Video-Coded Maternal Behaviours and Stress Reactivity in Preschoolers of Mothers with Depression

Parents play an important role in supporting their children’s social-emotional development and well-being. Social buffering theory suggests that positive parent-child relationships are associated to children’s ability to cope with acute stress. One method utilized to measure parent-child relationships is through observed video-coded interactions, but in the context of acute stress, there is an identified gap in standardized video coding systems. We created a video coding scheme to capture maternal behaviours associated with children’s stress reactivity and recovery in a sample of mothers with clinical depression and their preschool aged children (N = 40). Mother-child dyads participated in a baseline assessment of a larger clinical trial study via online videoconferencing platform. Children partook in an acute stressor task alongside salivary cortisol and heart rate measurements. Video recordings of maternal behaviours were collected both during and after the acute stressor task. Transcriptions of maternal behaviours were recorded to inform the microanalytic coding scheme development. These transcriptions were consolidated into codes based on established systems and clinical theory. Partial construct validity of the video coding scheme was found when comparing the observed maternal behaviours with a standardized questionnaire of parenting behaviour. Results indicate that observed global maternal involvement during the online stressor task produced a blunting effect on children’s stress reactivity. However, no associations between mothers’ parenting behaviours after the stressor and children’s stress physiology were found. Results may inform parenting interventions aimed at supporting children’s well-being.

Facilitating Adaptive Emotion Processing and Somatic Reappraisal via Sustained Mindful Interoceptive Attention

Emotions are by nature embodied, as the brain has evolved to quickly assess the emotional significance of stimuli and output signals to the body’s viscera and periphery to aid adaptive responses. Emotions involve both implicit bodily and explicit narrative processes, and patients may experience transdiagnostic distress when bodily signals are not attended to and holistically integrated with explicit narratives about experience. Similarly, therapists may be trained in more implicit body-based approaches (i.e., massage/bodywork, physical and occupational therapy, and nursing/medicine) or more explicit narrative-based approaches (i.e., psychotherapy), and may lack training in skills that integrate both levels of emotion processing to aid healing and growth. To address these gaps, we propose a framework where the bridge between implicit bodily sensations and explicit narratives lies in cultivating mindful awareness of bodily sensations associated with emotions. This process brings subjective awareness to notice inner body experience (or interoceptive awareness) that is often outside of conscious awareness, so that it may be understood and re-integrated in more adaptive ways, which we call somatic reappraisal. Using clinical theory and example vignettes, we present mindful interoceptive awareness for adaptive emotion processing as a framework to cultivate and enhance somatic reappraisal. Mindful interoceptive awareness brings more focused and sustained attention to inner body experience; likewise, internal sensations associated with emotions become more granular, vivid, and can shift in ways that facilitate somatic reappraisal. Learning to sustain interoceptive awareness when engaged with mindfulness qualities of nonjudgment and compassion promotes an experience where new associations between emotions, meanings, and memories can be made that generate insights that are holistic and integrative. A clinical vignette is used in this paper to provide examples of this approach in psychotherapy. An example script for use in mindfulness groups is included, and resources are suggested for clinicians to gain more experience. Mindful interoceptive awareness for adaptive emotion processing is a clinical process that can be learned and applied by a range of clinicians to treat mental and physical health conditions that may benefit greater embodied awareness.

Attending to the Ignored

Ostracism – being excluded and ignored – has received considerable attention in social psychology in the past few decades. Experimental evidence suggests that negative psychological reactions to ostracism are robust and widespread. Initially, ostracism is detected quickly as painful and reduces the satisfaction of four fundamental needs: belonging, self-esteem, control, and meaningful existence. When ostracism is experienced occasionally, individuals tend to respond and cope by trying to fortify the threatened needs, either by attempting to improve their inclusionary status (fortifying belonging and self-esteem by being more likable, agreeable, and pliable), by exerting more control and attention (by becoming more provocative, noticeable, but also sometimes more aggressive and violent), or by reducing future episodes of ostracism by seeking solitude. Persistent or long-term exposure to ostracism results in decreased coping attempts, and higher rates of alienation, depression, learned helplessness, and unworthiness. In this article, we integrate these findings with clinical theory and practice, seeking to apply experimental results to therapeutic applications.

Evaluations of anxious others: Using cluster analyses to explore the co-existence of positive and negative evaluations and social anxiety

Introduction: Research on individuals with social anxiety has primarily focused on their evaluations of themselves before, during, and after social situations. However, our most evidence-based treatment remains not effective for some. Considering social and clinical theory, we wonder if some people with social anxiety experience negative evaluations of others. Prior studies tested for group-based differences, which does not allow for the possibility that only a subset of people with social anxiety evaluate others negatively. Across two studies, we use cluster analyses to determine how social anxiety and negative other-evaluations co-vary. Methods: 267 (study 1) and 290 (study 2) unselected participants completed an online survey, including two measures modified for the current study: Modified-Interpretation and Judgemental Questionnaire (M-IJQ) and Modified Ways of Thinking about Social Behaviour Questionnaire (M-WTSBQ). Participants read several vignettes and judged the hypothetical anxious person across several positive and negative attributes (M-IJQ). Results: Results from the cluster analysis revealed consistent groups of individuals across both studies, including people with: 1) severe social anxiety and no judgements; 2) low social anxiety and no judgements; 3) mild-to-moderate social anxiety and positive judgements; and 4) some social anxiety who disagreed with all judgements. We discuss how these clusters relate to thoughts about themselves and others on the M-WTSBQ. Discussion: Previous research has been mixed on the presence of negative evaluations of others in social anxiety. This study clarifies some of the confusion by revealing subgroups of individuals with varying social anxiety and judgements of others.

Values-based practice: how can history taking help psychiatrists explore the values involved in clinical decision-making?

SUMMARY Values-based practice (VBP) is a framework of clinical theory and skills to facilitate a good process whereby the (often conflicting) values involved in clinical decision-making can be recognised and balanced productively. Many of these values come from the personal histories of the patient and of the clinician, and the traditions and history of psychiatry. New developments in science lead to increasing choice and increasing complexity of values. Therefore, psychiatrists will need more skills in this area, as reflected by the inclusion of VBP in the Royal College of Psychiatrists’ training curricula. This article describes some tools for understanding and navigating this value diversity in applying science to clinical practice during history taking.

Seek Consultation

Seeking consultation commences with the recognition that seeking consultation is itself an ethical duty to the client. The chapter recommends three types of consultation, including ethical consultation, clinical consultation, and legal consultation. Ethical consultation occurs best when it is regularly scheduled, part of an ongoing relationship, and nurtures the professional’s own ethical growth. Clinical consultation can be used for ongoing supervision, understanding the connection between emotional and academic problems, staying current with clinical theory and interventions, recognizing the need for self-care, and managing clinical concerns. Legal consultation can assist with understanding constitutional rights of due process and equal protection, federal statutes such as the Every Student Succeeds Act or Individuals with Disabilities Act, state statutes, administrative regulations, and case law, such as the Tarasoff duty to protect and Jaffee v. Redmond. It ends with a discussion of the relationship between law and ethics and provides guidance regarding civil disobedience.