On This Day … 22 October

Events

  • Fechner Day (International observance).

People (Deaths)

  • 1979 – Mieko Kamiya, Japanese psychiatrist and author (b. 1914).

Fechner Day

Gustav Theodor Fechner (19 April 1801 to 18 November 1887) was a German experimental psychologist, philosopher, and physicist.

An early pioneer in experimental psychology and founder of psychophysics, he inspired many 20th-century scientists and philosophers.

Psychophysics quantitatively investigates the relationship between physical stimuli and the sensations and perceptions they produce.

He is also credited with demonstrating the non-linear relationship between psychological sensation and the physical intensity of a stimulus via the formula: S = K 1n I, which became known as the Weber–Fechner law.

Honours

  • Fechner Crater:
    • In 1970, the International Astronomical Union named a crater on the far side of the moon after Fechner.
  • Fechner Day:
    • In 1985 the International Society for Psychophysics called its annual conference Fechner Day.
    • The conference is now scheduled to include 22 October to allow psychophysicists to celebrate the anniversary of Fechner’s waking up on that day in 1850 with a new approach into how to study the mind.
    • Fechner Day runs annually with the 2018 Fechner Day being the 34th.
    • It is organised annually, by a different academic host each year.

Mieko Kamiya

Mieko Kamiya (神谷 美恵子, Kamiya Mieko, 12 January 1914 to 22 October 1979) was a Japanese psychiatrist who treated leprosy patients at Nagashima Aiseien Sanatorium.

She was known for translating books on philosophy.

She worked as a medical doctor in the Department of Psychiatry at Tokyo University following World War II. She was said to have greatly helped the Ministry of Education and the General Headquarters, where the Supreme Commander of the Allied Powers stayed, in her role as an English-speaking secretary, and served as an adviser to Empress Michiko.

She wrote many books as a highly educated, multi-lingual person; one of her books, titled On the Meaning of Life (Ikigai Ni Tsuite in Japanese), based on her experiences with leprosy patients, attracted many readers.

Can Conditional Cash Transfers Improve Mental Health?

Research Paper Title

The worse the better? Quantile treatment effects of a conditional cash transfer programme on mental health.

Background

Poor mental health is a pressing global health problem, with high prevalence among poor populations from low-income countries.

Existing studies of conditional cash transfer (CCT) effects on mental health have found positive effects. However, there is a gap in the literature on population-wide effects of cash transfers on mental health and if and how these vary by the severity of mental illness.

Methods

The researchers use the Malawian Longitudinal Study of Family and Health containing 790 adult participants in the Malawi Incentive Programme, a year-long randomised controlled trial.

They estimate average and distributional quantile treatment effects and we examine how these effects vary by gender, HIV status and usage of the cash transfer.

Results

The researchers find that the cash transfer improves mental health on average by 0.1 of a standard deviation.

The effect varies strongly along the mental health distribution, with a positive effect for individuals with worst mental health of about four times the size of the average effect.

These improvements in mental health are associated with increases in consumption expenditures and expenditures related to economic productivity.

Conclusions

The results show that CCTs can improve adult mental health for the poor living in low-income countries, particularly those with the worst mental health.

Reference

Ohrnberger, J., Fichera, E., Sutton, M. & Anselmi, L. (2020) The worse the better? Quantile treatment effects of a conditional cash transfer programme on mental health. Health Policy and Planning. doi: 10.1093/heapol/czaa079. Online ahead of print.

On This Day … 21 October

People (Deaths)

  • 1980 – Hans Asperger, Austrian physician and psychologist (b. 1906).

Hans Asperger

Johann ‘Hans’ Friedrich Karl Asperger (18 February 1906 to 21 October 1980) was an Austrian paediatrician, eugenicist, medical theorist, and medical professor for whom Asperger syndrome is named.

He is best known for his early studies on mental disorders, specifically in children. His work was largely unnoticed during his lifetime except for a few accolades in Vienna, and his studies on psychological disorders acquired world renown only posthumously. He wrote over 300 publications, mostly concerning a condition he termed autistic psychopathy (AP).

There was a resurgence of interest in his work beginning in the 1980s, and due to his earlier work on autism spectrum disorders, Asperger syndrome (AS), was named after him. Both Asperger’s original paediatric diagnosis of AP and the eponymous diagnosis of AS that was named after him several decades later have been controversial.

The controversy has intensified since revelations that, during the Nazi years, Asperger sent at least two disabled children to the Am Spiegelgrund clinic, knowing they would be the subject of cruel experiments and be likely to be euthanised under the Nazi programme named, post-bellum, ‘Aktion T4’.

What is the Evidence for Psychological Interventions for Antisocial Personality Disorder?

Research Paper Title

Psychological interventions for antisocial personality disorder.

Background

Antisocial personality disorder (AsPD) is associated with poor mental health, criminality, substance use and relationship difficulties.

This review updates Gibbon 2010 (previous version of the review).

To evaluate the potential benefits and adverse effects of psychological interventions for adults with AsPD.

Methods

The researchers searched CENTRAL, MEDLINE, Embase, 13 other databases and two trials registers up to 5 September 2019. They also searched reference lists and contacted study authors to identify studies.

Randomised controlled trials of adults, where participants with an AsPD or dissocial personality disorder diagnosis comprised at least 75% of the sample randomly allocated to receive a psychological intervention, treatment-as-usual (TAU), waiting list or no treatment.

The primary outcomes were aggression, reconviction, global state/functioning, social functioning and adverse events.

The researchers used standard methodological procedures expected by Cochrane.

Results

  • This review includes 19 studies (eight new to this update), comparing a psychological intervention against TAU (also called ‘standard Maintenance'(SM) in some studies).
  • Eight of the 18 psychological interventions reported data on the primary outcomes.
  • Four studies focussed exclusively on participants with AsPD, and 15 on subgroups of participants with AsPD.
  • Data were available from only 10 studies involving 605 participants.
  • Eight studies were conducted in the UK and North America, and one each in Iran, Denmark and the Netherlands.
  • Study duration ranged from 4 to 156 weeks (median = 26 weeks).
  • Most participants (75%) were male; the mean age was 35.5 years.
  • Eleven studies (58%) were funded by research councils.
  • Risk of bias was high for 13% of criteria, unclear for 54% and low for 33%.
  • Cognitive behaviour therapy (CBT) + TAU versus TAU One study (52 participants) found no evidence of a difference between CBT + TAU and TAU for physical aggression (odds ratio (OR) 0.92, 95% CI 0.28 to 3.07; low-certainty evidence) for outpatients at 12 months post-intervention.
  • One study (39 participants) found no evidence of a difference between CBT + TAU and TAU for social functioning (mean difference (MD) -1.60 points, 95% CI -5.21 to 2.01; very low-certainty evidence), measured by the Social Functioning Questionnaire (SFQ; range = 0-24), for outpatients at 12 months post-intervention.
  • Impulsive lifestyle counselling (ILC) + TAU versus TAU One study (118 participants) found no evidence of a difference between ILC + TAU and TAU for trait aggression (assessed with Buss-Perry Aggression Questionnaire-Short Form) for outpatients at nine months (MD 0.07, CI -0.35 to 0.49; very low-certainty evidence).
  • One study (142 participants) found no evidence of a difference between ILC + TAU and TAU alone for the adverse event of death (OR 0.40, 95% CI 0.04 to 4.54; very low-certainty evidence) or incarceration (OR 0.70, 95% CI 0.27 to 1.86; very low-certainty evidence) for outpatients between three and nine months follow-up.
  • Contingency management (CM) + SM versus SM One study (83 participants) found evidence that, compared to SM alone, CM + SM may improve social functioning measured by family/social scores on the Addiction Severity Index (ASI; range = 0 (no problems) to 1 (severe problems); MD -0.08, 95% CI -0.14 to -0.02; low-certainty evidence) for outpatients at six months. ‘Driving whilst intoxicated’ programme (DWI) + incarceration versus incarceration.
  • One study (52 participants) found no evidence of a difference between DWI + incarceration and incarceration alone on reconviction rates (hazard ratio 0.56, CI -0.19 to 1.31; very low-certainty evidence) for prisoner participants at 24 months.
  • Schema therapy (ST) versus TAU One study (30 participants in a secure psychiatric hospital, 87% had AsPD diagnosis) found no evidence of a difference between ST and TAU for the number of participants who were reconvicted (OR 2.81, 95% CI 0.11 to 74.56, P = 0.54) at three years.
  • The same study found that ST may be more likely to improve social functioning (assessed by the mean number of days until patients gain unsupervised leave (MD -137.33, 95% CI -271.31 to -3.35) compared to TAU, and no evidence of a difference between the groups for overall adverse events, classified as the number of people experiencing a global negative outcome over a three-year period (OR 0.42, 95% CI 0.08 to 2.19).
  • The certainty of the evidence for all outcomes was very low.
  • Social problem-solving (SPS) + psychoeducation (PE) versus TAU One study (17 participants) found no evidence of a difference between SPS + PE and TAU for participants’ level of social functioning (MD -1.60 points, 95% CI -5.43 to 2.23; very low-certainty evidence) assessed with the SFQ at six months post-intervention.
  • Dialectical behaviour therapy versus TAU One study (skewed data, 14 participants) provided very low-certainty, narrative evidence that DBT may reduce the number of self-harm days for outpatients at two months post-intervention compared to TAU.
  • Psychosocial risk management (PSRM; ‘Resettle’) versus TAU One study (skewed data, 35 participants) found no evidence of a difference between PSRM and TAU for a number of officially recorded offences at one year after release from prison.
  • It also found no evidence of difference between the PSRM and TAU for the adverse event of death during the study period (OR 0.89, 95% CI 0.05 to 14.83, P = 0.94, 72 participants (90% had AsPD), 1 study, very low-certainty evidence).

Conclusions

There is very limited evidence available on psychological interventions for adults with AsPD.

Few interventions addressed the primary outcomes of this review and, of the eight that did, only three (CM + SM, ST and DBT) showed evidence that the intervention may be more effective than the control condition.

No intervention reported compelling evidence of change in antisocial behaviour.

Overall, the certainty of the evidence was low or very low, meaning that the researchers have little confidence in the effect estimates reported.

The conclusions of this update have not changed from those of the original review, despite the addition of eight new studies.

This highlights the ongoing need for further methodologically rigorous studies to yield further data to guide the development and application of psychological interventions for AsPD and may suggest that a new approach is required.

Reference

Gibbon, S., Khalifa, N.R., Cheung, N.H-Y., Vollm, B.A. & McCarthy, L. (2020) Psychological interventions for antisocial personality disorder. The Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD007668.pub3.

On This Day … 18 October

People (Births)

  • 1941 – Martha Burk, American psychologist and author.

People (Deaths)

  • 1911 – Alfred Binet, French psychologist and author (b. 1857).

Martha Burk

Martha Gertrude Burk (born 18 October 1941) is an American political psychologist, feminist, and former Chair of the National Council of Women’s Organisations.

Alfred Binet

Alfred Binet (08 July 1857 to 18 October 1911), born Alfredo Binetti, was a French psychologist who invented the first practical IQ test, the Binet–Simon test.

In 1904, the French Ministry of Education asked psychologist Alfred Binet to devise a method that would determine which students did not learn effectively from regular classroom instruction so they could be given remedial work.

Along with his collaborator Théodore Simon, Binet published revisions of his test in 1908 and 1911, the last of which appeared just before his death.

On This Day … 16 October

People (Births)

  • 1888 – Paul Popenoe, American founder of relationship counselling (d. 1979).

People (Deaths)

  • 2015 – James W. Fowler, American psychologist and academic (b. 1940).

Paul Popenoe

Paul Bowman Popenoe (16 October 1888 to 19 June 1979) was an American agricultural explorer and eugenicist.

He was an influential advocate of the compulsory sterilisation of the mentally ill and the mentally disabled, and the father of relationship counselling in the US.

What is Relationship Counselling?

Couples therapy (also known couples’ counselling, marriage counselling, or marriage therapy) attempts to improve romantic relationships and resolve interpersonal conflicts.

Marriage counselling originated in Germany in the 1920s as part of the eugenics movement. The first institutes for marriage counselling in the United States began in the 1930s, partly in response to Germany’s medically directed, racial purification marriage counselling centres. It was promoted by prominent American eugenicists such as Paul Popenoe, who directed the American Institute of Family Relations until 1976, and Robert Latou Dickinson and by birth control advocates such as Abraham and Hannah Stone who wrote A Marriage Manual in 1935 and were involved with Planned Parenthood. Other founders in the United States include Lena Levine and Margaret Sanger.

It wasn’t until the 1950s that therapists began treating psychological problems in the context of the family. Relationship counselling as a discrete, professional service is thus a recent phenomenon. Until the late 20th century, the work of relationship counselling was informally fulfilled by close friends, family members, or local religious leaders. Psychiatrists, psychologists, counsellors and social workers have historically dealt primarily with individual psychological problems in a medical and psychoanalytic framework. In many less technologically advanced cultures around the world today, the institution of family, the village or group elders fulfil the work of relationship counselling. Today marriage mentoring mirrors those cultures.

With increasing modernisation or westernisation in many parts of the world and the continuous shift towards isolated nuclear families, the trend is towards trained and accredited relationship counsellors or couple therapists. Sometimes volunteers are trained by either the government or social service institutions to help those who are in need of family or marital counselling. Many communities and government departments have their own team of trained voluntary and professional relationship counsellors. Similar services are operated by many universities and colleges, sometimes staffed by volunteers from among the student peer group. Some large companies maintain a full-time professional counselling staff to facilitate smoother interactions between corporate employees, to minimize the negative effects that personal difficulties might have on work performance.

Increasingly there is a trend toward professional certification and government registration of these services. This is in part due to the presence of duty of care issues and the consequences of the counsellor or therapist’s services being provided in a fiduciary relationship.

James W. Fowler

James William Fowler III (1940–2015) was an American theologian who was Professor of Theology and Human Development at Emory University. He was director of both the Centre for Research on Faith and Moral Development and the Centre for Ethics until he retired in 2005. He was a minister in the United Methodist Church.

Life and Career

Fowler was born in Reidsville, North Carolina, on 12 October 1940, the son of a Methodist minister. In 1977, Fowler was appointed Associate Professor of Theology and Human Development at the Candler School of Theology at Emory University. He was later named Charles Howard Candler Professor of Theology and Human Development. He died on 16 October 2015.

He published Stages of Faith: The Psychology of Human Development and the Quest for Meaning in 1981.

Stages of Faith

He is best known for his book Stages of Faith, published in 1981, in which he sought to develop the idea of a developmental process in “human faith”.

These stages of faith development were along the lines of Jean Piaget’s theory of cognitive development and Lawrence Kohlberg’s stages of moral development.

  • Stage 0:
    • “Primal or Undifferentiated” faith (birth to 2 years), is characterised by an early learning of the safety of their environment (i.e. warm, safe and secure vs. hurt, neglect and abuse).
    • If consistent nurture is experienced, one will develop a sense of trust and safety about the universe and the divine.
    • Conversely, negative experiences will cause one to develop distrust with the universe and the divine.
    • Transition to the next stage begins with integration of thought and language which facilitates the use of symbols in speech and play.
  • Stage 1:
    • “Intuitive-Projective” faith (ages of three to seven), is characterized by the psyche’s unprotected exposure to the Unconscious, and marked by a relative fluidity of thought patterns.
    • Religion is learned mainly through experiences, stories, images, and the people that one comes in contact with.
  • Stage 2:
    • “Mythic-Literal” faith (mostly in school children), stage two persons have a strong belief in the justice and reciprocity of the universe, and their deities are almost always anthropomorphic.
    • During this time metaphors and symbolic language are often misunderstood and are taken literally.
  • Stage 3:
    • “Synthetic-Conventional” faith (arising in adolescence; aged 12 to adulthood) characterized by conformity to authority and the religious development of a personal identity.
    • Any conflicts with one’s beliefs are ignored at this stage due to the fear of threat from inconsistencies.
  • Stage 4:
    • “Individuative-Reflective” faith (usually mid-twenties to late thirties) a stage of angst and struggle.
    • The individual takes personal responsibility for his or her beliefs and feelings.
    • As one is able to reflect on one’s own beliefs, there is an openness to a new complexity of faith, but this also increases the awareness of conflicts in one’s belief.
  • Stage 5:
    • “Conjunctive” faith (mid-life crisis) acknowledges paradox and transcendence relating reality behind the symbols of inherited systems.
    • The individual resolves conflicts from previous stages by a complex understanding of a multidimensional, interdependent “truth” that cannot be explained by any particular statement.
  • Stage 6:
    • “Universalising” faith, or what some might call “enlightenment”.
    • The individual would treat any person with compassion as he or she views people as from a universal community, and should be treated with universal principles of love and justice.

Empirical Research

Fowler’s model has inspired a considerable body of empirical research into faith development, although little of such research was ever conducted by Fowler himself. A useful tool here has been Gary Leak’s Faith Development Scale, or FDS, which has been subject to factor analysis by Leak.

Psychological Trauma: Metaphor and Psychiatrists Beliefs

Research Paper Title

A frog in boiling water? A qualitative analysis of psychiatrists’ use of metaphor in relation to psychological trauma.

Background

Tensions about the definition, diagnostics, and role of psychological trauma in psychiatry are long-standing. This study sought to explore what metaphor patterns in qualitative interviews may reveal about the beliefs of psychiatrists in relation to trauma.

Methods

A qualitative inquiry using systematic metaphor analysis of 13 in-depth interviews with Australian psychiatrists.

Results

Three themes were identified: a power struggle between people, trauma, and psychiatry; trauma is not a medical condition; and serving the profession to protect society.

Conclusions

Metaphors present trauma as a powerful force that people can manage in different ways. Psychiatrists may view trauma as a social rather than medical issue. Psychiatrists experience role pressure associated with trauma including incongruence with risk management expectations of their roles.

Reference

Isobel, S., McCloughen, A. & Foster, K. (2020) A frog in boiling water? A qualitative analysis of psychiatrists’ use of metaphor in relation to psychological trauma. Australasian Psychiatry. doi: 10.1177/1039856220946596. Online ahead of print.

What are the Risk factors of Hospitalisation for any Medical Condition among Patients with Prior Emergency Department Visits for Mental Health Conditions?

Research Paper Title

Risk factors of hospitalization for any medical condition among patients with prior emergency department visits for mental health conditions.

Background

This longitudinal study identified risk factors for frequency of hospitalisation among patients with any medical condition who had previously visited one of six Quebec (Canada) emergency departments (ED) at least once for mental health (MH) conditions as the primary diagnosis.

Methods

Records of n = 11,367 patients were investigated using administrative databanks (2012-13/2014-15). Hospitalisation rates in the 12 months after a first ED visit in 2014-15 were categorised as no hospitalisations (0 times), moderate hospitalisations (1-2 times), and frequent hospitalisations (3+ times). Based on the Andersen Behavioural Model, data on risk factors were gathered for the 2 years prior to the first visit in 2014-2015, and were identified as predisposing, enabling or needs factors. They were tested using a hierarchical multinomial logistic regression according to the three groups of hospitalisation rate.

Results

Enabling factors accounted for the largest percentage of total variance explained in the study model, followed by needs and predisposing factors. Co-occurring mental disorders (MD)/substance-related disorders (SRD), alcohol-related disorders, depressive disorders, frequency of consultations with outpatient psychiatrists, prior ED visits for any medical condition and number of physicians consulted in specialized care, were risk factors for both moderate and frequent hospitalisations. Schizophrenia spectrum and other psychotic disorders, bipolar disorders, and age (except 12-17 years) were risk factors for moderate hospitalisations, while higher numbers (4+) of overall interventions in local community health service centres were a risk factor for frequent hospitalisations only. Patients with personality disorders, drug-related disorders, suicidal behaviours, and those who visited a psychiatric ED integrated with a general ED in a separate site, or who visited a general ED without psychiatric services were also less likely to be hospitalised. Less urgent and non-urgent illness acuity prevented moderate hospitalisations only.

Conclusions

Patients with severe and complex health conditions, and higher numbers of both prior outpatient psychiatrist consultations and ED visits for medical conditions had more moderate and frequent hospitalisations as compared with non-hospitalised patients. Patients at risk for frequent hospitalisations were more vulnerable overall and had important biopsychosocial problems. Improved primary care and integrated outpatient services may prevent post-ED hospitalisation.

Reference

Penzenstadler, L., Gentil, L., Grenier, G., Khazaal, Y. & Fleury, M-J. (2020) Risk factors of hospitalization for any medical condition among patients with prior emergency department visits for mental health conditions. BMC Psychiatry. 20(1), pp.431. doi: 10.1186/s12888-020-02835-2.

On This Day … 14 October

People (Births)

  • 1936 – Jürg Schubiger, Swiss psychotherapist and author (d. 2014).

Jürg Schubiger

Jürg Schubiger (14 October 1936 to 15 September 2014) was a Swiss psychotherapist and writer of children’s books.

Schubiger was born in Zürich and raised in Winterthur, Switzerland. He graduated from the University of Zürich in German Studies, Psychology and Philosophy. He wrote his PhD thesis on Franz Kafka.

He won the Deutscher Jugendliteraturpreis (German Youth Literature Award) in 1996 for Als die Welt noch jung war. For his ‘lasting contribution’ as a children’s writer Schubiger received the biennial Hans Christian Andersen Medal in 2008. The award conferred by the International Board on Books for Young People is the highest recognition available to a writer or illustrator of children’s books.

Schubiger died in 2014, aged 77, four weeks and one day before his 78th birthday.

Online CBT Using a Waitlist Method

Research Paper Title

Online cognitive-behavioural therapy for traumatically bereaved people: study protocol for a randomised waitlist-controlled trial.

Background

The traumatic death of a loved one, such as death due to a traffic accident, can precipitate persistent complex bereavement disorder (PCBD) and comorbid post-traumatic stress disorder (PTSD) and depression. Waitlist-controlled trials have shown that grief-specific cognitive-behavioural therapy (CBT) is an effective treatment for such mental health problems. This is the first study that will examine the effectiveness of online CBT (vs waitlist controls) in a sample exclusively comprised of people bereaved by a traumatic death.

The primary hypothesis is that people allocated to the online CBT condition will show larger reductions in PCBD, PTSD and depression symptom levels at post-treatment than people allocated to a waitlist. We further expect that reductions in symptom levels during treatment are associated with reductions of negative cognitions and avoidance behaviours and the experience of fewer accident-related stressors. Moreover, the effect of the quality of the therapeutic alliance on treatment effects and drop-out rates will be explored.

Methods

A two-arm (online CBT vs waiting list) open-label parallel randomised controlled trial will be conducted. Participants will complete questionnaires at pre-treatment and 12 and 20 weeks after study enrolment. Eligible for participation are Dutch adults who lost a loved one at least 1 year earlier due to a traffic accident and report clinically relevant levels of PCBD, PTSD and/or depression. Multilevel modelling will be used.

Discussion

This study will provide new insights in the effectiveness of online CBT for traumatically bereaved people. If the treatment is demonstrated to be effective, it will be made publicly accessible. Findings will be disseminated among:

  • Lay people (e.g. through newsletters and media performances);
  • Research collaborators (e.g. through presentations at support organisations); and
  • Clinicians and researchers (e.g. through conference presentations and scientific journal articles).

Reference

Lenferink, L., de Keijser, J., Eisma, M., Smid, G. & Boelen, P. (2020) Online cognitive-behavioural therapy for traumatically bereaved people: study protocol for a randomised waitlist-controlled trial. BMJ Open. 10(9), pp.e035050. doi: 10.1136/bmjopen-2019-035050.