Bridging the transmission gap in attachment: The role of mind-mindedness in mothers and fathers

Antenatal attachment representations (Adult Attachment Interview classification and reflective function), 'mind-mindedness' (Meins, 1997) in relation to the foetus, and attachment to the unborn child (Condon, 1993) were assessed in 25 couples and 3 solo mothers. Families were followed up at 6 months postpartum, at which time infant-parent interaction was observed separately for mothers (N=21) and fathers (N=17). These free-play interactions were coded for parents' sensitivity (Ainsworth, Bell, & Stayton's, 1974) and mind-mindedness (Meins, Femyhough, Fradley, & Tuckey, 2001). Infant-parent attachment security was assessed using the Strange Situation in a further follow-up at 12 months for mothers (№=18) and 15 months for fathers (iV=15), with parents predicting in advance how their infants would react. Parental mind-mindedness in the Strange Situation was also assessed using Meins et al.'s (2001) scheme. The results across the four testing ages largely showed that autonomous AAI classification and RF were both positively associated with parental mind-mindedness, although in general, stronger effects were seen (a) for fathers than for mothers, and (b) using RF rather than AAI classification as the index of parental attachment representations. There was evidence for continuity in mind-mindedness from pregnancy to 6 months in mothers and fathers, but there was less continuity in mind- mindedness across different contexts than was observed over time. With respect to accuracy of parental predictions about attachment behaviours, maternal mindedness both antenatally and at 6 months was positively related to accuracy. Accuracy in mothers was also related to higher levels of sensitivity and RF. Potential pathways from antenatal attachment representations to Strange Situation via indices of infant-parent interaction (mind-mindedness or sensitivity) were explored using a descriptive approach. Regardless of whether high sensitivity or high mind-mindedness was used as the intermediary, autonomous AAI classification related to secure Strange Situation classification. Low sensitivity or mind-mindedness appeared to have a negligible impact on the likelihood of a secure attachment being formed if the parent was autonomous. Non-autonomous AAI classification coupled with low sensitivity or mind-mindedness was similarly strongly related to insecure Strange Situation classification. However, unlike for high sensitivity, having a mind- minded parent appeared to ameliorate the effect of non-autonomous AAI classification on infant attachment security, at least for fathers

Behavioural activation for overweight and obese adolescents with low mood delivered in a community setting : feasibility study

Background Mood and weight problems are common in young people, yet few treatments address both conditions concurrently. Behavioural activation (BA) has shown promise as a treatment for adults with comorbid obesity and depression. This study aimed to examine the feasibility and acceptability of a manualised BA treatment targeting weight and mood problems in young people. Methods Young people with low mood and weight difficulties were identified via a school-based screening process. Following a diagnostic interview, young people with clinically significant mood problems and concurrent overweight/obesity were invited to participate. A total of 8–12 sessions of BA were delivered by a graduate therapist to eight adolescents (four male) aged 12–15 years. Weight, mood and functioning were assessed before, during and after treatment, and a semistructured qualitative interview was conducted, along with selected outcome measures at 4 months’ follow-up. Results Low attrition and positive qualitative feedback suggested the intervention was acceptable. Trends towards a reduction in reported depression symptoms and improved functioning scores were observed at follow-up, with more mixed results for change in body mass index. Of those attending the 4-month follow-up, 57% (4/7) no longer met the screening threshold for major depressive disorder. However, low screening and baseline recruitment rates would pose challenges to executing a larger trial. Conclusions BA delivered by a graduate therapist in a British community setting is an acceptable, feasible treatment for comorbid mood and weight problems in adolescence, and its effectiveness should be evaluated in an adequately powered randomised controlled trial

A feasibility study of the effect of phone-based feedback of other commuters’ subjective experiences on driver intentions to change

Encouraging people to make sustainable transport choices remains a global challenge and many interventions have been attempted. This study investigated the reflection on own/others’ subjective experiences (SE) as an intervention using a smartphone application as the intervention tool. Participants were car drivers and used the app to automatically capture and reflect on their commute journeys and experiences. The experimental group were also able to reflect upon others’ experiences across car, walk and cycle modes. Others’ experiences were designed based on a previous self-report study. Results of the study showed that quantitative measures of intentions to change were not affected by the intervention but that qualitative data showed that the positive experience of the active transport modes did bring about reflection on behaviour and a potential influence on opinions and intentions which warrants further study

Phone-based presentation of other commuters’ subjective experiences: impact on car-driver intentions

Previous research demonstrates that people using active modes of transport (e.g. walking or cycling) generally report more positive subjective wellbeing than car drivers. This study demonstrates an experiment investigating the impact of this information on car drivers. We designed a smartphone application (CommuterExperience), which captures drivers’ subjective experiences (via comments and ratings) after the commute and displays similar data from other people using different modes of transport. After a two week trial, participants (n=18) were interviewed and qualitative data were analysed. We evaluate how the application managed to encourage comparison, foster reflection and ultimately influence opinions, intentions to change and, potentially, behaviour

Understanding parents’ school travel choices: A qualitative study using the Theoretical Domains Framework

© 2017 Elsevier Ltd Traffic related air pollution is detrimental to health and creates a substantial attributable mortality burden. It is suggested that a shift from motorised transport to active forms of travel will therefore have significant health benefits. Currently 46% of school journeys for primary aged children are made by car and this figure has risen steadily. Understanding barriers to active school travel (AST) is an important first step in developing behavioural interventions to increase active travel. The purpose of this study was to explore parents’ experiences of school travel and their choices regarding travel mode with a focus on identifying barriers and facilitators to AST. Twenty parents of primary school children (4–12 years) in the West Yorkshire region took part in semi-structured interviews regarding school travel, informed by the Theoretical Domains Framework. Framework Analysis was used to identify key themes in the data and to develop a comprehensive picture of parents’ experiences of school travel at both individual and structural levels. Distance was the biggest barrier to AST. Time constraints were reported as the main barrier to parents accompanying children in AST, while concerns about safety deterred parents from allowing children to travel independently. The need to incorporate multiple jouneys, such as the work commute and/or multiple school drop-offs, placed demands on parents’ time, while difficulty getting children into local schools meant further to travel for a number of parents. Findings suggest that interventions to promote AST may be particularly effective if tailored towards working parents. However, also addressing factors such as distance to school and school travel at a policy level may produce more significant shifts in behaviour

Multinational survey of treatment practices of clinicians managing subclinical hypothyroidism in older people in 2019

Background: International societies have recommended that levothyroxine should not routinely be prescribed in older individuals for the management of mild subclinical hypothyroidism (SCH). However, it is unknown whether clinicians managing people with SCH are either aware of or adhere to these guidelines. Methods: A web-based survey of members of several international thyroid associations and general practitioners in North-East England was conducted. Respondents were presented with a vignette of an 80-year-old gentleman with mild persistent SCH experiencing tiredness. Multivariable logistic regression analyses were performed to evaluate predictors of awareness of guidelines and responses to treatment. Results: The survey response rate was 21.9% (565/2,583). Only 7.6% of clinicians were unaware of guidelines regarding management of SCH in older people. Twenty percent of clinicians stated that they would treat the older patient with mild SCH, whereas 13% were unsure. Clinicians from North America were more likely to treat the older person with mild SCH than clinicians from elsewhere (OR 2.24 [1.25–3.98]). Likewise, non-endocrinologists were also more likely than endocrinologists to treat the older person with mild SCH (OR 3.26 [1.45–6.47]). Conclusion: The majority of clinicians are aware of guidelines regarding management of SCH in older individuals. However, a considerable proportion of clinicians would still treat an older person with non-specific symptoms and mild SCH. These guidelines need to be disseminated more widely and more research is required to understand barriers to adherence to international recommendations

Effects of a novel, brief psychological therapy (Managing Unusual Sensory Experiences) for hallucinations in first episode psychosis (MUSE FEP): findings from an exploratory randomised controlled trial.

Hallucinations are a common feature of psychosis, yet access to effective psychological treatment is limited. The Managing Unusual Sensory Experiences for First-Episode-Psychosis (MUSE-FEP) trial aimed to establish the feasibility and acceptability of a brief, hallucination-specific, digitally provided treatment, delivered by a non-specialist workforce for people with psychosis. MUSE uses psychoeducation about the causal mechanisms of hallucinations and tailored interventions to help a person understand and manage their experiences. We undertook a two-site, single-blind (rater) Randomised Controlled Trial and recruited 82 participants who were allocated 1:1 to MUSE and treatment as usual (TAU) (n=40) or TAU alone (n=42). Participants completed assessments before and after treatment (2 months), and at follow up (3-4 months). Information on recruitment rates, adherence, and completion of outcome assessments was collected. Analyses focussed on feasibility outcomes and initial estimates of intervention effects to inform a future trial. The trial is registered with the ISRCTN registry 16793301. Criteria for the feasibility of trial methodology and intervention delivery were met. The trial exceeded the recruitment target, had high retention rates (87.8%) at end of treatment, and at follow up (86.6%), with good acceptability of treatment. There were 3 serious adverse events in the therapy group, and 5 in the TAU group. Improvements were evident in both groups at the end of treatment and follow up, with a particular benefit in perceived recovery in the MUSE group. We showed it was feasible to increase access to psychological intervention but a definitive trial requires further changes to the trial design or treatment

Use of a targeted, computer/web-based guided self-help psychoeducation toolkit for distressing hallucinations (MUSE) in people with an at-risk mental state for psychosis: protocol for a randomised controlled feasibility trial

Individuals who access at-risk mental state (ARMS) services often have unusual sensory experiences and levels of distress that lead them to seek help. The Managing Unusual Sensory Experiences (MUSE) treatment is a brief symptom targeted intervention that draws on psychological explanations to help account for unusual experiences. Practitioners use formulation and behavioural experiments to support individuals to make sense of their experiences and enhance coping strategies. The primary objective of this feasibility trial is to resolve key uncertainties before a definitive trial and inform parameters of a future fully powered trial