Implementation of an integrated primary care behavioral health training model on campus.

In the last 15 years, demand has surged among college students for mental health care and many campuses are struggling to keep up with the demand for services. Primary care services represent a pathway where individuals can receive mental health care without accessing specialty mental health services. There is evidence that integrating mental health services into primary care can reduce racial disparities in access to mental health care and provide greater access to mental health care for underserved persons. This paper describes the development and implementation of a fully integrated model of mental health care services into Xavier University's (XU) primary care clinic. In partnership with TriHealth, a local healthcare provider, and following the primary care behavioral care model, XU integrated supervised psychology doctoral students as behavior health consultants into a campus primary care clinic. Administrative, clinical care, and training processes together with preliminary findings and recommendations are shared.

The assessment of successful emotion regulation skills use: Development and validation of an English version of the Emotion Regulation Skills Questionnaire.

Emotion regulation has become an important topic in mental health and psychotherapy research. Skills supposingly relevant for adaptive responses towards emotions include the abilities to be consciously aware of emotions, identify and correctly label emotions, understand what has caused and maintains one's present emotions, modify the intensity or duration of one's emotions, accept and tolerate undesired emotions, confront situations likely to cue negative emotions, and provide effective self-support when working to cope with challenging emotions. To economically assess these abilities, a self-report measure has been developed in German and validated in various studies. To facilitate the use of the measure in English speaking countries, we have developed and validated an English version of the Emotion Regulation Skills Questionnaire (ERSQ) in a student sample (n = 263) and a sample of individual clinical sample (n = 35). Findings from this study provide significant evidence for the reliability and validity of the ERSQ. Thus, the measure can be used to assess a broad range of important emotion regulation skills in an economic way.

Expert reasoning in psychotherapy case formulation.

Therapist reasoning in case formulation construction was investigated. Sixty-five psychodynamic or cognitive-behavioral therapists classified as experts, experienced, or novices generated "think aloud" formulations based on six standardized vignettes. Formulations were reliably transcribed, segmented into idea units, and content coded. ANOVA and sequential analysis compared formulation content and reasoning processes. Expert formulations contained more descriptive, diagnostic, inferential, and treatment planning information. They focused more on given and inferred symptoms, on adult relationship history, on inferred psychological mechanisms, on the need for further evaluation, and on plans to focus on treatment expectations and symptoms. They exhibited more forward (inferential) than backward (deductive) reasoning and, compared with non-experts, they exhibited more forward and backward reasoning. Results are discussed in terms of cognitive science models for expert problem solving and on implications for psychotherapy training, practice, and research.

Functional imaging of emotion reactivity in opiate-dependent borderline personality disorder.

Opiate dependence (OD) and borderline personality disorder (BPD), separately and together, are significant public health problems with poor treatment outcomes. BPD is associated with difficulties in emotion regulation, and brain-imaging studies in BPD individuals indicate differential activation in prefrontal cingulate cortices and their interactions with limbic regions. Likewise, a similar network is implicated in drug cue responsivity in substance abusers. The present, preliminary study used functional MRI to examine activation of this network in comorbid OD/BPD participants when engaged in an "oddball" task that required attention to a target in the context of emotionally negative distractors. Twelve male OD/BPD participants and 12 male healthy controls participated. All OD/BPD participants were taking the opiate replacement medication Suboxone, and a subset of participants was positive for substances of abuse on scan day. Relative to controls, OD/BPD participants demonstrated reduced activation to negative stimuli in the amygdala and anterior cingulate. Unlike previous studies that demonstrated hyperresponsivity in neural regions associated with affective processing in individuals with BPD versus healthy controls, comorbid OD/BPD participants were hyporesponsive to emotional cues. Future studies that also include BPD-only and OD-only groups are necessary to help clarify the individual and potentially synergistic effects of these two conditions.

Dialectical behavior therapy for borderline personality disorder.

Since the introduction of Linehan's treatment manuals in 1993, dialectical behavior therapy (DBT) has been widely disseminated throughout multiple therapeutic settings and applied to a variety of diagnoses. The enthusiasm with which it was embraced by clinicians early on led some to question whether DBT's popularity was outstripping its empirical foundation. Most of the specific concerns raised regarding DBT's early empirical base have been meaningfully addressed in subsequent randomized controlled trials. This review provides a brief introduction to DBT, followed by a critical appraisal of empirical support for the treatment and a discussion of current research trends.

Educational attainment, positive psychological mediators, and resources for health and vitality in older adults.

OBJECTIVES: To further explain the relationship of education to health by a prospective examination of positive psychological states as mediators. Furthermore, to examine the resources of desirable events, self-esteem, and social support as possible mediators between positive psychological states and subsequent health and vitality. METHODS: Four in-home interviews were conducted at 6-month intervals with a probability sample of 1,277 older adults (aged 55 and older); multiple regression was used to estimate mediating effects. RESULTS: Positive states mediated the education relationship to both symptoms and vitality, independent of negative states; the resource measures did not mediate the positive state-health relationship. DISCUSSION: Higher education level appears to increase the likelihood of being serene and happy, and healthy and vital, in later years; positive psychological states appeared to have both a promotion function (for vitality) and protective function (against health symptoms); self-esteem showed promise as a possible mediator of the effects of psychological states on health.