bluuebunny/crossref_metadata_2025 huggingface dataset:
Avoidant/Restrictive Food Intake Disorder
Authors: Menzel Jessie
Published: October 2017

Avoidant/restrictive food intake disorder (ARFID) captures a broad range of restrictive eating behaviors and presents challenges to treatment providers due to the lack of treatment guidelines. Individuals diagnosed with ARFID may present with extreme selective or picky eating, food phobias, or generally poor appetite. This chapter describes the prevalence and clinical characteristics of ARFID. It also provides treatment recommendations for ARFID that are drawn from the literature on eating disorders, anxiety disorders, and feeding disorders. Family-based treatment approaches, similar to those used in treating anorexia nervosa, are recommended to target weight restoration and correct disruptive mealtime behaviors. Cognitive–behavioral approaches used in treating other anxiety and mood disorders may be helpful in targeting specific food fears. Other adaptations of treatment are discussed for addressing the presence of extreme selective or picky eating.
Anorexia Nervosa with a History of Obesity or Overweight
Authors: Lebow Jocelyn , Sim Leslie
Published: October 2017

The relationship between obesity and restrictive eating disorders is poorly understood and fraught with many misperceptions. Unfortunately, these misperceptions pose challenges for identification and treatment of eating disorders, and may even increase eating disorder risk in higher weight status individuals. Research suggests that restrictive eating disorders are prevalent in individuals with a history of overweight or obesity, and although these individuals may present to treatment at a higher weight, they should not be mistaken to have a subclinical or less malignant illness. In fact, there is mounting evidence that these individuals can have equally as serious or even more severe symptoms, consequences, and comorbidities, and their eating disorder may take significantly longer to be identified than patients with no overweight history. Research is needed to inform treatment adaptations for these individuals, to address realistic fear of weight gain and set appropriate weight restoration goals, as well as to inform prevention interventions.
Diabetes and Eating Disorders
Authors: Abascal Liana , Goebel-Fabbri Ann
Published: October 2017

Rates of eating disorders are higher in patients with type 1 and type 2 diabetes than in the general population. Types of eating disorders include anorexia; bulimia; binge-eating disorder; subclinical eating disorders; and an eating disorder unique to type 1 diabetes, intentionally restricting insulin doses as a calorie purge—often referred to by laypeople as “diabulimia.” Women with diabetes and eating disorders (including disordered eating behaviors) have significantly elevated blood glucose ranges, higher rates of hospitalization, higher rates of diabetes complications, and, in some cases, higher mortality rates. This chapter discusses risk factors, presentation, and identification of eating disorders within the diabetes population. Specific recommendations are given for this difficult-to-treat population, including the need for an expanded treatment team as well as the need to establish mutually agreed upon and incremental diabetes management goals.
Muscle Dysmorphia
Authors: Griffiths Scott , Murray Stuart B.
Published: October 2017

Muscle dysmorphia is a recently identified, complex, and largely unknown psychiatric disorder. Individuals with muscle dysmorphia typically report preoccupation with thoughts of attaining greater muscularity; conceal their bodies in public; have poor levels of insight into their preoccupation; report extreme functional impairment due to their preoccupation; have elevated rates of comorbid eating, mood, anxiety, and body dysmorphic disorders; use steroids; exercise compulsively; are strong adherents to traditional male gender roles; and report an elevated history of suicide attempts. Treatments for eating disorders and body dysmorphic disorder may be effective for muscle dysmorphia, and case report evidence has shown family-based therapy to be effective for adolescent muscle dysmorphia. Additional treatment strategies include dismantling ego-syntonic beliefs and toxic beliefs surrounding masculinity. Comorbid steroid use and/or dependence complicates treatment and may require incorporating an endocrinologist into the treatment team.
Rumination Disorder in Adults
Authors: Murray Helen B. , Thomas Jennifer J.
Published: October 2017

Rumination disorder has classically been categorized as a disorder of infancy or early childhood. However, a number of recent reports describe rumination symptoms in adults, particularly in the setting of disordered eating. Although there is no established cognitive–behavioral model of rumination disorder, hypothesize that some maintaining mechanisms are common to all cases (e.g., habit), whereas others (e.g., anxiety, shape and weight concerns, and learned associations with specific foods) vary across individuals. No standard treatment currently exists for rumination. Although some cognitive and behavioral interventions appear to be effective based on case reports, little systematic research supports their generalizability across cases. To propel the field forward, this chapter offers a conceptual framework for the development and maintenance of rumination disorder in adults, and it introduces a novel treatment—cognitive–behavioral therapy for rumination disorder (CBT-RD)—as a resource for practicing clinicians.
Atypical Eating Disorders and Specific Phobia of Vomiting
Authors: Keyes Alexandra , Veale David
Published: October 2017

Some individuals with specific phobia of vomiting (SPOV) (emetophobia) may present with disordered eating, including food restriction and weight loss. Such cases may be misdiagnosed as anorexia nervosa (AN), thus complicating case conceptualization, formulation, and treatment. This chapter outlines the clinical features of SPOV, including those that overlap with AN and other disorders. Treatment approaches and their evidence base are discussed, and a clinical case example of an individual with SPOV and disordered eating is presented. More research is needed to address the overlap between eating disorders and SPOV in order to better distinguish overlaps in presentation and to develop treatments that effectively target the central fears in these cases.
Pediatric Eating Disorders
Authors: Gray Emily K. , Eddy Kamryn T.
Published: October 2017

Eating disorders typically appear during childhood or adolescence, but they can go unrecognized by clinicians or parents, delaying diagnosis and treatment. Early recognition and treatment is essential because early disordered eating patterns can be associated with an eating disorder diagnosis in adolescence or adulthood. Children presenting with an eating or feeding disorder offer a unique set of challenges. The feeding and eating disorders share a common pattern of maladaptive eating behaviors and impaired quality of life, and although the diagnoses have distinct clinical concerns, issues pertaining to assessment and treatment are overlapping. This chapter reviews the clinical presentations of feeding and eating disorders in youth aged 7–13 years, including assessment strategies and treatment approaches.
Eating Disorders in Athletes
Authors: Plateau Carolyn R. , Arcelus Jon
Published: October 2017

Eating disorders are highly prevalent among athletes and particularly among competitors in sports in which weight is integral to performance (e.g., aesthetic sports such as dancing and endurance sports such as distance running). Early management of mild eating disorders and disordered eating in athletes may be the most effective way of preventing the development of severe eating disorders. However, the early detection and treatment of eating disorders in this population carries some unique challenges, which are discussed in this chapter. Because the presentation of eating disorders among athletes and dancers can differ from the norm, modified treatments may be required. Currently, there is a lack of research exploring the efficacy of evidence-based treatment approaches within the athletic population.
An Outline of IPT
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

As an acute treatment, IPT has three phases: a beginning, a middle, and an end. Each phase lasts a few sessions and has specific tasks. A fourth phase may follow acute treatment: namely, continuation or maintenance treatment, for which therapist and patient contract separately. Key steps in the initial sessions are defining and diagnosing depression, exploring the patient’s interpersonal inventory of current relationships to find potential social supports and interpersonal difficulties, providing the sick role, setting a time limit, defining an interpersonal focus, and linking the focus to the depressive diagnosis in a focal formulation. In the intermediate sessions, therapist and patient work on one of the four IPT problem areas: grief, role dispute, transitions, or deficits. Termination of this time-limited therapy is addressed in the last few sessions.
What Is IPT?
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

IPT is a time-limited, specified psychotherapy developed initially for patients with major depressive disorder and later adapted for other disorders as well. IPT is based on the idea that the symptoms of depression have multiple causes, genetic and environmental. Whatever the causes, however, depression does not arise in a vacuum. Depressive symptoms are usually associated with something going on in the patient’s current personal life, usually in association with people the patient feels close to. The goals of IPT are to reduce the symptoms of depression and to help the patient deal better with the people and life situations associated with the onset of symptoms. This chapter provides an overview of the underlying theory and discusses the concepts and goals of this treatment. The types of depression are defined: major depression, MDD, dysthymic (persistent depressive) disorder, bipolar disorder, and mild depression.
Grief
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

The symptoms of a normal grief reaction typically resolve over the course of a few months as the person processes the loss, thinking through remembered experiences with the deceased. This period of grief or mourning is a normal, useful, adaptive process. In contrast, in complicated grief, the person tries to contain her emotions, distancing herself from emotional life. This postponing and avoidance of grief is characteristic of complicated bereavement, a long-recognized form of major depression. This chapter discusses both normal and complicated grief and how grief is defined by the DSM-5 and how it presents as a problem area in IPT. The two goals of the therapist are to facilitate mourning (catharsis) and to reestablish interests and relationships that can to some degree substitute for the person and the relationship that have been lost. Case examples are included.
Role Disputes
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

IPT defines an interpersonal role dispute as a situation in which the patient and an important person in the patient’s life have differing expectations about their relationship. This leads to either an open or a tacit struggle. The depressed individual is invariably losing out in this conflict, which may be either a source or consequence of a depressive episode. This chapter covers definition, goals, and strategies when working with this problem area of role disputes. The three stages of role dispute are renegotiation, impasse, and dissolution. To manage a role dispute, patients need to recognize their own feelings about what they want and don’t want, feelings about the relationship and the other person, and what might constitute a reasonable compromise. Case examples of role disputes are included.
Termination and Maintenance Treatment
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

This chapter covers strategies relating to the termination of IPT and maintenance treatment. Sessions usually run weekly for twelve or sixteen weeks for treatment of acute major depression. The therapist and patient make an explicit contract at the beginning of treatment about its frequency and length. Several sessions before the end of that agreed-upon interval, the therapist begins the third, termination phase with an open discussion about the end of the treatment, and reviews what has been accomplished and what remains to be done. The patient is encouraged to discuss any feelings, positive or negative, about ending the therapy. Maintenance IPT is in most respects like acute treatment; the focus remains on interpersonal functioning and mood in relation to life events. A case example of maintenance therapy is included.
IPT Techniques and the Therapist’s Role
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

The time spent in IPT focuses on discussing feelings, normalizing them as responses to interpersonal interactions and as useful interpersonal information, and using them to take action to change the patient’s interactions in order to resolve the identified problem area. Therapists can use the techniques discussed in this chapter to accomplish this. IPT techniques are nondirective exploration, direct elicitation, encouragement of affect, clarification, communication analysis, decision analysis, and role play. The therapeutic relationship and the therapist’s role in IPT are also described. The therapeutic relationship may reflect how the patient thinks and acts in other close relationships. For example, the therapeutic relationship can be used in role disputes to give feedback on how patients come across to others and to help them understand maladaptive approaches to interactions.
Common Therapeutic Issues and Patient Questions
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

This chapter reviews common therapeutic issues and various questions asked by patients during IPT. Common therapeutic issues include deciding whether a patient’s main problem is a psychiatric illness or a personality disorder, dealing effectively with passive or intellectualizing patients, keeping to the agreed-on focus and time limit of treatment, and making therapeutic use of silence in session. Technical issues such as rating scales and recording sessions are discussed, and IPT was contrasted with other types of psychotherapy such as CBT. Common patient questions include how IPT works, therapist credentials, lateness to sessions, family members attending treatment sessions, the genetic and biological basis of depression, the use of alcohol and drugs, recurrence of depression, and suicide. Some problems that are more often seen in primary care settings are also covered, such as depression manifesting through physical symptoms and poor adherence to treatment.
Depression in Adolescents and Children
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

This chapter covers the use of IPT for the treatment of depression in adolescents and children. Adaptations of IPT when used in treating depressed adolescents include flexibility, definitions of the sick role, the involvement of parents or guardians, the use of information from outside sources, and confidentiality. Obtaining information about the interpersonal context of depression and using the interpersonal inventory are similar in adolescents and adults. Depression prevention programs have been developed for teenagers. Depression is uncommon in preadolescents, but family-based IPT has promise as an efficacious intervention with readily measurable targets and mechanisms of action.
Depression in Older Adults
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

Depression ranks among the most common psychiatric diagnoses in older adults. This chapter gives an overview of the use of IPT for depression in older adults. Older patients presenting for treatment of major depression should undergo a complete medical evaluation to rule out comorbid general medical illness that may account for the symptoms. Older adults find the medical model of depression used in IPT appealing because their other health problems often render it familiar. They may be less acquainted with the view of depression as a medical illness and may need psychoeducation about depression and its treatment. Therapists who are treating geriatric patients need to fight negative, ageist views of the elderly. Ample evidence from controlled clinical trials shows that psychotherapy, particularly IPT, is a useful, efficacious, and accepted treatment in depressed elderly adults. A case example of the use of IPT in a widower is provided.
Persistent Depressive Disorder/Dysthymia
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

This chapter describes the adaptation of IPT for the treatment of patients with persistent depressive disorder/dysthymia. The usual IPT model connects a recent event in the patient’s life with current mood and symptoms, but for patients who have been depressed for years, this model makes less sense. Instead, the IPT therapist makes the treatment itself a role transition from longstanding depression to euthymia in which patients learn to recognize depressive symptoms of long duration and how they have affected their social functioning. The therapist offers a formulation that shifts the blame for the patient’s situation from the patient to the illness. Treatment includes sixteen weekly sessions to drive these points home, although monthly continuation sessions and maintenance therapy are frequently offered so that patients’ new self-image and track record of healthy interpersonal functioning can sink in. A case example is given of a chronically depressed woman who improves with IPT.
Bipolar Disorder
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

This chapter covers the treatment of bipolar disorder using an adaptation of IPT called Interpersonal and Social Rhythm Therapy (IPSRT). An amalgam of IPT with behavioral therapy developed by Frank and colleagues, IPSRT is an efficacious adjunct to medication for patients with bipolar I disorder. The behavioral component addresses coordination and stabilization of daily behaviors, especially the preservation of sleep, which is a critical factor in avoiding manic episodes, and modulation of environmental stimulation, whereas IPT targets the depressive aspects of the disorder. This combination represents an important extension of IPT into novel treatment territory. IPSRT is the first IPT adaptation to be designed as an adjunct to medication, rather than as a standalone, primary treatment; it is also the first attempt to integrate IPT with a behavioral approach. A case example is provided of the use of IPSRT in a patient with bipolar II disorder.
Eating Disorders
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

This chapter provides an overview of the use of IPT for patients with eating disorders. The most common eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder. The chapter discusses the adaptations of IPT that have been used for the treatment of eating disorders and evaluates their performance in research studies. The assumption for testing IPT with eating disorders is that they occur in response to distress at poor social and interpersonal functioning and consequent negative mood, to which the patient responds with maladaptive eating behaviors. For anorexia nervosa, few data provide evidence for the benefit of IPT. For bulimia and binge eating disorder, however, IPT is considered a viable option for treatment and is recommended in numerous guidelines. A case example of a woman with bulimia nervosa is provided.
Anxiety Disorders
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

This chapter discusses the use of IPT for patients with social anxiety disorder (social phobia) and panic disorder. Anxiety and depression frequently overlap, and the focal IPT problem areas fit both categories of syndromes. Like depressed patients, anxious individuals are often risk-averse. The general IPT approach for mood disorders has seemed to need little overhaul for anxiety disorders: the usual focal problem areas and approaches still apply, simply linking life events and interpersonal circumstances to anxiety states rather than to mood states. For patients with panic disorder, IPT seems an intuitively reasonable intervention that takes a very different approach from somatically focused forms of CBT. The findings for IPT in anxiety disorders are encouraging but preliminary and need confirmation in controlled trials. A case example describes a businessman with social anxiety disorder.
Borderline Personality Disorder
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

Borderline personality disorder (BPD) is a prevalent, debilitating syndrome. Patients with BPD heavily utilize mental health services and have historically had a poor prognosis. In the IPT adaptation for BPD, the therapist presents BPD to the patient as a poorly named syndrome that has a significant depressive component. The goals of IPT in this population are threefold: to link mood (including anger) to interpersonal situations, to find better ways of handling such situations, and to build better social supports and skills. When patient–therapist problems crop up, the therapist addresses them in a here-and-now, interpersonal fashion rather than making psychodynamic interpretations. Because patients with BPD are sensitive to abandonment, termination is discussed early and often. Research on the use of IPT in patients with BPD is tantalizing but fragmentary, in need of a larger and more definitive trial.
IPT Across Cultures and in Resource-Poor Countries
Authors: Weissman Myrna M. , Markowitz John C. , Klerman Gerald L.
Published: October 2017

This chapter covers the dissemination of IPT across cultures and in resource-poor countries such as Uganda and Ethiopia. Two important organizations are described: the World Health Organization and the International Society of Interpersonal Psychotherapy, a multidisciplinary, nonprofit, noncommercial international organization that is committed to the advancement of IPT through research, training, and dissemination. The principles of adapting IPT to different cultural contexts are straightforward, although IPT clinicians must proceed carefully in approaching cultures to which they do not belong. This chapter describes the development and results of IPT programs adapted for use with depressed patients in Uganda. As IPT proved easily transplantable to Uganda, it is likely to fit into many cultures with relatively minor adjustment. Implementation of IPT for humanitarian reasons is growing at an impressive pace.
Major Techniques and Interventions
Authors: Conoley Collie W. , Scheel Michael J.
Published: October 2017

This chapter present the techniques and interventions of Goal Focused Positive Psychotherapy (GFPP). Highlighted are the therapist’s intentions to emphasize the client’s strengths and to facilitate the expression of positive emotions, hope, and goals while focusing on the therapeutic alliance. Psychotherapy is not viewed as a set of potent scripted treatments that act upon the client. The therapeutic techniques include nonverbal communication, mirroring, open and closed questions, paraphrase and reflection, challenge, summarizing, empathy, interpretation, self-disclosure, immediacy, information giving, and direct guidance. The interventions include capitalization, self-affirmation, formula-first-session-task, reframing, success-finding, encouragement, visualizing success, miracle question, scaling questions, best-possible-self, count your blessings, self-compassion, and mindfulness. The practitioner is urged to use GFPP’s theoretical model to guide the treatment intentions and use any techniques and interventions that fit with the client and the GFPP model.
Training Therapists in GFPP and Building GFPP Skills
Authors: Conoley Collie W. , Scheel Michael J.
Published: October 2017

This chapter discusses the training of therapists based on the authentic commitment to promoting client well-being. Experiential learning of Goal Focused Positive Psychotherapy (GFPP) principles facilitates allegiance to this model. Goal Focused Positive Supervision (GFPS) is offered as a new model emphasizing supervisee strengths, approach goals, capitalizing on successes, and hopefulness. A supervision case example is given to illustrate GFPS. Supervisee training includes a developmental orientation to autonomy, relatedness, and competence. Expansion of traditional supervision models includes attention to positive supervisee events and strengths. The contagious relationship between client hope and therapist hope is highlighted. Therapist hope is required to build the therapeutic alliance. Training includes the promotion of essential GFPP therapist skills, and training methods are suggested. The Partners for Change Outcome Management System is useful in training and therapy to measure client progress toward well-being and alliance formation.
Cognitive Behaviour Therapy for Obsessive-compulsive Disorder
Authors: Bream Victoria , Challacombe Fiona , Palmer Asmita , Salkovskis Paul
Published: October 2017

Obsessive-compulsive disorder (OCD) can be a very disabling and distressing problem. Cognitive behavioural therapy (CBT) has been shown to be very effective in helping people to overcome OCD. OCD is a highly heterogeneous disorder, often complicated by contextual factors, and therapists are often left wondering how to apply their knowledge of treatment to the particular problems as they face them in clinical practice. This book guides the reader through understanding the background to and principles of using CBT for OCD in a clear practical ‘how to’ style. It also elucidates the particular challenges and solutions in applying CBT for OCD using illustrative case material and guidance on formulation-driven intervention. The book also addresses commonly occurring complexities in the treatment of OCD; for example, working with comorbidity, perfectionism, shame, and family involvement in symptoms. Throughout the book, tips are provided on receiving and giving supervision to troubleshoot commonly encountered problems. This book provides a guide to improved practice for clinicians at all levels of experience.
Before you meet someone with obsessive-compulsive disorder: understanding the problem
Authors: Bream Victoria , Challacombe Fiona , Palmer Asmita , Salkovskis Paul
Published: October 2017

This chapter provides detailed background information on obsessive-compulsive disorder (OCD) that will give the therapist a clear understanding of current knowledge about the context and causes of this problem. Research evidence on the epidemiology of OCD, impact, and causal factors is presented. Here we introduce the cognitive-behavioural model of OCD, offering a discussion of the key elements of this model. The chapter will also include case examples to illustrate different manifestations of OCD (including contamination, checking, rumination, just-right feelings) and common processes that are key in the maintenance of obsessional problems (for example, reassurance-seeking and magical thinking). This chapter reviews the evidence base for the treatment of OCD, including medication, and identifies cognitive-behavioural therapy (CBT) as the recommended treatment.
Cognitive-behaviour therapy for obsessive-compulsive disorder
Authors: Bream Victoria , Challacombe Fiona , Palmer Asmita , Salkovskis Paul
Published: October 2017

This chapter guides the reader through the process of eliciting a shared understanding of obsessive-compulsive disorder (OCD), working collaboratively with the client—a cornerstone of the cognitive-behaviour therapy (CBT) approach. Step-by-step guidance includes examples of therapy dialogue for key aspects of this process. The emphasis in CBT is typically focussed on the here-and-now; this chapter emphasizes how to elicit a maintenance formulation that focusses on how the problem operates in day-to-day life. There is guidance on how much developmental information to include and how much emphasis to place on this. The chapter breaks down different stages of the therapy process, beginning with how to develop a credible alternative explanation to the person’s existing beliefs about their OCD—building up a ‘theory A/B’. This forms the basis for the remainder of the treatment, which essentially involves the client engaging in a process of putting the two theories to the test, often using behavioural experiments. A range of metaphors is described.
How the engine works: Trust and making sense of each other and ourselves
Authors: Bevington Dickon , Fuggle Peter , Cracknell Liz , Fonagy Peter
Published: October 2017

This chapter lays out AMBIT’s core integrating theory of mentalizing, and the developmental and experimental research evidence supporting it. Mentalizing is a specific (prefrontal cortical) activity of mind, directed at explaining an agent’s (one’s own or another’s) behavior on the grounds of presumed or imagined intentional mental states. The chapter covers evidence from developmental and attachment studies supporting this. The multidimensional nature (automatic–controlled, self–other, internal–external, cognitive–affective) and complexity of this activity is described, as well as the implications when it fails—as it frequently does, given its fragility in the face of anxiety or arousal. Finally, the role of mentalizing in allowing access to learning from another person is explored. It is a powerful ostensive cue, triggering epistemic trust (trust in the social value of information that a helping individual may have to offer). AMBIT is reframed as a systemic application of this theory of communication.
Working with your client
Authors: Bevington Dickon , Fuggle Peter , Cracknell Liz , Fonagy Peter
Published: October 2017

The first quadrant of the AMBIT wheel is presented, focusing on mentalizing in face-to-face client work. The “therapist’s mentalizing stance” (first developed in mentalization-based treatment) is described—behavioral prompts promoting a “way of being with” the client to foster mentalizing. Next, the “Mentalizing Loop” is described: a sequence of activities providing structure for sessions. Common sources of “unbalance” in the work are explored that can make it stressful; this is particularly expressed in the common tension between “Scaffolding existing relationships” and “Managing risk,” two often apparently contradictory elements of AMBIT’s principled stance. Broadcasting intentions, and other explicit mentalizing techniques, are presented, leading on to a presentation of the AMBIT wheel from the client’s perspective, emphasizing parallel helping processes between worker and client. The place of other (non mentalization-based) specific evidence-based interventions within AMBIT frameworks is discussed. Risk assessment, and the tension between support and challenge, is described.
Working with your networks
Authors: Bevington Dickon , Fuggle Peter , Cracknell Liz , Fonagy Peter
Published: October 2017

This chapter describes the third quadrant of the AMBIT wheel: efforts toward improving networks around clients. Typical networks around complex clients are described, emphasizing the diverse ways constituent parts are understood by each other (and understand themselves), and the reciprocal ways these influence function. Systemic and positioning theories explain the tendency of networks to organize around concrete understandings of roles, responsibilities, and accountabilities. The inevitability of “dis-integration” across such ‘industrially designed’ networks is described, alongside AMBIT’s intention to reduce blame and shame as primary drivers in networks. The AMBIT stance describes the paradoxical demand that workers must both address multiple domains in a client’s life (requiring large networks) and take responsibility for minimizing the harms of dis-integration that these networks entail. Rather than describing (teleological) reorganization as the only possible response, systematic practices and tools to increase mindfulness about the minds that make up systems are presented: the un-service-centric stance, Dis-Integration Grids, Pro-grams, and sculpting.
Learning at work: Toward a learning stance in teams
Authors: Bevington Dickon , Fuggle Peter , Cracknell Liz , Fonagy Peter
Published: October 2017

Team learning, the focus of the fourth quadrant of the AMBIT wheel, is justified by strong evidence about the weak translation of evidence-based trainings into practice fidelity, and weak clinical outcomes from even the most powerfully evidenced practices. The need for strong leadership (and what this entails) to support development of a learning organization is described. Research findings on quality improvements and outcomes in health and social care settings lead to a framework of AMBIT competencies. The notion of local team “manualization” is introduced; this is the systematic effort of a team over time to reflect upon and record (mentalize) how the team works, and why. Discussion of treatment manuals and (as the AMBIT stance presents it) the tension between “Respect for evidence” and “Respect for local practice and expertise” lead to notions of co-construction. Technical aspects of AMBIT’s wiki manual are described, along with how these aspects support a community of practice and mirror “open-source” IT developments.
“It was somebody I could trust”: A descriptive case study of one young man’s experience with an AMBIT-influenced team
Authors: Bevington Dickon , Fuggle Peter , Cracknell Liz , Fonagy Peter
Published: October 2017

This chapter presents an interview by a keyworker of a client (pseudonym Thomas) recently discharged from an AMBIT-influenced team, reflecting on his experiences of that episode. A verbatim account is provided of Thomas describing memories of the therapeutic relationship, issues of trust, similarities and differences between his experience of this team and of others, his thoughts about other people who helped him, and what made the difference. A commentary by the worker follows, commenting on her experience of the work, framing Thomas’s comments in relation to AMBIT’s principled stance and core features, and discussing how an AMBIT framework and AMBIT-influenced team helped steady her in work that was, at times, unsettling and isolated.
There is no such thing as a standard AMBIT team
Authors: Bevington Dickon , Fuggle Peter , Cracknell Liz , Fonagy Peter
Published: October 2017

The chapter offers accounts by seven different teams trained and working in AMBIT-influenced ways, illustrating a variety of settings, the ways in which AMBIT has helped to improve their practice, and the challenges they faced. The chapter starts with an analogy comparing AMBIT with the operating system of a computer, which may run multiple different types of programs to address specific issues. The seven teams are: (i) an intensive CAMHS adolescent outreach service in London, designed to reduce inpatient admissions, (ii) a Tier 4 specialist adolescent inpatient unit in East Anglia, managing high risk/highly challenging behaviors, (iii) a voluntary sector outreach team working in London with highly excluded and gang-related young people, (iv) a therapeutic residential community for children with severe disturbance in the USA, (v) an intensive CAMHS community treatment service in Scotland, (vi) a service for young people on the edge of care in London, and (vii) a young people’s substance use service in a mixed urban/rural setting in the UK.
Adopting the AMBIT approach to changing wider systems of help
Authors: Bevington Dickon , Fuggle Peter , Cracknell Liz , Fonagy Peter
Published: October 2017

AMBIT is now beginning to address larger whole systems of professional help, predicated on four assumptions: help is relational, contingent on trust, and requires collaboration, and processes are all underpinned by effective mentalizing. To illustrate this, problems in the UK’s existing service delivery model for children and young people are presented, followed by a description of a novel approach (the THRIVE model) organizing offers of help around service users’ needs, wishes, and help-seeking behaviors, rather than the technical specialisms that the system offers. AMBIT develops ways of delivering the offer described by THRIVE as “supportive risk management” for families not wanting or responding to advice-giving for self-management, or to specific forms of therapeutic help, or to more specialized/adapted evidence-based practices. Next, the systemic and organizational assumptions in AMBIT are described, especially the invitation for practitioners to relate to existing systems of help (formal and informal), which professional workers of any type must inevitably join (or disrupt).
Future ambitions for the AMBIT project
Authors: Bevington Dickon , Fuggle Peter , Cracknell Liz , Fonagy Peter
Published: October 2017

The evidence for AMBIT is described, together with our intentions regarding future development and dissemination. Existing evidence, and its limits, is sketched out. Challenges for future data collection/analysis are highlighted in relation to a “model” that is, by design, broad and adaptable, rendering “fidelity” difficult to define in conventional terms. Opportunities for meaningful randomized trials are limited, but possible. A description of AMBIT’s strategy for future model development (referencing open-source computing, learning organizations, and quality improvement models) concludes with a summary of AMBIT’s “evidence-informed” approach. AMBIT’s role as a learning system is supported by innovative web-based collaborations (for instance POD, a pooled online data system). Diverse training methods and reflective self-audit questions for teams considering training are described. Skepticism about how conventional trainings could ever create the necessary “step change” in services is balanced by the opportunities for dissemination offered by web-based learning and devolved engagement of a community of practice.
Who Are the School Mental Health Professionals?
Authors: Kininger Rachel , Schultz Brandon K. , Harrison Judith R.
Published: October 2017

This chapter from School Mental Health Services for Adolescents provides an overview of the professionals most often at the forefront of school mental health service delivery, including teachers, school counselors, school psychologists, school social workers, and school nurses. It explores the training these professionals typically receive, as outlined by the relevant professional accrediting bodies, and discusses the roles these professionals assume in schools. The chapter also explores how those roles have evolved in recent years in relation to expanded school mental health (ESMH) efforts. It is clear that school mental health practitioners have training comparable to their community-based counterparts, but this capability is routinely underutilized in practice.
Supporting Students Following School Crises
Authors: Vona Pamela , Jaycox Lisa H. , Kataoka Sheryl H. , Stein Bradley D. , Wong Marleen
Published: October 2017

The chapter “Supporting Students Following School Crises: From the Acute Aftermath Through Recovery,” in School Mental Health Services for Adolescents, provides an overview of the strategies and interventions used in schools to mitigate the impact of school crises on adolescents. It provides a definition of school crisis, describes the impact of school crises on students and the school system, and offers a historical perspective on crisis response in schools. The chapter merges the President’s Policy Directive (PPD-8) with the Positive Behavior Interventions and Supports (PBIS) framework to describe the universal, early intervention, and targeted interventions that schools can implement to provide a continuum of care from disaster preparedness to long-term recovery. Strategies for integrating these practices into the school community are discussed.
Emotion Regulation and Social Functioning in Adolescence
Authors: Bunford Nora , Evans Steven W.
Published: October 2017

The chapter “Emotion Regulation and Social Functioning in Adolescence: Conceptualization and Treatment,” in School Mental Health Services for Adolescents, is focused on the development of emotion regulation into adolescence and considers ways in which such development can go awry and result in emotion dysregulation (ED). The chapter argues that ED often contributes to the social impairment adolescents experience in the home, peer, and school settings, and that psychosocial interventions for teens should both (1) target ED and social impairment and (2) be such that they are deliverable by school mental health professionals with gains generalizable to relevant settings. The chapter describes and reviews empirical evidence on the effectiveness of one such intervention, the Interpersonal Skills Group (ISG), designed for adolescents to target ED and social impairment.
Working with Adolescents with Autism Spectrum Disorder
Authors: Koegel Lynn Kern , Kim Sunny , Koegel Robert L.
Published: October 2017

The chapter “Working with Adolescents with Autism Spectrum Disorders,” in School Mental Health Services for Adolescents, provides information and guidance related to identification and referral, evidence-based practices, and service delivery issues and models for adolescents with autism spectrum disorder (ASD). The authors open the chapter with a brief history of autism, beginning with the category of Pervasive Developmental Disorder in the DSM-III in 1980, and culminating with the changes made in criteria for ASD in the DSM-5 in 2013. Next, the authors explore issues related to assessment, including diagnosis of ASD during adolescence and assessing challenges to be targeted in schools. They then describe evidence-based practices that can be implemented to train teachers and paraprofessionals, intervene with ASD, and avoid problems before they occur. Finally, the authors present service delivery issues and models when working with adolescents with ASD in secondary schools.
Mental Health Promotion With Aboriginal Youth
Authors: Crooks Claire V. , Dunlop Caely
Published: October 2017

Aboriginal youth in Canada are at disproportionate risk for a range of mental health concerns compared to their non-Aboriginal counterparts. To address this disparity, communities, researchers and policymakers have called for culturally relevant prevention and intervention programming to mitigate risk and promote well-being. A number of promising initiatives have been developed that are grounded in culture. The goal of these programs is to maximize the protective influence of multiple facets of culture in youth’s lives, such as cultural identity, connectedness, and engagement in traditional practices. One such program is The Fourth R: Uniting Our Nations, a strengths-based, culturally relevant program delivered to Aboriginal youth in Canadian schools. This chapter outlines the rationale for promoting such programming with Aboriginal youth. We describe the development and evaluation of the Uniting Our Nations program. We also highlight the importance of authentic partnerships and committing to a time frame that is sufficient for this work.
Defining Depression and Bipolar Disorder
Authors: Neuhut Rachel , Benton Tami , Crits-Christoph Paul , Davila Marivel , Weissman Myrna , Nemeroff Charles
Published: October 2017

Chapter 1 reviews the epidemiology of depression and bipolar disorder; the definition of the disorders; and psychological, social, and biological factors that have been shown to increase the risk of mood disorders in children and adolescents. Two major developments have taken place since the publication of the previous edition of this volume: new population-based studies and the publication of the DSM-5. The epidemiologic data reported in the previous edition were based on studies of adults and extrapolated rates in youth from retrospective reports of age of onset. Since then, a number of large-scale, population-based studies of children and adolescents have been conducted. This chapter presents new data directly derived from U.S. epidemiologic studies of youth either nationally or based on a selected community. The chapter also updates risk factors based on more current research and speculates on the implications of the DSM-5 criteria changes.
Research Agenda for Depression and Bipolar Disorder
Authors: Evans Dwight L. , Craighead W. Edward , Nemeroff Charles , Neuhut Rachel , Rynn Moira
Published: October 2017

Research on child and adolescent MDD and bipolar disorder needs to proceed on many fronts to maximize the diagnosis, treatment, and prevention of these disorders. Identification of risk factors – psychological, sociological, familial, and biological – to include studies of biomarkers, genetics and epigenetics, and brain imagining are needed to inform the development of new treatments and prevention programs. Studies are needed in both MDD and bipolar disorder regarding the identification of predictors of clinical outcome and selection of psychosocial and/or pharmacological treatment(s) that are personalized for an individual patient. Maintenance studies are needed to guide optimal treatment duration. Studies focusing on the treatment and prevention of suicide are needed in both MDD and bipolar disorder. More prevention programs are needed in MDD with a focus on a full range of risk factors and the active ingredients and predictors of change that will ultimately guide a specific prevention program for a given patient. Prevention programs in bipolar disorder await further research advances in the identification of risk factors and in the characterization of early signs and symptoms to target those individuals who are at risk for the development of bipolar disorder in youth.
Treatment of Schizophrenia
Authors: Gur Raquel E. , Gur Ruben C. , Keshavan Matcheri S. , Kohler Christian , Rapoport Judith , Walker Elaine
Published: October 2017

This chapter starts by showing how interest in psychological treatments for schizophrenia have increased recently, especially in Europe and Australia. However, the issue is that there is a paucity of data concerning the application of approaches to adolescents suffering from schizophrenia. This means that inferences need to be drawn mainly from studies of adult populations. The chapter looks at how patients respond in terms of positive symptoms to antipsychotic treatment for schizophrenia. However, cognitive and negative symptoms are often slower to respond or refractory to treatment, leaving many individuals with significant social disability. The chapter concludes by arguing that sequential trials of adequate dose and duration of antipsychotics and adjunctive treatments should be employed to help patients achieve their optimal response. Psychosocial therapies such as cognitive behavioral therapy and education groups may be helpful in addressing residual symptoms and helping patients to adhere to their medication regimens.
Prevention of Schizophrenia
Authors: Gur Raquel E. , Gur Ruben C. , Keshavan Matcheri S. , Kohler Christian , Walker Elaine
Published: October 2017

This chapter introduces the topic with an overview of the current thinking on preventative measures for schizophrenia. It states that there are currently recognized precursors of schizophrenia that are apparent during adolescence. A wide variety of early intervention techniques have been developed, which draw on the knowledge of these precursors to identify individuals at risk for the illness and to prevent the predisposition toward schizophrenia from developing into the full disorder. However, prevention efforts have necessarily lagged behind studies of the risk factors, detection, and early intervention of the disease. The chapter ends by asking the question: do early intervention and prevention efforts work?