Identity influences on medical students' orientation to feedback during third year clinical rotations

Medical students' feedback orientation (their attitudes about and preferences for feedback from preceptors) may change over the course of the third year of medical school and is likely influenced by identity-related factors. This study proposed that both how students view themselves personally (i.e., impostor syndrome) and how they view themselves in relation to the group (i.e., identification with the profession) are identity factors related to related to feedback orientation during clinical rotations. 177 third-year medical students enrolled in a four-phase longitudinal survey study beginning at the start of clinical rotations and continuing every twelve weeks of the academic year thereafter. Feedback orientation was conceptualized and measured as comprising aspects of utility (i.e., feedback is valuable and useful), sensitivity (i.e., feeling intimidated or threatened by corrective feedback), confidentiality (i.e., public/private context of feedback), and retention (i.e., feedback remembered). Results indicated that these aspects of feedback orientation did not significantly change during the third year. Instead, impostor syndrome was at least marginally, significantly associated with all aspects of feedback orientation across phases. Group identity was associated with feedback utility and retention, and female-identifying students reported significantly greater feedback confidentiality and feedback retention. Interventions may be needed to improve medical students' attitudes about feedback, particularly for those who experience impostor syndrome. Fostering group cohesion among medical students may influence how well students remember feedback and find it useful.

Patient adherence as a predictor of acute and long-term outcomes in concentrated exposure treatment for difficult-to-treat obsessive-compulsive disorder

BACKGROUND

Exposure and response prevention (ERP) is considered the first-line psychotherapy for obsessive-compulsive disorder (OCD). Substantial research supports the effectiveness of ERP, yet a notable portion of patients do not fully respond while others experience relapse. Understanding poor outcomes such as these necessitates further research. This study investigated the role of patient adherence to ERP tasks in concentrated exposure treatment (cET) in a sample who had previously not responded to treatment or relapsed.

METHOD

The present study included 163 adults with difficult-to-treat OCD. All patients received cET delivered during four consecutive days. Patients' treatment adherence was assessed using the Patient EX/RP Adherence Scale (PEAS-P) after the second and third day of treatment. OCD severity was evaluated at post-treatment, 3-month follow-up, and 1-year follow-up by independent evaluators.

RESULTS

PEAS-P scores during concentrated treatment were associated with OCD-severity at post-treatment, 3-month follow-up, and 1-year follow-up. Moreover, PEAS-P scores predicted 12-month OCD severity adjusting for relevant covariates. Adherence also predicted work- and social functioning at 1-year follow-up.

CONCLUSIONS

These results indicate that ERP adherence during the brief period of cET robustly relates to improvement in OCD symptoms and functioning in both the short and long term. Assessing adherence might identify patients at risk of poor outcomes, while improving adherence may enhance ERP for treatment resistant patients.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02656342.

Recreating the village: the patient experience with a hybrid model of Group Perinatal Care (GPPC) in an academic family health team

BACKGROUND

Group prenatal care (GPC) has been shown to have a positive impact on social support, patient knowledge and preparedness for birth. We developed an interprofessional hybrid model of care whereby the group perinatal care (GPPC) component was co-facilitated by midwives (MW) and family medicine residents (FMR) and alternating individual visits were provided by family physicians (FP's) within our academic family health team (FHT) In this qualitative study, we sought to explore the impact of this program and how it supports patients through pregnancy and the early newborn period.

METHODS

Qualitative study that was conducted using semi-structured telephone interviews with 18 participants who had completed GPPC in the Mount Sinai Academic Family Health Team in Toronto, Canada and delivered between November 2016 and October 2018. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted by team members using grounded theory.

RESULTS

Four over-arching themes emerged from the data: (i) Participants highly valued information they received from multiple trusted sources, (ii) Participants felt well cared for by the collaborative and coordinated interprofessional team, (iii) The design of GPPC enabled a shared experience, allowing for increased support of the pregnant person, and (iv) GPPC facilitated a supportive transition into the community which positively impacted participants' emotional well- being.

CONCLUSIONS

The four constructs of social support (emotional, informational, instrumental and appraisal) were central to the value that participants found in GPPC. This support from the team of healthcare providers, peers and partners had a positive impact on participants' mental health and helped them face the challenges of their transition to parenthood.

Application of motivational interviewing to group: Teaching advance care planning via group visits for clinical professionals

OBJECTIVE

Advance Care Planning (ACP) via Group Visits (ACP-GV) is an innovative patient-centered intervention used in the United States Department of Veterans Affairs (VA) healthcare system. The goal of ACP-GV is to spread ACP to veterans and caregivers in medically underserved rural areas. Veterans, caregivers and those they trust participate in a group led by clinicians in Veterans Health Administration healthcare and/or community-based settings. To learn how to facilitate ACP-GV, clinicians attend ACP-GV training. The training teaches the ACP-GV group model and the theoretical components of Motivational Interviewing (MI) (Rollnick & Miller, 1995), which are used to empower participants to have conversations about their healthcare values and preferences. Therefore, the aim is to describe the specific MI techniques utilized by group facilitators in the innovative ACP-GV intervention.

DISCUSSION

We provide exemplars for how group facilitators apply the MI techniques to the group discussion with participants. Lastly, we provide a scripted case example of a coded MI-concordant session of ACP-GV delivered with veterans in a healthcare setting that can be used in future training and education for clinicians interested in facilitating ACP using a group modality.

CONCLUSION

MI is a key aspect of delivering ACP-GV, a high-quality, patient-centered intervention for veterans, caregivers and those they trust.

Acceptability and feasibility of recovery-oriented group acceptance and commitment therapy for psychosis in routine practice: an uncontrolled pilot study

BACKGROUND

Personal recovery is a persisting concern for people with psychotic disorders. Accordingly, mental health services have adopted frameworks of personal recovery, prioritizing adaptation to psychosis alongside symptom remission. Group acceptance and commitment therapy (ACT) for psychosis aims to promote personal recovery alongside improved mood and quality of life.

AIMS

The objectives of this uncontrolled, prospective pilot study were to determine whether 'Recovery ACT' groups for adults are a feasible, acceptable and safe program within public mental health services, and assess effectiveness through measuring changes in personal recovery, wellbeing, and psychological flexibility.

METHOD

Program feasibility, acceptability and safety indicators were collected from referred consumers (n=105). Adults (n=80) diagnosed with psychotic disorders participated in an evaluation of 'Recovery ACT' groups in Australian community public mental health services. Participants completed pre- and post-group measures assessing personal recovery, wellbeing, and psychological flexibility.

RESULTS

Of 101 group enrollees, 78.2% attended at least one group session (n=79); 73.8% attended three or more, suggesting feasibility. Eighty of 91 first-time attendees participated in the evaluation. Based on completer analyses (n=39), participants' personal recovery and wellbeing increased post-group. Outcome changes correlated with the linear combination of psychological flexibility measures.

CONCLUSIONS

'Recovery ACT' groups are feasible, acceptable and safe in Australian public mental health services. 'Recovery ACT' may improve personal recovery, wellbeing, and psychological flexibility. Uncontrolled study design, completer analyses, and program discontinuation rates limit conclusions.

Absolutely closed semigroups

Let C be a class of topological semigroups. A semigroup X is called absolutely C -closed if for any homomorphism h : X → Y to a topological semigroup Y ∈ C , the image h[X] is closed in Y. Let T 1 S , T 2 S , and T z S be the classes of T 1 , Hausdorff, and Tychonoff zero-dimensional topological semigroups, respectively. We prove that a commutative semigroup X is absolutely T z S -closed if and only if X is absolutely T 2 S -closed if and only if X is chain-finite, bounded, group-finite and Clifford + finite. On the other hand, a commutative semigroup X is absolutely T 1 S -closed if and only if X is finite. Also, for a given absolutely C -closed semigroup X we detect absolutely C -closed subsemigroups in the center of X.

Emotional intelligence, leadership, and work teams: A hybrid literature review

Emotional intelligence (EI) has been widely researched in different fields of knowledge. This paper reviews the literature on emotional intelligence, leadership, and teams in 104 peer-reviewed articles and reviews provided by the Web of Science and Scopus databases from 1998 to 2022. It is a hybrid or mixed review as it uses both quantitative and qualitative analysis techniques. The aims of this study are a performance analysis of the selected documents (years of publication, country, sectors, techniques used, most cited authors, authors with more publications, journals, journal quartiles, and scope of publication), as well as a co-word analysis using Atlas. ti v8. The results of the quantitative analysis indicate that the majority are empirical works. The qualitative analysis is a co-word analysis providing the following results: (i) classification of authors by major themes-categories (EI, leadership, team), (ii) classification of themes within each major theme: three subcategories in EI, 17 subcategories in leadership, and 19 subcategories in team and, lastly, (iii) classification according to the chronological development of main objectives from the most cited authors' articles we analyzed. Leadership (transformational, emergence, virtual, effective, health, effectiveness) is the major theme we studied. Our in-depth review of the articles has shown that emotionally intelligent leaders improve both behaviors and business results and have an impact on work team performance. It also highlighted a positive relationship between emotional competence and team members' attitudes about work. The new trends focus on the impacts of COVID19, the global crisis due to the Ukraine War, working in VUCA and BANI environments, comparative studies between generations, the application of artificial intelligence and the influence of mindfulness on organizations.

Implementing a nurse-delivered cognitive behavioural therapy intervention to reduce the impact of hot flushes/night sweats in women with breast cancer: a qualitative process evaluation of the MENOS4 trial

BACKGROUND

Hot flushes and night sweats are life-altering symptoms experienced by many women after breast cancer treatment. A randomised controlled trial (RCT) was conducted to explore the effectiveness of breast care nurse (BCN)-led group cognitive behavioural therapy (CBT). This paper reported findings from a qualitative process evaluation to optimise the CBT intervention and explore the determinants of implementation into routine practice.

METHODS

Qualitative process evaluation occurred in parallel with the RCT to explore patient and healthcare staff experiences and perspectives using semi-structured interviews pre-and post-intervention. Normalisation Process Theory (NPT) informed data collection, analysis, and reporting of findings. The analysis involved inductive thematic analysis, NPT coding manual and subsequent mapping onto NPT constructs.

RESULTS

BCNs (n = 10), managers (n = 2), surgeons (n = 3) and trial participants (n = 8) across six recruiting sites took part. All stakeholders believed group CBT met a need for non-medical hot flushes/night sweats treatment, however, had little exposure or understanding of CBT before MENOS4. BCNs believed the work fitted with their identity and felt confident in delivering the sessions. Despite little understanding, patients enrolled onto group CBT because the BCNs were trusted to have the knowledge and understanding to support their needs and despite initial scepticism, reported great benefit from group-based participation. Both managers and surgeons were keen for BCNs to take responsibility for all aspects of CBT delivery, but there were some tensions with existing clinical commitments and organisational priorities.

CONCLUSIONS

Both healthcare staff and patient participants believe BCN-led group CBT is a beneficial service but barriers to long-term implementation into routine care suggest there needs to be multi-level organisational support.

TRIAL REGISTRATION

NCT02623374 - Last updated 07/12/2015 on ClinicalTrials.gov PRS.

"Stop and just breathe for a minute": perspectives of children on the Autism Spectrum and their caregivers on a Mindfulness Group

Children on the autism spectrum often experience anxiety. Mindfulness is growing in popularity as a method to support children with anxiety; however, there is limited evidence on mindfulness for children on the autism spectrum. This study investigated the feasibility of a 10-week group-based mindfulness intervention for 14 children on the autism spectrum. A one-group pre-post design determined outcomes of anxiety (caregiver and child report), mindful attention, and wellbeing (child report). Interviews explored children's and caregivers' perceptions. There were no significant differences in outcomes post-intervention. Five themes were identified from interviews: (1) Children felt calmer; (2) Parents observed differences in anxiety; (3) Breathing and yoga helped; (4) Parents wanted more; and (5) Challenges and benefits of group intervention.

Effectiveness of group arts therapies (art therapy, dance movement therapy and music therapy) compared to group counselling for diagnostically heterogeneous psychiatric community patients: study protocol for a randomised controlled trial in mental health services (the ERA study)

BACKGROUND

Arts therapies are widely but inconsistently provided in community mental health. Whilst they are appealing to patients, evidence for their effectiveness is mixed. Trials to date have been limited to one art-form or diagnosis. Patients may hold strong preferences for or against an art-form whilst group therapies rely on heterogeneity to provide a range of learning experiences. This study will test whether manualised group arts therapies (art therapy, dance movement therapy and music therapy) are effective in reducing psychological distress for diagnostically heterogeneous patients in community mental health compared to active group counselling control.

METHODS

A pragmatic multi-centre 2-arm randomised controlled superiority trial with health economic evaluation and nested process evaluation. Adults aged ≥ 18, living in the community with a primary diagnosis of psychosis, mood, or anxiety disorder will be invited to participate and provide written informed consent. Participants are eligible if they score ≥ 1.65 on the Global Severity Index of the Brief Symptom Inventory. Those eligible will view videos of arts therapies and be asked for their preference. Participants are randomised to either their preferred type of group arts therapy or counselling. Groups will run twice per week in a community venue for 20 weeks. Our primary outcome is symptom distress at the end of intervention. Secondary outcomes include observer-rated symptoms, social situation and quality of life. Data will be collected at baseline, post-intervention and 6 and 12 months post-intervention. Outcome assessors and trial statisticians will be blinded. Analysis will be intention-to-treat. Economic evaluation will assess the cost-effectiveness of group arts therapies. A nested process evaluation will consist of treatment fidelity analysis, exploratory analysis of group process measures and qualitative interviews with participants and therapists.

DISCUSSION

This will be the first trial to account for patient preferences and diagnostic heterogeneity in group arts therapies. As with all group therapies, there are a number of logistical challenges to which we have had to further adapt due to the COVID-19 pandemic. Overall, the study will provide evidence as to whether there is an additive benefit or not to the use of the arts in group therapy in community mental health care.

TRIAL REGISTRATION

ISRCTN, ISRCTN88805048 . Registered on 12 September 2018.

In-person and online sensory wellbeing workshop for eating disorders: updated case series

BACKGROUND

A one-off sensory wellbeing workshop has been developed to help patients with eating disorders (ED) manage sensory sensitivities. The aim of this study was to evaluate and compare the outcomes of the workshop in online versus face-to-face (F2F) formats among a sample of patients with ED.

METHODS

Cumulative link models were applied to the outcome measures (awareness of sensory wellbeing, awareness of strategies to enhance sensory wellbeing, and confidence in managing sensory wellbeing) to test the differences between online and F2F workshops. Participants' ratings of usefulness of the workshop were also compared between online and F2F workshops.

RESULTS

A total of 14 workshops (4 online and 10 F2F) were run from 2020 to 2023. All participants reported significant and substantial improvements in all outcome measures. There was no significant difference in outcomes between online and F2F workshops. The majority of patients rated the workshops as useful.

CONCLUSIONS

Both online and face-to-face formats of the sensory workshop led to improvement in sensory wellbeing management for patients with ED. Future studies are warranted to test the impact of the workshop on ED treatment outcomes.

An open trial of VA CONNECT: Caring for Our Nation's Needs Electronically during the COVID-19 Transition

The COVID-19 pandemic impacted emotional well-being due to safety concerns, grief, employment impacts, and social interaction limitations. Face-to-face mental health treatment restrictions were especially impactful to veterans who often gain social enrichment from Veterans Health Administration (VHA) care. We present results from a novel group-based telehealth intervention, VA Caring for Our Nation's Needs Electronically during the COVID-19 Transition (VA CONNECT), which integrates skills training and social support to develop a COVID-19 Safety & Resilience Plan. Veterans (n ​= ​29) experiencing COVID-related stress participated in an open trial of this 10-session, manualized group VHA telehealth intervention. We examined whether COVID-19-related stress, adjustment disorder symptoms, and loneliness decreased, and coping strategy use increased after participation in VA CONNECT. Between baseline and two-month follow-up, participants reported a significant reduction in perceived stress and adjustment disorder symptoms, and an increase in planning coping skills use. Significant changes were not observed in loneliness or other specific coping strategies. Findings may support the utility of VA CONNECT as an intervention for pandemic-related stress and improving certain coping skills. Future research should explore group-based telehealth interventions like VA CONNECT with other populations within and outside of the VA, which have value during major disruptions to face-to-face mental healthcare access.

A qualitative longitudinal study of motivation in the REtirement in ACTion (REACT) physical activity intervention for older adults with mobility limitations

BACKGROUND

Physical activity (PA) is beneficial for older adults' health, however they remain the least active age group in the UK. This qualitative longitudinal study aims to understand motivations in older adults receiving the REACT physical activity intervention, through the lens of self-determination theory.

METHODS

Participants were older adults randomised to the intervention arm of the Retirement in ACTion (REACT) Study, a group-based physical activity and behaviour maintenance intervention to prevent decline of physical functioning in older adults (≥ 65 years). Stratified purposive sampling by physical functioning (Short Physical Performance Battery scores) and 3-month attendance was employed. Fifty-one semi-structured interviews were conducted at 6, 12 and 24-months with twenty-nine older adults (Mean age (baseline) = 77.9 years, SD 6.86, 69% female) and at 24-months with twelve session leaders and two service managers. Interviews were audio recorded, transcribed verbatim and analysed using Framework Analysis.

RESULTS

Perceptions of autonomy, competence and relatedness were associated with adherence to the REACT programme and maintenance of an active lifestyle. Motivational processes and participants' support needs, changed during the 12-month REACT intervention and across the 12-months post-intervention. Group interactions were an important source of motivation during the first six months but increased competence and mobility drove motivation at the later stages (12 months) and post-intervention (24 months).

CONCLUSIONS

Motivational support needs vary in different stages of a 12-month group-based programme (adoption and adherence) and post-intervention (long-term maintenance). Strategies to accommodate those needs include, (a) making exercise social and enjoyable, (b) understanding participants' capabilities and tailoring the programme accordingly, (c) capitalising on group support to motivate participants to try other activities and prepare sustainable active living plans.

TRIAL REGISTRATION

The REACT study was a pragmatic multi-centre, two-arm, single-blind, parallel-group, RCT (ISRCTN registration number 45627165).

"Monkeying around" together facilitates problem solving

Sehner et al. (PNAS Nexus, 2022, 1-14) report that groups of common marmosets solve problems more frequently and faster than individuals working alone. This result is partially explained by greater persistence at the task in the group context and may have important implications for the evolution of cognition and culture.

Multifamily Group Psychotherapy for Patients With Nonepileptic Seizures and Their Families

OBJECTIVE

Multifamily group (MFG) psychotherapy is widely used for mental and general medical conditions. MFG therapy engages family members in caring for a loved one experiencing illness and helps clarify the impact of illness on family. Use of MFG therapy for patients with nonepileptic seizures (NES) and their families to explore satisfaction with treatment and family functioning is described.

METHODS

MFG therapy for patients with NES and their participating family members was incorporated into an existing interdisciplinary group-based psychotherapy treatment program. The Family Assessment Device and a novel feedback questionnaire were used to understand the effect of MFG therapy on this population.

RESULTS

Patients with NES (N=29) and their corresponding family members (N=29) indicated on the feedback questionnaire their satisfaction with having MFG therapy as part of their treatment; satisfaction was also evidenced by a 79% (N=49 of 62) patient participation rate. Patients and family members reported enhanced understanding of the impact of illness on the family and believed MFG therapy would help them communicate about illness and reduce family conflict. Scores on the Family Assessment Device indicated that family members perceived better family functioning than did patients (average scores of 1.84 and 2.99, respectively).

CONCLUSIONS

The discrepancy in perceived family functioning supports the idea of integrating family members in treatment for patients experiencing NES. The group treatment modality was satisfactory to participants and may prove useful for other kinds of somatic symptom disorders, which are often external manifestations of internal distress. Family members can become treatment allies in psychotherapy when included in treatment.

Evaluation of an inpatient occupation-based group program using a process evaluation framework

INTRODUCTION

Occupation-based groups are used in inpatient rehabilitation to enhance delivery and intensity of intervention; however, little research is available to understand their effectiveness. The aim of this study was to examine the process of an occupation-based group to understand mechanisms and success factors.

METHODS

A mixed methods process evaluation using an evidence-based framework guided implementation and analysis. Participants were those involved in the 'LifeSkills' group run daily in an adult inpatient general rehabilitation ward. Quantitative administrative data, goal achievement outcome measures, group observations and qualitative semistructured interviews were conducted.

RESULTS

Thirty participants were recruited. Factors for success included consistency in group structure and support, using meaningful practise opportunities and facilitating a real-world experience. There was no significant relationship between patient outcomes and dose of training or patient demographics.

CONCLUSION

This evaluation contributes to a growing body of evidence for incorporating occupation-based approaches into rehabilitation and offers insights into practice implementation.

Qualitative Study of Telehealth Delivery of Suicide-Specific Group Treatment "Project Life Force"

Minimal evidence exists for suicide-specific group treatment for high-risk patients offered over telehealth. This qualitative study assessed the acceptability, feasibility, and impact of a telehealth suicide safety planning intervention (SPI) multi-session group. High-risk suicidal Veterans (n = 17) participating in "Project Life Force-telehealth" (PLF-T); a manualized, 10-session SPI video group completed semi-structured qualitative interviews including measures of acceptability, appropriateness, and feasibility. We also interviewed the PLF-T coordinator and PLF-T group facilitators to identify adaptations to deliver PLF-T and learn about barriers and facilitators to implementation. A summary template and matrix analysis approach was used to analyze qualitative data. Veteran group participants were mostly male (88%), age 50 (SD = 15.6), ethnically diverse, and either divorced or separated (54%). Suicide symptoms upon study entry included past month ideation with methods (100%); and past year aborted, interrupted, or actual suicide attempt (59%). Participant interviews revealed an overall positive endorsement of PLF-telehealth with enhanced suicidal disclosure, and improved ability to manage urges and mitigate loneliness. On scales from 1 to 20, PLF-T was rated as highly acceptable (M = 17.50; SD = 2.92), appropriate (M = 17.25; SD = 3.59), and feasible (M = 18; SD = 2.45) by participants. Adaptations to deliver PLF-T included using a communications coordinator to conduct assertive outreach and engagement, adding a telehealth orientation session, restructuring sessions to review suicide severity, and screen-sharing safety plans to maximize learning. PLF-T enhanced convenience and access without compromising safety. Concerns included privacy and technological limitations including connectivity. Project Life Force-telehealth is acceptable and feasible to deliver via telehealth. This opens the possibility of delivery to hard-to-reach high-risk populations. ClinicalTrials.gov Identifier: NCT0365363.

A new infinite family of star normal quotient graphs of twisted wreath type

We construct the first infinite families of locally 2-arc transitive graphs with the property that the automorphism group has two orbits on vertices and is quasiprimitive on exactly one orbit, of twisted wreath type. This work contributes to Giudici, Li and Praeger's program for the classification of locally 2-arc transitive graphs by showing that the star normal quotient twisted wreath category also contains infinitely many graphs.

A systematic review and meta-analysis of trauma-focused cognitive behavioral therapy for children and adolescents

BACKGROUND

Among minors, posttraumatic stress symptoms (PTSS) are a common consequence of traumatic events requiring trauma-focused treatment.

OBJECTIVE

This meta-analysis quantified treatment effects of trauma-focused cognitive behavioral therapy (TF-CBT) with PTSS as primary outcome and symptoms of depression, anxiety, and grief as secondary outcomes.

PARTICIPANTS AND SETTING

Inclusion criteria for individual settings: (1) patients aged between 3 and 21, (2) at least one traumatic event, (3) minimum 8 sessions of (4) TF-CBT according to Cohen, Mannarino and Deblinger (2006, 2017), (5) a quantitative PTSS measure at pre- and post-treatment, (6) original research only. Inclusion criteria for group settings: had to involve (1) psychoeducation, (2) coping strategies, (3) exposure, (4) cognitive processing/restructuring, (5) contain some reference to the manual and no minimum session number was required.

METHODS

Searched databases were PsychInfo, MEDLINE, Cochrane Library, PTSDPubs, PubMed, Web of Science, and OpenGrey.

RESULTS

4523 participants from 28 RCTs and 33 uncontrolled studies were included. TF-CBT showed large improvements across all outcomes from pre- to post-treatment (PTSS: g = 1.14, CI 0.97-1.30) and favorable results compared to any control condition including wait-list, treatment as usual, and active treatment at post-treatment (PTSS: g = 0.52, CI 0.31-0.73). Effects were more pronounced for group settings. We give pooled estimates adjusted for risk of bias and publication bias, which initially limited the quality of the analyzed data.

CONCLUSIONS

TF-CBT is an effective treatment for pediatric PTSS as well as for depressive, anxiety, and grief symptoms. It is superior to control conditions, supporting international guidelines recommending it as a first-line treatment.

A spectacular new species of Hyloscirtus (Anura: Hylidae) from the Cordillera de Los Llanganates in the eastern Andes of Ecuador

We have discovered a spectacular new species of frog in the genus Hyloscirtus, belonging to the H. larinopygion species group. The adult female is characterized by a mostly black body with large bright red spots on the dorsal and ventral surface, extremities, and toe pads. The adult male is unknown. Small juveniles are characterized by a yellow body with variable black markings on the flanks; while one larger juvenile displayed irregular orange or yellow marks on a black background color, with light orange or yellow toe pads. Additional distinctive external morphological features such as cloacal ornamentation are described, and some osteological details are imaged and analyzed. The performed phylogeny places the new species as the sister to a clade consisting of ten taxa, all of which are part of the H. larinopygion group. We use genetic distances to fit the new species into a published time-calibrated phylogeny of this group; our analysis based on the published chronology suggests that the divergence of the new species from its known congeners pre-dates the Quaternary period. The new species is currently only known only from Cerro Mayordomo, in Fundación EcoMinga´s Machay Reserve, at 2,900 m in the eastern Andes of Tungurahua province, Ecuador, near the southern edge of Los Llanganates National Park, but its real distribution may be larger.

Effectiveness of a Brief Group Intervention for Harmful Alcohol Use in Men at a Primary Health Care Facility in Brazil: A Randomized Clinical Trial

To evaluate the effectiveness of a brief group intervention (BGI) in reducing the use of alcohol and increasing the readiness to change in men with risky and harmful alcohol use. A randomized clinical trial with follow-ups at 30 and 90 days that was conducted in a primary health care (PHC) facility in the central region of São Paulo (Brazil). A total of 112 men were randomized to the experimental group (EG) (n = 55) or the control group (CG) (n = 57). To identify the pattern of alcohol use and the readiness to change, the Alcohol Use Disorders Identification Test (AUDIT) and the readiness to change (RTC) rule were used. The EG received a BGI session applied by nurses using the Feedback, Responsibility, Advice, Menu of options, Empathy, Self-efficacy (FRAMES) model. The CG was instructed to continue with the standard service of the unit after an initial interview. Intergroup analyses using the generalized equation estimation (GEE) method were performed. A significant difference in the pattern of use was observed between the EG and CG at follow-up evaluated (EG T1 (7.73 ± 5.14), CG T1 (12, 48 ± 5.62)) and EG T2 (6.65 ± 4.83), CG T2 (11.68 ± 6.65)). When compared the baseline (T0) measures (13.04) with the last time (T2) (6.65) at EG, it was identified a reduction of 6.39 in the AUDIT score. Differences between groups were found for readiness to change at follow-up ((EG T1 (8.50 ± 2.44) and CG T1 (5.67 ± 3.10) and (EG T2 (8.80 ± 1.73) and CG T2 (5.36 ± 3.33)), when contrasting with the baseline. The data suggest that the BGI was effective when compared to the control condition, as there was a reduction in risky and harmful use of alcohol for low-risk use, according to the alcohol use scores, and an increase in the stages of readiness to change.

Secret Agent Society: A Randomized Controlled Trial of a Transdiagnostic Youth Social Skills Group Treatment

Group programs are key for targeting social skills (SS) for children with developmental disorders and/or mental illness. Despite promising evidence regarding efficacy of group treatments, there are several limitations to current research regarding generalizability and effectiveness across diagnoses. This randomized control trial assessed whether the Secret Agent Society (SAS) group program was superior to treatment as usual (TAU) in improving social-emotional functioning for children with Attention Deficit-Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and/or anxiety. Eighty-nine youth (8-12) with ADHD, ASD, and/or an anxiety disorder receiving treatment at hospital-based outpatient clinics were randomized to receive SAS (n = 47) or TAU (n = 42) over a three-month period, at which point TAU participants were offered the SAS intervention. Parent report showed significant improvement in Emotion Regulation (ER) and Social Skills (SS) for youth in SAS vs. TAU (Fs ≥ 6.79, ps ≤ 01). Gains for the SAS condition were maintained at 6-months. Intent-to-treat analysis of teacher report indicated youth in SAS had positive gains in SS (F = 0.41, p = 0.475) and ER (F = 0.99, p = 0.322), though not significantly better than youth in TAU. Clinically reliable improvement rates were significantly higher for SAS participants than TAU for parent and teacher reported SS and ER. Improvements were significant for youth with single and comorbid diagnoses. Results suggest that SAS was superior to TAU in improving SS and ER for youth aged 8-12 with ADHD, ASD, and/or anxiety. Gains maintained in the medium-term. Trial registration number NCT02574273, registered 10/12/2015.

Group behavioral interventions for tics and comorbid symptoms in children with chronic tic disorders

Exposure and Response Prevention (ERP), Habit Reversal Training (HRT) and Comprehensive Behavioral Intervention for Tics (CBIT) are effective in reducing tic severity. ERP and HRT have recently gained primary support in a group setting, while CBIT has not been examined similarly. We compared the efficacy of group-CBIT to group-Educational Intervention for Tics (group-EIT) for tics and comorbid symptoms. Children with Tourette Syndrome (TS) or Chronic Tic Disorder (CTD) were randomized to group-CBIT or group-EIT. Tics and comorbid symptoms were assessed in forty-six children pre- and postintervention, and 3-month later. Yale Global Tic Severity Scale (YGTSS) Motor tic severity decreased following both interventions, and was maintained at follow-up for group-CBIT only. The Parent Tic Questionnaire (PTQ) showed significant decrease in total and motor tic severity following group-CBIT only, a gain maintained three months later. YGTSS impairment score decreased following both interventions and was maintained at follow-up. YGTSS vocal tic severity score increased following both interventions, and then decreased significantly at follow up. Co-morbid symptoms including anxiety, behavioral problems, and aggressive behavior decreased following both interventions. Children with behavioral problems benefitted less while children with higher intellectual ability benefit more from intervention. Both group interventions showed efficacy in reducing tic impairment and comorbid symptoms. Group-CBIT was superior to group-EIT in reducing motor tic severity at 3-month follow-up, showing an advantage for tic-focused treatment. Based on the PTQ, group-CBIT was superior to group-EIT in reducing motor, vocal, and total tic scores, a gain maintained three months later. Clinical trial registry information-Group Intervention for Children with Chronic Tics Syndrome: CBIT vs Psychoeducational Intervention URL: http://clinicaltrials.gov , Identifier: NCT02407951, http://www.controlled-trials.com ).

Increasing knowledge about recovery-related life domains among pregnant and parenting women in comprehensive substance use disorder treatment: The Art of Addiction Recovery Program

BACKGROUND

Group treatments designed specifically for pregnant and parenting women with substance use disorders are lacking. This study provides a preliminary assessment of the Art of Addiction Recovery Program, a manualized group treatment imbedded within a comprehensive substance use disorder treatment program for pregnant and parenting women.

METHODS

The Program consists of 14 sessions, each focusing on a different topic, including health, social relationships, the recovery process, well-being, and introspection. Each session includes both the presentation of information by a facilitator, group discussions guided by the facilitator, and a creative project. A single-group pretest-posttest design provides an initial evaluation of the Art of Addiction Recovery Program.

RESULTS

Participants were 51 women with an average age of 28.7 (SD = 5.0) with most (69%) having a primary opioid use disorder and 82% reporting tobacco use. Significant (ps < 0.001) pre- to post-session increases in session-specific knowledge occurred for all 14 sessions with a measure of multivariate association indicating that these changes were substantial. Ratings of learning and effectiveness were generally high, with 19/28 means at 3.7 or above (maximum score = 4).

CONCLUSIONS

Findings suggest that The Art of Addiction Recovery Program was effective in conveying knowledge about substance use and recovery, and that participants increased their knowledge and generally strongly agreed that the sessions provided high levels of learning and were highly effective. The Art of Addiction Recovery Program provides an option for those seeking a manual-based group treatment program as an aid in the treatment process for this subpopulation.

The institution, mental disability and the psychoanalyst: Prospects presented by a revival of intersubjective receptivity in groups

This presentation aims at giving an account of a novel group project, conducted with adults with mental and/or psychic disabilities. The evolution of post-war psychiatry in France is marked by several important changes. The development of psychotherapy in institutions asserts the role of psychoanalysis in the institutional sphere. We then will describe the environmental contexts for the reception and support of the mentally disabled subject as it currently exists in France, highlighting their effects on psychic disability. This novel project takes place in a medico-social institution, a residential home in which live eight adults with disabilities, women and men, aged 19 to 55, and at a particular moment in institutional history. Sustained by several mediations, it is first through the support of a jigsaw puzzle project that the experience is initiated. Then a writing workshop will be organised, whereby residues of proceedings will find a form in which to be recorded. The objective will be the implementation of intersubjective space, despite the impediment identified at the level of individual subjective psyches. The effectiveness of the methods used can be detected in the intersubjective connections, allowing the renewal of symbolization and creativity.

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.