse U-shaped trend.

CONCLUSION

The results show that exposure is feasible within the scope of a trauma-focused group intervention for youth. The further dissemination of trauma-focused group treatments is an important component in the mental health care of children and youth who are traumatized.

Connection During COVID-19: Pilot Study of a Telehealth Group Parenting Intervention

OBJECTIVE

The COVID-19 pandemic has resulted in considerable stress for families, placing parents at risk for heightened psychological distress, while prompting widespread changes in mental health service delivery. This study evaluated treatment engagement, acceptability, and psychiatric distress among participants in the telehealth adaptation of the Connecting and Reflecting Experience (CARE) program after the onset of COVID-19.

METHODS

CARE is a transdiagnostic, bigenerational, mentalizing-focused group parenting intervention based out of an outpatient child mental health clinic in an underserved urban community. Individuals participating in CARE during the clinic's transition to telehealth services were recruited for participation in this pre-post design pilot study. Participants (N=12) completed self-report surveys before and after their first telehealth group session and at their 20-week follow-up. Quantitative and qualitative measures were used to evaluate psychiatric symptoms, treatment engagement, and preliminary acceptability of the adaptation.

RESULTS

Self-reported mood and anxiety symptoms decreased significantly after 20 weeks of telehealth therapy. Participants reported high levels of therapeutic alliance and group cohesion in the telehealth format. Results also showed minimal participant-reported privacy concerns and a trend toward increased treatment engagement.

CONCLUSIONS

These findings have implications regarding the acceptability of teletherapy interventions for caregivers of children during this period of heightened vulnerability and limited access to social support and health services. They also are relevant to establishing the preliminary acceptability of mentalizing-focused parenting inventions delivered via telehealth.

A pilot trial of a transdiagnostic treatment for emotional disorders-a locally adapted variant of group Unified Protocol (UP) for Chinese adults

There has been increasing interest in transdiagnostic cognitive-behavioral therapy (CBT), which is more cost efficient yet yields similar effect sizes when compared to disorder-specific CBT. The Unified Protocol (UP) for Transdiagnostic Treatment of Emotional Disorders was adapted for Hong Kong Chinese adults with common mental disorders, such as depression and anxiety. It was piloted in community settings and delivered in a group format. Thirty-one Chinese adults (female = 93.5%, mean age = 44 years) with heterogeneous anxiety and depressive disorders were recruited from a number of public-funded community mental health centers in Hong Kong to participate in a pilot trial of a locally adapted variant of UP. Treatment consisted of 14 group sessions plus one individual session. Each group included six to nine participants. The diagnostic and outcome measures included Anxiety Disorders Interview Schedule for DSM-IV, The Chinese versions of Beck Depression Inventory-Revised (C-BDI-II), Beck Anxiety Inventory (C-BAI), Positive Affect subscale of Positive and Negative Affect Scale, and Work and Social Adjustment Scale. Results indicate significant improvement across a number of outcome measures, with moderate-to-large effect sizes for measures of depression (d = 1.11), anxiety (d = 0.67), positive affect (d = 0.54), and work and social functioning (d = 0.49). Furthermore, 45.2% and 29.0% of the participants scored within the normal range of C-BDI-II and C-BAI at posttreatment, respectively, compared to 3.2% and 6.5% at pretreatment. This pilot, uncontrolled trial demonstrated potential effectiveness of a locally adapted variant of group UP for Chinese adults with common mental disorders. It achieved comparable effect sizes to those observed in western populations.

[Feasibility of a psychoeducation group for patients with anorexia nervosa: An open study]

INTRODUCTION

Management of anorexia nervosa is difficult and few treatments have shown their effectiveness, justifying the exploration of new therapeutic approaches. Available evidence suggests an interest of psychoeducational groups in a significant number of psychiatric disorders. In patients suffering from anorexia, to date there are few groups or interventions available. We aimed to assess the feasibility and acceptability of a psycho-educational program promoting information about the disease and presenting techniques that can help to cope with anorexia and the functional impact it causes. The exploratory secondary objectives were to evaluate if such a group is associated with clinical improvement.

METHOD

Twenty-seven patients suffering from anorexia nervosa, in three groups, received eight weekly interventions in addition to their usual care. The study was open-label and non-randomized. Patients were assessed three times (baseline, at the end of the group and three months later). The assessments were both qualitative (Eating Disorder Examination questionnaire, The Anorexia Nervosa Stage of Change Questionnaire, the Eating Disorders Quality of Life questionnaire, Work and Social Adjustment Scale) and qualitative.

RESULTS

Seventy-eight percent of participants attended more than 75 % of the sessions. Seventy percent of participants found the group useful, and 95 % said it helped them improve their knowledge of the disease and its consequences. The average BMI of participants changed significantly with an average increase of 2.5kg between baseline and the three month assessment. There was an improvement of the eating disorders features in EDE-Q for the total score and for all subscores. The improvement in the total score was significant at the end of the group sessions, while the improvement in the sub scores became significant at three months. There was also a significant mood improvement at the end of the group. Finally, there was a significant improvement in daily functioning with a decrease in Work and Social Adjustment Scale scores and an improvement in quality of life. On qualitative assessment, patients were satisfied with the care proposal. They were able to appreciate the support and sharing of experience provided by the group formula. Most of them reported changes in their daily lives, either in their relationship to care and illness, or in their relationships with their loved ones, their leisure/work, their mood or their eating behavior.

CONCLUSION

Both qualitative and quantitative results suggest that this group psychoeducation program is feasible and well accepted by patients in addition to usual management. Although the methodology does not allow any conclusions, the clinical improvements observed during the group are encouraging with regard to the safety of this type of intervention and its possible effectiveness and argue for a controlled study.

Perceived Costs versus Actual Benefits of Demographic Self-Disclosure in Online Support Groups

Millions of U.S. adults join online support groups to attain health goals, but the social ties they form are often too weak to provide the support they need. What impedes the strengthening of ties in such groups? We explore the role of demographic differences in causing the impediment and demographic self-disclosure in removing it. Using a field study of online quit-smoking groups complemented by three laboratory experiments, we find that members tend to hide demographic differences, concerned about poor social integration that will weaken their ties. However, the self-disclosures of demographic differences that naturally occur during group member discussions actually strengthen their ties, which in turn facilitates attainment of members' health goals. In other words, social ties in online groups are weak not because members are demographically different, but because they are reluctant to self-disclose their differences. If they do self-disclose, this breeds interpersonal connection, trumping any demographic differences among them. Data from both laboratory and field about two types of demographic difference-dyad-level dissimilarity and group-level minority status-provide convergent support for our findings.

Practice Considerations for Adapting in-Person Groups to Telerehabilitation

The Coronavirus-2019 (COVID-19) pandemic has shifted research and healthcare system priorities, stimulating literature on implementation and evaluation of telerehabilitation for a variety of patient populations. While there is substantial literature on individual telerehabilitation, evidence about group telerehabilitation remains limited despite its increasing use by rehabilitation providers. Therefore, the purpose of this manuscript is to describe our expert team's consensus on practice considerations for adapting in-person group rehabilitation to group telerehabilitation to provide rapid guidance during a pandemic and create a foundation for sustainability of group telerehabilitation beyond the pandemic's end.

A review of research-supported group treatments for drug use disorders

This paper reviews methodologically rigorous studies examining group treatments for interview-diagnosed drug use disorders. A total of 50 studies reporting on the efficacy of group drug use disorder treatments for adults met inclusion criteria. Studies examining group treatment for cocaine, methamphetamine, marijuana, opioid, mixed substance, and substance use disorder with co-occurring psychiatric conditions are discussed. The current review showed that cognitive behavioral therapy (CBT) group therapy and contingency management (CM) groups appear to be more effective at reducing cocaine use than treatment as usual (TAU) groups. CM also appeared to be effective at reducing methamphetamine use relative to standard group treatment. Relapse prevention support groups, motivational interviewing, and social support groups were all effective at reducing marijuana use relative to a delayed treatment control. Group therapy or group CBT plus pharmacotherapy are more effective at decreasing opioid use than pharmacotherapy alone. An HIV harm reduction program has also been shown to be effective for reducing illicit opioid use. Effective treatments for mixed substance use disorder include group CBT, CM, and women's recovery group. Behavioral skills group, group behavioral therapy plus CM, Seeking Safety, Dialectical behavior therapy groups, and CM were more effective at decreasing substance use and psychiatric symptoms relative to TAU, but group psychoeducation and group CBT were not. Given how often group formats are utilized to treat drug use disorders, the present review underscores the need to understand the extent to which evidence-based group therapies for drug use disorders are applied in treatment settings.

Brief early adolescent multi-family therapy (BEAM) trial for anorexia nervosa: a feasibility randomized controlled trial protocol

INTRODUCTION

Multi-family therapy (MFT) is a recommended treatment for adolescent anorexia nervosa internationally. Despite recent significant advances in single-family therapy, the evidence base for MFT remains relatively small. Several individual and family factors have been associated with poorer outcomes in single-family therapy, many of which may be addressed or ameliorated by MFT if delivered early in treatment. This trial aims to determine the feasibility and acceptability of adding a five-day multi-family therapy group to the early stages of family therapy for anorexia nervosa. Secondary objectives are to explore effect size changes in key individual and family factors across treatment.

METHODS

This feasibility trial will use a randomised controlled design. Sixty adolescents (age 10-17 inclusive) with anorexia nervosa or atypical anorexia nervosa and their parents will be recruited from a community-based specialist eating disorder service in London, UK. Participants will be randomly allocated to receive six months of eating disorder focussed family therapy with a five-day MFT group (experimental group) or without (control group). Block randomisation will be conducted by the King's Clinical Trials Unit and researchers will be blind to participants' intervention allocation. Feasibility, acceptability and secondary outcomes measures will be collected at baseline, post-MFT, end of treatment, six-month and 12-month follow-up. Feasibility and acceptability will be assessed according to trial sign-up rates, retention, measure completion rates and satisfaction. Secondary outcomes include physical health improvements, changes in psychiatric symptoms, emotion regulation and reflective function capacity, expressed emotion, parental difficulties and therapeutic alliance. Descriptive data and exploration analysis of trends and effect sizes will be reported upon at trial completion.

DISCUSSION

The five-day MFT program developed for this study is novel, brief and more accessible than previous MFT models. The inclusion of a data collection point during treatment and follow-up will allow for an investigation of trends during and after treatment. This will allow exploration and comparison of future potential mediators and moderators of MFT and FT-AN outcomes and how these may differ between treatments.

TRIAL REGISTRATION

ISRCTN registry; ISRCTN93437752 , on 27 January 2021.

Obstacles, Challenges, and Benefits of Online Group Psychotherapy

Although telepsychiatry is not new, the COVID-19 pandemic has dramatically boosted and legitimized it, especially in the field of group therapy. Group therapists have been forced to move online without enough training in leading online groups. Online groups are not the same as meeting in person and present specific obstacles and challenges that should either be compensated for or acknowledged as losses. In this article, the author summarizes these obstacles, identifying factors in group therapy, such as body-to-body interaction, that are absent online and suggesting ways to compensate for other differences, such as the therapist's reduced control over the setting. Surprisingly, some group members may benefit from online groups more than from in-person ones, but the online format is not for everyone. Research on online therapy has already shown this format's effectiveness, and the therapeutic alliance that is positively correlated with outcome seems to be achievable online as well. However, more research is needed, especially on cohesion in online groups, which seems to develop slower online.

Terrified of Group Therapy: Investigating Obstacles to Entering or Leading Groups

Despite substantial evidence that group therapy is effective, many individuals are reluctant to join groups, and clinicians are reluctant to refer patients to them or to lead a group themselves. This article investigates the obstacles to participation in group therapy. It focuses primarily on the deeply personal elements of this hesitation for potential group members, which include social anxiety, fear of anger from other group members, dread of experiencing shame or humiliation, and desire for individual attention. Clinicians, as well, are reluctant to lead groups, because they feel insufficiently trained and may fear the experience of inadequacy, shame, and humiliation. These obstacles to participation are often driven by powerful components of transference and countertransference.

When Coleaders Differ: Rupture and Repair in Group Psychotherapy

The nature and quality of coleader relationships in group psychotherapy have been the subjects of numerous investigations. Coleader rupture and repair, however, remain understudied in the group psychotherapy literature. Coleader ruptures vary in intensity, from relatively minor tensions, of which one or both group leaders may be only dimly aware, to major breakdowns in collaboration, understanding, or communication. Effective coleaders are able to identify and repair ruptures in the coleader alliance. This article examines rupture and repair in the coleader relationship through the lens of attachment and interpersonal integrative group theory. Case examples are used to illustrate the application of the principles discussed, and suggestions are provided for strengthening the coleader alliance.

Re-activating life skills in cancer patients through expressive-creative workshops: A qualitative exploratory study

Background: Cancer strongly impacts on patients' lives, undermining their life skills. This research aimed to explore the perception of efficacy of participants in a series of expressive-creative workshops (ArtLab) designed to reactivate life skills in cancer patients.Methods:Quotations of two semi-structured focus groups with ten participants in ArtLab (Mean Age = 59; SD = 11.19) enrolled at [Fondazione IRCCS Istituto Nazionale dei Tumori] have been analyzed through a priori (top-down) thematic analysis which allowed us to identify life skills provided by WHO 1948: Emotional, Relational and Cognitive.Results:Thematic analysis showed ArtLab program's effectiveness, especially regarding Emotional and Relational life skills. Cognitive skills, instead, seemed to be only partially expressed. Sub-themes articulation for each life skill has been discussed.Conclusion:This study provides encouraging results with respect to the effectiveness of expressive-creative group workshops among cancer patients.

Coevolution of group-living and aposematism in caterpillars: warning colouration may facilitate the evolution from group-living to solitary habits

BACKGROUND

Animals use diverse antipredator mechanisms, including visual signalling of aversive chemical defence (aposematism). However, the initial evolution of aposematism poses the problem that the first aposematic individuals are conspicuous to predators who have not learned the significance of the warning colouration. In one scenario, aposematism evolves in group-living species and originally persisted due to kin selection or positive frequency-dependent selection in groups. Alternatively, group-living might evolve after aposematism because grouping can amplify the warning signal. However, our current understanding of the evolutionary dynamics of these traits is limited, leaving the relative merit of these scenarios unresolved.

RESULTS

We used a phylogenetic comparative approach to estimate phenotypic evolutionary models to enable inferences regarding ancestral states and trait dynamics of grouping and aposematic colouration in a classic model system (caterpillars). We find strong support for aposematism at the root of the clade, and some (but weaker) support for ancestral solitary habits. Transition rates between aposematism and crypsis are generally higher than those between group-living and solitary-living, suggesting that colouration is more evolutionarily labile than aggregation. We also find that the transition from group-living to solitary-living states can only happen in aposematic lineage, suggesting that aposematism facilitates the evolution of solitary caterpillars, perhaps due to the additional protection offered when the benefits of grouping are lost. We also find that the high frequency of solitary, cryptic caterpillars is because this state is particularly stable, in that the transition rates moving towards this state are substantially higher than those moving away from it, favouring its accumulation in the clade over evolutionary time.

CONCLUSIONS

Our results provide new insights into the coevolution of colour and aggregation in caterpillars. We find support for an aposematic caterpillar at the root of this major clade, and for the signal augmentation hypothesis as an explanation of the evolution of aposematic, group-living caterpillars. We find that colouration is more labile than aggregation behaviour, but that the combination of solitary and cryptic habits is particularly stable. Finally, our results reveal that the transitions from group-living to solitary-living could be facilitated by aposematism, providing a new link between these well-studied traits.

Modified CBT for social anxiety and social functioning in young adults with autism spectrum disorder

Background

There is a strong research imperative to investigate effective treatment options for adolescents and adults with autism spectrum disorder (ASD). Elevated social anxiety, difficulties with social functioning and poor mental health have all been identified as core treatment targets for this group. While theoretical models posit a strong bidirectionality between social anxiety and ASD social functioning deficits, few interventions have targeted both domains concurrently. Of the two group interventions previously conducted with adolescents and adults with ASD, significant results have only been observed in either social anxiety or social functioning, and have not generalised to changes in overall mood. The aim of this study was to evaluate the potential benefit, tolerability and acceptability of a group cognitive-behaviour therapy (CBT) intervention in young adults with ASD. Primary treatment outcomes were social anxiety symptoms and social functioning difficulties; secondary outcomes were self-reported mood and overall distress.

Method

Ten groups of participants completed an eight-week, modified group CBT intervention targeting both social anxiety and social functioning, that included social skills training, exposure tasks and behavioural experiment components. Seventy-eight adolescents and young adults with ASD, without intellectual impairment, aged between 16 and 38 (M = 22.77; SD = 5.31), were recruited from the community, Headspace centres and the Autism Clinic for Translational Research at the Brain and Mind Centre, University of Sydney. Outcomes (social anxiety, social functioning and mood) were measured pre- and post-intervention via self-report questionnaires (administered either online or through the return of hard-copy booklets), and participants were invited to provide anonymous feedback on the intervention (at the mid-point and end of the intervention).

Results

Participants demonstrated statistically significant improvements on all outcome measures in response to the intervention. Specifically, social anxiety symptoms decreased (p < .001), and specific subdomains of social functioning improved post-intervention, particularly in social motivation (p = .032) and restricted interests and repetitive behaviours (p = .025). Self-reported symptom improvements also generalised to mood (depression, anxiety and stress; p < .05). All improvements demonstrated small effect sizes. Participant feedback was positive and indicated strong satisfaction with the program.

Limitations

The absence of a control group and follow-up measures, reliance on self-report instruments as outcome measures and the exclusion of those with intellectual disability represent significant limitations to this study.

Conclusions

These findings indicate that a group CBT intervention appears to be a beneficial intervention for self-reported social anxiety, social functioning and overall mental health in adolescents and young adults with ASD. The stand-alone nature of the intervention combined with positive participant feedback indicates it was well tolerated, has potential clinical utility and warrants further study in a randomised-controlled, follow-up design.

INTRODUCTION: Investigating Malingering and Public Policy Through an Interdisciplinary Working Group

This Introduction frames the context of the interdisciplinary working group that examined the role of malingering in health and social policy in 2019-2020. The Symposium Issue here is the result of the group's time, energy, and analysis.

Does the Cerebellum Implement or Select Geometries? A Speculative Note

During evolution, living systems, actively interacting with their environment, developed the ability, through sensorimotor contingencies, to construct functional spaces shaping their perception and their movements. These geometries were modularly embedded in specific functional neuro-architectures. In particular, human movements were shown to obey several empirical laws, such as the 2/3 power law, isochrony, or jerk minimization principles, which constrain and adapt motor planning and execution. Outstandingly, such laws can be deduced from a combination of Euclidean, affine, and equi-affine geometries, whose neural correlates have been partly detected in several brain areas including the cerebellum and the basal ganglia. Reviving Pellionisz and Llinas general hypothesis regarding the cerebrum and the cerebellum as geometric machines, we speculate that the cerebellum should be involved in implementing and/or selecting task-specific geometries for motor and cognitive skills. More precisely, the cerebellum is assumed to compute forward internal models to help specific cortical and subcortical regions to select appropriate geometries among, at least, Euclidean and affine geometries. We emphasize that the geometrical role of the cerebellum deserves a renewal of interest, which may provide a better understanding of its specific contributions to motor and associative (cognitive) functions.

A systematic review of the effectiveness of group-based exercise interventions for individuals with first episode psychosis

BACKGROUND

Treating first episode psychosis represents a critical time to improve the trajectory of people's physical health, mental health, functioning, and quality of life. Individuals should be offered a variety of evidence-based interventions to promote physical activity and social connectedness. This review aimed to establish the effectiveness of group-based exercise interventions for improving outcomes in people with first episode psychosis.

METHOD

We undertook a systematic review of the following databases; Medline (Ovid), PsycINFO (Ovid), Embase (Ovid) and CINAHL, to identify studies in first episode psychosis populations that implemented a group-based exercise intervention and examined outcomes in physical health, mental health or functioning and quality of life.

RESULTS

From 1431 studies screened, five met our inclusion criteria. Whilst group-based exercise interventions did not have a significant impact on physical health, there was a significant effect on psychiatric symptomatology, quality of life and functioning (including cognition). The overall risk of bias was high.

CONCLUSIONS

Group-based exercise interventions may be feasible and acceptable in first episode psychosis populations. However, more, high quality research is required to understand the best mode of delivery of exercise interventions to maximise patient outcomes and optimise patient contact with services using an engaging and cost-effective approach.

Weekly group tummy time classes are feasible and acceptable to mothers with infants: a pilot cluster randomized controlled trial

Background

The World Health Organization recommends 30 min of tummy time daily for improved motor development and reduced likelihood of plagiocephaly. As only 30% of infants meet this recommendation, parents require strategies and support to increase this proportion.

Methods

The aim of this study was to determine the feasibility, acceptability, and potential efficacy of a group intervention to promote tummy time. The design is a cluster randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Five groups of healthy infants (N = 35, baseline mean (SD) age 5.9 (2.8) weeks) and their mothers attending local mother’s groups (Australia) were randomly allocated to the intervention or control group. The intervention group received group tummy time classes in addition to usual care. The control group received usual care with their child and family health nurse. Primary outcomes were intervention feasibility and acceptability. Secondary outcomes were tummy time duration (accelerometry), adherence to physical activity guidelines, head shape, and motor development. Measures were taken at baseline, post-intervention, and when infants were 6 months of age. Analyses were by linear mixed models and Cohen’s d statistic.

Results

Recruitment, retention, and collection of objective data met feasibility targets. Acceptability was also met with intervention mothers reporting the information, goal planning, and handouts significantly more useful and relevant than control group mothers (p < 0.01). Moderate effect sizes were also found at post-intervention for tummy time duration, adherence to physical activity guidelines and infant ability in prone and supine favoring the intervention group (intervention infants had a mean of 30 min and 30% adherence to guidelines (95% CI 0 to 60.6 min) compared to the control infants who had a mean of 16.6 min and 13% adherence to the guidelines (95% CI 0 to 42.1 min, Cohen’s d = 0.5). Limitations were the small sample size, 4-week intervention, limited accelerometer use, and a homogenous sample of participants.

Conclusion

Group tummy time classes delivered in a mother’s group setting were shown to be feasible and acceptable. A larger randomized controlled trial is warranted.

Trial registration

ANZCTR, ACTRN12617001298303p. Registered 11 September 2017

You feel it was written about you: client acceptability of a group intervention for repeat suicide attempts

BACKGROUND

Repeat attempts increase risk of death by suicide. The Psychosocial/psychoeducational Intervention for People with recurrent Suicide Attempts (PISA)/Skills for Safer Living (SfSL) is a group intervention targeting repeat attempts.

AIMS

To evaluate the acceptability of PISA/SfSL to clients and identify key model components influencing this.

METHODS

This exploratory mixed-methods study involved adults who completed PISA/SfSL (N = 16). Participants completed semi-structured interviews and a satisfaction questionnaire post-intervention, and self-report outcome measures of population specific challenges pre and post-intervention and at 6-month follow-up.

RESULTS

Qualitative themes illuminate three interrelated response processes; connection with each other and the model, taking control of life, and gaining a sense of value. Quantitative outcome measures indicated positive trends in suicidality, hopelessness, alexithymia, and problem-solving. High satisfaction levels indicated its quality, relevancy, applicability and helpfulness. Key components influencing responses were PISA/SfSL's; psychosocial group format and processes, psychoeducational and skill development content, and ethos. Results suggest PISA/SfSL was acceptable to those with repeat suicide attempts.

CONCLUSIONS

The study highlights the usefulness of group work and the importance of consistency with guidelines in suicide intervention. It supports the view that recovery in suicidality and engagement in treatment are complex processes. It adds to previous research demonstrating acceptability among facilitators.

Leveraging family dynamics to increase the effectiveness of incentives for physical activity: the FIT-FAM randomized controlled trial

Background

Insufficient physical activity is a global public health concern. Research indicates incentives can increase physical activity levels of children but has not tested whether incentives targeted at children can be leveraged to increase physical activity levels of their parents. This study evaluates whether a novel incentive design linking children’s incentives to both their and their parent’s physical activity levels can increase parent’s physical activity.

Methods

We conducted a two-arm, parallel, open-labelled randomized controlled trial in Singapore where parent-child dyads were randomly assigned to either (1) rewards to child contingent on child’s physical activity (child-based) or (2) rewards to child contingent on both child’s and parent’s physical activity (family-based). Parents had to be English-speaking, computer-literate, non-pregnant, full-time employees, aged 25–65 years, and with a participating child aged 7–11 years. Parent-child dyads were randomized within strata (self-reported low vs high weekly physical activity) into study arms in a 1:1 ratio. Participants were given activity trackers to assess daily steps. The outcome of interest was the between-arm difference in the change from baseline in parent’s mean steps/day measured by accelerometry at months 6 and 12 (primary endpoint).

Results

Overall, 159 and 157 parent-child dyads were randomized to the child-based or family-based arms, respectively. Outcomes were evaluated on an intent-to-treat basis. At month 6, there was a 613 steps/day (95% CI: 54–1171) differential in favour of family-based parents. At month 12, our primary endpoint, the differential was reduced to 369 steps/day (95% CI: − 88–1114) and was no longer statistically significant.

Conclusions

Our findings suggest that novel incentive designs that take advantage of group dynamics may be effective. However, in this design, the effectiveness of the family-based incentive to increase parent’s physical activity was not sustained through one year.

Trial registration

NCT02516345 (ClinicalTrials.gov) registered on August 5, 2015.