'It's always difficult when it's family. . . whereas when you're talking to a therapist. . .': Parents' views of cognitive-behaviour therapy for depressed adolescents

BACKGROUND: Parents are key to helping their adolescent child access psychological therapy for mental health problems such as depression. However, little is known about how parents experience their child's psychological therapy. We aimed to explore parents' experiences of their adolescent child's cognitive behaviour therapy for depression. METHOD: We applied Thematic Analysis (TA) to qualitative data from in-depth interviews with parents (N = 16) whose adolescent child was randomly allocated to CBT in a large multisite RCT for adolescent depression (the IMPACT trial). Interviews were conducted at the end of treatment. RESULTS: We generated two main themes: parents' perceptions of the adolescent's journey through therapy, and parents' perceptions of the therapeutic setting and process. Each included four sub-themes. Parents talked about key factors that impacted on their child's progress through treatment, including the adolescent's readiness for therapy and the adolescent-therapist relationship. CONCLUSION: Parents' insights confirm the foundations of what is considered good clinical practice of CBT for adolescent depression, including tailoring therapy to the adolescent, and establishing a strong adolescent-therapist relationship. Parents recognised that, for CBT to be helpful, their child had to be willing to engage in therapy and able to develop a trusting relationship with their therapist

The experience of cognitive behavioural therapy in depressed adolescents who are fatigued

Objective: Fatigue is a common and debilitating symptom of major depressive disorder (MDD). Cognitive behavioural therapy (CBT) is a recommended psychological treatment for adolescents with moderate to severe depression. This study explored the experience of CBT in fatigued adolescents with MDD. Design: A qualitative study was conducted using existing data from the qualitative arm of a large randomized control trial, the IMPACT study. Methods: Data were obtained from semi-structured interviews conducted after therapy. Participants were 18 adolescents (aged 13–18 years) who reached the clinical threshold for fatigue on diagnostic assessment before starting treatment. The data were analysed using thematic framework analysis. Results: Three themes and seven sub-themes were developed. Adolescents appeared to find taking part in initial sessions, engaging in ongoing sessions and completing homework challenging. Perceiving the therapist as genuine seemed to provide a sense of safety which enabled adolescents to open up in sessions. When the therapist was not perceived as genuine, adolescents appeared to find CBT less helpful. The structure of CBT appeared to enable treatment goals to be set, and facilitated an increase in meaningful activity. Ensuring that tasks were perceived as manageable and goals as achievable seemed important for participation. Cognitive restructuring appeared useful, although some adolescents tended to engage in distraction from thoughts as an alternative strategy. Conclusions: This study provides an initial insight into how fatigued adolescents with MDD experience CBT. Further research is required to establish whether the themes are pervasive and relatedly, how best to treat depression in fatigued adolescents receiving CBT. Practitioner points: Fatigued adolescents with depression found engaging in CBT sessions and therapeutic homework demanding. Establishing a collaborative therapeutic relationship, where the therapist was perceived as genuine, appeared helpful for participation. The structured approach to therapy, combined with flexibility, was experienced as helpful. Adolescents who perceived the pace of sessions to be manageable and therapeutic goals as achievable seemed to find CBT helpful overall. These findings provide insight into how fatigued adolescents with depression experience CBT and highlight the importance of being aware of fatigue and adapting therapy accordingly

‘What is the self anyway?’ : towards a more parsimonious conceptualisation of the self : a review

The ‘self’ is of interest across multiple psychological, cognitive, and social sciences. Unhelpfully, a plethora of terms are used across different theoretical and empirical areas. This leads to inconsistency, confusion and lack of clarity and impedes cross-disciplinary communication and progress. To improve clarity, increase parsimony and support theoretical and empirical advances, it is important to establish clear terms that can be applied consistently across psychology. The aim of this paper is to present a comprehensive initial inventory of synthesised self-terms that can be used by, and across psychology. We review self-terms used across different areas in psychology and identify a set of terms that are most frequently and consistently used across these domains. We then present a synthesis of commonly used ‘self-terms’ that are specifically related to six psychological sub-disciplines; Cognitive, Social, Developmental, Neuroscience, Clinical and Personality psychology. A glossary of self-terms, together with frequently used synonymous self-terms are presented

Loneliness and mental health in children and adolescents with pre-existing mental health problems: A rapid systematic review

Objectives: Periods of social isolation are associated with loneliness in children and young people, and loneliness is associated with poor mental and physical health. Children and young people with pre-existing mental health difficulties may be prone to loneliness. Containment of COVID-19 has necessitated widespread social isolation, with unprecedented school closures and restrictions imposed on social interactions. This rapid review aimed to establish what is known about the relationship between loneliness and mental health problems in children and young people with pre-existing mental health problems. Methods: We sought to identify all primary research that examined the cross-sectional and longitudinal associations between loneliness/perceived social isolation and mental health in children and young people with pre-existing mental health problems. We also aimed to identify effective interventions that reduce the adverse impact of loneliness. A rapid systematic search was conducted using MEDLINE, PsycINFO, and Web of Science. Results: Of 4,531 papers screened, 15 included children and young people with pre-existing mental health conditions. These 15 studies included 1,536 children and young people aged between 6 and 23 years with social phobia, anxiety and/or depression, and neurodevelopmental disorders. Loneliness was associated with anxiety and depression both cross-sectionally and prospectively in children and young people with mental health problems and neurodevelopmental conditions. We found preliminary evidence that psychological treatments can help to reduce feelings of loneliness in this population. Conclusions: Loneliness is associated with depression and anxiety in children and young people with pre-existing mental health conditions, and this relationship may be bidirectional. Existing interventions to address loneliness and/or mental health difficulties in other contexts may be applied to this population, although they may need adaptation and testing in younger children and adolescents. Practitioner points: Loneliness is common in children and young people, and during periods of enforced social isolation such as during COVID-19, children and young people report high levels of loneliness (or increased rates of loneliness). The review showed that loneliness is associated, both cross-sectionally and prospectively, in children and young people with mental health problems and also in children and young people with neurodevelopmental conditions, such as autism spectrum disorder. Thus, loneliness is a possible risk factor of which mental health providers should be aware. Maintaining social contact both by direct and by indirect means, especially through the Internet, could be important in mitigating loneliness. Interventions to address loneliness should be further developed and tested to help children and young people with pre-existing mental health problems who are lonely by preventing exacerbation of their mental health difficulties, in particular anxiety and depression

Climate stories: Why do climate scientists and sceptical voices participate in the climate debate?

Public perceptions of the climate debate predominantly frame the key actors as climate scientists versus sceptical voices; however, it is unclear why climate scientists and sceptical voices choose to participate in this antagonistic and polarised public battle. A narrative interview approach is used to better understand the underlying rationales behind 22 climate scientists’ and sceptical voices’ engagement in the climate debate, potential commonalities, as well as each actor’s ability to be critically self-reflexive. Several overlapping rationales are identified including a sense of duty to publicly engage, agreement that complete certainty about the complex assemblage of climate change is unattainable and that political factors are central to the climate debate. We argue that a focus on potential overlaps in perceptions and rationales as well as the ability to be critically self-reflexive may encourage constructive discussion among actors previously engaged in purposefully antagonistic exchange on climate change

Tumor-specific expression of αvβ3 integrin promotes spontaneous metastasis of breast cancer to bone

INTRODUCTION: Studies in xenograft models and experimental models of metastasis have implicated several β3 integrin-expressing cell populations, including endothelium, platelets and osteoclasts, in breast tumor progression. Since orthotopic human xenograft models of breast cancer are poorly metastatic to bone and experimental models bypass the formation of a primary tumor, however, the precise contribution of tumor-specific αvβ3 to the spontaneous metastasis of breast tumors from the mammary gland to bone remains unclear. METHODS: We used a syngeneic orthotopic model of spontaneous breast cancer metastasis to test whether exogenous expression of αvβ3 in a mammary carcinoma line (66cl4) that metastasizes to the lung, but not to bone, was sufficient to promote its spontaneous metastasis to bone from the mammary gland. The tumor burden in the spine and the lung following inoculation of αvβ3-expressing 66cl4 (66cl4beta3) tumor cells or control 66cl4pBabe into the mammary gland was analyzed by real-time quantitative PCR. The ability of these cells to grow and form osteolytic lesions in bone was determined by histology and tartrate-resistant acid phosphatase staining of bone sections following intratibial injection of tumor cells. The adhesive, migratory and invasive properties of 66cl4pBabe and 66cl4beta3 cells were evaluated in standard in vitro assays. RESULTS: The 66cl4beta3 tumors showed a 20-fold increase in metastatic burden in the spine compared with 66cl4pBabe. A similar trend in lung metastasis was observed. αvβ3 did not increase the proliferation of 66cl4 cells in vitro or in the mammary gland in vivo. Similarly, αvβ3 is not required for the proliferation of 66cl4 cells in bone as both 66cl4pBabe and 66cl4beta3 proliferated to the same extent when injected directly into the tibia. 66cl4beta3 tumor growth in the tibia, however, increased osteoclast recruitment and bone resorption compared with 66cl4 tumors. Moreover, αvβ3 increased 66cl4 tumor cell adhesion and αvβ3-dependent haptotactic migration towards bone matrix proteins, as well as their chemotactic response to bone-derived soluble factors in vitro. CONCLUSION: These results demonstrate for the first time that tumor-specific αvβ3 contributes to spontaneous metastasis of breast tumors to bone and suggest a critical role for this receptor in mediating chemotactic and haptotactic migration towards bone factors

Seismic characterization of pyroclastic flow activity at Soufrier Hills Volcano, Montserrat, 8 January 2007

A partial dome collapse with concurrent pyroclastic flow (PF) activity occurred at Soufrière Hills Volcano (SHV), Montserrat on 8 January 2007. Pyroclastic density currents were observed to propagate from the Northwest and West sectors of the summit dome into the heads of Tyres Ghaut and Gages Valley, respectively. Between 10:00 and 10:15 UTC pyroclastic flows entered Tyres Ghaut and from there descended into the Belham Valley reaching a distance of about 5 km from the source. Pyroclastic flow activity on the Northwest and West side of the edifice continued at high levels over the following 1.5 h, although run-out distances of individual flows did not exceed 1.5 km. Subsequent observations showed that material had been removed from the lower Northwest side of the dome leaving an amphitheatre-like structure cutting through the old crater rim. The seismic waves excited by the propagation of pyroclastic flows were recorded by the Montserrat Volcano Observatory's network of broadband seismometers. The seismic records show the onset of a continuous signal before 09:30 UTC with gradually increasing amplitudes and spectral energy in the 1–8 Hz band. The signal rapidly increased in amplitude and a characteristic spindle-shaped waveform with broadband energy (1–25 Hz) was observed accompanying large PF that descended along the slopes of the volcano. The main phase was followed by a sequence of individual seismic pulses which correlated well with visual observations of PF. PF are a major hazard at SHV and pose significant risk for the population living in the proximity of the volcano. They can occur with little or no warning and have the potential to reach inhabited areas to the Northwest. The study of the seismic activity associated with the generation and propagation of pyroclastic flows can help to identify characteristic precursory seismic sequences providing valuable information to improve the understanding of the hazards posed by the SHV and to allow better warning to be given to the authorities