Friday Factoids Catch-Up: City Interns Have Higher Burnout!

City Interns, have higher burnout rates!

 

Or, one current intern’s shameful –but heartfelt-plug, to incoming interns.

 

Going through this stressful ordeal only one year ago, I often wondered about the creators of the psychology internship process? Obviously, self-care, mindfulness and mental health were not the cornerstones by which this gem was hatched. The process starts when you are at the final stages of finishing your academic year, in addition to practicum (thankfully no other life exists outside these two realms for us budding psychologists).

 

Forcefully sucking out any refreshing accomplishment air, you attempt to gasp as you scramble to get your letters of recommendations and essays written before those heart stopping due dates. And as the first official semester break (and I use the term ‘break’ very loosely) approaches, you gather with family and loved ones to celebrate Thanksgiving; those infamous letters start arriving! I mean really….Can’t we just at least enjoy a turkey leg in peace, without feeling so relentlessly pressured? I remember thinking about those sites who choose to send their rejection letters the day before, or day of Thanksgiving. Seriously? At least the pilgrims had the heart to offer corn before the big fallout. I simply emotionally bandaged myself up that day, comforted myself (CBT style), bowed my head with the rest of the family at the dinner table, and offered my own secret version of the Thanksgiving prayer:  “Dear God, thank you for a bullet well-dodged.”

 

It is sometimes painful to watch what we psychologist do to each other, in the name of advancement. Not to mention our statisticians and psychometricians who for some reason fail to recall that the holiday seasons usually marks the height of suicide rate among our population and possibly not the best times to send those letters. Perhaps maybe it Freudian-slipped their minds. Nevertheless, we students bear and push through the pain, adding continuous enormous debt as we optimistically back-pack across the nation (again, statistically the worse time of the year for travel) in search of that perfect internship. Relentlessly we attempt to convince ourselves that sweet, peaceful, victory is just around the turn.

 

And, cue Burnout.

 

Where does it all end, or does it ever? Here is one article to consider when deciding how much emotional stamina you have left, as you prepare to assess and ultimately rank your internship interview experience:  City interns have greater burnout rates.

 

Apparently the growing number of stress related symptoms reported by graduates seeking mental health services while on internship prompted Doctors in the UK to study the relationship between internship and burnout. What they found is far from any earth shattering enlightenment to our generation, which is, interns sleep less, are more sad and stressed out (simplifying the results to its bare minimum)–especially those interns living in big city, and working in high-paced environments.

 

Luckily, there are places that offer high quality, APA-accredited internship programs like WKPIC in Kentucky (yes, another shameless plug) that come without the high burnout price tag those big cities bring.

 

A small start, but definitely something to CBT about.

 

Reference:
Gallagher, P. (2013). City interns ‘are at greater risk of Burnout’. The Independent Retrieved from https://login.libproxy.edmc.edu/login?URL=http://search.proquest.com.libproxy.edmc.edu/docview/1426666006?accountid=34899

 

Dianne Rapsey-VanBuren,
WKPIC Intern

 

(Director’s Note: We at WKPIC approve this shameless plug!)

 

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Friday Factoids Catch-Up: CBT, Anxiety Reduction, and First Episode Psychosis

 

Did you know that teaching a single day CBT workshop on anxiety reduction techniques and interventions, can significantly help clients with First Episode Psychosis?

 

A study conducted with clients experiencing First Episode Psychosis with co-morbid anxiety symptoms who were offered a single day CBT workshop on anxiety reduction techniques yielded the following results:

1) Participants reported a lessening of anxious symptoms following intervention; and

2) Participants reported that they “felt they were more likely to make use of the skills in the future.”

 

This study seems to once again reiterate both the effectiveness and ‘cost benefits’ of CBT, within an ever-shrinking pool of resources within the health care field.

 

Maybe it is true what they say after all, “teach a man how to fish….”

 

Welfare-Wilson, Alison; Jones, Amy (2015). A CBT-based anxiety management workshop in first-episode psychosis. British Journal of Nursing, 24(7): 378-382. doi:http://dx.doi.org.libproxy.edmc.edu/10.12968/bjon.2015.24.7.378

 

Dianne Rapsey-VanBuren
WKPIC Doctoral Intern

 

 

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Friday Factoids Catch-Up: Kids and Coping

Coping skills are important not only because they allow children to manage their social emotional challenges, they may also contribute to their feelings of connectedness. Success for Kids (SFK) is a program that provides a curriculum for children’s social emotional learning (PR, 2011). Thought this Friday factoid is not an advert for program,  programs like SFK bring to the forefront the importance of teaching children, early in life, how to manage the day to day stressors we can encounter, in hopes that it will contribute to their positive decision making later in life.

 

Programs like SFK highlight the needs for children to learn that coping skills also include facets of communication, problem solving, responsibility, empathy, respect for others, etc.… and cannot be reduced to a simplistic list of tasks like take ten deep breaths or walk away. We have to teach our children the how difficult and nuanced coping can actually be.

 

Puskar, Sereika and Tusaie-Mumford (2003) explored the effects of another program, Teaching Kids to Cope (TKC).  Considering the amount of children that present with signs and symptoms of social emotional challenges, attention to how children are learning to cope in important.  This study noted that children enrolled in this program, over time, began not only to identify strategies “to decrease the intensity of emotional reactivity and depressive thoughts” (p. 78) they also began to explore and openly discuss other related issues that emerged.

 

Though these are two of the many programs that are available across our country, the take home message is that being proactive in teaching our children how to cope may have a positive effect in their overall ability to manage stressors as they transition from childhood in to adolescence and adulthood.

 

 

 

 

PR, N. (2011, January 26). Social Emotional Learning Key to Helping Children and Adolescents Develop Purpose, Connectedness and Coping Skills. PR Newswire US.

 

Puskar, K., Sereika, S., & Tusaie-Mumford, K. (2003). Effect of the Teaching Kids to Cope (TKC) program on outcomes of depression and coping among rural adolescents. Journal Of Child And Adolescent Psychiatric Nursing: Official Publication Of The Association Of Child And Adolescent Psychiatric Nurses, Inc16(2), 71-80

 

Jennifer Roman, M.A.
WKPIC Doctoral Intern

 

 

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Friday Factoids Catch-Up: Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) has been a hot topic for some time now and more and more children are being diagnosed with ADHD than ever before. Lunau (2014) quoted Enrico Gnaulati by writing that an ADHD diagnosis is “as prevalent as the common cold.” If this is the case, how do we, as clinicians, respond to this phenomena?

 

Lunau noted that more than one in ten children are diagnosed, typically, boys. (Lunau 2015) In her research, she look at various states and how each approached the diagnosis and subsequent treatment of ADHD.  She brought forward information regarding North Carolina and California to elucidate the vast differences how one can approach ADHD. She noted a 16 % diagnosis rate for children in North Carolina, whereas California has a 6%; she also discovered that children in North Carolina were 50% more likely to receive medications as treatment for ADHD symptoms.  Lunau looked to the work of Hinshaw and Scheffler (reference information not provided in Lunau’s work) who explore the multiple variables that may impact these statistics, including demographics cultural influences, and health care policy. Ultimately, they discovered that school policy has the largest impact.

 

Specifically, school mandates in North Carolina for higher test scores may have impacted the perceived need for some children to receive additional services and, in some cases, children receiving academic based services are not included in the test score average (Lunau, 2015).

 

So, given the significant difference between the incidences of ADHD across state, are we witnessing an epidemic or a cultural phenomena that carries with it a secondary gain of medication management to attempt to manage behaviors or increase school testing scores. Taking a step back and looking at ADHD from a global perspective, Lunau noted other countries are not experiencing a similar increase in the onset of ADHD in their children and briefly explored how other factors may mimic ADHD symptoms, like sleep deprivation.  Though briefly mentioned, Lunau indicated the need for further exploration into how ADHD is assessed and diagnosed.

 

When looking at the high rates of ADHD, we must also begin to consider how this diagnosis is treated. Is medication the ideal treatment?  The CDC published a study (PR, 2015) which looked at the various types of treatment our children are exposed to.  Results indicated 1 in 10 children, ages 4-17, diagnosed with ADHD received behavioral therapy, 3 in 10 received medication and therapy, and 1 in 10 received no treatment. When looking at preschool aged children, 1 in 4 received medication alone and 1 in 2 received both medication and therapy.  This begs the question of whether or not we are over medicating our children so early in life. What are the long term implications of medication only interventions on the overall development of the child?

 

The CDC study highlighted that states which provided increased amounts of behavioral therapy also experienced lower rates of medication management for the treatment of ADHD, and vice versa. Bell and Efron (2015) briefly explored the impact of tri-cyclic antidepressants as a possible treatment for children with ADHD and noted tricyclic outperformed, in one trial, clonidine in the reduction of symptoms.  The information in these three articles is obviously not exhausted, however, it does highlight the need for continued research in the assessment, diagnosis and treatment of ADHD and an active re-evaluation of how cultural/social influences can impact the national conversation of how we understand ADHD.

 

 

Bell, G., & Efron, D. (2015). Tricyclic antidepressants – third-line treatment for attention deficit hyperactivity disorder in school-aged children. Journal Of Paediatrics & Child Health51(12), 1232-1234. doi:10.1111/jpc.13031

 

Lunau, K. (2014). Giving ADHD a Rest. Maclean’s127(8), 48-50.

 

PR, N. (2015, April 1). CDC publishes first national study on use of behavioral therapy, medication and dietary supplements for ADHD in children. PR Newswire US.

 

Jennifer Roman, M.A.
WKPIC Doctoral Intern

 

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Friday Factoids Catch-Up: The Multiple Roles of a Psychologist

The role of psychologists is changing as overall mental health service needs and service systems change. Separating medical health from mental health is not always so clear cut. With advances in the medical fields, psychologists must also embrace a new way of looking at overall mental health.  Wahass (2005) noted that health was “seen as the absence of diseases or injury and their presence meant ill health.” This approach was suggestive of there being a solution to the malady. However, over time, the connection between the mind and body began to shift the traditional medical model (illness and its corresponding cure) to a more dynamic view, a biopsychosocial perspective on approaching maladies.

 

The biopsychosocial model integrates the biological, psychological and social factors that interact independently or in concert with each other to sustain a healthy or unhealthy status. (Wahass, 2005)  This is particularly important to keep in mind as we encounter clients from culturally, linguistically, and socioeconomically diverse background.  As psychologist we must have an awareness of and become champions of not only serving in a clinical role, but advocating for it as well.  Our work is not limited to assigning diagnoses; rather, our responsibility to is act as a liaison between our clients and their communities.

 

Wahass identified several areas of focus, including clinical, health/medical, counseling, rehabilitation and community psychology. Many of the quotidian responsibilities may overlap; however, each has distinct demands and expectations, which not only allow for a more robust treatment of our clients presenting problems, they also encourage a more meaningful understanding of the person behind the list of concerns.

 

Chang, Ling and Hargreaves explored the relationship between scientist and practitioner and the effectiveness of graduate programs in preparing psychology students for the real life demands of the various roles psychologists assume. Results revealed that there is not one predominant stance, in part because depending on the setting (e.g. hospital, private practice, community bases setting, etc…) there are distinct demands on a psychologist.

 

As the approach to medical and mental health issues evolves, we must also look to our training program to ensure that developing clinicians are able to respond to the demands placed on psychologists in the real world.

 

 

Chang, K., I.-Ling, L., & Hargreaves, T. A. (2008). Scientist versus Practitioner-An abridged meta-analysis of the changing role of psychologists. Counselling Psychology Quarterly21(3), 267-291. doi:10.1080/09515070802479859

 

Wahass, S.H. (2005) The Role of Psychologists in Health Care Delivery. Journal of Family and Community Medicine, 12(2)), 63-70

 

Jennifer Roman, M.A.
WKPIC Doctoral Intern

 

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Friday Factoids Catch-Up: Bilingualism, Biculturalism and Personality

There is plenty of research dedicated to the topics of bilingualism and biculturalism, but they may often be lumped together and defined as one in the same. Grosjean (2015) attempts to describe how a bicultural bilingual can take on different meanings.  He highlights the plethora of research dedicated to bilingualism and how the topic of biculturalism is, at times, less explored. A simple internet search of bilingualism will yield countless articles on the relationship of bilingualism and cognition, education, and the various types of bilingualism. Grosjean proposes that this difference is to the distinct nature of how each is studied and how those researchers tend not to overlap in their work; in essence, linguists study bilingualism and biculturalism is studied by social psychologists. Grosjean highlights that one can not only be bilingual and bicultural, they can also be bicultural and monolingual or monocultural and bilingual, and monolingual and monocultural.

 

Grosjean explored the various ways in which one can become bilingual, learning a home language and later learning a host language at different points in life,  or bicultural, the byproduct of migration to another region.  Of interest is the individualist process by which a person identifies as bicultural, independent of their bilingual status, however, proficiency in an alternate language can impact how they view themselves.

 

Grosjean highlights an experiment conducted with bilinguals where participants were administered the TAT (Thematic Apperception Test) or sentence completion task. In each experiment, there were significant qualitative differences in the responses given in English and responses in their home or base language (French and Japanese).  For example, with a TAT stimulus card, a response in English highlighted a man going to college at night and having a supportive wife whereas the response in French indicated a man wanting to separate from his wife.  A similar pattern emerged with Japanese/English bilingual participants.

 

Another experiment mentioned in Grosjean’s article reveals parallel results several years later. A group of bilingual/bicultural Hispanic, Spanish speaking women were asked to interpret advertisements with women as the protagonist in English at one time and in Spanish some months later. Result revealed participants viewed the women in the advert as more independent and intelligent when interpreting in Spanish, whereas they viewed the women in the advert as adhering to more traditional roles when interpreting the ad in English.

 

Chen (2015) noted differences on some personality traits when assessing native English vs native Chinese speakers, specifically, native English speakers were “perceive to be higher on extraversion and openness to experience” (p. 5) when compared to native Chinese speakers.  Chen also explored if a bilingual individual behaves differently depending on whom they are speaking with.  Her work reveals that language, activated “normative traits of that culture and shifted bilinguals’ expression of personality” (p.5).

 

Studies, like the ones mentioned above, highlight the complex nature of the interplay that bilingualism and biculturalism can have on our personality development. This research highlights need for further exploration culture and language, not just specifically English/other language, but also the nuanced differences between how we each define culture within the context of bilingualism and vice versa.

 

References

Chen, S. X. (2015). Toward a social psychology of bilingualism and biculturalism. Asian Journal Of Social Psychology18(1), 1-11. doi:10.1111/ajsp.12088

 

Grosjean, F. (2015). Bicultural bilinguals. International Journal Of Bilingualism19(5), 572-586. doi:10.1177/1367006914526297

 

Jennifer Roman, M.A.
WKPIC Doctoral Intern

 

 

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Article Review: Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample (Kodish, Herres, Shearer, et al, 2016)

Kodish, Herres, and Shearer, et al’s Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample seeks to explore what, if any, causal relationship there may be between bullying and the prevalence of suicide among youth aged 14 to 24 years.  Uniquely, their study seeks to identify not only the relationship between bullying and suicide among youth, but also to distinguish between the different types of bullying and their associated effects on suicidal ideation, as well as to explore what role depression may have as a moderating factor between bullying and suicide risk.  Kodish, et al, derived their cohort for study from ten primary care practices located in rural and semi-urban Northeastern Pennsylvania,and used the Behavioral Health Screen (BHS) to arrive at a sample of 5,429 participants.

 

By using the DSM in conjunction with the BHS, the surveyors were able to assess risk for bullying by type (verbal, physical, and/or cyber) as well as the presence of depressive symptoms (using five factors gauged over a two week period), and also included a four item mean from the lifetime suicide scale that included questions to determine if the participant had felt life to be not worth living; had considered suicide; planned to commit suicide; or had attempted suicide.  Controlling for depression and demographics, the collected data was then analyzed to determine what relationship, if any, existed between the types of bullying and suicidal risk levels, as well as testing the interactions between each bullying type and incidences of depression (Kodish, et al, 2016).  It was determined that there is a statistically significant relationship between risk of suicide and all three types of bullying, with a cumulative bullying experience also associated with a heightened risk of suicide.  It should also be noted that significance was recognized between all four bullying factors (verbal, physical, cyber, cumulative) and incidences of depression, with a stronger link between bullying occurrences and suicide severity among patients with depressive symptoms.  While the effects of physical, cyber, and cumulative bullying experiences were found not to be statistically significant with regard to suicide attempts, patients who experienced verbal bullying were shown to be 1.5 times more likely to report a suicide attempt (Kodish, et al, 2016).

 

Overall, it was discovered that all three forms of bullying were linked to suicide risk severity, with the effect being acutely heightened when symptoms of depression were present.  Of the three forms of bullying assessed, it was discovered that verbal bullying had, by far, the most impact, which may be due to it being the most common type reported (25% of the sample cohort reported verbal abuse in bullying situations).  This may be due to the fact that it is usually delivered publicly and in person.  By contrast, physical bullying, which may be painful and socially humiliating, may have a lesser psychological impact than other forms of bullying.  This could be due to any number of factors (“David v Goliath”-type situation, physical confrontation being motivated by racism, etc).  In regards to cyber bullying, the fact that it is usually done anonymously as well as the fact that the Internet is impersonal in nature may have a curtailing effect on the impact of this particular type of bullying.  Depression has been shown in this particular study to definitely be a moderator between bullying and suicide risk, but further study is warranted to determine the overall extent to which this relationship exists, as well as determining the extent of moderation for each type of bullying.

 

Looking at the relationship between bullying, suicidal ideation and the relevance of associated depression provides insight into developing appropriate and effective treatment protocols for those who are most at-risk.  By establishing a solid connection between bullying, suicidal ideation, and depression, the authors have furthered insight into a serious issue facing our youth, and it should be noted that not only does this research benefit those who are bullied, but also those who do the bullying; youth who bully others have been found to be at significantly increased risk for suicide and depression as well.

 

Delving further into these issues will help to improve not only the understanding necessary for addressing the victims of bullying but also to understand what it is that causes a bully to victimize others, thus allowing earlier interventions for prevention of escalation, and ultimately the reversal of those trends that lead to bullying, depression, and suicidal ideation.  The authors note that assessing for these issues during primary care visits is warranted.  Going forward, improving the assessment for these issues through clinical interviews should be a priority for those not only in healthcare occupations, but also those who are likely to have the most social non-parental contact with children (teachers, clergy, etc).

 

Kodish, T., Herres, J., Shearer, A., Atte, T., Fein, J., & Diamond, G. (2016). Bullying, Depression, and Suicide Risk in a Pediatric Primary Care Sample. Crisis, 37(3), 241-246. doi:10.1027/0227-5910/a000378

 

 

Teresa King
PMHC Doctoral Intern

 

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Friday Factoids: The Dangers of Synthetic Marijuana

 

 

While many states have decriminalized the possession, use, and cultivation of natural Cannabis for either medicinal or recreational purposes, a majority of states continue to follow Federal guidelines with their approach to natural Cannabis and the law.  This seems to be driving the popularity of synthetic marijuana in those states where natural Cannabis is still treated as a controlled substance.  Synthetic marijuana goes by many names such as Spice, K-2, “fake weed”, etc., and the biggest issue seems to be that although it binds to the same CB1 receptor in the brain, it acts as a full agonist, rather than just a partial agonist as in the case of THC. (NIDA, 2015; Walton, 2014)  Binding with a much greater efficiency seems to make it much more difficult for the body to process and metabolize the acting ingredient that gives the high the user is looking for, with the result that the effect is many times more powerful than that produced by THC.

 

While the active ingredients in synthetic marijuana are called “cannabinoids” due to their chemical resemblance to cannabinoids that are found in natural Cannabis, they are much more potent, and unpredictable, in their effects on the user.  Even though they are marketed as a safe and legal alternative, their effects can be so much more powerful that they can become life-threatening. (NIDA, 2015)  The fact that CB1 receptors are in every structure of the brain is a key part of what makes the issue so serious, as are the symptoms experienced during an overdose event.  CB1 receptors in the hippocampus (memory affect), temporal cortex (seizure initiation), prefrontal cortex (psychosis), and brain stem (cardiac, respiratory, and gastrointestinal affect) all contribute to the myriad of symptoms that occur during an overdose on synthetic marijuana having a lasting effect, while the effects of an “overdose” from THC in natural Cannabis tend to dissipate fairly quickly.   “Clinically, they just don’t look like people who smoke marijuana,” says Lewis Nelson, MD, at NYU’s Department of Emergency Medicine, Division of Medical Toxicology. “Pot users are usually interactive, mellow, funny. Everyone once in a while we see a bad trip with natural marijuana. But it goes away quickly. With people using synthetic, they look like people who are using amphetamines: they’re angry, sweaty, agitated.” (Walton, 2014)

 

Newly available and unregulated psychoactive compounds, including synthetic marijuana, belong to a drug group called “new psychoactive substances”, or NPS.  NPS are problematic in that as soon as a compound is added to the group for regulation, another is quickly made available, and the cycle continues.  Fundamental changes in drug policy, drug law, public perception/attitudes, and approaches to treatment will be necessary before the depth of the problem can be ascertained, and a suitable method for treatment and recovery developed and implemented.

 

References

NIDA (2015). Synthetic Cannabinoids. Retrieved November 24, 2016, from          https://www.drugabuse.gov/publications/drugfacts/synthetic-cannabinoids

 

Walton, A. G. (2014, August 28). Why synthetic marijuana is more toxic to the brain than pot. Forbes. Retrieved November 24, 2016, from http://www.forbes.com/sites/alicegwalton/2014/08/28/6-reasons-synthetic-marijuana-spice-k2-is-so-toxic-to-the-brain/#5e615f9249eb

 

Teresa King
Pennyroyal Doctoral Intern

 

 

 

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Article Review: Early Identification of and Treatment for Borderline Personality Disorder

 

Sharp and Fonagy (2015) offer a review of the phenomenology, prevalence, etiology, clinical problems, and interventions for adolescents with BPD. Borderline personality disorder (BPD) is said to capture the core of personality pathology (Sharp & Fonagy, 2015).  The symptoms of BPD usually manifest in adolescence (Chanen & Kaess, 2012, as cited in Sharp & Fogay, 2015); yet many clinicians are hesitant to diagnose personality pathology in children due to the presumed normal emotional liability during this developmental period.  Interesting though, this period of turmoil has received only limited support in the research (Cicchetti & Rogosch, 2002, as cited in Sharp & Fonagy, 2015).  Furthermore, a poor prognosis is often associated with individuals that have problems throughout adolescence, and as cited by Paris (2015), pathological symptoms greater than one year should not be dismissed and may likely be associated with BPD.   Regardless, the symptoms of BPD compared to typical adolescence are often more severe, pervasive, long-standing, and reflected in both internalizing and externalizing disorders.

 

Sharp and Fonagy (2015) report that studies for early detection of BPD in adolescence have shown that “chronic feelings of emptiness and inappropriate, intense anger” are considered the “most stable symptoms,” whereas identity disturbance, affective instability, and intense anger have the “greatest predictive power for development of BPD” (p. 1268). These characteristics are said to be consistent across age groups.  Additionally, for boys, paranoid ideation, and in girls, identity disturbance, have shown to be discriminating symptoms of BPD in adolescents.  Persistent self-harm behaviors are known to distinguish BPD from other disorders. Similar to adults with BPD, risk factors in adolescents with BPD are general impulsivity, risky behaviors, difficulty dealing with stress, and negative affect.  Impairment in social and academic functioning is also common.

 

As cited in Sharp and Fonagy (2015), Chanen & Kaess (2012) describe BPD as a developmental disorder. Research has indicated a mean age of onset at 18, with a standard deviation of 5- 6 years. Adolescence is said to be a critical period for the development of BPD due to the social demands (e.g., establishing stable friends, remaining close to family).  Furthermore, the social and emotional development in adolescence is associated with functional and structural brain changes.  While, BPD symptoms appear in adolescence, they are known to peak in early adulthood, with a decline in impulsive symptoms over time. Affective symptoms are more likely to persist.  Sharp and Fonagy (2015) have shown evidence for heterotypic developmental course, meaning that there is “coherence in the underlying organization or meaning of behaviors over time” (p. 1271).

 

Regarding comorbidity, BPD in adolescence is highly associated with internalizing and externalizing disorders. Sharp and Fonagy (2015) cite that around 70% of adolescents with BPD have comorbid mood disorders, 67% have anxiety disorders, and 60% have externalizing disorders.  Thus, the authors argue that BPD is a confluence of both externalizing and internalizing disorders, and is not a female expression of antisocial personality disorder.  Additionally, there is evidence that constitutional factors (i.e., temperament) and environmental factors have a role in BPD etiology.

 

Yet, it is also difficult to distinguish BPD from other clinical disorders. For identification of BPD, several measures have shown clinical utility (See Sharp & Fonagy, 2015, for a more comprehensive review).  Clinical assessment along with an objective measures is thought to be best clinical practice for precision in diagnosis. Regarding intervention, there is not a wealth of information available.  Programs such as Helping Young People Early (HYPE) and Dutch Emotion Regulation Training (ERT) are early intervention efforts for BPD.  They are based on cognitive analytic therapy and cognitive-behavioral elements and skills training, respectively. Cognitive-analytic therapy integrates psychoanalytic object relations theory and cognitive psychology and has demonstrated effectiveness and rapid recovery.  Mentalization-based treatment for adolescents has similar components to cognitive analytic therapy and has shown effectiveness by “improved mentalizing and reduced attachment avoidance” (p. 1281).  Dialectical behavior therapy (DBT) has also been adapted for treatment of BPD in adolescents. DBT targets emotional dysregulation, distress tolerance, and interpersonal difficulties.  Transference-focused psychotherapy is grounded in object relations theory and has been adapted for adolescents, but has not underwent RCT to assess its effectiveness.

 

Sharp and Fonagy (2015) conclude that successful interventions should contain extensive efforts to maintain engagement in treatment, have an evidence-based model of developmental pathology, and have an active therapist role, with a focus on validation and modeling of empathy, as well as the development of a strong attachment. Additionally, there should be a facilitation of trust and belief that something can be learned in therapy.  Treatment should focus on emotional processing and the connection between action and feelings, have structure to promote activity, proactivity, and self-agency, as well as be manualized, with supervision for deviations from the manual.   There should be a commitment to the approach in treatment between both the therapist and client.

 

Evidence-based treatments for BPD have common treatment characteristics (Bateman, Gunderson, & Mulder, 2015). They are structured (manual directed) and they encourage clients to control themselves (agency). Therapists help connect feelings and actions and are active, responsive, and validating. They also discuss cases with others (i.e., supervision and/or consultation).

 

Overall, there is a delicate balance in assessing BPD in adolescents compared to recognizing the potential for emotional liability during this developmental period. Yet, understanding the clinical picture, as well as the distinguishing pervasive features of BPD, will help differentiate it from either normal turmoil and/or other disorders.  Finally understanding treatment options can help clinicians gain confidence in identifying and providing subsequent treatment for adolescents with BPD.

 

 

References
Bateman, A. W., Gunderson, J., & Mulder, R. (2015). Treatment of personality disorder. The Lancet, 385, 735-743.

 

Sharp, C., & Fonagy, P. (2015). Practitioner review: Borderline personality disorder in adolescence – recent conceptualization, intervention and implications for clinical practice. The Journal of Child Psychology and Psychiatry, 56(12), 1266-1288.

 

Dannie S. Harris, MA
WKPIC Doctoral Intern

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Friday Factoids Catch-Up: Memory, the Real McCoy?

Memories develop starting at birth and continue to develop throughout the life cycle as we age. The brain remembers by association, strengthening neural connections through repetition (“use it or lose it principle”) (Willingham, 2007).  Research has shown that, although memory is often considered to be a singular ability in and of its self, it is actually a process of at least three inter-related functions: encoding, storage, and retrieval.  The first step to creating a memory is encoding, a crucial step involving the conversion of the perceived item of interest into a construct that can be stored, and then later recalled through retrieval processes, from either short- or long-term memory at some point in the future.  The process of storage occurs between encoding and retrieval, when the memory exists only as a possibility for remembrance. (Arbuthnott, et al., 2001)  Memories are, in a sense, us; they chart our life details.  There are several types of memory processes that deal with differing aspects of how memories are formed.  Short- and long-term memory are the two most common forms people tend to recognize, but there are others, such as associative, elaborative, and autobiographical, that come into play.

 

The study of memory in early childhood is centered around development as it relates to the cognitive self, and a particularly important aspect of early memory centers on childhood amnesia, specifically the fading ability to recall events that occur during early childhood.  Although children may remember events prior to ages 3-4, those memories also tend to fade with time as we age. (Goleman, 1993; Willingham, 2007)  Most adults remember very little prior to age 3 or 4, since this is the age at which our cognitive memory first begins to truly function.  Prior to that age, the cognitive and language skills that are necessary for the processing of external events are not yet developed fully enough to allow this processing to occur, which is essential to the storing of events as memories. (Kihlstrom, 1994)   As aging occurs and cognitive and language skills improve, new knowledge is also being acquired, as well as the establishment of a sense of self.  During the aging process in children, major developments occur in the expansion of memory, perhaps with less processing being required to enable long-term storage.  According to a study published by the New York Times, memories that are autobiographical in nature begin when children learn about themselves and their early years through their parents. (Goleman, 1993)  Over time, as we navigate through the aging process, some memories fade, some are lost, and others are distorted as a natural result of the progression of time and aging.

 

Traditionally, faulty memory has often been associated with either the elderly or those who have suffered a traumatic brain injury, but the ongoing research that has occurred over the last couple of decades tells a different story.  There are certainly instances where people’s memories are obviously faulty, and often this is due to such factors as dementia, Alzheimer’s, concussion, or some other such factor exerting an influence on the brain’s ability to manifest an effective and accurate recall of prior events.  However, the distortion of memories, from the changing of details to the outright planting of false memories, has become an area of real interest and research due to the fact that the accuracy of memories can have much greater implications than just those that directly affect the individual in their quest for resolution of a particular psychological issue.  The likelihood of false memories, in conjunction with the fact that there is still much about the mind that we do not yet understand, make it a dangerous prospect for the therapist to suggest too much.  The evidence exists that people can be led to believe that they have experienced events in their lives that are patently untrue, or at the least, highly unlikely to ever have occurred. (Loftus, 2004)  One particular study showed that even a brief exposure to a false memory of a childhood event serves to boost their confidence that the event actually occurred. (Sharman, Powell, 2012; Garry, et al., 1996; Sharman, et al., 2005)  This was attributed to a phenomenon called imagination inflation.  The study participants were asked to rate their confidence levels on a range of childhood events that occurred prior to 10 years of age.  They were then asked two weeks later to imagine events that they indicated did not occur, and rate their confidence of the event occurrences a second time.  The confidence ratings of the events that did not happen were rated higher in confidence of their occurrence the second time around than the events that actually occurred, which were used as control events.

 

There are several techniques that have been used to attempt to determine the validity of false memories through “planting” of events that were false and never actually occurred, including hypnosis, guided imagery/imagination, dream interpretation, and picture cuing, and all proved successful at inducing false memories in research study participants in statistically significant numbers.  One of the earliest studies that specifically attempted to plant false memories for an entire event used a technique that came to be called the “lost in the mall” technique, which utilized stories about events that happened to participants as related by their parents, and included one wholly false story that was verified as having never occurred, usually lost in a mall, or, alternatively, spilling punch on a bride’s parents at a wedding or having a serious accident.  Based on the results of a series of interviews that utilized memory recovery techniques, 20%-25% of the study participants confirmed a memory of these false events even though they never actually occurred. It was also determined that these false memories exhibited high levels of detail and emotional responses in those that developed them. (Laney, Loftus, 2013)

 

Scoboria et al. (2004) posited a model for autobiographical beliefs and memories that, based on their research, indicated the memories, thoughts, and beliefs concerning plausibility of an event are of a “nested” format.  For a person to remember an event, they necessarily have to believe that it occurred, meaning that the memory itself is nested within confidence.  It also needs to be personally plausible, so confidence is nested within personal plausibility.  The event has to be plausible generally, so personal plausibility is nested within general plausibility. While the research shows that false beliefs and memories will increase due to repeated exposures, brief exposure to false events does not increase confidence or implant false memories. (Sharman, Powell, 2012)

 

The research on false memory has firmly established that people can be led to believe that they have experienced events that have never actually occurred.  Not only can these false memories be wrapped in exquisite detail and sensory associations of recollection, conveying all the characteristics of being the genuine article, but they can be extremely far-fetched in their subject matter such that they are extremely unlikely to be true, yet people will still insist on having experienced them.  The consequences of false memories can have far-reaching, and often unintended, consequences.  There are documented cases of people having spent decades of their lives in prison based on testimony that relied on what turned out to be an instance of false memory, and were only exonerated because of DNA evidence.  While this is an extreme example of the consequences of reliance on memory to be infallible, it clearly illustrates that memory is fluid, malleable, and completely vulnerable to improper influence and subsequent dubious recall.  As a Clinical Psychology student, I previously held to the belief that a memory which is uncovered during therapy is more than likely to be true.  After all, why would a profession devoted to helping people end up doing harm by implanting false memories?  In my opinion, it is not intentional harm on the part of the therapist but, rather, a misuse of techniques which can, and sometimes does, lead to disastrous consequences.  Knowing that memories can become twisted and confused should be reason enough to become skeptical of any method of regression treatment or therapy.

 

References
Arbuthnott, K. D., Arbuthnott, D. W., Rossiter, L. (2001). “Guided imagery and memory: implications for Psychotherapists”. Journal of Counseling Psychology Vol. 48, No. 2, 123-132. Retrieved from Ebscohost, November 17, 2016.

 

Durbin, P. G., Ph.D. Beware false memories in regression hypnotherapy. Retrieved November 16, 2016, from http://alchemyinstitute.com/false-memory.html

 

Goleman, D. (1993, April 6). Studying the secrets of childhood memory. The New York Times. Retrieved from http://www.nytimes.com

 

Kihlstrom, J. E. (1994). “Hypnosis, delayed recall and the principles of memory”. The International Journal of Clinical & Experimental Hypnosis. 1994, Vol. XLII, No. 4, 337-344. Retrieved from Ebscohost, November 15, 2016.

 

Laney, C., Loftus, E. F. (2013). “Recent advances in false memory research”. South African Journal of Psychology 43(2) 137-146. Retrieved from Ebscohost, November 17, 2016.

 

Loftus, Elizabeth F. (2004). ”Memories of things unseen”. Current Directions in Psychological Science. 2004. Vol. 13, No. 4, 145-147. Retrieved from Ebscohost, November 15, 2016.

 

Sharman, S. J., Powell, M. B. (2012). “Do cognitive interview instructions contribute to false beliefs and       memories?”. Journal of Investigative Psychology and Offender Profiling. 10: 114-124 (2013).

 

Willingham, D. T. (2007). Cognition: The thinking animal (3rd ed.). Upper Saddle River, New Jersey: Pearson.

 

Teresa King
Pennyroyal Doctoral Intern

 

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