bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenges of End-Stage Renal Disease Patients in Ethiopia
Authors: Atnafu Rahel , Selfako Andualem Hadero , Mishna Faye , Regehr Cheryl , Soklaridis Sophie , Kotecho Messay Gebremariam
Published: August 2022

Affecting all aspects of patients’ lives, end-stage renal disease (ESRD) presents significant challenges. Individuals with ESRD face biological, psychological, economic, and social issues. ESRD patients in Ethiopia bear multifaceted burdens of multiple medical conditions, including comorbid hypertension, diabetes, cardiac problems, anemia, gastrointestinal issues, and bone and mineral disorders. The aim of this study was to address the gap in research on patients in Ethiopia with ESRD and examine biopsychosocial and economic challenges. A qualitative hermeneutic phenomenology design was employed. In-depth interviews were held with 10 women and 10 men. Major themes include the physical corollary of ESRD (e.g., fatigue), and psychological (e.g., fear of loss of capacity and/or occupation) and socioeconomic challenges (e.g., difficulty obtaining social and economic support). Along with complications of ESRD and side effects of dialysis, patients face trauma and social and economic repercussions. Social workers are well positioned to help manage associated biopsychosocial and economic challenges. The findings indicate the need for policies that promote multidisciplinary teams in working with patients who are diagnosed with ESRD.
Long-term survival of single versus bilateral internal mammary artery grafting in patients under 70
Authors: Abreu Armando , Máximo José , Leite-Moreira Adelino
Published: August 2022

OBJECTIVES

As definitive data from randomized controlled trials comparing the effect on long-term survival of using single internal mammary artery (SIMA) or bilateral internal mammary artery (BIMA) grafting are not yet available, observational studies allow for long-term follow-up in large and representative populations, which might complement the information potentially derived from randomized trials. To compare long-term survival in patients under 70 years of age undergoing SIMA or BIMA grafting.

METHODS

Retrospective analysis of 3384 consecutive patients under 70 years undergoing primary isolated coronary artery bypass grafting, performed from 2000 to 2015, in a Portuguese level III Hospital. We identified 2176 and 1208 patients from the study population who underwent SIMA and BIMA grafting, respectively. The primary end point was all-cause mortality at 10 years. We employed inverse probability weighting to restrict confounding by indication.

RESULTS

The mean age of the study population was 59.4 (± 7.6) years, and 567 (16.8%) were females. Inverse probability weighting was effective in eliminating differences in all significant baseline characteristics. Follow-up was 99.88% complete. The median follow-up time was 12.82 (interquartile range, 9.65, 16.74) years: the primary end point of all-cause mortality at 10 years occurred in 463 patients (21.3%) and 166 (13.7%) in the SIMA and BIMA grafting groups, respectively (hazard ratio, 0.78; 95% confidence interval, 0.66–0.92; P = 0.004).

CONCLUSIONS

Bilateral internal mammary grafting is associated with lower long-term mortality than single internal mammary grafting. Moreover, this survival benefit comes at no increased perioperative morbidity or mortality cost.
Pollen interference emerges as a property from agent-based modelling of pollen competition in Arabidopsis thaliana
Authors: Beckford Charlotte , Ferita Montana , Fucarino Julie , Elzinga David C , Bassett Katherine , Carlson Ann L , Swanson Robert , Capaldi Alex
Published: August 2022

Differences in pollen performance, often revealed during pollen competition, have long been recognized as evolutionarily significant and agriculturally important. Though we have sophisticated models for the growth of individual pollen tubes, we have few robust models for larger-scale pollen competition, a process that has been linked with inbreeding avoidance, sexual selection, reproductive barrier reinforcement and speciation. Here we use existing data on pollen performance traits to develop an agent-based model of pollen competition. We calibrate our model parameters to empirical data found in the literature of seed siring proportions from mixed pollinations and pollen tube length distributions from single-accession pollinations. In this model, parameters that influence pollen tube movement and sensing of ovules were found to be primary factors in competition. Our model also demonstrates that interference competition emerges as a property of pollen competition, and suggests a potential mechanism for this phenomenon. This study integrates pollen performance measures with mathematical modelling conducted on a simplified and accessible system. This represents the first mechanistic agent-based model for pollen competition. Our model may be extended to predict seed siring proportions for other accessions of Arabidopsis thaliana given data on their pollen performance traits.
Understanding the Limits of Transnational NGO Power: Forms, Norms, and the Architecture
Authors: Schmitz Hans Peter , Mitchell George E
Published: August 2022

A growing chorus of critics have called upon transnational nongovernmental organizations (TNGOs) from the Global North to “decolonize” their practices, to “shift the power” to the Global South, and to put an end to “white saviorism” by initiating a variety of significant organizational changes. Despite these repeated calls, the TNGO sector still struggles to reform. Explanations for TNGOs’ ongoing struggles from within the field of international relations have generally centered on TNGOs themselves and the ironies and paradoxes of organizational growth and financial success. This article introduces a different argument that TNGOs’ struggles to adapt in response to their critics are the result of TNGOs’ “nonprofitness.” By virtue of being nonprofit, TNGOs are embedded in an architecture consisting of forms and norms that inherently limit the extent to which they are able to change. Using the construct of the architecture, this article provides a novel account for the challenges that TNGOs confront as they attempt to close the gap between the rhetoric and reality of inclusive and transformational socioeconomic, political, or environmental change.
Dietary creatine nitrate enhances muscle creatine loading and delays postmortem glycolysis of broilers that experienced preslaughter transport
Authors: Xu Jiawen , Xing Tong , Li Jiaolong , Zhang Lin , Gao Feng
Published: August 2022

This study investigated the attenuating effects of dietary creatine nitrate (CrN), a novel form of creatine, on energy expenditure and rapid glycolysis in pectoralis major (PM) muscle of broiler induced by preslaughter transport. A total of 288 Arbor Acres broilers (28 day old) were randomly assigned into five dietary treatments, including a basal diet or the basal diet supplemented with 600 mg/kg guanidinoacetic acid (GAA), 300, 600, or 900 mg/kg CrN for 14 d, respectively. On the day of transportation, the broilers from basal diet group were divided into two equal groups: one group was transported for 0.5 h (Control group) and the other group was transported for 3 h (T3h group). Meanwhile, the birds from GAA and CrN supplementation groups were transported for 3 h (identified as GAA600, CrN300, CrN600, and CrN900 group, respectively). The results demonstrated that dietary supplementation of GAA or CrN from 28 to 42 d of age did not significantly affect the growth performance, carcass traits, and textural characteristics (P > 0.05) in PM muscle of transported broilers. Compared with T3h group, GAA600, CrN600, and CrN900 groups increased the pH45min (P < 0.01), and CrN600, CrN900 groups decreased the cooking loss (P < 0.05) of PM muscle. Meanwhile, the muscle of GAA600, CrN600, and CrN900 groups showed a higher glycogen content (P < 0.01) and a lower lactic acid content (P < 0.01). GAA600 and all CrN treatments enhanced muscle Cr content and reduced AMP/ATP ratio (P < 0.01). In addition, GAA600 and all CrN treatments downregulated the relative mRNA expression levels of LKB1 and AMPKα2 (P < 0.001) and the protein expression of p-AMPKαThr172 compared with the T3h group (P < 0.01). All CrN treatments showed lower protein expression levels of LKB1 and p-LKB1Thr189 than those of the T3h group (P < 0.05). In summary, dietary supplementation with GAA and CrN enhanced the content of muscle creatine, and inhibited transport-induced activation of LKB1/AMPK pathway, which is beneficial for delaying rapid muscle glycolysis and improving meat quality.
The Nairobi fly in the Himalayas
Authors: Dorji Thinley , Lhendup Karma , Gyeltshen Kinley
Published: August 2022

The Nairobi fly has been sighted in the sub-Himalayan range with an outbreak of Paederus dermatitis in Nepal, Bhutan and north-eastern India in 2022. With increasing international travel and a warmer earth, tropical vectors in non-native regions are an emerging global health challenge.
Physical and Psychosocial Development
Authors: Winters Ken C. , Ingwalson Ann
Published: August 2022

This chapter provides an overview of adolescent physical and psychosocial development. Such changes happen at an accelerated rate during adolescence. Physical changes include the onset of puberty and the development of a sexually dimorphic body shape. The adolescent’s view of their personal identity and how they relate to the outside world are greatly influenced by these physical changes. Genetic factors strongly influence several personality traits, including tendencies to engage in antisocial behavior and risk for depression. The influence of peers and parents will shape various features of a teenager’s personality. The critical psychosocial challenges of adolescence involve developing a clearer sense of personal and sexual identity and a desire of independence from one’s parents. Other hallmarks of psychosocial development are involvement in romantic relations, risk-taking tendencies, changes in physical activity, and sleep deprivation. Psychological health can be adversely affected by indulgence in social messaging and too much screen time.
Adolescent Brain Development
Authors: Winters Ken C. , Ingwalson Ann
Published: August 2022

Adolescents go through significant brain development during their teenage years. This process likely contributes to increased risk taking and lapses in sound decision making but also supports learning and being open to new experiences. A growing research base points to the view that drug use is a harmful activity for youth and that early-onset and frequent use of drugs may disrupt brain development. The “brain under construction” of a teenager is vulnerable to the effects of stress, and in combination with biological risk, adolescence is a period of onset of many mental illnesses. Several cognitive deficits have been linked to early use of alcohol or cannabis; the earlier age of onset of regular use, the worse the neurocognitive outcomes. Also, the risk for addiction for all licit and illicit drugs is greatly increased when a person starts to use a drug during their teen years.
Overview of Psychoactive Substances
Authors: Winters Ken C. , Ingwalson Ann
Published: August 2022

Initiation to substance use peaks at a time when the developing brain may be particularly vulnerable to the neurotoxic effects of heavy substance use, highlighting the importance of efforts to prevent substance use. In recent years, the gender gap in rates of substance involvement has narrowed, with females catching up to or surpassing males in rates of use for certain substances, such as tobacco. Cannabis use remains the most frequently used substance by adolescents of a drug that is federally illicit for all of the United States. The rate of its use has been relatively stable over recent years, whereas the rates of use of other illicit drugs are declining. Vaping of nicotine and of cannabis is a new trend among adolescents, which is contributing to health concerns.
Substance Use Disorders
Authors: Winters Ken C. , Ingwalson Ann
Published: August 2022

Addiction occurs when repeated use of drugs changes how a person’s brain functions over time. The transition from voluntary to compulsive drug use reflects changes in the brain’s natural inhibition and reward centers that keep a person from exerting control over the impulse to use drugs even when there are negative consequences—the defining characteristic of addiction. Many adolescent risk factors, including genetic vulnerability, prenatal exposure to alcohol or other drugs, lack of parental supervision or monitoring, a history of physical and/or sexual abuse, and an association with drug-using peers are risk factors that contribute to a greater likelihood of being diagnosed with a substance use disorder. On average, adolescents tend to show a reduction in use following treatment, but post-treatment course is variable. Aftercare helps to maintain treatment gains, and more than one episode of treatment may be needed for some adolescents with more severe substance involvement.
Behavioral Addictions
Authors: Winters Ken C. , Ingwalson Ann
Published: August 2022

Behavioral (or process) addictions, which are defined as addictions when an individual repeatedly engages in a behavior that leads to negative effects on the their ability to function normally in daily life and has a deleterious effect on the person’s overall health. Core features of behavioral addictions are similar to symptoms of a substance use disorder: compulsive-like behavior, continuing of the behavior in the face of negative consequences, and difficulty in cutting back or halting the addictive-like behavior. Behavioral addictions discussed in this chapter are gambling, internet/video gaming, social media, eating, sex, and shopping. Eating disorders are the behavioral addiction most relevant among youth. This domain includes bulimia, anorexia, and binge eating disorder. Many individuals with a behavioral addiction need professional help to address their problem.
Family-Based Treatments
Authors: Winters Ken C. , Ingwalson Ann
Published: August 2022

Family therapies for adolescents with a substance abuse problem are based on the view that family risk factors are the main contributor to the adolescent’s problem. Thus, the teen’s substance abuse problem is a consequence of a larger problem. Family risk factors that are attended to in treatment typically center on poor family communication, lack of or weak effective parenting practices, and poor family connectedness. The predominant and effective family therapies include brief strategic family therapy, functional family therapy, multidimensional family therapy, and multisystemic therapy. The changing landscape of the family in the United States (e.g., increased proportion of single-parent families) poses unique challenges to family therapists.
Diagnostic Issues and Complexities in Autism and Related Conditions
Authors: Volkmar Fred R. , Woodbury-Smith Marc , Macari Suzanne L. , Øien Roald A.
Published: August 2022

Since the first recognition of autism and Asperger’s disorder, there have been important debates about the boundaries of these conditions and the degree to which they ‘shade off’ into normalcy. These debates have centered on the relevance of a narrow versus broad view of the clinical disorder(s) as well as on the implications of its complex genetic underpinnings and increased knowledge of the social neuroscience of autism and related conditions. With the recognition of the complexity of the genetics of autism there has been much debate regarding the broader autism phenotype and the potential adaptive function of some aspects of the condition. In addition, concerns with boundary issues in relation to cognitive and communicative ability, and the relevance of gender, diverse backgrounds, and cultural issues have all arisen. The current DSM-5 definition was developed using research instruments and has proven overly stringent in important respects. Clarification of these issues will enhance both clinical work and research.
Autism Spectrum Disorder Versus Attention-Deficit/Hyperactivity Disorder
Authors: Davis Naomi O. , Carpenter Kimberly L. H. , Dawson Geraldine
Published: August 2022

Although the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnostic criteria for autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) show very little symptom-level overlap between the conditions, similar behavioral challenges are evident in individuals with each of these disorders. Clinical questions often arise about whether presenting concerns should be conceptualized as reflecting a primary diagnosis of ASD or ADHD. The current chapter provides guidelines for the differential diagnosis of these disorders. Using clinical case studies, the chapter describes behaviors that may be understood as part of the core symptom domains of ASD and ADHD. Specific suggestions are provided for disentangling the underlying nosology of common behavioral challenges. The chapter ends with recommendations to support differential diagnosis in clinical practice.
Autism Spectrum Disorder Versus Anxiety Disorders
Authors: South Mikle , Brewe Alexis , Kerns Connor M. , White Susan
Published: August 2022

Anxiety is one of the most common co-occurring diagnoses in people with autism, but an overlap in traits between autism and anxiety can complicate diagnosis of both conditions. This chapter reviews commonalities and distinctions that are useful for disambiguating anxiety from autism, including transdiagnostic factors related to emotion regulation, intolerance of uncertainty, sensory processing, and physiological arousal. Clinicians are encouraged to consider the degree of impairment owed specifically to the anxiety, duration, and developmental course of the anxiety-related concerns, and change from baseline functioning and behavior that may be due to anxiety, in determining if a co-occurring diagnosis of an anxiety disorder is warranted. Appropriate attention to the overlap of autism and anxiety traits is essential for effective, ongoing treatment planning.
Autism Spectrum Disorder Versus Major Depressive Disorder
Authors: Stavropoulos Katherine K. M. , Bolourian Yasamin , Gotham Katherine
Published: August 2022

This chapter discusses differential diagnosis between autism spectrum disorder (ASD) and major depressive disorder (MDD). Though individuals with ASD and/or MDD may present with clinical similarities (e.g. social-communicative challenges and rigid patterns of thinking and behavior), differences are also present. Developmental considerations in the diagnosis and co-occurrence of MDD and ASD are discussed, and particular attention is paid to symptoms manifesting in early life (e.g. birth to 4-years-old). Specific clinical similarities and differences and recommendations for providers are given. A case study is presented to illustrate diagnostic considerations and decision-making. A decision tree is provided to outline diagnostic considerations based on presenting symptoms.
Autism Spectrum Disorders Versus Genetic Syndromes
Authors: Capal Jamie , Jeste Shafali
Published: August 2022

Approximately 25% of neurodevelopmental disorders, including intellectual disability and autism spectrum disorder, are caused by rare genetic variants and mutations. In fact, genetic testing is the gold standard medical workup for all individuals with an autism spectrum disorder. With the advances in genetic testing, new genes are being discovered daily. This chapter discusses the basis of genetic abnormalities in neurodevelopmental disorders, reviews clinical features of specific neurogenetic conditions, and outlines the current recommendations for genetic testing of individuals with neurodevelopmental disorders. The importance of identifying a neurodevelopmental condition, regardless of the underlying genetic etiology, is emphasized, with the goal of leveraging the support of patient advocacy groups, understanding clinical prognosis, and accessing appropriate, often targeted interventions. The chapter concludes with discussion about the promise of precision health for these genetic syndromes and the need for rigorous studies to improve clinical trial readiness.
Roles, Activities, and Opportunities of Behavioral Health Clinicians in Delivering Continuity of Care
Authors: Willis Tiffany , Dowtin LaTrice L. , Acosta Dailyn , Hansen Kara
Published: August 2022

Continuity of care is vitally important and allows families to feel safe and supported in a frequently changing environment. Mental health services across perinatal/neonatal settings can address parental mental health concerns, infant development, and infant–parent relationships. Although an integrated behavioral health clinician is the preferred model, at minimum a consult/liaison behavioral health clinician (BHC) is recommended in order to adequately meet the needs of infants and their parents across the continuum of care. All fetal care centers, neonatal intensive care units (NICUs), and NICU follow-up clinics should have a BHC who can develop programming that supports the patient experience and evaluates program outcomes through research and quality improvement projects. The push for BHCs in these settings is central to ensuring the highest potential is reached for infants and families alike.
Quality Improvement and Research Across Fetal and Neonatal Care Settings
Authors: Geller Pamela A. , Albanese Ariana , Grunberg Victoria A. , Chuo John , Patterson Chavis A.
Published: August 2022

Fetal care centers, neonatal intensive care units, and neonatal follow-up settings provide a vast and unique frontier for important and novel research. Investigative efforts focusing on psychosocial issues and mental health across fetal and neonatal care settings have surged in recent decades, but additional research is necessary to further identify psychosocial needs of parents, refine and develop evidence-based care for families, better assist with staff education and support, create an evidence base to provide information critical to advocate for staffing and policy changes, and extend knowledge to propel the field forward. This chapter discusses two investigative disciplines—research and quality improvement—and presents their distinctions as well as their synergies and application within fetal and neonatal care settings. This is followed by presentation of key areas that warrant research exploration related to behavioral health issues and an overview of practical considerations for research application in these settings.
Systems Interventions and Program Development
Authors: Klawetter Susanne , Hoffman Jill A. , Roybal Kristi , Hwang Sunah S.
Published: August 2022

Parents of high-risk infants experience increased risk for perinatal mood and anxiety disorders and other behavioral health conditions, which have short- and long-term consequences for parent and infant outcomes. Integrated care is a promising strategy to address the behavioral health needs of high-risk infants and families in perinatal and pediatric settings. Systems change theories and core components of needs assessment and program evaluation provide guidance for fetal, neonatal, and neonatal intensive care unit follow-up providers wishing to implement integrated care. Understanding the importance of demonstrating the value of integrated care will help providers anticipate and respond to the reality of resource constraints as they reimagine services and programs. Through thoughtful design and evaluation, integrated care approaches hold potential to improve parent and infant health and developmental outcomes.
Operations and Ethical Considerations
Authors: Fischer Elizabeth A. , Cedars KristiLynn R. , Kruper Abbey , Leuthner Steven R.
Published: August 2022

As fetal and neonatal care evolves, increasing attention is brought to bear on maternal, family, and infant mental health. Psychologists and other mental health professionals are increasingly involved in neonatal intensive care unit settings, providing care for infants and families. These settings bring with them unique challenges to clinical care in terms of the day-to-day work of managing patient care, documentation in maternal and infant medical records, and considerations of professional and bioethical standards. As the psychologist’s role evolves, questions arise as to ethical issues and operational procedures. Clinicians may struggle with clarifying therapeutic roles, managing confidentiality and documentation, and understanding the application of ethical and legal rules of conduct. This chapter addresses a number of these concerns and identifies areas of consideration for clinicians who provide care in this environment.
Perinatal Mood and Anxiety Disorders Among Parents of High-Risk Fetuses and Infants
Authors: Meyer Birdie G. , Papierniak Brenda , Raines Christena B.
Published: August 2022

Perinatal mood and anxiety disorders (PMADs) are the most common complications of pregnancy and postpartum, affecting up to 20% of all pregnancies. Mothers with medical complications and parents of infants admitted to the neonatal intensive care unit (NICU) are at increased risk for developing a PMAD. Thus, it is imperative for providers to understand symptoms and recognize when a parent is struggling. This chapter describes PMADs by examining the prevalence rates along with risk and protective factors. Case studies are presented to incorporate learning into real-life situations. The chapter helps the readers synthesize the information and increase their understanding of PMADs. Awareness of how medical complications for mother and infant can increase the risk for mood disturbances in pregnancy and postpartum is important clinical knowledge and adds to the overall care and support of parents in the NICU. The chapter also presents ideas worth sharing.
Screening for Perinatal Mood and Anxiety Disorders Across Settings
Authors: Baughcum Amy E. , Clark Olivia E. , Gillespie Shannon L. , Decker Jeanne
Published: August 2022

Parents whose infants are hospitalized in the neonatal intensive care unit (NICU) are at greater risk of difficulties in adjustment and coping, including a higher incidence of perinatal mood and anxiety disorders (PMADs). The presence of a PMAD is known to influence parent–infant bonding and developmental outcomes. Many organizations have advocated for parental screening for PMADs during pregnancy, as well as during NICU admission and post-discharge, to better identify families at risk and triage psychological care. Screening can be challenging for NICU providers due to constraints in time and resources. Screening protocols must include well-validated measures, trained staff to administer, and clear plans for addressing elevated risk. This highlights the need for the integration of mental health professionals into perinatal settings to help foster resilience in families during this vulnerable time.
Psychotherapy and Medication Interventions for Perinatal Mood and Anxiety Disorders Across Settings
Authors: Davoudian Teni , Knapp Jacquelyn M. , Weber Lana S. , Cirino Nicole
Published: August 2022

Untreated or undertreated perinatal mood and anxiety disorders (PMADs) negatively impact mothers and their infants. Impaired maternal–fetal bonding, marital discord, and neuro-affective development issues in children are associated with PMADs. Mothers of medically fragile infants are particularly susceptible to developing PMADs. Evidence-based psychotherapies, such as interpersonal therapy and cognitive–behavioral therapy, are effective in treating anxiety and depression in parents of high-risk infants. Adjunctive modalities, such as peer support groups, can also be effective in reducing perinatal depression. When anxiety and depression do not respond to psychotherapy alone, antidepressants are widely utilized, evidence-based treatments. Major medical organizations throughout the world support the use of medications in pregnant and lactating women because the benefit of treated illness outweighs the risk of untreated illness for the mother and the infant.
Trauma and Trauma-Informed Care
Authors: Coughlin Mary
Published: August 2022

Adversity in childhood negatively impacts health and wellness across the life span. Infants across all gestational ages requiring newborn intensive care are exposed to a myriad of early adverse experiences ranging from painful and stressful procedures to sleep fragmentation, social isolation, and maternal separation. For the family, neonatal intensive care unit hospitalization has been described as a traumatic event that shatters hopes, dreams, and expectations for parenthood. Acknowledging the nature of traumatic experiences endured by infants, families, and clinicians within the setting of intensive critical care assists in identifying and developing strategies aimed at reducing traumatization and re-traumatization while creating effective compassionate caring encounters. Trauma-informed developmental care invites practitioners to move past procedure-driven practices and create a culture of care that focuses on the human experience. This requires a shift in mindset, intention, and language.
Human Milk and Breastfeeding
Authors: Spatz Diane L. , Morris Elizabeth D.
Published: August 2022

The use of human milk and breastfeeding is a lifesaving medical intervention for infants who are cared for in intensive care units at birth. Despite modest increases in breastfeeding initiation rates in the United States, exclusive human milk rates at 6 months continue to be only approximately 25%. Health care providers must be aware of disparities in breastfeeding rates with many low-income groups and persons of color. The Spatz 10-step model for human milk and breastfeeding in vulnerable infants has been implemented throughout the United States and the world. Key components include, but are not limited to, informed decision-making, establishment and maintenance of milk supply, oral care and feeding of human milk, preparation for discharge, and appropriate follow-up. Breastfeeding has been reported to positively impact mood and stress reactivity, and it can help facilitate maternal sensitivity and secure attachment between mother and infant compared to formula feeding. In this chapter, parental mood and anxiety symptoms related to feeding are explored, and the role of the provision of human milk as a positive intervention strategy is discussed. The entire multidisciplinary team should be involved in helping parents meet their personal goals for the provision of human milk and breastfeeding.
Shared Decision-Making Across Settings
Authors: Zuk Jeannie , Carter Kristin , McManus Beth M. , Holliman Brooke Dorsey
Published: August 2022

Fetal care centers and neonatal intensive care units necessitate ongoing complex decisions by parents and health care providers about birth plans, prenatal assessments for suspected anomalies, an antenatal diagnostic workup for an infant’s condition, treatment options for both the mother and the infant, and infant care following discharge from the hospital. Many decisions must be made quickly in a highly charged, stressful environment amid uncertainty with no obvious correct answer. Engaging parents in shared decision-making is one of the most effective ways to support parents’ decisions with the best interest standard in mind. Health care providers, care teams, and parents are encouraged to foster a culture that promotes effective shared decision-making. This includes creation of genuine opportunities for parents to understand, process, and discuss options prenatally and following birth in a context that facilitates active listening and mutual understanding, encouraging a team approach toward complex care decisions.
Perinatal Crisis and Traumatic Bereavement
Authors: Stein Mara Tesler , Davis Deborah L.
Published: August 2022

For parents, the perinatal period is a challenging time of growth, so when a crisis occurs and parents perceive a threat to their infant’s well-being, they are vulnerable to trauma, pathogenic memories, and the ensuing disruption of parental development. Whether their infant lives or dies, parents can experience multiple losses and the intertwining of bereavement and traumatic stress. Practitioners can soften trauma’s impact by providing trauma-informed care, particularly in the form of developmentally supportive care that fosters the parent–infant relationship, emotional regulation, and supportive relationships. Another key element is to refer parents to specialists who are trained to provide neurologically based trauma-focused treatment. Many parents require this extra intervention to make their adjustment easier and healing more complete, especially if they have been repeatedly or significantly traumatized.
Role of Behavioral Health Clinicians in Fetal Care Settings
Authors: Chavis Lacy , Butt Sakina , Vaught Elizabeth
Published: August 2022

Expectant parents of pregnancies notable for fetal anomaly are at increased risk for perinatal mood and anxiety disorders (PMADs) and traumatic stress. PMADs are the most common medical complication during pregnancy and the postpartum period. Caring for the unique needs of a family and fetus with a congenital anomaly requires specialized care with clinical expertise. This chapter highlights the expertise of behavioral health care clinicians within the fetal care center (FCC) to provide integrated care through screening, assessment, intervention, and consultation to improve mental health outcomes and mitigate negative impact for the expectant parent(s) and infant. Embedding behavioral health clinicians in the FCC provide access to services and facilitate continuity in care.
Common Neurodevelopmental and Behavioral Health Challenges in Neonatal Follow-Up
Authors: Gustafson Kathryn E. , Warren Mollie G.
Published: August 2022

High-risk infants seen in neonatal intensive care unit developmental follow-up programs are at increased risk for problems in neurodevelopment, including developmental delay, neuromotor impairment such as cerebral palsy and developmental coordination disorder, academic difficulties, and neuropsychological deficits such as impaired executive functioning. In addition, these children are at risk for behavioral health challenges such as dysregulation, autism spectrum disorder, attention-deficit/hyperactivity disorder, anxiety disorders, and sleep problems. Social and environmental factors have a significant effect on developmental outcome independent of biomedical risk factors. Poorer outcomes are evident in children who confront poverty, parental mental illness, and other adverse childhood experiences. Parents are at increased risk for stress and distress but can also exhibit resiliency, particularly when provided with social support and resources to address their children’s needs.
What Is Supportive Psychotherapy?
Authors: Markowitz John C.
Published: August 2022

This chapter offers a brief history of supportive therapy from its humble origins in the heyday of psychoanalysis to increasing respectability with repeated research outcome testing. The chapter defines Brief Supportive Psychotherapy and its key components as (1) an affect focus, (2) psychotherapeutic “common factors” (e.g., affective arousal, helping the patient to feel understood), and (3) developing an emotional conceptualization of the patient. These components are elaborated in subsequent chapters. “Sitting on one’s hands” is contrasted with active listening.
The Common Factors of Psychotherapy
Authors: Markowitz John C.
Published: August 2022

What are the building blocks of any good therapy? Jerome Frank defined its key parameters years ago. This chapter explains the following terms with clinical examples: (1) affective arousal, (2) feeling understood by the therapist, (3) providing a framework for understanding (here: emotions matter; they’re powerful but not dangerous), (4) embodying therapeutic expertise or poise, (5) a therapeutic ritual, (6) realistic optimism for improvement (vs. the overly chipper, affectively disconnected therapist), and (7) therapeutic success experiences. The chapter also contrasts affect-focused and exposure-based psychotherapies and notes some of the structural assumptions inherent in Brief Supportive Psychotherapy.
The Structure of Brief Supportive Psychotherapy
Authors: Markowitz John C.
Published: August 2022

This chapter describes the structure of Brief Supportive Psychotherapy (BSP): its beginning, middle, and end phases. It describes therapist techniques such as (1) active listening, curiosity, and pursuing affect; (2) taking a personal and cultural history; (3) spending time gathering data rather than talking to or at the patient; and (4) exploring versus telling. A therapist can provide clarifications and emphases but not lengthy recaps: Less is more, both in the whole BSP approach and in the therapist’s verbalizations. The therapist stance is described as supportive and empathic. The chapter also discusses the use of praise and nonverbal synchrony. It reviews therapist adherence, prescriptions and proscriptions, and clinical contingencies.
Supportive Evidence
Authors: Markowitz John C.
Published: August 2022

For a therapy to be taken seriously these days, for it to receive insurance reimbursement, it’s crucial to demonstrate that it effectively relieves symptoms. Brief Supportive Psychotherapy (BSP) has been subjected to frequent study, generally as a “control” condition in comparison to a favored treatment. In the face of potential research bias against it, BSP has fared extremely well, relieving symptoms of depression and anxiety, promoting tolerance of emotions, and often at least matching the favored competitor. This chapter provides a narrative review and summary of each of the nine relevant randomized controlled treatment studies of depression and anxiety disorders that have involved BSP. The treatment experience has often won over psychotherapists who previously saw themselves as exclusively cognitive behavioral types.
Brief Supportive Psychotherapy Training and Supervision
Authors: Markowitz John C.
Published: August 2022

This final chapter discusses the process of training therapists in and supervising therapists in Brief Supportive Psychotherapy (BSP), based on the author’s experience. That process attunes both supervisor and supervisee to an affect focus and to enhancing common factor elements of psychotherapy. Elements of training include an orientation workshop, supervisor understanding of each therapist’s background and motivation, and supervision based on taped sessions. The chapter further discusses the issue of certification, or rather, the lack of a certification process for BSP therapists. Finally, the chapter addresses the issues prior therapeutic allegiance raise in learning a novel therapeutic approach like BSP.
Transdiagnostic LGBTQ-Affirmative Cognitive-Behavioral Therapy
Authors: Pachankis John E. , Harkness Audrey , Jackson Skyler , Safren Steven A.
Published: August 2022

This book covers the principles and techniques that mental health practitioners can use to affirmatively respond to the distinct stressors that their LGBTQ clients often face. It outlines a clear step-by-step approach that teaches skills for enhancing LGBTQ clients’ mental well-being by undoing the deep impact that early and ongoing LGBTQ-related stress can have on basic psychological processes. It also provides essential tools for helping therapists effectively and affirmatively respond to the unique needs of their LGBTQ clients. The book is accompanied by a workbook that presents cognitive-behavioral therapy techniques that directly respond to the distinct stressors facing LGBTQ individuals. The workbook is designed to enhance mental well-being and covers a broad range of mental health challenges, such as depression, anxiety, substance use problems, and psychological distress.
Introduction to LGBTQ-Affirmative Cognitive-Behavioral Therapy
Authors: Pachankis John E. , Harkness Audrey R. , Jackson Skyler D. , Safren Steven A.
Published: August 2022

This chapter introduces a treatment that employs evidence-based cognitive-behavioral principles and techniques to significantly improve mood and anxiety disorders in the general treatment-seeking population. These techniques were adapted to specifically help lesbian, gay, bisexual, transgender, and queer (LGBTQ) people improve their mental health. It cites epidemiological studies showing that LGBTQ people are significantly more likely than heterosexual and cisgender individuals to experience mood and anxiety disorders because of the stress they face as a result of their disadvantaged social status. The chapter refers to LGBTQ-related stress, which largely explains the excess burden of mental health problems borne by LGBTQ populations. It mentions how the treatment can help LGBTQ clients understand this stress and the impact it has on their presenting concerns.
Module 4: Increasing Mindful Awareness of LGBTQ-Related Stress Reactions
Authors: Pachankis John E. , Harkness Audrey R. , Jackson Skyler D. , Safren Steven A.
Published: August 2022

This chapter demonstrates how to help the client further understand the ways that LGBTQ-related stress may shape their emotional experience. It describes a session that provides psychoeducation about judging one’s emotions, present-focused emotion awareness, and how these correspond to LGBTQ-related stress reactions. It also covers strategies for anchoring in the present and in-session practice of mindfulness in the context of an emotion-induction exercise. The chapter explains how past and current encounters with LGBTQ-related stress can elevate LGBTQ individuals’ vulnerability to experience uncomfortable emotional experiences in the face of life stressors. It notes that many LGBTQ people use substance as a primary way of coping with stress.
Module 6: Countering Emotional Behaviors
Authors: Pachankis John E. , Harkness Audrey R. , Jackson Skyler D. , Safren Steven A.
Published: August 2022

This chapter explores the concept of emotional behaviors, such as avoidance, and how LGBTQ-related stress experiences can contribute to emotional behaviors. It presents examples of different types of emotional behaviors and looks at the client’s own unhelpful emotional behaviors that derive from LGBTQ-related stress. It demonstrates the paradoxical effects of emotion avoidance and how emotional behaviors get maintained and strengthened, providing a rationale for alternative actions. The chapter notes that some clients have difficulty slowing down to notice or challenge their automatic thoughts while experiencing strong emotions. It reinforces the importance of continuing to practice the skill of identifying and challenging clients’ automatic thoughts, which will increase their awareness of the sequence of their emotions and provide opportunities to alter their interpretations of emotional triggers.
About This Treatment
Authors: Pachankis John E. , Jackson Skyler D. , Harkness Audrey R. , Safren Steven A.
Published: August 2022

This chapter focuses on LGBTQ-affirmative cognitive behavioral therapy (CBT), including where it came from, how it was developed, and how it can help to address some of the specific stressors an LGBTQ person might face. It introduces the concept of LGBTQ-related stress and the role that it can play in the emotional experiences of LGBTQ people. It also explores the rationale for LGBTQ-affirmative CBT, which is designed for LGBTQ people who are currently experiencing uncomfortable emotions that over time can cause depression, anxiety, and related emotions and behaviors that cause distress. The chapter describes LGBTQ-affirmative CBT as a mental health treatment created for LGBTQ people by LGBTQ people. This treatment is based on CBT that has a particular focus on helping people better understand and respond to their emotional experiences.
Module 2: Understanding the Nature and Emotional Impact of LGBTQ-Related Stress
Authors: Pachankis John E. , Jackson Skyler D. , Harkness Audrey R. , Safren Steven A.
Published: August 2022

experiences of LGBTQ-related stress, including how that stress may make a patient’s general stress worse. It points out that one of the most effective ways to make changes is through setting goals and breaking them down into clear, achievable steps. It also helps a patient reflect on how LGBTQ-related stress may be affecting them in their daily life. The chapter discusses how the LGBTQ people face LGBTQ-related stress as a result of a lifetime of being treated differently and often worse than non-LGBTQ people. When these experiences build up over time, many LGBTQ folks may feel like they have less control over their life and might feel unsure about their future.
Module 4: Increasing Mindful Awareness of LGBTQ-Related Stress Reactions
Authors: Pachankis John E. , Jackson Skyler D. , Harkness Audrey R. , Safren Steven A.
Published: August 2022

This chapter helps increase the patient’s ability to experience emotions in the moment, with fuller acceptance and less judgment. It highlights the concept of nonjudgmental emotion awareness, or mindfulness, and provides opportunities to practice it within a patient’s daily life. It also considers this present-focused awareness as a first step towards finding better ways to cope with emotions. The chapter describes a skill that can help patients to not only face their emotions, but also to accept them, allow them to pass, and learn from them. LGBTQ people might experience strong uncomfortable emotions as their everyday stress builds on top of their LGBTQ-related stress, which make them feel more stress overall and feel it more strongly.
Module 5: Increasing Cognitive Flexibility
Authors: Pachankis John E. , Jackson Skyler D. , Harkness Audrey R. , Safren Steven A.
Published: August 2022

This chapter explores the impact of LGBTQ-related stress on a patient’s thoughts, including negative opinions they may have about themselves, others, and their future. It help patients identify their stressful ways of thinking. Automatic thoughts are the first thoughts people have about new situations; they help people filter out unimportant information in order to respond quickly. The chapter explains why it is useful to focus on only a few key pieces of information, such as the facial expressions of a person during a conversation, while ignoring other information, such as the sounds of cars honking during the conversation. Research shows that because LGBTQ people often have negative experiences, they are more likely than heterosexual or cisgender people to have negative thinking styles, which can cause depression or anxiety.
Module 6: Countering Emotional Behaviors
Authors: Pachankis John E. , Jackson Skyler D. , Harkness Audrey R. , Safren Steven A.
Published: August 2022

This chapter analyzes how emotions can drive a person’s behaviors called emotional behaviors, which usually serve important functions. For example, emotional behaviors often reduce how intense an emotion is and can even help a person survive difficult situations. However, it also points out that some emotional behaviors may be less helpful and even harmful when used all the time or in certain contexts. The chapter helps patients identify situations, activities, and people that lead them to use unhelpful emotional behaviors. It talks about the development of different behaviors for distressing situations to improve a patient’s mood, relationships, and self-esteem so that emotional behaviors can start losing the power they currently have on their life.
Module 7: Experimenting with New Reactions to LGBTQ-Related Stress
Authors: Pachankis John E. , Jackson Skyler D. , Harkness Audrey R. , Safren Steven A.
Published: August 2022

This chapter talks about how many LGBTQ people falsely learn from an early age, based on their lived experience, that they do not have the right to stand up to stigma or to stand up for their needs or wants. It emphasizes the recognition of how patients might be “silencing” themselves around others because they expect to experience stigma. It also demonstrates how patients can communicate their needs and wants rather than holding themselves back, and how patients can be their most effective self in social situations. The chapter mentions the difficulties in changing emotional behaviors as change involves facing the difficult emotions that come along with emotional behaviors. Many LGBTQ people feel isolated, guilty, and ashamed because they live in a society that invalidates their experiences and denies them some of the same rights and respect that others get.