Helen Mildred

Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review

A large body of research has implicated difficulties in emotion regulation as central to the development and maintenance of psychopathology. Emotion regulation has therefore been proposed as a transdiagnostic construct or an underlying mechanism in psychopathology. The transdiagnostic role of emotion regulation has yet to be systematically examined within the psychological treatment outcome literature. It can be proposed that if emotion regulation is indeed a transdiagnostic construct central to the maintenance of psychopathology, then changes in emotion regulation difficulties will occur after effective treatment and this will occur for different disorders. We conducted a systematic review, identifying 67 studies that measured changes in both emotion regulation and symptoms of psychopathology following a psychological intervention for anxiety, depression, substance use, eating pathology or borderline personality disorder. Results demonstrated that regardless of the intervention or disorder, both maladaptive emotion regulation strategy use and overall emotion dysregulation were found to significantly decrease following treatment in all but two studies. Parallel decreases were also found in symptoms of anxiety, depression, substance use, eating pathology and borderline personality disorder. These results contribute to the growing body of evidence supporting the conceptualization of emotion regulation as a transdiagnostic construct. The present study discusses the important implications of these findings for the development of unified treatments that target emotion regulation for individuals who present with multiple disorders.

Predicting impulsive self-injurious behavior in a sample of adult women

Abstract Different types of self-injury have been classified as reflecting impulsive and compulsive characteristics (article by Simeon and Favazza [Self-injurious Behaviors: Assessment and Treatment {pp 1–28}. Washington, DC: American Psychiatric Publishing, Inc, 2001]). The current research used a prospective design to evaluate whether there is a progression between these different types of self-injurious behaviors (SIB) over time. Support was found for a progression from compulsive SIB (including hair pulling, nail-biting, skin picking, scratching, and preventing wounds from healing) to impulsive SIB (including cutting, burning, carving, pin sticking, and punching) in a group of adult women (N = 106). Other factors hypothesized to be linked to this outcome were disordered eating, age, and personality facets of impulsivity (specifically, urgency and lack of perseverance). Of these variables, only urgency positively predicted impulsive SIB at the study’s conclusion. These findings are discussed, limitations of the study are noted, and directions for future research are outlined.

Brief intervention: a promising framework for child and youth mental health?

There is a discrepancy between the demand for mental health treatment amongst children, young people and their carers, and the capacity of the current service system to provide evidence based interventions. Innovative models of care are required to redress this discrepancy. One such model is the single session model, which provides a single or small number of solution focused sessions targeting one or two identified problems. Single session interventions have been trialled across a range of presenting concerns including child and youth mental health services. This paper provides a rationale for offering a brief focused intervention as part of a broader Child and Youth Mental Health Service, and introduces a model of how brief intervention fits within a broader system of care.

Training General Practitioners in the Assessment of Childhood Mental Health Problems

Epidemiological studies have found that most children with mental health problems are not receiving appropriate help. The aim of this study was to assess an approach to train general practitioners (GPs) to detect mental health problems early, engage the families, and assist them in the access of service. Five GPs were given three hours of training on a brief assessment method. Each then interviewed parents whose children they suspected might have a mental health problem. An experienced research clinician then repeated the assessment. This information was fed back to the GP who then assisted the family in obtaining appropriate help. Twenty-nine parents were interviewed in six months. The research clinician and the GPs were in agreement for 90% of the cases for the recognition of mental health problems. GPs’ opinions on the brief assessment method were: easy to use (100%), helpful in obtaining information (100%) and helpful in engaging the parent (100%). The parents were followed up by telephone 3-4 months after the interview. Eighty-eight percent reported that the process was helpful, 67% had received help from services and 67% had improved. We conclude that with brief training, the GPs in this study were able to improve their capacity to provide early intervention for childhood mental health problems.

Homeless youth: Barriers and facilitators for service referrals

Young people who are homeless and experiencing mental health issues are reluctant to use relevant services for numerous reasons. Youth are also at risk of disengaging from services at times of referral to additional or alternative services. This study aimed to identify barriers and facilitators for inter-service referrals for homeless youth with mental health issues who have already engaged with a service. Qualitative, semi-structured interviews were conducted with homeless youth (n = 10), homelessness support workers (n = 10), and mental health clinicians (n = 10). Barriers included: resource shortages; programs or services having inflexible entry criteria; complexity of service systems; homeless youth feeling devalued; and a lack of communication between services, for example, abrupt referrals with no follow up. Referral facilitators included: services providers offering friendly and client-centred support; supported referrals; awareness of other services; and collaboration between services. Relationships with service providers and inter-service collaboration appeared essential for successful referrals for homeless youth. These facilitating factors may be undermined by sector separation and siloing, as well as resource shortages in both the homelessness and mental health sectors. Service transitions may be conceptualised as a genuine service outcome for homeless youth, and as a basis for successful future service provision.

Characteristics of non-suicidal self-injury in women accessing internet help sites

Background This article aimed to examine and compare the frequency of occurrence of a broad range of non-suicidal self-injury (NSSI) behaviours in an international sample of women. Methods Female participants with NSSI (n = 464) were recruited via a range of websites and completed a questionnaire examining 17 different types of NSSI types and their frequency, severity, and duration. Results Prevalent acts were cutting, scratching, and word carving; cutting and scratching occurred frequently, whilst word carving most often occurred as a single episode. Analyses revealed significant differences between Australian and U.S. participants, with U.S. participants having significantly higher rates of cutting, wound interference, carving, scratching, and sharp object sticking. Participants also reported on other self-harm methods not assessed by the questionnaire. Conclusions Word carving may be qualitatively different from other forms of NSSI. More severe NSSI methods (e.g., bone breaking) are less prevalent than less dangerous methods (e.g., scratching). Participants considered a range of indirectly harmful or suicidal behaviours as self-injury contrary to researcher or clinician understanding. Finally, there may be cultural differences in relation to NSSI between countries where such behaviours are common, although further research is required to determine this. Language: en

The young adult Strengths and Difficulties Questionnaire (SDQ) in routine clinical practice

Expansion of the youth mental health sector has exposed a need for an outcome measure for young adults accessing services. The Strengths and Difficulties Questionnaire (SDQ) is a widely used consumer and carer outcome measure for children and adolescents. The aim of this study was to evaluate the psychometric properties of a young adult SDQ. The young adult SDQ was introduced for routine clinical practice at Eastern Health Child and Youth Mental Health Service (EH-CYMHS), complementing the well-established adolescent and child versions. Data for adolescents (aged 12-17) and young adults (aged 18-25) where both self-report and parent SDQs had been completed at entry point to the service were extracted from a two-year period. Overall, paired cases involved 532 adolescents and 125 young adults. Across both self-report and parent SDQs, a similar pattern of results was found between adolescents and young adults on mean scores, inter-scale correlations, internal consistency, and inter-rater agreement. The findings of the current study support the use of the young adult SDQ in public mental health as an instrument whose psychometric properties, to date, appear consistent with those of the adolescent version. Further investigation is warranted.

Adolescent violence towards parents: prevalence and characteristics using Australian Police Data

Adolescent violence toward parents is a unique form of family violence which for many, including police personnel, challenges traditional views of parent–child relationship, and raises questions about victimization. There has been minimal research in Australia to date in this area, and knowledge about both prevalence rates and the characteristics of offenders and victims remains limited. This exploratory study utilized police data from four Australian States to document prevalence rates of reported offenses to police, and the characteristics of adolescent violence toward parents in Australia. Between 1% and 7% of family violence reported to the police is adolescent violence toward parents. The “typical” perpetrator is a 15- to 17-year-old Caucasian young man who is generally violent toward his mother. Findings are limited by the differing police practice and policy variations between States, including the use of police discretion, leaving several questions open for further investigation. In conclusion, there is a need for change in policy and practice with regards how best to assess and respond to adolescent violence toward parents.

How Do People Stop Non-Suicidal Self-Injury? A Systematic Review

The current paper reviews extant quantitative and qualitative literature into how Non-Suicidal Self-Injury cessation occurs, and individuals’ experiences of stopping. Specific search criteria utilizing a PRISMA format were used across 5 databases, which resulted in 454 papers being identified. After utilizing exclusion criteria and then review, nine of the 454 papers identified were retained for extensive synthesis and critique. Results: Results from 8 of the identified papers indicated that both intra and inter personal factors can influence self-injury cessation. These include: family support, self-esteem, emotional regulation, and professional help. Only 1 paper articulated a cessation process, describing it as a procedural event of developing interpersonal strength, then implementing alternative coping strategies. Limitations and implications of the studies are reported, concluding that further research is warranted to inform effective prevention and treatment strategies to ameliorate this growing public health concern.