Crying in Psychotherapy: The Perspective of Therapists and Clients

Eighteen U.S.-based doctoral students in counseling or clinical psychology were interviewed by phone regarding experiences of crying in therapy. Specifically, they described crying as therapists with their clients, as clients with their therapists, and experiences when their therapists cried in the participants’ therapy. Data were analyzed using consensual qualitative research. When crying with their clients, therapists expressed concern about the appropriateness/impact of crying, cried only briefly and because they felt an empathic connection with their clients, thought that the crying strengthened the relationship, discussed the event with their supervisor, and wished they had discussed the event more fully with clients. Crying as clients was triggered by discussing distressing personal events, was accompanied by a mixture of emotions regarding the tears, consisted of substantial crying to express pain or sadness, and led to multiple benefits (enhanced therapy relationship, deeper therapy, and insight). When their therapists cried, the crying was brief, was triggered by discussions of termination, arose from therapists’ empathic connection with participants, and strengthened the therapy relationship. Implications for research, training, and practice are presented

Mortality from head injury over four decades in Scotland

Although the causes of head injury, the population at risk and approaches to prevention and treatment are continually evolving, there is little information about how these are reflected in patterns of mortality over time. We used population based comprehensive data uniquely available in Scotland to investigate changes in the total numbers of deaths from 1974 to 2012, as well as the rates of head injury death, from different causes, overall and in relation to age and gender. Total mortality fell from an annual average of 503 to 339 with a corresponding annual decrease in rate from 9.6 to 6.4 per 100,000 population, the decline substantially occurring between 1974 and 1990. Deaths in children fell strikingly but rose in older people. Deaths in males fell to a greater extent than females but remained at a higher rate overall. Initially, a transport accident accounted for most deaths but these fell by 80%, from 325 per year to 65 per year over the 39 year period. Deaths from falling and all other causes did not decline, coming to outnumber transport accident deaths by 1998, which accounts for the overall absence of change in total mortality in recent years. In order to reduce mortality in the future, more effective measures to prevent falls are needed and these strategies will vary in younger adults (where alcohol is often a factor), and in older adults where infirmity can be a cause. In addition, measures to sustain reductions in transport accidents need to be maintained and further developed

The effect of worrying on intolerance of uncertainty and positive and negative beliefs about worry

Background and Objectives: The effect of a worry manipulation on the clinical constructs intolerance of uncertainty (IU), negative beliefs about the consequences of worry (NCOW), positive beliefs about the consequences of worry (PCOW), in addition to the emotions anxiety and sadness, was examined. Methods: A non-clinical sample was split into two groups, a worry group (n = 29), who were asked to generate 20 potential worries about a hypothetical scenario, and a control group (n = 28), who were asked to generate 2 potential worries about the same scenario. Subsequently, participants were asked to complete measures of IU, NCOW, PCOW, sadness and anxiety. Results: The worry group scored significantly higher than the control group on measures of IU, NCOW and PCOW but not on measures of sadness and anxiety. Limitations: Possible limitations of the current study include the use of a student sample and the use of a hypothetical worry scenario. Conclusions: The results suggest that engaging in worry can increase scores on measures of the beliefs and thought patterns often used to causally explain worry. The results are in line with recent research showing bidirectionality between anxiety related symptoms and their associated clinical constructs, and are consistent with an approach which sees anxiety symptoms as part of an evolved integrated threat management system that alerts the individual to threats to goals or challenges, and coordinates cognitive, behavioral, and affective reactions to enable effective responding to these threats and challenges

Patterns and Trends in Cetacean Occurrence Revealed by Shorewatch, a Land-Based Citizen Science Program in Scotland (United Kingdom)

Shorewatch is a citizen science project, managed by Whale and Dolphin Conservation (WDC), that records the occurrence of cetaceans during regular, standardized watches from a series of locations along the coast of Scotland (United Kingdom). Observer training and a clearly defined protocol help deliver a valuable source of information about cetacean occurrence and activity along the coast. Between 2005–2018, over 52000 watches generated over 11000 sightings of at least 18 cetacean species. Generalized Additive Models based on sightings for the five most commonly sighted species (bottlenose dolphin, harbor porpoise, minke whale, Risso’s dolphin, and common dolphin), at those sites with the longest time series, demonstrated seasonal, geographical and year-to-year differences in their local occurrence and relative abundance. Bottlenose dolphins are mainly present at observation sites located on the east coast of Scotland, being uncommon on the west coast, while harbor porpoise and minke whale are principally present at sites located on the west coast. The seasonality observed in cetacean occurrence is consistent with peak abundance in summer months described by previous studies in the area. Mean depth around the observation sites is the static variable that apparently has the greatest influence on species presence and number of sightings, except for Risso’s dolphin. All the species except bottlenose dolphin showed upward trends in occurrence and number of sightings over the period 2012–2018. Evidence of temporal autocorrelation was found between results from consecutive watches at the same site on the same day as well as between results from consecutive days at the same site. The power to detect declines in local abundance over a 6-year period depends on the underlying sighting rate of each cetacean species, the number of watches performed and the rate of decline. Simulations performed to determine the power to detect a decline suggest that the current intensity of observation effort in some observation sites, of about 2500 watches per year, may offer good prospects of detecting a 30% decline of the most frequently sighted species (95% of the time) over a 6-year period, although a more even distribution of observation effort in space and time is desirable. The data could potentially be used for monitoring and 6-yearly reporting of the status of cetacean populations.En prens

Dislodgement force and shell morphology vary according to wave exposure in a tropical gastropod (Cittarium pica)

Wave exposure has strong influences on population density, morphology and behaviour of intertidal species in temperate zones, but little is known about how intertidal organisms in tropical regions respond to gradients in wave exposure. We tested whether dislodgement force and shell shape of a tropical gastropod, Cittarium pica, differs among shores that vary in wave exposure. After adjusting for body size, we found that C. pica from exposed shores required greater dislodgement force to remove them from the shore, had slightly larger opercula (the closure to the shell aperture), and were slightly squatter in shape (reduced in shell height relative to shell width) than C. pica from sheltered shores. These morphological adjustments are consistent with those observed in temperate gastropods, which are argued to represent adaptive responses to the risk of mortality associated with dislodgement

Emergency supply of prescription-only medicines to patients by community pharmacists: a mixed methods evaluation incorporating patient, pharmacist and GP perspectives

Objective To evaluate and inform emergency supply of prescription-only medicines by community pharmacists (CPs), including how the service could form an integral component of established healthcare provision to maximise adherence. Design Mixed methods. 4 phases: prospective audit of emergency supply requests for prescribed medicines (October–November 2012 and April 2013); interviews with CPs (February–April 2013); follow-up interviews with patients (April–May 2013); interactive feedback sessions with general practice teams (October–November 2013). Setting 22 community pharmacies and 6 general practices in Northwest England. Participants 27 CPs with experience of dealing with requests for emergency supplies; 25 patients who received an emergency supply of a prescribed medicine; 58 staff at 6 general practices. Results Clinical audit in 22 pharmacies over two 4-week periods reported that 526 medicines were requested by 450 patients. Requests peaked over a bank holiday and around weekends. A significant number of supplies were made during practice opening hours. Most requests were for older patients and for medicines used in long-term conditions. Difficulty in renewing repeat medication (forgetting to order, or prescription delays) was the major reason for requests. The majority of medicines were ‘loaned’ in advance of a National Health Service (NHS) prescription. Interviews with CPs and patients indicated that continuous supply had a positive impact on medicines adherence, removing the need to access urgent care. General practice staff were surprised and concerned by the extent of emergency supply episodes. Conclusions CPs regularly provide emergency supplies to patients who run out of their repeat medication, including during practice opening hours. This may aid adherence. There is currently no feedback loop, however, to general practice. Patient care and interprofessional communication may be better served by the introduction of a formally structured and funded NHS emergency supply service from community pharmacies, with ongoing optimisation of repeat prescribing

Artificial intelligence approaches to predicting and detecting cognitive decline in older adults: A conceptual review.

Preserving cognition and mental capacity is critical to aging with autonomy. Early detection of pathological cognitive decline facilitates the greatest impact of restorative or preventative treatments. Artificial Intelligence (AI) in healthcare is the use of computational algorithms that mimic human cognitive functions to analyze complex medical data. AI technologies like machine learning (ML) support the integration of biological, psychological, and social factors when approaching diagnosis, prognosis, and treatment of disease. This paper serves to acquaint clinicians and other stakeholders with the use, benefits, and limitations of AI for predicting, diagnosing, and classifying mild and major neurocognitive impairments, by providing a conceptual overview of this topic with emphasis on the features explored and AI techniques employed. We present studies that fell into six categories of features used for these purposes: (1) sociodemographics; (2) clinical and psychometric assessments; (3) neuroimaging and neurophysiology; (4) electronic health records and claims; (5) novel assessments (e.g., sensors for digital data); and (6) genomics/other omics. For each category we provide examples of AI approaches, including supervised and unsupervised ML, deep learning, and natural language processing. AI technology, still nascent in healthcare, has great potential to transform the way we diagnose and treat patients with neurocognitive disorders

Geometry and Adhesion of Extracellular Domains of DC-SIGNR Neck Length Variants Analyzed by Force–Distance Measurements

Force-distance measurements have been used to examine differences in the interaction of the dendritic cell glycan-binding receptor DC-SIGN and the closely related endothelial cell receptor DC-SIGNR (L-SIGN) with membranes bearing glycan ligands. The results demonstrate that upon binding to membrane-anchored ligand, DC-SIGNR undergoes a conformational change similar to that previously observed for DC-SIGN. The results also validate a model for the extracellular domain of DC-SIGNR derived from crystallographic studies. Force measurements were performed with DC-SIGNR variants that differ in the length of the neck that result from genetic polymorphisms, which encode different numbers of the 23-amino acid repeat sequences that constitute the neck. The findings are consistent with an elongated, relatively rigid structure of the neck repeat observed in crystals. In addition, differences in the lengths of DC-SIGN and DC-SIGNR extracellular domains with equivalent numbers of neck repeats support a model in which the different dispositions of the carbohydrate-recognition domains in DC-SIGN and DC-SIGNR result from variations in the sequences of the necks