Eileen Britt

Motivational interviewing in health settings: a review

There is evidence that patient-centred approaches to health care consultations may have better outcomes than traditional advice giving, especially when lifestyle change is involved. Motivational interviewing (MI) is a patient-centred approach that is gathering increased interest in health settings. It provides a way of working with patients who may not seem ready to make the behaviour changes that are considered necessary by the health practitioner. The current paper provides an overview of MI, with particular reference to its application to health problems.

Motivational interviewing: a review

There has been considerable interest shown in motivational interviewing (MI), since Miller (1983) initially presented it as an alternative and potentially more effective way of working with problem drinkers, particularly those individuals who may have been perceived as being resistant or in denial. This interest has included developing specific interventions using MI, and extending its use beyond alcohol abuse to a range of problem behaviours, including other mental health problems (e.g., eating disorders) and health problems (e.g., diabetes). The current paper provides an overview of Ml — its development, theoretical basis, and applications. Research on its efficacy is reviewed, and recommendations are made for future research.

A comparison of adult outcomes for males compared to females following pediatric traumatic brain injury

OBJECTIVE To identify the association between traumatic brain injury (TBI) and internalizing and externalizing problem behaviors and determine if these apply equally to males and females. METHOD The association between adult psychosocial functioning and childhood TBI for males and females was examined using groups with a history of childhood TBI (mild or moderate/severe) or orthopedic injury (injury age, 1-17, assessed 18-31 at >5 years postinjury), including rates of depression and anxiety disorders, substance abuse/dependence and offending behavior. Repeated-measures logistic regression was used to determine if the rates of internalizing and externalizing problem behaviors varied by group and sex. RESULTS Overall rates of problem behaviors were significantly greater for both moderate/severe TBI (OR = 4.00) and mild TBI (OR = 3.60) groups compared with orthopedic controls. Females were significantly more likely than males to report a history of internalizing problems (OR = 2.22), whereas males were more likely than females to report externalizing problems (OR = 2.10). The sex difference in internalizing/externalizing problems was found consistently across TBI groups and controls. CONCLUSIONS Childhood TBI is associated with psychosocial problems in adulthood, regardless of injury severity. How deficits are expressed differs between the sexes, with important implications for interventions strategies.

Predictors of posttraumatic growth 10–11 months after a fatal earthquake.

Objective: Posttraumatic growth (PTG) is a commonly observed phenomenon in the wake of a distressing event, capturing potentially beneficial effects for posttraumatic adaptation. However, it is not entirely clear what factors are essential for the development of PTG, especially after natural disasters. Most importantly, it is uncertain what type of relationship exists between posttraumatic stress symptoms (PTSS) and PTG. As yet, there is also no consensus on whether PTG can best be seen as a process outcome or as a coping mechanism. The current study aimed to elucidate these uncertainties. Method: The study explored PTG in a community sample (N = 412) 10–11 months after a major earthquake in Christchurch, New Zealand. Nonsymptomatic predictors of PTG were assessed 4–7 months after the earthquake, and symptomatic predictors were assessed both 4–7 and 10–11 months after the earthquake, with PTG measured in the second assessment. Results: Results showed that the unique relationship between PTSS and PTG was modeled best both linearly and curvilinearly, suggesting that PTSS over a certain level shift from a positive association with PTG to a negative one. PTG was predicted by being female, having less household income, PTSS symptoms modeled linearly and curvilinearly at Time 1, and PTSS modeled linearly at Time 2. Conclusion: Support was found for the coping model of PTG, suggesting the importance of fostering growth to manage posttraumatic distress.

Earthquake Aftershock Anxiety: An Examination of Psychosocial Contributing Factors and Symptomatic Outcomes

ABSTRACT This study examined the direct and indirect effects of cognitions and anxiety associated with aftershocks on psychological symptoms (anxiety, depression, acute stress) and daily functioning (general and relationship). Participants were 600 adults from Christchurch, New Zealand. Data collection was approximately four months after the fatal 2011 earthquake. Path analysis was used for modelling. Socioeconomic status was directly associated with appraisals of uncontrollability of response to aftershocks. These cognitions were directly related to aftershock anxiety, which heightened general anxiety, depression, and acute stress symptoms. These symptoms were directly associated with relationship and general life dysfunction. Aftershock anxiety plays a significant role in ongoing psychological distress associated with earthquakes.

Developmental trajectories of competency attainment amongst clinical psychology trainees across field placements

OBJECTIVE This research aimed to describe the developmental trajectories of clinical psychology trainees across competency domains over multiple placements. METHOD Competency reviews of 252 trainees were completed at mid-placement and end-placement for up to four consecutive placements by 143 field supervisors. Competency was measured across multiple domains using the Clinical Psychology Practicum Competencies Rating Scale. RESULTS There was an overall ascending stepped pattern occurring across all competency domains from early to late placements. The starting point of competency ratings varied across domains with the largest discrepancy between Response to supervision (highest) and Intervention competencies (lowest). There were significant increases from mid-placement to end-placement for all competencies within each of the four placements. There were few significant decreases in competency between different placements and these were largely restricted to the transition from placement one to placement two. CONCLUSIONS This research has the potential to be used as a benchmark to indicate expected levels of competency attainment for trainees across their training, allowing for early identification of difficulties and more targeted remediation plans.

Context and tension in psychiatric diagnoses in people with intellectual disabilities: Challenges and responses

ABSTRACTPeople with intellectual disabilities are more likely than the general population to experience psychiatric disorders. Service provision changes in New Zealand, similar to those in other countries, have resulted in increased expectations for primary health practitioners to take responsibility for the assessment and treatment of psychiatric disorders in people with intellectual disabilities. The study explored (via thematic analysis of responses to an online survey, focus group, and an individual interview) challenges that health practitioners (13 psychiatrists, 24 clinical psychologists, 3 general practitioners, and 8 other health practitioners) had experienced when diagnosing psychiatric disorders in people with intellectual disabilities, and how they had overcome these challenges. The study revealed the complexities that health practitioners experience when diagnosing psychiatric difficulties in people with intellectual disabilities. Additionally, a number of strategies to address these challeng...