Family Caregiver Adaptation during the Transition to Adulthood of Individuals with Intellectual Disabilities: A Scoping Review

During the transition to adulthood, individuals diagnosed with intellectual disability (ID) and their family caregivers have unique experiences. This scoping review studies the sources of the family caregiver's objective burden, support, coping mechanisms, positive caregiving, and quality of life to understand the caregiver's adaptation process when the individual with ID transits to adulthood, according to Joanna Briggs Institute (JBI) Scoping Review methodology guidelines. The inclusion criteria included studies of family caregivers of any age who provide unpaid care and live with individuals diagnosed with ID who are transitioning to adulthood. Of 2875 articles identified, 12 published studies were included. The main themes included caregivers reporting dissatisfaction with the available adult services and exhaustion from being a caregiver. Overall, a vicious cycle of likely increased demands during the transition, with caregivers not being prepared to cope with these demands while concurrently being dissatisfied with the adult services system, leads the caregivers to develop a pervasive sense of helplessness. Future studies would benefit from recruiting caregivers from sources other than adult-only service centres and using qualitative (to identify the broad aspects of the key factors) and quantitative (to identify the significant differences between the key factors) methodologies.

A bridge to recovery: an interpretative phenomenological analysis with peer support specialists in Singapore

Recovery-oriented mental health care approach is gaining acceptance in Asian countries, including Singapore. Following Western countries, Singapore started hiring peer support specialists (PSS) as part of mental healthcare services. The aim of this paper was to explore and understand how individual peer support specialists in Singapore perceive and make sense of their role given their unique perspective as both recipients and providers of mental healthcare treatment. Six PSS in Singapore were interviewed utilizing a semi-structured interview schedule. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis. Four superordinate themes were generated illustrating how PSS viewed their role: embracing and embodying recovery, balancing on a bridge, impossible without support, and helping to end stigma. Findings also illustrated participants' awareness of the nature of the job and the role of PSS as still in the infancy stage. They embraced a recovery-oriented mindset despite experiencing stigma from professionals and/or their social support. The need to understand familial attitudes towards the PSS role is discussed. The limitations, contributions to the research, and several areas for future research are also outlined.

Protocol for scoping review study to map out the existing research in relation to post-traumatic stress symptoms among caregivers of individuals with neurodevelopmental, psychiatric and neurocognitive disorders

INTRODUCTION

The challenges of providing caregiving that impacts the caregiver have been attributed to high levels of intensity and physical strain, burden and distress. This is likely to include emotional and psychological distress as manifested in post-traumatic stress symptoms (PTSS). As this is a new area of investigation among caregivers of individuals with neurodevelopmental, neurocognitive and psychiatric disorders, the extent of the literature for PTSS in these groups of caregivers is limited and unclear. This scoping review aims to map the existing research focusing on key concepts and identifying gaps in relation to PTSS among these caregivers.

METHODS AND ANALYSIS

The scoping review will be guided by Arksey and O'Malley's proposed 5-stage framework. A search for published and unpublished grey literature between years 2005 to 2020 in the electronic databases of CINAHL, SCOPUS, PsychInfo, OVID PubMed and ProQuest Dissertation, and Thesis Global electronic databases was conducted using keywords to identify relevant studies. Articles will be limited to the English language. Endnote 20 software will be used to eliminate duplicates, and results will be exported into Abstrackr for the review screening process consisting of two stages: title and abstract reviews and full-text reviews. Selection process of eligible studies will follow the recommendations in the Preferred Reporting Items of Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. A data chart will be used to capture relevant information from all included studies, and results will be presented in tabular form and in a narrative report.

ETHICS AND DISSEMINATION

This scoping review consists of reviewing and collecting data from publicly available materials and hence does not require ethics approval. The scoping review results will be disseminated via publications in peer-reviewed journals and conference presentations. The results will also guide the design of a mixed method research study to examine the extent of trauma symptomatology and potentially traumatising experiences, and how they relate to the mental health of caregivers of adults with intellectual and developmental disability from different cultural backgrounds.

Application of Dialectical Behaviour Therapy in treating common psychiatric disorders: study protocol for a scoping review

INTRODUCTION

Dialectical behaviour therapy (DBT) is a well-known intervention for treating borderline personality disorder, and has been increasingly adapted for other disorders. Standard DBT consists of four treatment modes, delivered over a year. Adaptations to DBT include changes to modes of delivery, treatment length, and skills modules taught to clients, or incorporating interventions from other evidence-based therapies. There is a need to synthesise existing evidence on DBT so that stakeholders-clinicians, researchers and policymakers-can understand how it has been provided for various psychiatric conditions, and whether it has been effective.

METHODS AND ANALYSIS

This study proposes a scoping review conducted according to Arksey and O'Malley's (2005) procedures, to map and summarise the literature on DBT interventions for treating a range of psychiatric concerns. Electronic databases (ie, the Cochrane Central Register of Controlled Trials, PubMed, PsycINFO, SCOPUS, EBSCOhost and ProQuest Dissertations and Theses), conference proceedings and the US National Institutes of Health Ongoing Trial Register will be searched for intervention studies that involve a control or comparison group, and that report quantitative data on pre/post-measures for psychiatric symptom severity. The initial search was conducted on 18 September 2020, and data charting has not commenced. An update will be performed in September 2022, pending this protocol's publication. Data charting will collect individual studies' characteristics, methodology and reported findings. Outcomes will be reported by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for Scoping Reviews.

ETHICS AND DISSEMINATION

No ethical approval is required for this study. The goal of dissemination is to keep DBT stakeholders abreast on latest updates in clinical applications of DBT. Findings from this research are intended to inform a more specific topic of study (eg, a meta-analysis), to further aid in the development of DBT interventions for psychiatric populations.

REGISTRATION DETAILS

The study protocol was pre-registered with the Open Science Framework on 24 August 2021 (https://osf.io/vx6gw).

The Good Enough Parenting early intervention schema therapy based program: Participant experience

Background and objectives

Schema therapy (ST) has become a mainstream therapy for the treatment of psychopathology and has been validated through a series of large scale, international randomized control trials. Among other things, schema therapy emphasizes the meeting of core emotional needs in children by primary caregivers as these unmet needs continue to adversely affect their lives into adulthood. An early intervention parenting program has been developed to help parents meet these core emotional needs in order to prevent the development of psychopathology in the first place. The program, Good Enough Parenting, is equally focused on reducing problems and strengthening parenting practices, regardless of where the child is on the “disordered to well-being continuum”. This study aims to explore “patient experience” by users of this program. Best clinical research guidelines advocate that participants should be used as collaborators rather than pure recipients; this process should predate large scale trials.

Design

An exploratory qualitative study with 55 parent-participants of Good Enough Parenting was conducted.

Methods

One-to-one interviews were conducted with participants, using critical incident technique and guided by semi-structured interview schedule, to explore their experiences with the program. Transcripts were then analyzed using thematic analysis.

Results

Coding showed a high degree of inter-rater reliability (kappa value of 0.78). The themes that emerged were Cultivating Awareness of Parents’ Own Schemas, Cultivating Intentionality, Working through Developmental Issues, Responses to Challenges at Home, Performing Multiple Roles, and the Learning Process. Participants overwhelmingly reported satisfaction within these key themes.

Conclusions

The results support the development of the program and the choice of “participant reported outcome measures” for use in subsequent randomized controlled trials.

Thinking about feeling: Using trait emotional intelligence in understanding the associations between early maladaptive schemas and coping styles

OBJECTIVES

Maladaptive interpersonal schemas can trigger distressing emotions and drive dysfunctional behaviour that leads to difficulties in interpersonal relationships and perpetuates the original maladaptive schemas. This study sought to identify patterns of association between trait emotional intelligence (TEI), early maladaptive schemas (EMS), and coping styles in a non-clinical sample. Emotionality profiles were hypothesized to be associated with EMS severity and poorer coping, as early experiences can shape an individual's self-perceptions through reinforcement by maladaptive responses.

DESIGN

Cross-sectional study with 142 undergraduate students.

METHODS

We obtained self-reports of TEI, coping styles, and EMS.

RESULTS

Disengagement coping was strongly correlated with EMS severity (r = .565, p < .01). TEI was negatively correlated with EMS (r = -.660, p < .01) and Disengagement (r = -.405, p < .01). Emotionality, Impaired Autonomy, and Overvigilance partially mediated the relationship between Disconnection and Emotion-Focused Disengagement. Self-Control fully mediated the relationship between Impaired Limits and Problem-Focused Disengagement.

CONCLUSIONS

The findings suggest that lower TEI is associated with the likelihood for maladaptive coping in response to EMS. The preference for certain coping styles associated with a particular domain of EMS may be explained by an individual's perceived metacognitive ability to regulate their stress and emotions. When individuals' needs for love, safety, and acceptance from others are not met, there might be poorer perceived self-efficacies in Emotionality and the tendency to cope through emotional avoidance. Individuals with difficulties establishing internal limits are more likely to respond with problem avoidance, possibly due to deficient distress tolerance. Longitudinal studies with a clinical population are warranted to replicate these findings.

PRACTITIONER POINTS

Clinicians will likely find it helpful to consider their clients' TEI to facilitate more individualized formulation and treatment planning, by considering whether related emotional regulation problems might be innate or a deficit in skills Implies the need to do more basic emotional regulation work to supplement and strengthen the established imagery work in schema therapy (ST).

The Effects of Temperament on Depression According to the Schema Model: A Scoping Review

Background: Recent studies have shown that not every depressed patient responds to Cognitive Behavioral Therapy, and some of those who do relapse upon termination. Due to its dual focus on the past and present, Schema Model (SM) represents a promising alternative model to understand depression. However, studies examining SM often operationalize the same construct differently, resulting in inconsistent evidence of change. There is no known review clarifying (1) how best to assess schema constructs; and (2) the relevant pathways to depression, without which, the empirical basis for SM cannot be examined. Methods: A scoping review was conducted in accordance to PRISMA guidelines to map evidence of the relationship between constructs of SM and depression, and measures used to assess the constructs. 2463 articles were identified with 49 primary research studies included. This paper is a subset of the scoping review and focuses on the five studies examining effects of temperament on depression. Results: Two models were used to operationalize temperament: The Five Factor Model (FFM) and the Psychobiological Model of Personality (PBM). The variables of neuroticism and harm avoidance were positively associated with depressive symptoms while self-directedness and cooperativeness were negative associated with depressive symptoms. Conclusion: The FFM is more suited to operationalize temperament in studies of SM and depression due to its theoretical compatibility with SM, established psychometric properties of its measures, and widespread use among studies of SM. Out of the five factors in the FFM, only neuroticism exerts direct and indirect effects on depression. These findings are limited by homogeneous sampling, hence future research studies should consider extending it to adult clinical samples. Nevertheless, this review represents a first step in the systematic examination of the empirical basis of SM and a contribution to treatment innovation and practice for depression.

The role of strengths in anger and conduct problems in maltreated adolescents

Despite multi-type maltreatment, some individuals demonstrate positive adaptation and continue to develop in a healthy way. A multitude of strength factors have been linked to adaptive functioning and resilience, but this has not been adequately examined in maltreated adolescent's psychosocial functioning. This study sought to examine the role of strengths such as having talents/interests, family relationships, educational support, the role of the recognition and application of these strengths, and the role of multi-type maltreatment on anger control and conduct problems. One hundred and thirty participants (61 males; 69 females) aged 13-19 years old were rated using the Singapore version of Child and Adolescent Needs and Strengths (CANS) tool. The results revealed that certain strengths were associated with anger and conduct problems, but the recognition and application of strengths emerged as a consistently significant predictor for both outcomes. Hence, to understand and apply one's strengths may be equally as important as merely possessing those strengths. This study extends current understanding of the importance of strengths with a group of maltreated adolescents in an Asian context. Adopting a person-centered and strength-based approach will further enhance the effectiveness of interventions and improve outcomes for maltreated adolescents living in residential care.