From symptoms of psychopathology to the explanation of clinical phenomena

Silence and related symptoms in children and adolescents: a network approach to selective mutism

Background

Silence in certain situations represents the core symptom of selective mutism (SM). However, it is unclear what additional symptoms are part of this disorder. Although knowledge of symptoms is essential for diagnostics and intervention, to date, only scarce research exists on circumscribed symptoms of SM. Given the large overlap between SM and social anxiety disorder (SAD), it remains also unclear which symptoms can differentiate both disorders.

Methods

A network analysis of potential symptoms of SM was performed based on a mixed sample of N = 899 children and adolescents with and without indication of SM (n = 629 with silence in certain situations). In a preliminary analysis, we demonstrated that children with and without silence in certain situations do not differ with respect to their network structure, justifying an analysis on the entire mixed sample. Possible communities (symptom clusters) within the network and thus potential latent variables were examined, and symptoms were analyzed in terms of their centrality (the extent to which they are associated with other symptoms in the network). To investigate the differentiability of symptoms of the SM network from symptoms of SAD, we computed a network that additionally contains symptoms of SAD.

Results

In the resulting network on symptoms of SM, silence was, as expected, the symptom with the highest centrality. We identified two communities (symptom cluster): (1) symptoms associated with the fear response of freezing, (2) symptoms associated with speech production and avoidance. SM network symptoms and SAD symptoms largely formed two separate symptom clusters, with only selectivity of speaking behavior (more talkative at home and taciturn or mute outside the home) falling into a common cluster with SAD symptoms.

Conclusions

Silence appears to have been confirmed by analysis as a core symptom of SM. Additional anxiety-related symptoms, such as avoidance behavior or motor inhibition associated with freezing, seem to co-occur with silence. The two communities of SM potentially indicate different mechanisms of silence. The symptoms of SM appear to be distinguishable from those of SAD, although there seems to be overlap in terms of difficulty speaking in situations outside the home.

Epistemic pluralism and the justification of conceptual strategies in science

In recent years, epistemic pluralism has received considerable endorsement as an approach to constructing scientific explanations and pursuing empirical research programs. In this article, we briefly discuss the advantages of an epistemically pluralist approach before outlining our own model of epistemic pluralism. The model we present emphasizes the specific considerations that occur when determining and justifying the selection of conceptual strategies and how conceptual strategies work together to provide task-relevant insights. By clarifying these constraint relationships, we highlight the kinds of systematic considerations that must be taken into account when selecting conceptual strategies for research tasks. We present a case study based on gang research to demonstrate how such considerations occur and the epistemic and pragmatic benefits of doing so.

Translating science into practice in clinical psychology: A reformulation of the evidence-based practice inquiry model

The model of evidence-based practice (EBP) directs clinicians to integrate the best available research evidence, clinical expertise, client preferences and values, and social and cultural factors in the assessment and treatment of psychological problems. Despite its many strengths, the five-step inquiry component of the EBP model suffers from several conceptual and practical problems that make it difficult to implement in practice. In this article, we first outline the transdisciplinary EBP model. Second, several criticisms of the overall EBP model are outlined and briefly discussed. Third, five pressing problems in the inquiry component of the EBP model are identified: (a) information overload, (b) a focus on questions rather than tasks, (c) neglect of theory, (d) difficulty dealing with conflicting evidence, and (e) an oversimplified view of the role of values in research and practice. Fourth, we suggest ways of modifying the inquiry part of the model to address these problems.

The Explanation of Eating Disorders: A Critical Analysis

Eating disorders (EDs) are one of the most severe and complex mental health problems facing researchers and clinicians today. The effective prevention and treatment of these conditions is therefore of paramount importance. However, at present our treatments fall short: generally demonstrating only poor to moderate efficacy, and often completely ineffective for severe or chronic cases. A possible reason for this is that the current theories underlying these treatments are flawed. In this paper, we review and evaluate several prominent theoretical explanations associated with current frontline and promising treatments for ED. In doing so, we identify fundamental problems within the construction of current ED explanations and their implications for treatment. In response to these findings, we propose several strategies for the construction of future ED explanations which we believe have the power to ameliorate these problems and potentially help to develop more efficacious treatment downstream.

Why theory matters in correctional psychology

Contemporary forensic psychology is characterized by a relative lack of attention to theory building and conceptual analysis. In my view, this neglect of theory amounts to theoretical illiteracy and represents a significant obstacle to the explanation of crime and its management. In this paper I explore the problem of theoretical illiteracy for forensic psychological research and practice. First, I discuss why theory is important in science and the dangers of ignoring it. Second, I review the role of theory in addressing the myriad of practical problems facing human beings. Third, I outline three strategies to increase researchers and practitioners’ appreciation of theory construction and development: adopting a more comprehensive model of scientific method, epistemic iteration, and promoting model pluralism. Fourth, I examine two examples of core concepts from correctional psychology, that of dynamic risk factors and classification, and demonstrate how the above strategies can be used to address problems with these constructs.

The Classification and Explanation of Depression

In the field of psychopathology there is still a lack of consensus on how mental disorders, such as depression, should be classified and explained. Many of our current classifications suffer from disorder heterogeneity and are conceptually vague. While some researchers have argued that mental disorders are better explained from a biological perspective, others have made the case for pluralistic and integrative explanations. Using depression as an extended example, we explore the challenges in classifying and explaining psychopathology. We begin by evaluating the current approaches to classification, including frameworks for what we consider a mental disorder. This is followed by a detailed summary of current explanatory perspectives in psychiatry. The relationship between classification and explanation presents unique theoretical challenges in understanding mental disorders. We suggest that by adjusting our focus from understanding syndromes to clinical phenomena we can advance our understanding of mental disorders.