The influence of attachment style on support and feedback seeking and depression severity among mothers during the COVID-19 pandemic

OBJECTIVES

The ways that people seek support during times of stress influence their mental health outcomes, including depression. Insecure attachment is a risk factor for depression and may also interfere with adaptive support and feedback-seeking behaviour during stress. The purpose of the present study was to test theorized associations between insecure attachment, support and feedback seeking, and changes in depression symptoms over 1 year, in a sample of mothers of school-age children in the context of stress elicited by the COVID-19 pandemic.

METHODS

Participants (N = 70 mothers) completed self-report measures of anxious and avoidant attachment and depression severity at baseline in spring 2020 and then completed measures of past-year engagement in direct and indirect support seeking and excessive reassurance seeking (ERS), preference for negative feedback, and depression severity at a follow-up assessment in summer 2021.

RESULTS

Greater attachment anxiety at baseline predicted more frequent direct support seeking, indirect support seeking, and ERS during the 1-year follow-up period. In turn, greater indirect support seeking predicted greater increases in depression from baseline to follow-up. Greater attachment avoidance at baseline predicted less direct support seeking during the 1-year follow-up period. Greater attachment avoidance at baseline also predicted depression severity at follow-up, particularly among mothers with moderate to high levels of attachment anxiety, although none of the examined support and feedback-seeking behaviours mediated this association.

CONCLUSIONS

These results provide support for the role of activated attachment systems in determining support and feedback-seeking behaviour during stress, as well as the role of support and feedback-seeking behaviour in the maintenance and exacerbation of depression.

The use of mentalization-based techniques in online psychodynamic child psychotherapy

Objective: Psychodynamic child psychotherapy is an evidence-based approach for a range of child mental health difficulties and needs to constantly adapt to meet the needs of children. This study is the first to investigate whether the use of mentalization-based interventions (i.e., a focus on promoting attention control, emotion regulation, and explicit mentalization) predicted a good therapeutic outcome in online psychodynamic child therapy sessions conducted during the COVID-19 pandemic. Methods: The sample included 51 Turkish children (Mage = 7.43, 49% girls) with mixed emotional and behavioral problems. Independent raters coded 203 sessions from different phases in each child's treatment using the Mentalization-Based Treatment for Children Adherence Scale (MBT-CAS). Results: Multilevel modeling analyses showed children with higher emotional lability benefited more from attention control interventions compared to those with lower emotional lability. Discussion: Interventions that focus on developing the basic building blocks of mentalizing may be effective components of therapeutic action for online delivery of psychodynamic child psychotherapy, especially for children with greater emotional lability.

Telecom-Wavelength Quantum Repeater Node Based on a Trapped-Ion Processor

A quantum repeater node is presented based on trapped ions that act as single-photon emitters, quantum memories, and an elementary quantum processor. The node's ability to establish entanglement across two 25-km-long optical fibers independently, then to swap that entanglement efficiently to extend it over both fibers, is demonstrated. The resultant entanglement is established between telecom-wavelength photons at either end of the 50 km channel. Finally, the system improvements to allow for repeater-node chains to establish stored entanglement over 800 km at hertz rates are calculated, revealing a near-term path to distributed networks of entangled sensors, atomic clocks, and quantum processors.

Entanglement of Trapped-Ion Qubits Separated by 230 Meters

We report on an elementary quantum network of two atomic ions separated by 230 m. The ions are trapped in different buildings and connected with 520(2) m of optical fiber. At each network node, the electronic state of an ion is entangled with the polarization state of a single cavity photon; subsequent to interference of the photons at a beam splitter, photon detection heralds entanglement between the two ions. Fidelities of up to (88.0+2.2-4.7)% are achieved with respect to a maximally entangled Bell state, with a success probability of 4×10^{-5}. We analyze the routes to improve these metrics, paving the way for long-distance networks of entangled quantum processors.

Facilitative interpersonal skills are relevant in child therapy too, so why don’t we measure them?

One of the consistent findings from psychotherapy process research has been the impact of therapist effects on patient change and the therapeutic alliance. The Facilitative Interpersonal Skills (FIS) paradigm is a task in which participants respond to standardized videos of actors playing patients in interpersonally challenging moments as if they were the therapist, which was designed to assess therapist effects. Participants’ video recorded responses are coded for eight skills: verbal fluency, emotional expressiveness, warmth/acceptance/understanding, empathy, persuasiveness, hope/positive expectations, alliance-bond capacity, and rupture-repair responsiveness. Performance-based procedures like the FIS minimize self-report bias and systematically control for client-related variability while maintaining strong clinical relevance. Research has shown that therapist FIS predicts the quality of the therapeutic alliance and outcome in adult psychotherapy. This paper describes the development and first adaptation of the FIS task using child and adolescent patients as the stimuli, and reports findings from a pilot study testing the reliability. The FIS-Child (FIS-C) task was administered to 10 therapists with a range of clinical backgrounds. Participants also completed the original FIS task and self-report measures of their empathy, social skills, and playfulness. Adequate interrater reliability was achieved on the FIS-C. There were no significant differences between participants’ ratings on the FIS-C compared to the original FIS, although there were minor differences in the correlations between the FISC and self-report measures compared to the original FIS. Findings support moving forward with utilizing the FIS-C to empirically study therapist effects that may be common factors across treatment models.

Be My Safe Haven: Parent-Child Relationships and Emotional Health During COVID-19

Objective

Since March 2020, millions of children have been confined to their homes and restricted from in-person activities, radically changing the dynamics of parent–child relationships. This study examines the association between coronavirus disease 2019 (COVID-19) impact and the mental health of parents and school-aged children; specifically, whether qualities of the parent–child relationship moderated the relationship between parents’ emotional health (EH) and children’s emotional and behavioral health (EBH).

Methods

Data from this Internet-based study of a community sample were collected in March–May 2020. Parents (N = 158, 92.4% White, 96.2% female) reported on COVID-19 impacts, their own EH, perceptions of their relationship with their eldest child between 6 and 12 years-old, and the EBH of that child.

Results

Responses to questions about COVID-19 impact were assigned weighted values and used to create a COVID-19 impact scale. Hierarchical linear regressions revealed that greater COVID-19 impact was associated with greater parents’ EH issues only, and parents’ EH was a significant positive predictor of children’s EBH. Positive qualities and conflict in the parent–child relationship moderated the link between parents’ and children’s EH. At higher levels of relationship conflict and lower levels of positivity, there were stronger positive associations between parents’ and children’s EH. Parent–child relationship quality did not moderate the association between parents’ EH and children’s behavioral health (BH).

Conclusions

These cross-sectional study results suggest that beyond focusing on symptom management, families may benefit from supports targeting the parent–child relationship. Insights and implications for practitioners are discussed.

A scoping review of machine learning in psychotherapy research

Machine learning (ML) offers robust statistical and probabilistic techniques that can help to make sense of large amounts of data. This scoping review paper aims to broadly explore the nature of research activity using ML in the context of psychological talk therapies, highlighting the scope of current methods and considerations for clinical practice and directions for future research. Using a systematic search methodology, fifty-one studies were identified. A narrative synthesis indicates two types of studies, those who developed and tested an ML model (k=44), and those who reported on the feasibility of a particular treatment tool that uses an ML algorithm (k=7). Most model development studies used supervised learning techniques to classify or predict labeled treatment process or outcome data, whereas others used unsupervised techniques to identify clusters in the unlabeled patient or treatment data. Overall, the current applications of ML in psychotherapy research demonstrated a range of possible benefits for indications of treatment process, adherence, therapist skills and treatment response prediction, as well as ways to accelerate research through automated behavioral or linguistic process coding. Given the novelty and potential of this research field, these proof-of-concept studies are encouraging, however, do not necessarily translate to improved clinical practice (yet).

Patients' Adult Attachment Interview classification and their experience of the therapeutic relationship: are they associated?

In the last decade of his career, Jeremy Safran became increasingly interested in investigating the ways in which attachment representations influence the therapeutic relationship. In this paper, we test such influence in a sample of thirty outpatients who received Brief Relational Therapy by comparing their independently coded pre-treatment Adult Attachment Interview (AAI) with their narratives in a post-treatment interview about the relationship with the therapist (the Patient Relationship Interview at Termination, PRI-T). The PRI-T was coded with the following three measures: i) The Patient Attachment to Therapist Rating Scale (PAT-RS), which assesses the quality of the patient's attachment relationship to the therapist; ii) the Coherence scale from the AAI, adapted for use on the PRI-T; and iii) the Patient Attachment Classification System (PACS), which measures generalized differences in how individuals convey their experiences and feelings. Results suggest that patients' AAI predicts how they experience, represent, and communicate about the therapeutic relationship at the end of treatment, as shown by the PAT-RS, the Coherence scale adapted for use on the PRI-T, and the PACS applied to the PRI-T. These findings lend support to Safran and others' hypothesis that patients' AAI-status plays a role in patients' representations of the relationship with the therapist.

Group attachment-based intervention: trauma-informed care for families with adverse childhood experiences

This article outlines the main premises of an innovative trauma-informed intervention, group attachment-based intervention, specifically developed to target vulnerable families with infants and toddlers, living in one of the poorest urban counties in the nation. It also reports on the trauma-relevant characteristics of 60 families entering a clinical trial to study the effectiveness of Group Attachment-Based Intervention. Initial survey results revealed high levels of neglect, abuse, and household dysfunction in mothers' histories (77% reported ≥4 adverse childhood experiences, with more than 90% reporting 2 or more current toxic stressors, including poverty, obesity, domestic and community violence, and homelessness).

Looking from the outside in: the use of video in attachment-based interventions

This paper provides an account of multiple potential benefits of using video in clinical interventions designed to promote change in parent-child attachment relationships. The power of video to provide a unique perspective on parents' ways of thinking and feeling about their own behavior and that of their child will be discussed in terms of current attachment-based interventions using video either as the main component of the treatment or in addition to a more comprehensive treatment protocol. Interventions also range from those that use micro-analytic as compared to more global units of analyses, and there are potential bridges to be made with neuro-scientific research findings. In addition, this paper provides a clinical illustration of the utility of showing parents vignettes of video-filmed observations of parent-child interactions from the Group Attachment Based Intervention (GABI) for vulnerable families. Emphasis is placed on the motivational force arising from seeing (and hearing) oneself in interaction with one's child on video, thus serving as a powerful catalyst for reflective functioning and updating one's frame of reference for how to think, feel and behave with one's child.

Risk factors for local recurrence in Wilms tumour and the potential influence of biopsy - the United Kingdom experience

RATIONALE

The UKW3 trial compared biopsy/pre-operative chemotherapy versus immediate nephrectomy and afforded the opportunity to examine the influence of percutaneous retroperitoneal biopsy and other factors on local and distant relapse of Wilms tumour (WT).

METHODS

Patients with unilateral WT (stages I-IV) excluding metachronous relapse or early progressive disease were eligible. Metastatic and 'inoperable' tumours were biopsied electively. 'Local' was defined as relapse within the abdomen, except for liver metastases considered as 'distant' relapse, together with other haematogenous routes. Uni- and multivariable analyses estimated the risk factors for relapse.

RESULTS

Overall, 285/635 (44.9%) patients had a biopsy. With a median follow-up of 10.1 years, 35 (5.5%) patients experienced a 'local', 15 a combined (2.4%) and 60 (9.4%) a 'distant' relapse. On univariate analysis, biopsy, anaplasia and tumour size were associated with an increased risk of local relapse. On multivariable analysis, anaplasia and tumour size remained significant for local relapse whereas the elevated risk of biopsy (hazards ratio (HR) = 1.80: 95% confidence interval (CI) 0.97-3.32, p = 0.060) was marginal. Age, anaplasia, tumour size, lymph nodes metastases and stage, but not biopsy, were individually associated with increased risk of distant relapse but only age and anaplasia remained significant following multivariable analysis.

CONCLUSIONS

The UKW3 trial provides some reassurance that biopsy should not automatically lead to 'upstaging' of WT. Further assessment of this controversial area is required. Comparison of local relapse rates in a multinational trial in which the United Kingdom (UK) continued the practice of routinely biopsying all patients in contrast to the standard European approach will afford this opportunity and is planned.

Adverse Childhood Experiences (ACEs) questionnaire and Adult Attachment Interview (AAI): implications for parent child relationships

Although Adverse Childhood Experiences (ACEs) are linked to increased health problems and risk behaviors in adulthood, there are no studies on the association between ACEs and adults' states of mind regarding their early childhood attachments, loss, and trauma experiences. To validate the ACEs questions, we analyzed the association between ACEs and emotional support indicators and Adult Attachment Interview (AAI) classifications in terms of unresolved mourning regarding past loss or trauma and discordant states of mind in cannot classify (U/CC) interviews. Seventy-five urban women (41 clinical and 34 community) completed a questionnaire on ACEs, which included 10 categories of abuse, neglect, and household dysfunction, in addition to emotional support. Internal psychological processes or states of mind concerning attachment were assessed using the AAI. ACE responses were internally consistent (Cronbach's α=.88). In the clinical sample, 84% reported≥4 ACEs compared to 27% among the community sample. AAIs judged U/CC occurred in 76% of the clinical sample compared to 9% in the community sample. When ACEs were≥4, 65% of AAIs were classified U/CC. Absence of emotional support in the ACEs questionnaire was associated with 72% of AAIs being classified U/CC. As the number of ACEs and the lack of emotional support increases so too does the probability of AAIs being classified as U/CC. Findings provide rationale for including ACEs questions in pediatric screening protocols to identify and offer treatment reducing the intergenerational transmission of risk associated with problematic parenting.

Narrow-band imaging in the evaluation of villous morphology: a feasibility study assessing a simplified classification and observer agreement

BACKGROUND AND STUDY AIMS

To determine the utility of narrow-band imaging with optical magnification (NBI-Z) in the evaluation of villous morphology.

PATIENTS AND METHODS

Patients considered at risk of having celiac disease were invited. After standard endoscopy, they underwent further evaluation with NBI-Z which was digitally recorded. Targeted biopsies of each area videoed with NBI-Z were performed and tissue sent for histopathological analysis. Two expert endoscopists then selected the best representative videos (developmental phase). Next, 41 representative images of these videos were classified as follows: villous patterns present (N) or absent (A). Images showing absence of villi were then classified as cerebriform (C) or flat (F), corresponding to partial or total villous atrophy respectively. Three NBI-Z-naïve endoscopists then graded the videos. They underwent an interactive training session (learning phase) with video and images from a digital library before embarking on the actual assessment. To test for reproducibility, all videos were randomly reordered and graded again after a week.

RESULTS

Forty-one videos (10 celiac disease, 31 normal) from 21 patients (3 celiac disease, 18 normal) were analyzed. The overall sensitivity and specificity in correctly distinguishing the presence or absence of villi were 93.3% and 97.8% respectively, with interobserver and intraobserver agreement (kappa, κ) at 0.82 and 0.86. The sensitivity and specificity in differentiating partial from total villous atrophy were 83.3% and 100%, κ at 0.73 and 0.68 respectively.

CONCLUSIONS

Using a simplified classification, we demonstrated the feasibility of using NBI-Z to detect villous atrophy in patients presenting with suspected celiac disease.

Audit in general practice by a receptionist: a feasibility study

OBJECTIVE

To examine whether audit can be done cost effectively by a practice's receptionist.

DESIGN

The practice set goals for various aspects of care, and forms were devised for the receptionist to collect, analyse, and present data to assess whether these goals had been achieved in the previous year.

SETTING

Six doctor practice in south London looking after 11,500 patients.

MAIN OUTCOME MEASURES

Ability of receptionist to present data showing the level of attainment of the practice's goals; time spent on audit by receptionist each week.

RESULTS

The practice set goals for immunisation; follow up of patients with abnormal cervical smears; frequency of recording of blood pressure and smoking habit; screening of patients over 75; care of diabetic patients and patients with serious mental illness; antenatal care; variations in workload; and availability of appointments. The receptionist was able to audit all these tasks in four hours a week; this increased her job satisfaction and extended her skills. A small amount of regular supervision was necessary--roughly 30 minutes a week in the first year of the study and 30 minutes a fortnight in the second--to ensure accuracy and deal with any difficulties that arose.

CONCLUSION

The method developed enabled a receptionist to audit aspects of the practice cost effectively. There is great scope for enlarging the conventional role of the receptionist.

Toxicity of interferon

The effects of partially purified human leucocyte interferon (PIF) and of a preparation purified by passage twice through a monoclonal antibody affinity chromatography column (NK21F) were compared with those of a control solution in healhty volunteers. After intramuscular injections both interferon preparations caused rises in pulse rate and body temperature, changes in circulating white cell counts, and various unpleasant symptoms, the most common of which were headache, malaise, and fever. Slightly lower doses of NK21F were given, and this was reflected in lower peak serum concentrations. Mean symptom scores, however, were not lower after NK21F than after PIF. Local inflammatory reactions eight hours after intradermal inoculations of these interferons were similar. Purification of interferon using a monoclonal antibody does not reduce the facets of its activity considered in this study. They are therefore inherent in the leucocyte interferon type selected by the antibody.