A Single-blinded, Randomized Clinical Trial of How to Implement an Evidence-based Treatment for Generalized Anxiety Disorder [IMPLEMENT] — Effects of Three Different Strategies of Implementation

BACKGROUND: Despite long-standing calls to disseminate evidence-based treatments for generalized anxiety (GAD), modest progress has been made in the study of how such treatments should be implemented. The primary objective of this study was to test three competing strategies on how to implement a cognitive behavioral treatment (CBT) for out-patients with GAD (i.e., comparison of one compensation vs. two capitalization models). METHODS: For our three-arm, single-blinded, randomized controlled trial (implementation of CBT for GAD [IMPLEMENT]), we recruited adults with GAD using advertisements in high-circulation newspapers to participate in a 14-session cognitive behavioral treatment (Mastery of your Anxiety and Worry, MAW-packet). We randomly assigned eligible patients using a full randomization procedure (1:1:1) to three different conditions of implementation: adherence priming (compensation model), which had a systematized focus on patients' individual GAD symptoms and how to compensate for these symptoms within the MAW-packet, and resource priming and supportive resource priming (capitalization model), which had systematized focuses on patients' strengths and abilities and how these strengths can be capitalized within the same packet. In the intention-to-treat population an outcome composite of primary and secondary symptoms-related self-report questionnaires was analyzed based on a hierarchical linear growth model from intake to 6-month follow-up assessment. This trial is registered at ClinicalTrials.gov (identifier: NCT02039193) and is closed to new participants. FINDINGS: From June 2012 to Nov. 2014, from 411 participants that were screened, 57 eligible participants were recruited and randomly assigned to three conditions. Forty-nine patients (86%) provided outcome data at post-assessment (14% dropout rate). All three conditions showed a highly significant reduction of symptoms over time. However, compared with the adherence priming condition, both resource priming conditions indicated faster symptom reduction. The observer ratings of a sub-sample of recorded videos (n = 100) showed that the therapists in the resource priming conditions conducted more strength-oriented interventions in comparison with the adherence priming condition. No patients died or attempted suicide. INTERPRETATION: To our knowledge, this is the first trial that focuses on capitalization and compensation models during the implementation of one prescriptive treatment packet for GAD. We have shown that GAD related symptoms were significantly faster reduced by the resource priming conditions, although the limitations of our study included a well-educated population. If replicated, our results suggest that therapists who implement a mental health treatment for GAD might profit from a systematized focus on capitalization models. FUNDING: Swiss Science National Foundation (SNSF-Nr. PZ00P1_136937/1) awarded to CF. KEYWORDS: Cognitive behavioral therapy; Evidence-based treatment; Implementation strategies; Randomized controlled trial

Isotopic prediction calculation methodologies: application to Vandellos-II Reactor cycles 7-11

Determining as accurate as possible spent nuclear fuel isotopic content is gaining importance due to its safety and economic implications. Since nowadays higher burn ups are achievable through increasing initial enrichments, more efficient burn up strategies within the reactor cores and the extension of the irradiation periods, establishing and improving computation methodologies is mandatory in order to carry out reliable criticality and isotopic prediction calculations. Several codes (WIMSD5, SERPENT 1.1.7, SCALE 6.0, MONTEBURNS 2.0 and MCNP-ACAB) and methodologies are tested here and compared to consolidated benchmarks (OECD/NEA pin cell moderated with light water) with the purpose of validating them and reviewing the state of the isotopic prediction capabilities. These preliminary comparisons will suggest what can be generally expected of these codes when applied to real problems. In the present paper, SCALE 6.0 and MONTEBURNS 2.0 are used to model the same reported geometries, material compositions and burn up history of the Spanish Van de llós II reactor cycles 7-11 and to reproduce measured isotopies after irradiation and decay times. We analyze comparisons between measurements and each code results for several grades of geometrical modelization detail, using different libraries and cross-section treatment methodologies. The power and flux normalization method implemented in MONTEBURNS 2.0 is discussed and a new normalization strategy is developed to deal with the selected and similar problems, further options are included to reproduce temperature distributions of the materials within the fuel assemblies and it is introduced a new code to automate series of simulations and manage material information between them. In order to have a realistic confidence level in the prediction of spent fuel isotopic content, we have estimated uncertainties using our MCNP-ACAB system. This depletion code, which combines the neutron transport code MCNP and the inventory code ACAB, propagates the uncertainties in the nuclide inventory assessing the potential impact of uncertainties in the basic nuclear data: cross-section, decay data and fission yields

Efficient PGD-based dynamic calculation of non-linear soil behavior

Non-linear behavior of soils during a seismic event has a predominant role in current site response analysis. Soil response analysis consistently indicates that the stress-strain relationship of soils is nonlinear and shows hysteresis. When focusing in forced response simulations, time integrations based on modal analysis are widely considered, however parametric analysis, non-linear behavior and complex damping functions make difficult the online use of standard discretization strategies, e.g. those based on the use of finite element. In this paper we propose a new harmonic analysis formulation, able to address forced response simulation of soils exhibiting their characteristic nonlinear behavior. The solution can be evaluated in real-time from the offline construction of a parametric solution of the associated linearized problem within the Proper Generalized Decomposition framework.

COMUNICAÇÃO E SAÚDE MENTAL: Estudo de Caso da TV Pinel no Brasil e do Espaço de Comunicação no Hospital Psiquiátrico de Havana

O presente estudo refere-se a uma investigação analítica e descritiva sobre a TV Pinel no Brasil, um programa de televisão desenvolvido no Hospital Psiquiátrico Philippe Pinel, no Rio de Janeiro. E, como trabalho complementar, apresentamos uma análise das atividades culturais, artísticas e esportivas desenvolvidas no Hospital Psiquiátrico de Havana, em Cuba. Este estudo refere-se à busca da compreensão do espaço de comunicação das pessoas que padecem de transtornos mentais, a partir das experiências desses hospitais psiquiátricos os quais se apóiam em estratégias comunicacionais e artísticas para promover a reabilitação psicossocial. As reflexões conceituais sobre o espaço de comunicação estão centradas no conceito de espaço, a partir dos estudos do geógrafo Milton Santos. As discussões teóricas foram sustentadas na Teoria da Complexidade, com base no pensamento do teórico francês Edgar Morin. Apresentamos uma reflexão sobre o modelo de tratamento psiquiátrico a partir dos trabalhos da psiquiatra Nise da Silveira, da artista Lygia Clark, e do médico e artista Lula Wanderley. Esta investigação aborda a importância da arte e da comunicação no processo da ressocialização da pessoa enferma mental.(AU)

COMUNICAÇÃO E SAÚDE MENTAL: Estudo de Caso da TV Pinel no Brasil e do Espaço de Comunicação no Hospital Psiquiátrico de Havana

O presente estudo refere-se a uma investigação analítica e descritiva sobre a TV Pinel no Brasil, um programa de televisão desenvolvido no Hospital Psiquiátrico Philippe Pinel, no Rio de Janeiro. E, como trabalho complementar, apresentamos uma análise das atividades culturais, artísticas e esportivas desenvolvidas no Hospital Psiquiátrico de Havana, em Cuba. Este estudo refere-se à busca da compreensão do espaço de comunicação das pessoas que padecem de transtornos mentais, a partir das experiências desses hospitais psiquiátricos os quais se apóiam em estratégias comunicacionais e artísticas para promover a reabilitação psicossocial. As reflexões conceituais sobre o espaço de comunicação estão centradas no conceito de espaço, a partir dos estudos do geógrafo Milton Santos. As discussões teóricas foram sustentadas na Teoria da Complexidade, com base no pensamento do teórico francês Edgar Morin. Apresentamos uma reflexão sobre o modelo de tratamento psiquiátrico a partir dos trabalhos da psiquiatra Nise da Silveira, da artista Lygia Clark, e do médico e artista Lula Wanderley. Esta investigação aborda a importância da arte e da comunicação no processo da ressocialização da pessoa enferma mental.(AU)

Expert Approaches to Mental Toughness Development in the High Risk Sport of Diving

Research focusing on mental toughness development and high risk sport is limited to one examination of elite gymnasts' perceptions. Coaches have acknowledged that mental toughness is important to performance success, while admitting they do not know effective development strategies. The aim of the current research is to address both these concerns by employing a grounded theory approach to ascertain elite diving coaches perceptions of mental toughness development and what mental toughness is. Seven diving coaches volunteered and were interviewed for an average of 49 minutes. They all coached an athlete that participated either in the world championships or Olympic games since 2008. Participants reported that mental toughness was the ability of a diver to perform a movement in a crucial moment that requires focus, extending beyond their comfort zone, overcoming fear, and never giving up. Mentaltoughness may not be the appropriate term due to its lack of multicultural sensitivity. Participants felt that dealing with adversity was something divers would have to constantly process. Mental toughness can be developed by the coach, the environment, or individual athlete. Unique attributes specific to divers were an awareness of self and a distinct level of knowing what the athlete was going to do. More research needs to be conducted to determine if these concepts can be generalized to other high risk sports. Future research could help establish a valid quantitative measure of mental toughness development.

Mental Health Effects of Equine Therapy with Children

This study examined the effects of eight weekly lessons of therapeutic horseback riding (THR) on five children between the ages of 6 and 12 years who displayed behavioral issues, mood disturbance, relationship issues, or other mental health disorders. All of the children's parents/caregivers completed the Child Behavior Checklist for Ages 6-18 at the onset of the lessons and at the conclusion of the lessons. The children did not show any significant improvement on the Internalizing, Externalizing, Total Problems scales or the syndrome scales. However, comparisons between the pre-test and post-test scores on the Behavior scale and the Externalizing scale showed positive trends which warrant further study. The lack of significance in the data suggests that a greater participant population or a mixed method study using a combination of quantitative and qualitative strategies may yield more conclusive results.

Play the game or get played? Researchers’ strategies around R&D policies

This chapter focuses on possible effects of current R&D policies in the scientific work, exploring some of the dilemmas they cause to researchers. In a transnational scale, R&D policies embrace performance-based research funding systems, calling for a growing accountability and a more useful and published research. Often justified by the importance of knowledge in public policies or as part of the new managerialism regime, these trends emphasize performativity on research. In this scenario, how researchers receive and interpret R&D policies is influenced according to their values and interests? Do they play the game or do they get played by it? These questions rely on a conceptual framework that conceives the research as a political scene, where researchers and R&D policies meet. Moreover, researchers’ strategies are perceived as political, considering that it is in the context of the practices that policy is interpreted and reinvented. The chapter presents an empirical study conducted in Portugal, which will be taken as an example of what Waitere et al (2011) already named as “choosing whether to resist or reinforce” R&D policies. In fact, the study revealed a strategic calculation made by researchers and the coexistence of convergent and divergent strategies concerning R&D policies. I will argue that the tensions in this strategic game are both a reflex and generator of the dilemmas of scientific work today and a sign of the complexity of public policies.

Change strategies to assist agencies in developing supported living services for people with developmental disabilities /

This material has been funded through a grant from the Illinois Planning Council on Developmental Disabilities.

Oh chale : Two stance-taking strategies in Ghanaian Pidgin English

A common assumption is that language is used for conveying factual information, but linguistic forms also serve a way to communicate pragmatic features, such as speakers’ intentions and mental state. This study describes and analyses two strategies for stance-taking in GhaPE, more specific the use of discourse particles and complement-taking predicates. Such grammatical resources have been identified in the literature to play important functions in signalling how the speaker evaluates and positions him/herself and the addressee with respect to objects of discourse. The analysis and discussion of forms is informed by Du Bois’ (2007) ‘stance triangle’, which has proved to be a useful analytical device for investigating stance from a dialogical perspective. GhaPE is at times anticipated as fairly simple both by scholars and in the community where it is spoken. This thesis is thus an attempt to display aspects of the richness of the language.

Cost-Effectiveness Analysis of Adaptive Monitoring Strategies for Depression Treatment

Thesis (Master's)--University of Washington, 2016-06

Young refugees talk about well-being: A qualitative analysis of refugee youth mental health from three states

Young people from refugee backgrounds face enormous challenges in the settlement process within Australia. They must locate themselves within a new social, cultural, geographic and adult space, yet also try to find security within the spaces of their own families and ethnic communities. Traumas of the past can mix with painful experiences of the present. The stressors in the lives of these young people can be both complex and diverse. This paper explores the nature a/these stressors among young people from refugee backgrounds living in Australia. [t is based On in-depth interviews with 76 young people from refugee backgrounds now living in Brisbane, Adelaide and Perth. A qualitative analysis of the impact of these stressors as well as the coping strategies employed are discussed It is argued that trauma exists

How young people from culturally and linguistically diverse backgrounds experience mental health: Some insights for mental health nurses

This article reports on part of a study that looked at the mental health of culturally and linguistically diverse (CALD) young people. The research sought to learn from CALD young people, carers, and service providers experiences relevant to the mental health of this group of young people. The ultimate goal was to gain insights that would inform government policy, service providers, ethnic communities and most importantly the young people themselves. To this end, qualitative interviews were undertaken with 123 CALD young people, 41 carers and 14 mental health service providers in Queensland, Western Australia and South Australia. Only one aspect of the study will be dealt with here, namely the views of the young CALD participants, which included risk factors, coping strategies and recommendations about how they could be supported in their struggle to maintain mental health. One of the most important findings of the study relates to the resilience of these young people and an insight into the strategies that they used to cope. The efforts of these young people to assist us in our attempts to understand their situation deserve to be rewarded by improvements in the care that we provide. To this end this article sets out to inform mental health nurses of the results of the study so that they will be in a position to better understand the needs and strengths of their CALD clients and be in a better position to work effectively with them.

A transdisciplinary approach to adolescent forensic mental health

Objective: To examine new strategies which may be implemented to address the significant mental health and substance abuse problems of young people within the juvenile justice system. Method: Wide-ranging literature review of mental health problems within the juvenile justice population is given, illustrating the high prevalence of mental health problems within this cohort of young people. Reference is made to the differing demographics and agendas of the American justice system compared to that found in Australia. Results: It is suggested that new initiatives stemming from quality Australian studies are required in order to facilitate reform within adolescent forensic mental health. Psychiatrists need to be at the forefront of innovative policy delivery within the juvenile justice system. Conclusions: A transdisciplinary approach is required to meet the changing needs of young people within the juvenile justice system. Such a system of care recognizes that these young people and their families have multiple needs that cross traditional boundaries and a collaborative approach across agencies is essential at both the policy and practical level. Psychiatrists have an important role to play in the development of these services. A systemic process to address such needs is offered.