Ernesto Caffo

Well-Being Therapy in School Settings: A Pilot Study

Background: There is increasing interest in the psychobiological mechanisms of resilience and psychological well-being. It is conceivable that activation of such mechanisms in the school setting may entail long-term benefits, both in terms of the developmental process and of prevention of distress. This study wants to apply and test the efficacy of a school-based intervention protocol derived from well-being therapy (WBT) compared to cognitive-behavioral strategies. Methods: School interventions were performed in a population of 111 students randomly assigned to: (a) a protocol using theories and techniques derived from cognitive-behavioral therapy; (b) a protocol derived from WBT. Assessment before and after interventions was performed using two self-rating scales: Kellner’s Symptom Questionnaire and Ryff’s Psychological Well-Being Scales. Results: Both school-based interventions resulted in a comparable improvement in symptoms and psychological well-being. Conclusions: This new well-being-enhancing strategy could play an important role in the prevention of psychological distress in school settings and in promoting optimal human functioning among children.

School intervention for promoting psychological well-being in adolescence

OBJECTIVE to test the efficacy of a new school program for the promotion of psychological well-being. In this study a school program for promoting psychological well-being has been compared to an attention-placebo intervention in a high school setting. METHODS Nine classes (227 students) were randomly assigned to: a) Well-Being intervention (5 classes); b)attention-placebo (4 classes). Assessment was performed at pre and post-intervention, and after six months using: 1) Symptom Questionnaire (SQ); 2) Psychological Well-Being Scales (PWB); 3) Revised Childrens Manifest Anxiety Scale (RCMAS). RESULTS A significant effect of WB school intervention in improving Personal Growth (PWB), and in decreasing distress (Somatization (SQ), Physical Well-being (SQ), Anxiety (SQ), and RCMAS Physiological Anxiety) emerged. CONCLUSIONS A school intervention based on promoting positive emotions and well-being was effective not only in increasing psychological well-being among adolescents, but also in decreasing distress, in particular anxiety and somatization.

Impact, psychological sequelae and management of trauma affecting children and adolescents.

Purpose of review In this review we examine the most recent literature on the impact, psychological sequelae and management of trauma affecting children and adolescents. We focus on consequences of early traumatic events in childhood, adolescence and adulthood; mediating variables (risk and protective factors) intervention strategies and available treatments. Recent findings Increasingly often, mental health professionals are being asked to address the needs of children and adolescents who have been exposed to traumatic events, either as individuals or in groups. Studies on a wide range of age groups, populations and types of trauma revealed that traumatized children and adolescents are at high risk for developing a range of different behavioural, psychological and neurobiological problems. Social support may have a protective effect on the relationship between exposure to traumatic events and psychosocial symptoms. Summary Several recent studies analyze a wide range of early traumatic events that may be directly or indirectly experienced by youth. These studies raise many fundamental questions such as validity of current diagnostic criteria for post-traumatic stress disorder, comorbidity with anxiety, depressive disorders and childhood traumatic grief symptoms. Vulnerability and protective factors, mainly gender, age and social support are considered. A common problem in research into the impact of trauma on children is the presence of many limitations: studies are often retrospective, use self-report questionnaires and the results may not be generalizable (i.e. they are trauma or population specific). There is a lack of well designed studies, addressing in particular treatments for post-traumatic symptoms in children and adolescents.

Differential effects of well-being promoting and anxiety-management strategies in a non-clinical school setting

The aim of the present study was to examine the differential effects of strategies for promotion of psychological well-being (Well-Being Therapy, WBT) and removal of distress (Anxiety Management, AM) in a non-clinical school setting.162 students attending middle schools in Northern Italy were randomly assigned to: (a) a protocol derived from WBT; (b) an anxiety-management protocol (AM). The students were assessed immediately before and after the interventions, and after 6 months using: Psychological Well-Being Scales (PWB), Symptom Questionnaire (SQ) and the Revised Childrens Manifest Anxiety Scale (RCMAS). In school children, well-being and symptom focused interventions produced slightly different effects on psychological dimensions. WBT, by facilitating progression toward positive and optimal functioning, may integrate symptom-centered strategies.

Promoting resilience and psychological well-being in vulnerable life stages.

vices, even in high-income countries [16] ; t he majority of young people with mental health problems are still not getting the help they need. A major reason for this is the worldwide gaps in child and adolescent mental health policy and services well identified by the World Health Organization through its Atlas project [17] . T he degree of coverage and quality of mental health services for the youths are generally worse compared with the ones pro-vided for adults [18] . Little information is now available about health and social investment into child and ad-olescent mental well-being. However, as denounced in the Florence Declaration – developed during the 13thEuropean Society for Child and Adolescent Psychiatry (ESCAP) Congress and signed by WHO and by EACAP (European Academy for Child and Adolescent Psychia-try) – as regards Europe, all indicators strongly suggest that child and adolescent mental health in most countries is receiving a relatively small proportion of funding, with, in turn, a typically low investment for general health, on average only 5.6% (see appendix). The median percentage of governments’ health budget earmarked for mental health is as little as 1% in low income countries [19] T . he gap is not limited to the quantity, as the quality of ser-vices is often extremely poor, even in high income coun-tries [19] . Nevertheless, the mental well-being of children still remains a major public health priority and a prominent area of international debate. Scientists and researchers from all over the world are focusing on how to improve Mental health and emotional and psychological well-being are fundamental for all children, enabling them to meet their potential, to experience life as meaningful and to be active citizens. Unfortunately, current estimates indicate that at least one out of every four to five young people in the general population will suffer from at least one mental disorder in any given year [1] . Similar data have been previously reported by WHO, showing that worldwide up to 20% of children and adolescents suffer from a mental illness with at least mild functional impairment: one adolescent in five has behavioural, cognitive and emotional difficul-ties and one adolescent in eight suffers from a mental dis-order [2]. C omorbidity is very common and can occur at three levels: with other mental disorders, with substance abuse and with chronic diseases [1] . Developmental psychiatric disorders rarely have a spontaneous remission and may cause difficulties in so-cial adaptation or mental disorders in adult life [3–12] . There is evidence that adult mental disorders usually be-gin during youth [13, 14] , although they are often first detected later in life [1] . Besides personal suffering, stigma and discrimina-tion, mental disorders may have a high social impact, in terms of treatment and support costs, reduced or lost pro-ductivity, and the expenditure of criminal justice (e.g. conduct and behavioural disorders) [15] . De spite these data, only a minority of vulnerable chil-dren and adolescents have access to mental health ser-

Letter to the EditorAgainst Le Packing: A Consensus Statement

To the Editor: C oinciding with the Ninth International Autism–Europe Congress held in Catania, Sicily from October 8 through 10, 2010, the undersigned keynote speakers of the meeting, a group of recognized professionals in the field, were greatly disturbed by the news that in some areas of the world—notably francophone countries—an alleged form of therapy labeled le packing is being applied and recommended for children and adolescents with autism spectrum disorders, especially those showing associated severe behavioral problems. This alleged therapy consists of wrapping the patient (wearing only underclothes or naked in the case of young children) several times a week during weeks or months in towels soaked in cold water (10°C to 15°C). The individual is wrapped with blankets to help the body warm up in a process lasting 45 minutes, during which time the child or adolescent is accompanied by two to four staff persons. The alleged goal of this technique, as defined by proponents of this therapy, is to “allow the child to rid himor herself progressively of its pathological defense mechanisms against archaic anxieties,” by achieving “a greater perception and integration of the body, and a growing sense of containment.” The French Public Health High Council, although purposely avoiding reviewing indications and ethical aspects, has recently established that, although psychological risks have not been excluded, performing le packing does not carry risks that would justify its prohibition. We have reached the consensus that practitioners and families around the world should consider this approach unethical. Furthermore, this “therapy” ignores current knowledge about autism spectrum disorders; goes against evidence-based practice parameters and treatment guidelines published in the United States, Canada, United Kingdom, Spain, Italy, Hungary, and Australia; and, in our view, poses a risk of preventing these children and adolescents from accessing their basic human rights to health and education.

Against le packing: a consensus statement.

To the Editor: C oinciding with the Ninth International Autism–Europe Congress held in Catania, Sicily from October 8 through 10, 2010, the undersigned keynote speakers of the meeting, a group of recognized professionals in the field, were greatly disturbed by the news that in some areas of the world—notably francophone countries—an alleged form of therapy labeled le packing is being applied and recommended for children and adolescents with autism spectrum disorders, especially those showing associated severe behavioral problems. This alleged therapy consists of wrapping the patient (wearing only underclothes or naked in the case of young children) several times a week during weeks or months in towels soaked in cold water (10°C to 15°C). The individual is wrapped with blankets to help the body warm up in a process lasting 45 minutes, during which time the child or adolescent is accompanied by two to four staff persons. The alleged goal of this technique, as defined by proponents of this therapy, is to “allow the child to rid himor herself progressively of its pathological defense mechanisms against archaic anxieties,” by achieving “a greater perception and integration of the body, and a growing sense of containment.” The French Public Health High Council, although purposely avoiding reviewing indications and ethical aspects, has recently established that, although psychological risks have not been excluded, performing le packing does not carry risks that would justify its prohibition. We have reached the consensus that practitioners and families around the world should consider this approach unethical. Furthermore, this “therapy” ignores current knowledge about autism spectrum disorders; goes against evidence-based practice parameters and treatment guidelines published in the United States, Canada, United Kingdom, Spain, Italy, Hungary, and Australia; and, in our view, poses a risk of preventing these children and adolescents from accessing their basic human rights to health and education.

Early-adult outcome of child and adolescent mental disorders as evidenced by a national-based case register survey

BACKGROUND Mental disorders show varying degrees of continuity from childhood to adulthood. This study addresses the relationship of child and adolescent mental disorders to early adult psychiatric morbidity. METHODS From a population at risk of 830,819 children and adolescents aged 6-16 years, we selected all those (n=6043) who were enrolled for the first time in the Danish Psychiatric Register with an ICD-10 F00-99 diagnosis in 1995-1997, and identified any mental disorder for which they received treatment up to 2009. RESULTS Neurodevelopmental and conduct disorders were the principal diagnostic groups at 6-16 years and exhibited a characteristic male preponderance; while affective, eating, neurotic, stress-related and adjustment disorders were more common in girls. Over a mean follow-up period of 10.1 years, 1666 (27.6%) cases, mean age 23.4 years, were referred for treatment to mental health services, and they had a markedly higher risk than the general population (RR 5.1; 95% CI 4.9-5.4). Affective, eating, neurodevelopmental, obsessive-compulsive and psychotic disorders had the strongest continuity. Heterotypic transitions were observed for affective, eating, neurodevelopmental, personality and substance use disorders. CONCLUSIONS These findings suggest that individuals with psychiatric antecedents in childhood and adolescence had a high risk of being referred for treatment in early adulthood, and many mental disorders for which they required treatment revealed both homotypic and heterotypic continuity.

[Promoting psychosocial well-being in adolescence. A controlled study].

INTRODUCTION In the recent years a large body of literature has focused its attention to the study of the positive aspects of adolescence, in particular quality of life, happiness and social functioning. The school is an ideal setting for promoting learning abilities, educational processes and also optimal human and social development. AIM A new school program for the promotion of psychological well-being has been tested and compared to an attention-placebo intervention in a high school setting. METHODS Nine classes (227 students) were enrolled in the study and randomized to: a) School Well-Being Therapy intervention (5 classes); b)attention-placebo (4 classes). 1) Symptom Questionnaire (SQ); 2) Psychological Well-Being Scales (PWB); 3) Revised Childrens Manifest Anxiety Scale (RCMAS) were administered at pre- and post-intervention, and after six months. RESULTS WBT school intervention was associated to an improved Personal Growth (PWB), and to decreased distress (Somatization (SQ), Physical Well-being (SQ), Anxiety (SQ), and RCMAS Physiological Anxiety). DISCUSSION AND CONCLUSIONS A school intervention focused on the promotion of positive emotions and psychological well-being has resulted to be effective not only in increasing these dimensions in high school students, but also in decreasing distress, in particular anxiety and somatization.

Innovative Interventions in the Community

This chapter describes three different services in three different countries that have two things in common: 1. They are directly addressed to and based in a community. 2. They are innovative in terms of the addressed population, in terms of methodology and also in terms of funding.