Friday Factoids: APA’s Psychotherapy Series is a Great Resource

 

 

APA’s Theories of Psychotherapy Series are like CliffsNotes for the different models of psychotherapy. The series has a book for many psychotherapy models written by master clinicians in that type of therapy. The books are affordable and concise, which makes them an excellent starting place when you want to learn more about a certain model or want to stay current on the different models popular today.

 

Current books include:

  • Acceptance and Commitment Therapy (Hayes & Lillis, 2012)
  • The Basic of Psychotherapy: An Introduction to Theory and Practice (Wampold, 2010)
  • Behavior Therapy (Antony & Roemer, 2011)
  • Brief Dynamic Therapy (Levenson, 2010)
  • Career Counseling (Savickas, 2011)
  • Cognitive Therapy (Dobson, 2012)
  • Cognitive-Behavioral Therapy (Craske, 2010)
  • Emotion-Focused Therapy (Greenberg, 2011)
  • Existential-Humanistic Therapy (Schneider & Krug, 2010)
  • Family Therapy (Doherty & McDaniel, 2010)
  • Feminist Therapy (Brown, 2010)
  • Interpersonal Psychotherapy (Frank & Levenson, 2011)
  • Narrative Therapy (Madigan, 2011)
  • Person-Centered Psychotherapies (Cain, 2010)
  • Psychoanalysis and Psychoanalytic Therapies (Safran, 2012)
  • Psychotherapy Integration (Stricker, 2010)
  • Rational Emotive Behavior Therapy (Ellis & Ellis, 2011)
  • Reality Therapy (Wubbolding, 2011)
  • Relational-Cultural Therapy (Jordan, 2010)

 

Danielle M. McNeill, M.S., M.A.
WKPIC Doctoral Intern

 

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Friday Factoids: Passing on the Wisdom

Here’s a list of must-knows when applying to our site, or coming to WKPIC for internship!

 

1.            Paula Halcomb, director of the Admissions Unit at WSH, is our resident restaurateur. If you want to know where to eat in the area, and even what to order when you get there, talk to Paula. She can also help you find obscure objects in the area, such as where to go when you want to buy used vinyl records.

 

2.            Dr. Ralph Greene at WSH is our very own statistician. He has helped a few of us out with our dissertation stats, but he doesn’t like to advertise.

 

3.            Dr. Susan Vaught, director of the psychology department at WSH and the internship director of clinical training, is a neuropsych genius. If you have a question about testing or a challenging case, just tell her the symptoms (one or two symptoms will do) and she will tell you exactly where the neurological damage is localized.

 

4.            Hopkinsville, KY is home to quit a few delicious and unique restaurants. It was surprising to find such good eats around our small town and these hidden jewels are must-haves for foodies.

•             Da Vinci Little Italian – European owner and chef serves authentic Italian food, which is seriously the best Italian food you will ever have outside of Italy. The restaurant stays packed on weekends so make a reservation.

•             Ferrell’s Hamburgers – Best hamburgers in town and for a good price.

•             El Bracero – Don’t waste your time trying to find your favorite Mexican restaurant, just go to Bracero. There are two locations, one in Hopkinsville and one in Clarksville, TN.

•             Whistle Stop Donuts – Bring these to work and you’ll soon favorite. There are two locations, one in Hopkinsville and one in Clarksville, TN.

 

5.            Clarksville, TN is a short drive south and home to many restaurants. Black Horse Pub & Brewery has amazing steaks and pizzas.

 

6.            Farmers’ Markets! There are two close by, one in downtown Hopkinsville that is open Wednesdays and Saturdays, and one in downtown Clarksville, TN that is open Saturdays.

 

7.            Contrary to popular belief, we are not land-locked. There are many parks with river access in the area, and two large lakes a short drive north. The Land Between the Lakes (LBL) recreational area has many water-sport and fishing opportunities. There are even trails for Jeeps/ATVs and a bison and elk reserve to tour.

 

8.            Culture! Despite the small town, there is much diversity in the area that we can probably attribute to the nearby large Army post, Fort Campbell, located in Oak Grove, KY and Clarksville, TN (yep, it’s that big). There are several museums in the area and you can enjoy great musicals and plays at Roxy Regional Theatre in Clarksville, TN.

 

9.            Most, if not all, staff at WSH can be bribed with food and/or coffee.

 

10.          The ladies at Pennyroyal Center in Greenville frequently have pot-luck lunches during the work week. Get ready for some yummy home-cooked food!

 

 

Danielle M. McNeill, M.S., M.A.
WKPIC Doctoral Intern

 

 

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Summary of Gianoli, Jane, O’Brien, & Ralevski (2012): Treatment for Comorbid Borderline Personality Disorder and Alcohol Use Disorders

 

Gianoli, Jane, O’Brien, & Ralevski (2012) explain that there is a high degree of comorbidity between borderline personality disorder (BPD) and alcohol use disorders (AUDs). Research has demonstrated that this pattern of comorbidity may be associated with poorer prognosis for these individuals. Three psychotherapies have been specifically developed for patients with borderline personality disorder and substance use disorders (SUDs), but only one of these (Dynamic Deconstructive Psychotherapy) has been tested among patients with dual diagnoses of BPD and AUDs. Of all substance-use disorders, alcohol use disorders (AUDs) including both alcohol abuse and alcohol dependence are the most common among individuals with borderline personality disorder.

 

Borderline personality disorder is present in approximately 1% to 1.6% of the general population and in about 20% of the psychiatric population. Borderline personality disorder is thought to be about three times more common among females than males but this gender difference has not always been proven in community-based studies. Data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) suggest that among patients with a lifetime diagnosis of borderline personality disorder, 58.3% also had lifetime diagnoses of alcohol use disorders. Rates of co-occurrence of lifetime borderline personality disorder among patients with alcohol use disorders ranged from 9.8% to 14.7% in this same study. A study found that among individuals with borderline personality disorder, the prevalence rate of alcohol use disorders was 48.8% and among patients with alcohol use disorders, the prevalence rate of borderline personality disorder was 14.3%. Comorbidity rates are even higher among female psychiatric patients, with 59% of women with borderline personality disorder also carrying a lifetime diagnosis of either alcohol abuse or dependence. Individuals diagnosed with both borderline personality disorder and alcohol use disorder have worse outcomes compared to those with either borderline personality disorder or alcohol use disorder alone. Borderline personality disorder traits are significantly predictive of future problems associated with alcohol use, even after controlling for other Axis I disorders (including other current substance use disorders) and nonborderline personality disorders.

 

There are surprisingly few treatments that have been developed or tested for concurrently treating borderline personality disorder and alcohol use disorders. Several randomized studies have found that targeting personality traits in brief coping skills interventions is effective in reducing alcohol and illicit substance use. An approach called, Personality-Guided Treatment for Alcohol Dependence (PETAD), was created that integrates cognitive therapy for addictive behaviors with strategic interventions for maladaptive personality features. Compared to those receiving standard cognitive therapy, those in the PETAD condition were more likely to stay in treatment, and had significantly more days of alcohol abstinence at their six-month follow-up visit. In another study, Linehan et al. (1999) examined the efficacy of Dialectical Behavior Therapy (DBT) with patients with borderline personality disorder and substance use disorders. In this particular study, patients were randomized to one year of either DBT-S or treatments as usual (TAU). At the 16-month follow-up, DBT-S patients reported better social and global adjustment compared to the TAU group.

 

Another psychotherapy has been developed for the concurrent treatment of personality disorders and substance use disorders called Dual Focus Schema Therapy (DFST). Unlike DBT-S, DFST was developed for the treatment of a broader range of personality disorders that are often comorbid with SUDs and AUDs. DFST includes a 24-week, manual-guided, individual cognitive-behavioral therapy integrating relapse prevention techniques while addressing chronic, maladaptive personality functioning and coping styles. The efficacy of DFST for specifically treating patients with borderline personality disorder and alcohol use disorder is unknown, but there are some encouraging findings regarding its efficacy among patients with dual diagnoses of personality disorders and SUDs. Both DBT-S and DFST appear to be promising approaches for the concurrent treatment of borderline personality disorder and substance use disorders.

 

The only form of psychotherapy that has been specifically tested for the concurrent treatment of borderline personality disorder and alcohol use disorders is Dynamic Deconstructive Psychotherapy (DDP), a time-limited, manual-based treatment based on object-relations theory, deconstructive philosophy and neurocognitive research. Analyses from a study comparing DDP and TAU found no significant differences between groups during the course of the study, however, there were statistically significant improvements found over time on measures of parasuicide behavior, alcohol misuse, and proportion of patients needing institutional care for those receiving DDP but not for those receiving TAU.

 

In summary, DBT-S and DFST appear to have only modest effects on drinking behavior. Further research is clearly needed for all three psychotherapies. It will be important for future studies to explore the effectiveness of these psychotherapies not only in bigger samples, but also in samples of patients with dual diagnoses specifically of borderline personality disorder and alcohol use disorders.

 

In treating individuals with alcohol use disorders, the main objective is relapse prevention. Thus, pharmacological strategies usually involve medications that deter alcohol use by moderating craving and/or producing adverse reactions when alcohol is consumed. The FDA approved medications for alcohol relapse prevention are disulfiram [acetaldehyde dehydrogenase (ALDH-1 and -2 inhibitor)], oral and injectable naltrexone (mu-opioid antagonist), and acamprosate (NMDA receptor modulator). Differentially, there are no FDA approved medications for the treatment of borderline personality disorder. Nevertheless, psychotropic medications, namely antidepressants, anticonvulsants, and antipsychotics, are often used to manage the anger, impulsivity and mood lability that are characteristic of borderline personality disorder. Of these medications, anticonvulsants, namely topiramate and lamotrigine, and second-generation antipsychotics, specifically aripiprazole and olanzapine, appear to be the most helpful. Antidepressants, although most commonly prescribed for patients with borderline personality disorder are only modestly effective in managing symptoms of borderline personality disorder. There are no published studies that have explored medication options to concurrently manage symptoms of borderline personality disorder and decrease alcohol consumption. A study was conducted utilizing disulfiram with individuals with borderline personality disorder and alcohol disorder. Two of the eight patients remained completely abstinent under supervised disulfiram therapy over their respective treatment period (4.5 and 14 months). These studies provided evidence that relapse prevention medications may be similarly effective in reducing alcohol consumption for individuals with and without comorbid borderline personality disorder. However, neither study reported on changes in borderline personality disorder symptoms. Therefore, while relapse prevention medications may help to control alcohol use, there is no evidence that they effectively manage borderline personality disorder symptoms. There is also emerging evidence that anticonvulsants and second-generation antipsychotics are most effective in the management of borderline personality disorder symptoms. Interestingly, the very same medications may be helpful in the treatment of alcohol use disorders. Of these classes of medications, most support has been found for topiramate and aripiprazole, however, encouraging findings have also been reported for lamotrigine and olanzapine.

 

Borderline personality disorder and alcohol use disorders are highly comorbid and this type of comorbidity has been associated with particularly negative prognosis. Yet, there are very few treatments that concurrently treat symptoms of both borderline personality disorder and alcohol use disorders. There have been three psychotherapies that have been designed to concurrently treat borderline personality disorder and substance use disorders. However, only one (Dynamic Deconstructive Psychotherapy) has been specifically evaluated for the concurrent treatment of borderline personality disorder and alcohol use disorders, and although it may be effective in reducing symptoms of borderline personality disorder, its efficacy in reducing alcohol consumption over time may be comparable to treatment as usual. There is evidence that some anticonvulsants and antipsychotics may significantly reduce anger (one core symptom of borderline personality disorder), and some like lamotrigine have been shown to reduce other core symptoms of borderline personality disorder including impulsivity and mood lability. Other studies have suggested that the same medications may also reduce alcohol craving and consumption in patients with alcohol use disorders/problems alone. Considering these results, further study of the role of anticonvulsants and second-generation antipsychotics is warranted, and further studies aimed at exploring other treatments that simultaneously treat both symptoms of borderline personality disorder and alcohol disorder are recommended. (Gianoli, Jane, O’Brien, & Ralevski, 2012)

 

Gianoli, M. O., Jane, J.S., O’Brien, E., & Ralevski (2012). Treatment for comorbid borderline personality disorder and alcohol use disorders: A review of the evidence and future recommendations. Experimental and Clinical Psychopharmacology, 12 (4). 333-344.

 

Cindy A. Geil, M.A.
WKPIC Doctoral Intern

 

 

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Friday Factoids: The Skills System

 

 

Julie F. Brown has modified DBT techniques for use with individuals with intellectual disabilities. The Skills System is comprised of skills and tools for effectively managing emotions, thoughts, and actions. Her guide for clinicians, The Skills System Instructor’s Guide: An Emotion Regulation Skills Curriculum for All Learning Abilities (2011) can be purchased through Amazon.

 

See her website www.theskillssystem.com for more information about this practical approach. Several psychologists in our department have been trained on this system and are finding it extremely useful in our work at the hospital.

 

 

Danielle M. McNeill, M.S., M.A.
Doctoral Intern
Western State Hospital

 

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Site Visit Scheduled

 

 

WKPIC is happy to announce the scheduling of our APA site visit, on December 8-9, 2014.  Thanks to the many, many folks who have helped us to get this far in the process. Fingers crossed, and positive thoughts!

 

 

 

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Friday Factoids: New Synthetic Drug Alert

 

 

A dangerous new drug has been associated with several deaths in Indiana. The drug “N-bomb” (25i-NBOMe) is a synthetic substance considered easy to manufacture and classified as a hallucinogen similar to LSD. The substance takes many forms including white powder, brown powder, or liquid that is then mixed with alcohol or energy drinks or placed on blotter paper.

 

There are many reports that dealers are selling the substance as LSD, when in fact they are selling the more lethal “N-bomb.” Side effects can last approximately 15 hours and include hallucinations, confusion, panic, paranoia, euphoria, anxiety, agitation, depression, violence, and death.

 

This substance is particularly dangerous because fatality can result from one dose, not just an overdose. The DEA classified this substance as a Schedule I substance in November 2013. The drug appears to be more popular among teens and young adults.

 

Danielle M. McNeill, M.S., M.A.
Doctoral Intern
Western State Hospital

 

 

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Friday Factoids: Good Resource for Treatment Planning

 

Developing specific and detailed treatment plans can be challenging when you are a new clinician. The Complete Adult Psychotherapy Treatment Planner, Fifth Edition (Jongsma, 2014) is a great resource that incorporates evidence-based interventions for 43 presenting problems.

 

This is a good place to start when wanting to tailor treatment plans for each individual client. The Practice Planners series has other adult treatment resources, The Adult Psychotherapy Progress Notes Planner (Jongsma, 2014) and Adult Psychotherapy Homework Planner (Jongsma, 2014), and similar resources for other populations including Child, Adolescent, Older Adult, Severe and Persisting Mental Illness, Personality Disorder, Co-Occurring Disorders, Addiction, Couples, Family, Group, Suicidal and Homicidal Risk, and Crisis Counseling and Traumatic Events.

 

Danielle McNeill, M.S., M.A.
WKPIC Doctoral Intern

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Article Summary: Operationalzing the Assessment and Management of Violence (Doyle & Logan, 2012)

 

 

In their article, Doyle and Logan (2012) suggest a system, Short-Term Assessment of Risk and Treatability (START), for assessing violence risk that addresses shortcomings of current methods. Studies have estimated between one in 10 and one in three admissions are preceded by violence toward others. Although assessing violence risk has been widely studied, there are far fewer studies related to managing and reducing risk once identified.

 

Risk judgments made based on total scores of risk factors is only loosely related to risk management. The structured professional judgment (SPJ) approach to risk assessment considers not only the presence or absence of specific risk factors, but also specific individual and contextual factors. There are six stages of SPJ:

 

  1. Gather information from a variety of sources.
  2. Consider the presence and relevance of risk factors – historical, current,  contextual, protective.
  3. Develop a risk formulation – motivators (drivers), (dis)inhibitors, destabilizers. Here the clinician discusses whether or not these risk factors are relevant to the individual’s potential to be violent in the future.
  4. Consider risk scenarios, e.g. repeat, escalation, twist. This step directly links risk assessment to risk management by formulating a judgment about risk and protective factors, and how these factors impact potential for violence in the future.
  5. Develop risk management strategies derived from the most relevant risk and
    protective factors.
  6. Summary of judgment including judgments of the urgency of action, risk in other areas, any immediate action required, and when the next review should occur.

 

Several risk assessment tools have been validated to assist in short-term risk assessment, stage two in SPJ. These include:

 

  • Violence Screening Checklist (VSC):
      • Assesses risk for aggression upon admission
      • Consists of four items: history of physical attacks and/or fear-inducing behavior during the two weeks prior to admission, absence of recent suicidal behavior, diagnosis of schizophrenia or mania, and male gender
  • Brøset Violence Checklist (BVC):
      • Developed to help nurses assess risk of imminent violence upon admission and during hospital stay
      • Consists of six items: confusion, irritability, boisterousness, verbal threats, physical threats, and attacks on objects
  • Dynamic Appraisal of Situational Aggression (DASA):
      • Developed to help clinical decision-making on admission units
      • Consists of the six items from the BVC, as well as negative attitudes and impulsivity
  • Classification of Violence Risk (COVR):
      • Developed to predict violence in the community after discharge
  • Violence Risk – 10 items (V-Risk 10):
      • Assesses risk for inpatient violence

 

The START is a brief guide for assessing risks, strengths, and treatability. It was developed based on forensic mental health services, but can be applied in a variety of mental health settings. Preliminary evidence suggests the START has the potential to be a useful tool in informing clinical judgment. Studies have also indicated adequate reliability and validity in a variety of settings and different countries. The START assesses risk across the following domains: risk to others, suicide, self-harm, self-neglect, substance misuse, unauthorized leave, and victimization. It consists of 20 dynamic items that may change across days or weeks. Changes in the items could result in an elevation or reduction of risk. All items can be considered as both risk factors and protective factors. The 20 items include:

1.            Social skills
2.            Relationships
3.            Occupational
4.            Recreational
5.            Self-care
6.            Mental state
7.            Emotional state
8.            Substance use
9.            Impulse control
10.          External triggers
11.          Social support
12.          Material resources
13.          Attitudes
14.          Medication adherence
15.          Rule adherence
16.          Conduct
17.          Insight
18.          Plans
19.          Coping
20.          Treatability

 

The next step is to address the fourth and fifth stages of SPJ by considering risk formulation and developing risk management strategies. When developing a risk formulation, it is important to first address the question “risk of what” because risks can have different antecedents. One should consider different scenarios an individual may decide to be harmful in the future, called scenario planning. Scenario planning is not prediction, but rather it is based on identifying why an individual has acted in a violent way in the past.

 

The final stage includes risk management, or taking action to prevent the identified future scenarios from happening in the future. Risk management strategies include treatment, supervision, and victim safety planning.

 

Doyle, M., & Logan, C. (2012). Operationalizing the assessment and management of violence risk in the short-term. Behavioral Sciences and the Law, 30, 406-419.

 

Danielle McNeill, M.S., M.A.
WKPIC Doctoral Intern

 

 

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Friday Factoids: Violence, Video Games, and Slenderman

 

 

When one thinks of deadly murderous duos, names that may come to the mind include: Leopold and Loeb; Lucas and Toole; Bianchi and Buono; and Lake and Ng. It’s no surprise to most that these notorious and sadistic male killers were accomplices who acted out their fantasies on their victims. Rarely do we hear of female killer duos like Gwen Graham and Catherine May, two nurses who smothered six patients in their care; Delfina and Maria Gonzales, who lured unsuspecting women into a deadly cult of prostitution; Christine and Lea Papin, French maids who gruesomely murdered their employers and their daughter with a hammer; and Pauline Parker and Juliet Hulme, two obsessed and devoted teenagers who murdered Parker’s mother. While these women were from an era that predated the internet, one wonders if their exposure to violent images in television media and video games would have driven many more to commit such heinous acts.

 

With the arrival of the World Wide Web and internet video games, young children and teenagers were exposed to an onslaught of video content that has become increasingly realistic and violent.  Research conducted in the 1980s by Huesmann and Eron (1986) as cited by the American Psychology Association (APA, 2013), determined that elementary students who watched excessive amounts of television violence displayed higher levels of aggression as teenagers.  Recently, two 12-year- old girls from Wisconsin attributed their violent attack and attempted murder of their best friend to an online video game called “Slenderman.” The girls stated they desired to earn favor with the mythical character by luring their friend to the woods near their home and stabbing her 19 times. Prior to the attack, the girls repeatedly played the video game and planned the attack for months. When asked by authorities their motivation for such a violent act, the girls reported they wanted to prove Slenderman was real.

 

According to Traister (2014), belief in a mythical fantasy world can intensify the connection between young women and can potentially lead to violent behavior. Traister further added, “The two Wisconsin preteens aren’t the first to confuse socially-crafted fiction into reality.” Unsurprisingly, this will not be the last.  Virtual reality internet video games on our youth can be something that will continue to worry parents and may perhaps become the focus of significant future psychological research.

 

References:
Huesmann, L. R., & Eron, L. D. (1986). Television and the aggressive child: A cross-national comparison. Hillsdale, NJ: Erlbaum.

 

Traister, R. (2014). The slender man stabbing shows girls will be girls too. Retrieved from http://www.newrepublic.com/article/118005/slenderman-stabbing-shows-youth-crime-isnt-exclusive-boys

 

Violence in the Media (2013).  Psychologist study tv and video game violence for potential harmful effects. Retrieved from  https://www.apa.org/research/action/protect.aspx

 

David J. Wright, MA., MSW
WKPIC Doctoral Intern

 

 

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Friday Factoids: The Power of (and Potential Problems with) Humor

 

Do psychologists have a sense of humor? Was Johnny Carson the “King of late night television?” Of course! I rest my case.

 

Seriously though, humor in the work place has been a tremendous outlet for stress reduction. We all have read how laughter improves mood or increases satisfaction. While all of this has been supported in current literature, one has to be careful that the humor is not in “poor taste.”  Scott (2014) mentioned that “approximately 70% of individuals surveyed said that workplace jokes concentrated on making fun of co-workers based on elements such as age, sexual orientation and weight.”  Remember, what may be funny to you can be perceived by others as inappropriate.

 

I close with appropriate office humor taken verbatim from Burton (2014):

1. Two psychotherapists pass each other in the hallway. The first says to the second, “Hello!” The second smiles back nervously and half nods his head. When he is comfortably out of earshot, he mumbles, “God, I wonder what that was all about?”

 

2. Receptionist to psychologist: “Doctor, there’s a patient here who thinks he’s invisible.”
“Tell him I can’t see him right now.”

 

3. There are three guys going through an exit interview at a mental hospital. The doctor says he can release them if they can answer the simple mathematical problem: What is 8 times 5?

The first patient says, “139.”

The second one says, “Wednesday.”

The third says, “What a stupid question. It’s obvious: The answer is 40.”

The doctor is delighted. He gives the guy his release. As the man is leaving, the doctor asks how he came up with the correct answer so quickly.

“It was easy, Doc. I just divided Wednesday into 139.”

 

4. A Stanford research group advertised for participants in a study of obsessive-compulsive disorder. They were looking for therapy clients who had been diagnosed with this disorder. The response was gratifying; they got 3,000 responses about three days after the ad came out. All from the same person.

 

References:

Burton, N. (2014). The Very Best Psychology Jokes: Top 21 psychology, psychotherapy, and psychiatry jokes. Retrieved from http://www.psychologytoday.com/blog/hide-and-seek/201405/the-very-best-psychology-jokes

 

Psychology humor—clinical (n.d.) Retrieved from http://users.erols.com/geary/psychology/clinical.htm

 

Scott, E. (2014). Workplace Humor: How to reduce stress with inoffensive office humor. Retrieved from http://stress.about.com/od/workplacestress/a/officehumor.htm

 

David J. Wright, MA., MSW
WKPIC Doctoral Intern

 

 

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