Can a computerised training paradigm assist people with intellectual disabilities to learn cognitive mediation skills? A randomised experiment

Aims: The aim was to examine whether specific skills required for cognitive behavioural therapy (CBT) could be taught using a computerised training paradigm with people who have intellectual disabilities (IDs). Training aimed to improve: a) ability to link pairs of situations and mediating beliefs to emotions, and b) ability to link pairs of situations and emotions to mediating beliefs. Method: Using a single-blind mixed experimental design, sixty-five participants with IDs were randomised to receive either computerised training or an attention-control condition. Cognitive mediation skills were assessed before and after training. Results: Participants who received training were significantly better at selecting appropriate emotions within situation-beliefs pairs, controlling for baseline scores and IQ. Despite significant improvements in the ability of those who received training to correctly select intermediating beliefs for situation-feelings pairings, no between-group differences were observed at post-test. Conclusions: The findings indicated that computerised training led to a significant improvement in some aspects of cognitive mediation for people with IDs, but whether this has a positive effect upon outcome from therapy is yet to be established

The virtues of virtual reality in exposure therapy

SummaryVirtual reality can be more effective and less burdensome than real-life exposure. Optimal virtual reality delivery should incorporate in situ direct dialogues with a therapist, discourage safety behaviours, allow for a mismatch between virtual and real exposure tasks, and encourage self-directed real-life practice between and beyond virtual reality sessions.</jats:p

Order and chaos in the local disc stellar kinematics induced by the Galactic bar

(Abridged) The Galactic bar causes a characteristic splitting of the disc phase space into regular and chaotic orbit regions which is shown to play an important role in shaping the stellar velocity distribution in the Solar neighbourhood. A detailed orbital analysis within an analytical 2D rotating barred potential reveals that this splitting is mainly dictated by the value of the Hamiltonian H and the bar induced resonances. Test particle and N-body simulations reveal how the decoupled evolution of the disc distribution function in the two kind of regions and the process of chaotic mixing lead to overdensities in the H>H_12 chaotic part of the u-v velocity distributions outside corotation, where H_12 is the effective potential at the Lagrangian points L_1/2. In particular, for realistic space positions of the Sun near or slightly beyond the outer Lindblad resonance and if u is defined positive towards the anti-centre, the eccentric quasi-periodic orbits trapped around the stable x1(1) orbits - i.e. the bar-aligned closed orbits which asymptotically become circular at larger distances - produce a broad u<0 regular arc in velocity space extending within the H>H_12 zone, whereas the corresponding u>0 region appears as an overdensity of chaotic orbits forced to avoid that arc. This chaotic overdensity provides an original interpretation, distinct from the anti-bar elongated quasi-periodic orbit interpretation proposed by Dehnen (2000), for the prominent stream of high asymmetric drift and predominantly outward moving stars clearly emerging from the Hipparcos data. The effects of spiral arms and of molecular clouds are also briefly discussed within this context.Comment: 25 pages, 20 figures (3 in gif format). A&A, in press. Full resolution postscript paper (5Mb) and MPEG movies available at http://www.mso.anu.edu.au/~fux/streams.htm

Intellectual disability and computers in therapy: views of service users and clinical psychologists

Background: Digital media have increased the accessibility of psychological therapies for the general population, but not for people with intellectual disability (ID), despite their greater mental health needs. This study explores and compares the views of service users and clinicians on how computers can be integrated in psychological therapies for people with ID who are traditionally under-represented in mainstream services. Methods: We conducted in-depth unstructured interviews with three clinicians who had experience of working with people with ID and with three adults with ID who have experienced computerised training in cognitive behaviour therapy skills. The interviews explored the a) potential functions and benefits, b) anticipated challenges and barriers, and c) required design features of computers in therapy for people with ID. We used inductive coding to identify independent themes in the responses of clinicians and service users, and then compared the emerging themes between the two sets of participants to arrive at common themes. Results: Six common themes emerged from service user and clinician responses: confidentiality of personal information and online applications, barriers in the communication with the therapist, value of therapist and personal contact, access to computer technologies, engagement potential of computer programmes and home practice. Three further themes were specific to clinician responses: patient suitability for computerised approaches, clinician distrust of computerised interventions, and involving a third party. Conclusion: Computer technologies open up possibilities for psychological therapy with people with ID by helping them overcome in-session communication difficulties and practise skills at home. On-screen pictures, interactive games, symbols, sign language and touch-screen are key design features to help engagement. The main challenges are clinician-reported difficulties in their own capacity and capability to access and use computers and in fitting computers into their own defined roles

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