Cognitive Behavioural Therapy (CBT) is the treatment of choice for most mental health problems. Each different problem is usually treated by a different model of CBT. Yet evidence tells us that the ...same processes are responsible for long term distress in us all. This handy manual draws on evidence and theory to provide the key principles to aid change and recovery.
The transdiagnostic approach is supported by a wealth of evidence that processes such as worry, emotion suppression, self-criticism and avoidance maintain distress across psychological disorders. Perceptual Control Theory (PCT) explains all of these processes as forms of 'inflexible control', and Method of Levels Therapy (MOL) helps people to let go of these habits. The principles and techniques of MOL are clearly and practically described for clinicians to offer a transdiagnostic CBT that is tailor-made to the goals of each client.
This novel volume will be essential reading for novice and experienced CBT therapists, as well as counsellors and psychotherapists. Its accessible explanation of Perceptual Control Theory and its application to real world problems also makes a useful resource for undergraduates, graduates and researchers in psychology.
Cognitive Behavioural Therapy (CBT) is the treatment of choice for most mental health problems. Each different problem is usually treated by a different model of CBT. Yet evidence tells us that the ...same processes are responsible for long term distress in us all. This handy manual draws on evidence and theory to provide the key principles to aid change and recovery.
The transdiagnostic approach is supported by a wealth of evidence that processes such as worry, emotion suppression, self-criticism and avoidance maintain distress across psychological disorders. Perceptual Control Theory (PCT) explains all of these processes as forms of 'inflexible control', and Method of Levels Therapy (MOL) helps people to let go of these habits. The principles and techniques of MOL are clearly and practically described for clinicians to offer a transdiagnostic CBT that is tailor-made to the goals of each client.
This novel volume will be essential reading for novice and experienced CBT therapists, as well as counsellors and psychotherapists. Its accessible explanation of Perceptual Control Theory and its application to real world problems also makes a useful resource for undergraduates, graduates and researchers in psychology.
The use of conversational agent interventions (including chatbots and robots) in mental health is growing at a fast pace. Recent existing reviews have focused exclusively on a subset of embodied ...conversational agent interventions despite other modalities aiming to achieve the common goal of improved mental health.
This study aimed to review the use of conversational agent interventions in the treatment of mental health problems.
We performed a systematic search using relevant databases (MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane library). Studies that reported on an autonomous conversational agent that simulated conversation and reported on a mental health outcome were included.
A total of 13 studies were included in the review. Among them, 4 full-scale randomized controlled trials (RCTs) were included. The rest were feasibility, pilot RCTs and quasi-experimental studies. Interventions were diverse in design and targeted a range of mental health problems using a wide variety of therapeutic orientations. All included studies reported reductions in psychological distress postintervention. Furthermore, 5 controlled studies demonstrated significant reductions in psychological distress compared with inactive control groups. In addition, 3 controlled studies comparing interventions with active control groups failed to demonstrate superior effects. Broader utility in promoting well-being in nonclinical populations was unclear.
The efficacy and acceptability of conversational agent interventions for mental health problems are promising. However, a more robust experimental design is required to demonstrate efficacy and efficiency. A focus on streamlining interventions, demonstrating equivalence to other treatment modalities, and elucidating mechanisms of action has the potential to increase acceptance by users and clinicians and maximize reach.
In this study, we aim to increase our understanding of the self-reported sources of distress among people who have experienced first-episode psychosis. Following a systematic literature search, 33 ...relevant studies containing first-person accounts of first-episode psychosis were identified, which were synthesized using thematic analysis. Two interrelated superordinate themes were identified: intrapersonal distress and interpersonal distress. Participants reported multiple, diverse, and multifaceted sources of distress across both themes. These were substantially different from those routinely recognized and targeted in clinical practice. This review suggests that practitioners who maintain a stance of genuine curiosity about the potential sources of distress for this population will be perceived as more helpful. The findings also highlight the importance of being service user–led when planning and delivering mental health care. Additional clinical and research implications are discussed.
This paper aims to identify potential areas for refinement in existing theoretical models of suicide, and introduce a new integrative theoretical framework for understanding suicide, that could ...inform such refinements.
Literature on existing theoretical models of suicide and how they contribute to understanding psychological processes involved in suicide was evaluated in a narrative review. This involved identifying psychological processes associated with suicide. Current understanding of these processes is discussed, and suggestions for integration of the existing literature are offered.
Existing approaches to understanding suicide have advanced the current knowledge of suicide in various ways. They have guided valuable research in the following areas: motivations for suicide and the psychological distress which influences suicide attempts; ambivalence about suicide; suicidal individuals' focus of attention; and ways in which individuals who contemplate suicide differ from individuals who attempt suicide. We outline a new theoretical framework as a means to integrating all of these concepts into the three principles of control, conflict, and awareness. Within this framework, suicide is regarded as occurring due to a long standing conflict between an individual's personal goals, culminating in an episode of acute loss of control. The new framework posits that the individual then strives to regain control through the means of suicide because of a narrowed awareness of consequences of their actions on other valued goals. This psychological mechanism of limited awareness is posited to be the common pathway by which individuals make a suicide attempt, regardless of which risk factors are present.
This article introduces a theoretical framework that generates several hypotheses for future research, and focuses on psychological processes occurring during immediate crisis. One of the key hypotheses resulting from our predictions on how individuals progress from contemplating to attempting suicide will be tested in an ongoing program of research: Individuals who attempt suicide have a significantly reduced awareness of consequences of suicide, which would negatively impact on their important life goals, values, principles, or ideals, compared to individuals who contemplate suicide. Therapy guided by the new framework may be more flexible, immediate, and client-focused than other therapies for suicidal individuals.
Although the biopsychosocial model has been a popular topic of discussion for over four decades it has not had the traction in fields of research that might be expected of such an intuitively ...appealing idea. One reason for this might be the absence of an identified mechanism or a functional architecture that is authentically biopsychosocial. What is needed is a robust mechanism that is equally important to biochemical processes as it is to psychological and social processes. Negative feedback may be the mechanism that is required. Negative feedback has been implicated in the regulation of neurotransmitters as well as important psychological and social processes such as emotional regulation and the relationship between a psychotherapist and a client. Moreover, negative feedback is purported to also govern the activity of all other organisms as well as humans. Perceptual Control Theory (PCT) describes the way in which negative feedback establishes control at increasing levels of perceptual complexity. Thus, PCT may be the first biopsychosocial model to be articulated in functional terms. In this paper we outline the working model of PCT and explain how PCT provides an embodied hierarchical neural architecture that utilizes negative feedback to control physiological, psychological, and social variables. PCT has major implications for both research and practice and, importantly, provides a guide by which fields of research that are currently separated may be integrated to bring about substantial progress in understanding the way in which the brain alters, and is altered by, its behavioral and environmental context.
Many strategies have been recommended to support caregivers in communicating with people who live with dementia. However, less is known about what makes communication a good and meaningful experience ...from the perspective of people with dementia. Understanding this may enhance the person with dementia's sense of connectedness, strengthen their relationships, and facilitate person-centered care. The current review aimed to evaluate research that examined experiences of communication in people living with dementia. Studies that examined reports provided by people with dementia, healthcare professionals, and family caregivers were included.
A mixed-methods systematic review was conducted using PsychINFO, MEDLINE, and EMBASE databases.
After applying the eligibility criteria, 15 studies were included. Although eight of these recruited people with dementia, only one focused on their perspectives of communication experiences and the remaining studies focused on the perspectives of family caregivers and healthcare professionals. These studies either explored experiences without suggestions of communication methods, "open exploration," or through examining experiences of strategies, "exploration of strategies." A significant theme was around communication difficulties that affected interpersonal relationships and activities of daily living. Conversely, personhood strategies and a strong underlying relationship were believed to facilitate communication. The one study that examined the perspectives of people with dementia emphasized the importance of retaining valued relationships and feeling respected during communication.
The need to involve people with dementia in research, particularly around their experiences of communication, is evident. Such research would be imperative for facilitating person-centered care, strengthening social relationships, and informing training programs.
In this study, we aimed to understand how people with first‐episode psychosis experienced a transdiagnostic cognitive therapy called method of levels (MOL). Semistructured interviews were conducted ...with 12 individuals who were participants of a feasibility randomized controlled trial of MOL for first‐episode psychosis. Interviews were analysed using thematic analysis. Four superordinate themes were identified: ‘The therapist's approach’; ‘I was in control’; ‘Thinking and talking’; and ‘Looking at problems from a different perspective’. Our findings suggest that therapy was experienced as most helpful when participants perceived themselves to have control over the process of therapy, could explore and express a wide range of difficulties, and were able to generate new perspectives on their problems. MOL and its associated system of client‐led appointment scheduling were predominantly perceived to be helpful and appear suitable for further testing in a larger clinical trial.
Accessible summary
What is known on the subject?
People with dementia experience cognitive decline which can affect their ability to communicate with others and consequently getting their needs met.
...Loneliness and social isolation are associated with depression and anxiety, while difficulties communicating may magnify such difficulties. Enhancing meaningful interactions may support maintenance of valued relationships and positive wellbeing.
Although previous research has examined communicative experiences, this has been from the perspectives of professionals or caregivers. Exploring meaningful communication from the perspectives of people with dementia is crucial in supporting relationships and wellbeing.
What the paper adds to existing knowledge?
People with dementia can be active participants in research. They are aware of their cognitive impairments as well as social interactions and features constituting meaningful communications.
People with dementia recognized carers’ attempts to understand and empathize with them; allowing them to feel valued and heard, empowering them to maintain interactions. Alternatively, feeling dismissed, inferior or pressured to provide ‘correct’ responses deterred them from further conversations.
What are the implications for practice?
People with dementia have an awareness of their relationships, communications and preferences. Thus, it is imperative to respect this population and make attempts to understand their communication as they sense this effort even when miscommunications occur.
Embrace qualities that facilitate person‐centred care within communications is vital as this can preserve valued relationships, support one's needs and enhance wellbeing. Such features include active listening, empathizing, being physically and mentally present, spending time to know the individual and sharing experiences, thoughts and emotions.
Introduction
Social isolation can be problematic for people with dementia; understanding what makes communication meaningful may reduce such risk.
Scientific rationale
Previous research has examined caregivers’ or professionals’ experiences of meaningful communication. Understanding this from the perspectives of people with dementia could enhance their interactions and wellbeing.
Aim
Exploring what makes communication meaningful from the perspective of people with dementia.
Methods
Nine dyadic interactions between a person with dementia and a family carer were filmed. Individuals with dementia watched the footage and reflected on their communications in semi‐structured interviews.
Results
Three superordinate themes emerged. Themes ‘sharing moments of emotional connection’ and ‘empowering one's ability to communicate’ related to the experience of feeling connected, understood, valued and heard, allowing further communication. Conversely, ‘inhibitors to communication’ related feeling disempowered and reduced interactions.
Discussion
Even when carers could not understand what people with dementia attempted to communicate, their efforts to interact with them were valued and considered meaningful as they reinforce their sense of connectedness.
Implications for practice
Embracing a person‐centred approach by actively attuning to the person and continuously attempting to empathize and understand persons with dementia can help preserve important relationships and allow the person to feel valued and interpersonally connected.
Abstract
CRISPR technologies have advanced cancer modelling in mice, but CRISPR activation (CRISPRa) methods have not been exploited in this context. We establish a CRISPRa mouse (
dCas9a-SAM
KI
) ...for inducing gene expression in vivo and in vitro. Using
dCas9a-SAM
KI
primary lymphocytes, we induce B cell restricted genes in T cells and vice versa, demonstrating the power of this system. There are limited models of aggressive double hit lymphoma. Therefore, we transactivate pro-survival BCL-2 in
Eµ-Myc
T/+
;dCas9a-SAM
KI/+
haematopoietic stem and progenitor cells. Mice transplanted with these cells rapidly develop lymphomas expressing high BCL-2 and MYC. Unlike standard
Eµ-Myc
lymphomas, BCL-2 expressing lymphomas are highly sensitive to the BCL-2 inhibitor venetoclax. We perform genome-wide activation screens in these lymphoma cells and find a dominant role for the BCL-2 protein A1 in venetoclax resistance. Here we show the potential of our CRISPRa model for mimicking disease and providing insights into resistance mechanisms towards targeted therapies.
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