Psychological interventions for social phobia

Social phobia is characterized by a marked and persistent fear of social or performance situations in which the person may be scrutinized by others and fears coming across in a way that would be embarrassing or humiliating. It is a chronic disorder that usually begins in early adolescence and results in considerable impairment that increases over an individual's lifespan. A lifetime prevalence ranging from 3-13% has been reported by epidemiological and community studies. A review of 30 studies into psychological interventions for social phobia has found that cognitive behaviour therapy (CBT) involving cognitive restructuring and exposure to feared or avoided social situations or behavioural experiments is an "efficacious and specific treatment for social phobia". Exposure therapy was also found to be effective. There were mixed findings regarding the relative efficacy of CBT and in vivo exposure with some studies reporting that the interventions were equivalent while others found that CBT produced better outcomes. There was little evidence to support the use of social-skills training.

Ponniah, K. and Hollon, S. D. - Empirically supported psychological interventions for social phobia in adults: a qualitative review of randomized controlled trials Psychological Medicine January 2008, 38(1), 3-14

Temperament, child rearing and bad behaviour

The role of temperament in the development of children's personalities and behaviour has been the subject of enquiry for decades. Difficult temperament includes features such as negative emotionality and mood, high reactivity, and fearfulness. Ratings of difficult temperament tend to be quite stable during infancy and early childhood and studies have shown links between difficult temperament, measured early in life, and later behaviour problems especially when other risk factors are present. A U.S. study of 985 children examined the links between difficult temperament, parenting styles and bad behaviour in the first year of school life. Three aspects of parenting style were assessed: harshness, sensitivity, and the opportunities the children were given for productive behaviour. The researchers found stronger relations between maternal sensitivity and bad behaviour and opportunities for productivity and bad behaviour in the children with difficult temperaments. Harsher parenting was associated with a fall in problem behaviour in the first grade but this was not found to be statistically significant. Those children with difficult temperaments whose mothers were sensitive to them and who gave them more opportunities to engage in productive activity were better behaved in the first grade.

Bradley, Robert H. and Corwyn, Robert F. - Infant temperament, parenting, and externalizing behavior in first grade: a test of the differential susceptibility hypothesis Journal of Child Psychology and Psychiatry February 2008, 49(2), 124-131

Cleft lips and later problems

Cleft lip and palate affects one in every 650 children. In the school years affected children are at raised risk for both socio-emotional and cognitive difficulties. An important question is the extent to which the problems of children with clefts may be explained by difficulties in parent-child interactions since these often predict poor child functioning. Giving birth to an infant with a cleft is often followed by shock and distress and this may affect parent-child interactions. A U.K. study of 190 very young children looked at the child's relationship with their mothers at two, six, twelve and eighteen months and measured their behaviour problems and mental development at eighteen months. Some of the children had clefts which were repaired early (before 3-4 months), others had clefts which were repaired later and others were unaffected by the condition. The study found that early interaction difficulties between mothers and the children who had 'late' repair for their cleft lips and palates were associated with poor cognitive functioning at 18 months.

Murray, Lynne ... [et al] - The effect of cleft lip and palate, and the timing of lip repair on mother-infant interactions and infant development Journal of Child Psychology and Psychiatry February 2008, 49(2), 115-123

ADHD and trauma

Attention Deficit Hyperactivity Disorder (ADHD) affects between 5-10% of children and adolescents and it continues into adulthood in 30-70% of cases. It has long been suspected that ADHD is associated with an increased risk of accidents and a study of 88 hospital patients in Turkey would appear to back this up. The researchers found that 62.2% of the people admitted to hospital with trauma had ADHD symptoms while only 13.2% of a control group of patients admitted to hospital with other conditions had ADHD symptoms. The researchers then divided the patients with trauma into two separate groups, high-velocity trauma (car crashes and falling off high buildings) and low-velocity trauma (falls and sports injuries). Almost twice as many patients in the high-velocity trauma group had ADHD.

Kaya, A. ... [et al] - Trauma and adult attention deficit hyperactivity disorder The Journal of International Medical Research January/February 2008, 36(1), 9-16

Brief words, lasting effect for writing therapy

Writing therapy has been found to improve people's physical and mental health. A review of studies into its effectiveness has found that, although the benefits are modest in absolute terms they are still very impressive in terms of the short amount of time that writing therapy takes compared to other interventions. In the vast majority of research participants write for 15-20 minutes but this is a matter of convention rather than being based on any evidence and no studies have sought to identify the minimum dosage required to reap the benefits of writing. A U.S. study of 49 students looked into the benefits of a very short (2 minutes x 2 days) writing intervention in which participants were asked to write about something they had found traumatic, or a positive experience or a neutral subject. 4-6 weeks later the students who had written about a trauma or a positive experience reported fewer health complaints than those who had written about a neutral topic.

Burton, Chad M. and King, Laura A. - Effects of (very) brief writing on health: the two-minute miracle. British Journal of Health Psychology March 2008, 13(1), 9-14

Caring for people with eating disorders

It is well established that caring for someone with a mental health problem has negative effects on both the mental and physical health of the carer and previous research has found that the carers of people with eating disorders experience a high level of distress and burden in their caregiving role. A sample of 115 individuals currently caring for someone with an eating disorder found that approximately 36% of them showed mental-health difficulties with 17% experiencing high psychological distress. A negative experience of caregiving was associated with carers' distress. The dependency of the individual with the eating disorder and the stigma associated with the illness were most highly predictive of carers' distress. Looking after someone who had recently become ill, higher levels of needs and a higher perception of the seriousness of the consequences of eating disorders also contributed to greater negative caregiving appraisals. The belief that the illness was attributable to the sufferer's personality was associated with fewer positive appraisals of caregiving.

Whitney, Jenna ..l [et al] - Caring for people with eating disorders: factors associated with psychological distress and negative caregiving appraisals in carers of people with eating disorders British Journal of Clinical Psychology 2007 46(4), 413-428

Reasoning in OCD

Most research investigating reasoning in OCD has focused on decision making and the evaluation of probabilities and has concluded that people with OCD require more information and time before making a decision. Recent research has begun to focus on the differences between deductive reasoning - based on given assumptions and premises - and inductive reasoning in which additional information and prior knowledge is needed to reach a conclusion. Some researchers have argued that people with OCD have a distinctive inductive style of reasoning in which unpleasant outcomes are reasoned to be probable on the basis of irrelevant associations. A U.K. study of 48 people compared deductive and inductive reasoning in people with and without OCD. Deductive reasoning was tested using syllogisms (e.g. All Frenchmen like cheese, He does not like cheese, He is not a Frenchman) which the participants were asked to judge as valid or invalid while inductive reasoning was tested using a game of 20 questions. In the twenty questions game the participants with OCD asked fewer direct hypothesis questions, i.e. guessing at the right answer, than the other group although their performance was more or less the same in the deductive reasoning task. In both tasks the participants with OCD's responses were characterized by the need for more information, states of uncertainty, and doubt and postponement of a final decision.

Simpson, Jane ... [et al] - Reasoning in people with obsessive-compulsive disorder British Journal of Clinical Psychology 2007, 46, 397-411

Eating disorders and attachment

Attachment theory, is, put very simply, the idea that how we bond with our caregivers (particularly our mothers) in early childhood can have significant and long-standing effects on our relationships with others and our mental health later in life. A study of 92 Portuguese women between the ages of 15 and 30 and their parents and - where applicable - therapists looked into their attachment styles, their memories of their parents' child-rearing and (for those undergoing treatment) the bonds between clients and their therapists. The participants were made up of 30 people with anorexia, 27 with bulimia and a 35-strong control group. The researchers found that the control group had lower levels of attachment anxiety. Their mothers exhibited higher security than mothers of anorexic patients and lower avoidance than mothers of bulimic patients. For the anorexic group a good relationship with their therapist was associated with higher levels of emotional support and lower levels of rejection from fathers. For the bulimic group a good therapeutic relationship was associated with higher maternal emotional support and lower rejection and lower paternal overprotection.

Tereno, Susana ... [et al] - Attachment styles, memories of parental rearing and therapeutic bond: a study with eating disordered patients, their parents and therapists European Eating Disorders Review January-February 2008, 16(1), 49-58

Antipsychotics for schizophrenia in children and young people

Although the prevalence of childhood-onset schizophrenia is very low with only 1 in 100 people with schizophrenia developing the condition before the age of 13 the incidence of schizophrenia rises sharply between 12 and 14 and approximately 12-33% of individuals with the condition become ill before the age of 18. Early onset schizophrenia is usually more severe, can lead to significant, chronic, functional impairment and has a poor response to antipsychotic drugs. A review of studies into the effectiveness and side effects of antipsychotic medication in this young age group found that antipsychotic medication consistently reduced the severity of psychotic symptoms compared to a placebo. Clozapine was demonstrated to be superior to haloperidol and olanzapine. However, the studies showed that young people were more vulnerable to developing side effects than adults, in particular weight gain, and could be at greater risk of diabetes. The researchers say that there is an 'urgent need to develop therapeutic strategies to prevent and/or mitigate weight gain and diabetes early in the course of treatment in this population'

Kumra, Sanjiv ... [et al] - Efficacy and tolerability of second-generation antipsychotics in children and adolescents with schizophrenia Schizophrenia Bulletin January 2008, 34(1), 60-71

Schizophrenia : cognitive deficits in relatives

Cognitive deficits, such as problems with inhibition and memory, are a central feature of schizophrenia and also occur in first-degree relatives of schizophrenia patients even though they may be unaffected by the condition themselves. In people with schizophrenia the deficits remain constant over time but little research has been done into whether this is true of their relatives as well. A study of 25 children aged between 6 and 15 who all had at least one schizophrenic parent assessed their cognitive functioning at different intervals. The researchers found that the children's inhibition and working memory were borderline to mildly impaired and that these deficits remained over time suggesting that it would be a good idea to give patients' relatives, as well as the patients themselves, therapy aimed at improving these cognitive deficits.

Ross, Randal G. ... [et al] - The stability of inhibitory and working memory deficits in children and adolescents who are children of parents with schizophrenia Schizophrenia Bulletin January 2008, 34(1), 47-51

Childhood infections and schizophrenia

It has been suggested that infections during early life can play a role in the development of schizophrenia. Most studies have looked at the effects of maternal infections on the developing fetus and of the few that have looked at the effects of childhood infections the results have been inconclusive. A study of 1.2 million children born in Sweden between 1973 and 1985 found that 2,435 of them had been admitted to hospital with bacterial infections of the central nervous system while 6,550 had been admitted with viral infections. 2,269 of the children had been admitted to hospital for treatment with non-affective psychotic illnesses. The researchers found a slightly increased risk of psychosis and schizophrenia among the children who had suffered from viral infections. Exposure to mumps or cytomegalovirus were associated with subsequent psychoses. There was no evidence of increased risk in relation to bacterial infections.

Dalman, Christine ... [et al] - Infections in the CNS during childhood and the risk of subsequent psychotic illness: a cohort study of more than one million Swedish subjects American Journal of Psychiatry January 2008, 165(1), 59-65

Sibutramine for binge-eating disorder

Binge-eating disorder is characterized by recurrent episodes of binge eating accompanied by feelings of loss of control and marked distress. The prevalence of binge-eating disorder in the general population is 2-3% and it usually occurs in conjunction with obesity which can have serious health consequences. Relative to other obese people people with binge-eating disorder have higher rates of mental-health problems, more medical complaints and psychosocial impairment and poorer quality of life. Psychological treatments, including cognitive behaviour therapy and interpersonal psychotherapy, have proved effective at reducing binge-eating but do not always lead to much weight loss so research has also concentrated on pharmacological approaches to the problem. A U.S. trial of an anti-obesity drug called sibutramine compared its effectiveness to that of a placebo in a study of 304 binge eaters over a 24-week period. Those taking sibutramine had a significantly greater reduction in weekly binge frequency, a higher weight loss, less days of bingeing and a reduction in eating pathology. However, the drug was associated with a significantly higher incidence of headache, dry mouth, constipation, insomnia and dizziness.

Wilfley, Denise E. - Efficacy of sibutramine for the treatment of binge eating disorder: a randomized multicenter placebo-controlled double blind study American Journal of Psychiatry January 2008, 165(1), 51-58

Body image, eating and the media : eating snack and watching beanpoles

Most women suffer from anxiety about their physical appearance, especially their weight. Even normal weight women express a desire to lose weight ; something that has been found in girls as young as nine. This can lead, in some cases, to women opting for plastic surgery (which has increased by 165% since 1992) or developing eating disorders, which can, in extreme cases, lead to death. It is often claimed that depictions of unrealistically thin women in the media contribute to this process and a Canadian study looked at the links between 'thin' images and eating behaviour. In four different mini studies young women between the ages of 18 and 21 were shown video clips which they were asked to memorize for a test later. They were then told that in their break they would be participating in a taste test of different foods before the memory test. The women were encouraged to eat as much as they liked and after a while were told the true nature of the experiment - which was to see how much food they ate after watching the video clips - by the researchers. The first study compared women watching neutral commercials with those watching thin models and found that those watching the thin models ate less. The second study included images of successful, heavier women among the thin ones and this group ate more. A third group were told before the 'thin' adverts were shown that a majority of their peers thought that the women in them were too skinny and this group ate more too. A fourth group were shown the commercials then given a psychological test designed to measure how much they associated heaviness with rejection ; the stronger the women's association between heaviness and rejection the less they ate.

Strahan, Erin J., Spencer, Steven J. and Zanna, Mark P. - Don't take another bite: how sociocultural norms for appearance affect women's eating behavior Body Image December 2007, 4(4), 331-342

Bipolar disorder, anxiety and drug use

People with bipolar disorder (BD) have higher rates of substance-abuse disorder (SUD) and anxiety than the rest of the population but it is unclear how substance problems and anxiety interact in people with bipolar disorder and how having SUD and/or anxiety problems affect people's bipolar disorder. A Canadian study of 1,411 people with bipolar disorder attempted to find some answers to these questions. The study found that among women the lifetime prevalence of SUDs was significantly greater among those with anxiety disorders but that the same link was not found in men. Anxiety disorders were significantly associated with mixed episodes, prolonged depressive episodes, 12-month prevalence of depression, BD-related health-service utilization and poorer current mental health functioning. SUDs were significantly associated with mixed episodes among females, 12-months prevalence of depression among males and with trouble with the law in both genders.

Goldstein, Benjamin E. and Levitt, Anthony J. - The specific burden of comorbid anxiety disorders and of substance use disorders in Bipolar I disorder Bipolar Disorders February 2008, 10(1), 67-78

Bipolar disorder and psychosis in children

Bipolar disorder in adults can often be accompanied by delusions and/or hallucinations (psychoses) but there has been little research into the prevalence of psychoses in children with bipolar disorder. A study of 257 children with bipolar disorder in the U.S. found that 76.3% of them had some form of psychosis. 38.9% of them had delusions, 5.1% had pathological hallucinations and 32.3% had both. The most common delusions were grandiose and the most common pathological hallucinations were visual. Benign hallucinations occured in 43.6%. Psychosis was equally prevalent in 6-9, compared to 10-16 year olds.

Tillman, Rebecca ... [et al] - Psychotic phenomena in 257 young children and adolescents with bipolar I disorder : delusions and hallucinations (benign and pathological) Bipolar Disorders February 2008, 10(1), 45-55

Lead and ADHD

Attention deficity hyperactivity disorder (ADHD) occurs in 3-7% of children, causing impairment due to extreme hyperactivity, impulsivity and/or inattention. The syndrome frequently co-occurs with other disruptive behaviours, particularly conduct and oppositional defiant disorders. Earlier studies have associated levels of lead in children's bloodstreams with ADHD but these were at levels much higher than are found today. A U.S. study of 115 children between the ages of 8 and 17 found that, even at relatively low concentrations, blood lead was associated with problems with hyperactivity and impulsivity and a lower IQ although not with inattention or disorganisation.

Nigg, Janet T. ... [et al] - Low blood levels associated with clinically diagnosed attention-deficity hyperactivity disorder and mediated by weak cognitive control. Biological Psychiatry February 2008, 63(3), 325-331

Schizophrenia : interventions to reduce emergencies

People with schizophrenia or psychosis have relatively high rates of emergency psychiatric and non-psychiatric medical service use and suicide and people with schizophrenia average more than twice the number of visits to general practitioners as those without a mental disorder. Approximately 28% of 'high users' of acute psychiatric inpatient services carry a schizophrenia diagnosis. Almost half of all patients with schizophrenia are admitted to an inpatient facility in any given 12-month period and the use of emergency medical services among those with schizophrenia exceeds that of other mental illnesses. One means of preventing excessive service use is to provide psychosocial interventions that teach skills necessary to manage life tasks. One such intervention is a behavioural skills training programme known as Functional Adaptation and Skills Training (FAST) aimed at improving functional skills in middle-aged and older patients with schizophrenia. By promoting everyday living skills patients are expected to have reduced need for emergency medical services thereby minimizing the burden on healthcare systems. A U.S. study of 240 older people with schizophrenia compared it to group sessions where people openly discussed problems that were important to them and other group members offered suggestions and support in managing these issues. Counsellors facilitated discussion but did not offer suggestions on managing problems, except in the case of a crisis. Those in the FAST group had half the likelihood of using emergency services in general and emergency psychiatric services in particular during the course of the interventions which lasted 24 weeks. However, there was little difference between the two groups after 6-18 months suggesting that there was a need for 'maintenance' sessions to encourage the continued use of skills in patients' everyday lives.

Mausbach, Brent T. ... [et al] - Reducing emergency medical service use in patients with chronic psychotic disorders: results from the FAST intervention study Behaviour Research and Therapy January 2008, 46(1), 145-153

Threat interpretation bias, and anxiety

The tendency to selectively process events as threatening is a central feature of cognitive models of anxiety. A number of studies with adults demonstrate an association between threat interpretation biases and panic disorder, social phobia and generalized anxiety disorder. Although investigations of cognitive factors in childhood anxiety disorders have lagged behind research with adults research has shown similar threat interpretation biases in relation to childhood anxiety disorders. A U.S. study of 45 7-12 year-olds presented them with three ambiguous situations and asked them how they would think, feel about and respond to them. 15 of the children suffered from anxiety disorders, 16 weren't anxious but were considered at risk because they had anxious parents and 14 were non-anxious with non-anxious parents. Compared to the other children the anxious children reported stronger negative emotions in response to the situations and felt that they had less ability to influence them. Children with anxious and non-anxious parents had similar results on the tests.

Waters, Allison M. ... [et al] - Threat interpretation bias as a vulnerability factor in childhood anxiety disorders Behaviour Research and Therapy January 2008, 46(1), 39-47

Maternal stress and asthma

An eight-year study of nearly 14,000 children in Manitoba, Canada has found that those whose mothers were chronically stressed during their early years had a higher asthma rate than their peers regardless of their income, gender or other known risk factors. The researchers determined whether the children had current asthma at age seven by analyzing records of doctor visits, hospitalizations and medicines in the year of the child's seventh birthday and related it to maternal distress as defined by visits to the doctor, hospitalizations and medication for depression and anxiety. Even after controlling for the known risk factors of male gender, maternal asthma and urban location long-term maternal stress was still associated with an increase of nearly a third in the prevalence of childhood asthma.

You can read more about this research at

http://psychcentral.com/news/2008/01/16/mothers-stress-linked-to-childs-asthma/1791.html

Statins and Alzheimer's disease

Some studies have shown that people taking cholesterol-lowering drugs called statins are less likely to go on to develop Alzheimer's disease. However, a long-term study of 929 Catholic priests who had an average age of 75 at the start of the study has found that statins have no effect on the development of Alzheimer's disease. The priests took annual cognitive tests and all agreed to a brain autopsy after their deaths. The study found no association between taking statins and a reduced risk of developing Alzheimer's or a slower cognitive decline and the brain autopsies found that the brains of those who had taken statins were no different to those of other people.

You can find out more about this study at

http://psychcentral.com/news/2008/01/17/mixed-finding-on-cholesterol-drugs-and-alzheimers/1797.html