Developing Attributes and Attribute-Levels for a Discrete-Choice Experiment: An Example for Interventions of Impulsive Violent Offenders.

BACKGROUND: Discrete-Choice Experiments (DCEs) are used to assess the strength of preferences and value of interventions, but researchers using the method have been criticised for failing to either undertake or publish the rigorous research for selecting the necessary attributes and levels. The aim of this study was to elicit attributes to inform a DCE to assess societal and offenders' preferences for, and value of, treatment of impulsive-violent offenders. In doing so, this paper thoroughly describes the process and methods used in developing the DCE attributes and levels. METHODS: Four techniques were used to derive the final list of attributes and levels: (1) a narrative literature review to derive conceptual attributes; (2) seven focus group discussions (FGDs) comprising 25 participants including offenders and the general public and one in-depth interview with an offender's family member to generate contextual attributes; (3) priority-setting methods of voting and ranking to indicate participants' attributes of preference; (4) a Delphi method consensus exercise with 13 experts from the justice health space to generate the final list of attributes. RESULTS: Following the literature review and qualitative data collection, 23 attributes were refined to eight using the Delphi method. These were: treatment effectiveness, location and continuity of treatment, treatment type, treatment provider, voluntary participation, flexibility of appointments, treatment of co-morbidities and cost. CONCLUSION: Society and offenders identified similar characteristics of treatment programs as being important. The mixed methods approach described in this manuscript contributes to the existing limited methodological literature in DCE attribute development.

Mindfulness and Rehabilitation: Teaching Yoga and Meditation to Young Men in an Alternative to Incarceration Program.

This study used participant/observation and open-ended interviews to understand how male participants (age 18-24 years) benefited from yoga and mindfulness training within an Alternative to Incarceration (ATI) program. Findings suggest that the male participants (age 18-24 years) benefited from the intervention through reductions in stress and improvements in emotion regulation. Several participants noted the importance of the development of an embodied practice for assisting them in managing anger and impulse control. The young men's narratives suggest that mindfulness-based interventions can contribute positively to rehabilitative outcomes within alternative to incarcerations settings, providing complementary benefit to existing ATI programs, especially for clients amenable to mindfulness training. With many jurisdictions expanding rehabilitation-focused interventions for young offenders, service providers should consider the potential positive contributions that mindfulness-based interventions can have for fostering desistance and reducing recidivism among justice system-involved populations.

An evaluation of time in establishing operation on the effectiveness of functional communication training.

We examined whether different durations of exposure to relevant establishing operations (EO) during treatment of problem behavior affected treatment efficacy and response bursting. In Study 1, we compared 2 functional communication training (FCT) interventions. In the first treatment, we used a card touch as the target mand; this was associated with limited exposure to the EO because we could physically guide the mand at prescribed times. In the other treatment, we used a vocal response as the mand; this was associated with longer exposure to the EO because it was not possible to guide the response. In Study 2, we exposed participants to time-based reinforcement schedules that were yoked to the schedules of obtained reinforcement from the 2 FCT interventions in Study 1. Results indicated that limited exposure to the EO was associated with less response bursting, larger and more rapid reductions in problem behavior, and faster acquisition of the alternative mand.

Predictors of response to a cognitive behavioral intervention for impulse control behaviors in Parkinson's disease.

BACKGROUND: Limited trial evidence suggests that cognitive-behavioral therapy (CBT) may be effective in managing impulse control behavior (ICBs) in Parkinson's disease. AIMS: To examine predictors of outcome in trial, participants (N=42) receiving treatment immediately or after a waiting time. METHODS: Dependent variables were Clinical Global Impression of Change (CGI-C) and the Neuropsychiatric Inventory (NPI). Baseline demographic and clinical variables were independent variables. RESULTS: Better CGI-C was predicted by fewer ICBs, taking a dopamine agonist, lower levodopa (l-dopa) equivalent dose (LEDD), higher social functioning, and lower NPI severity before treatment. Improvement on the NPI was predicted by lower LEDD, lower anxiety, lower baseline global clinical severity, and higher social functioning. CONCLUSIONS: Patients with lower burden of ICBs and other psychiatric symptomatology, better social functioning, and lower dose of antiparkinsonian medication may benefit more from CBT. However, we cannot yet identify individual patients with sufficient confidence at this stage to target treatment.

Decreasing excessive functional communication responses while treating destructive behavior using response restriction.

Functional communication training (FCT) is an established treatment for destructive behavior that missucceeds in about 37% of cases when the reinforcement schedule for the functional communication response (FCR) is thinned using multiples schedules (mult FCT; Hagopian, Boelter, & Jarmolowicz, 2011). In this investigation, we evaluated the use of response restriction FCT (RR FCT) in a cohort of patients with poorly differentiated responding of the FCR during mult FCT. Results showed that (a) RR FCT maintained high rates of correct FCRs during the reinforcement component of RR FCT without increasing destructive behavior; (b) children displayed highly discriminated FCRs when an FCR card and a control card were simultaneously available during the reinforcement component of RR FCT; and (c) near-zero rates of destructive behavior were observed during the last five sessions of the terminal reinforcement schedule. Results are discussed relative to differences between mult FCT and RR FCT and successive and simultaneous discriminations.

Prevalence of co-occurring disorders in a sample of adults with mild and moderate intellectual disabilities who reside in a residential treatment setting.

The presence of an intellectual disability (ID) is associated with a myriad of co-occurring conditions, including psychiatric and genetic disorders, behavior problems, physical disabilities, and seizure disorders. Often the most severely affected individuals reside in residential treatment facilities, where they may obtain specialized treatment and management of their challenging behavior. The present study examines the prevalence of psychiatric disorders, seizures, and ID within the context of demographic categories in a sample of 101 individuals with mild to moderate ID living in a long-term residential treatment facility. Autism spectrum disorders (ASDs) were more prevalent among individuals with moderate ID, whereas personality disorders were more likely to be diagnosed in individuals with mild ID. Impulse disorders were more frequently observed in females. Further research is needed in order to determine appropriate treatment for such individuals, which should include therapies that are targeted to the specific problems of this population.

Pharmacological treatments in pathological gambling.

Pathological gambling (PG) is a relatively common and often disabling psychiatric condition characterized by intrusive urges to engage in deleterious gambling behaviour. Although common and financially devastating to individuals and families, there currently exist no formally approved pharmacotherapeutic interventions for this disorder. This review seeks to examine the history of medication treatments for PG. A systematic review of the 18 double-blind, placebo-controlled pharmacotherapy studies conducted for the treatment of pathological gambling was conducted. Study outcome and the mean dose of medication administered was documented in an effort to determine a preferred medication choice in this population. A variety of medication classes have been examined in the treatment of PG with varying results. Antidepressants, atypical antipsychotics and mood stabilizers have demonstrated mixed results in controlled clinical trials. Although limited information is available, opioid antagonists and glutamatergic agents have demonstrated efficacious outcomes, especially for individuals with PG suffering from intense urges to engage in the behaviour. Given that several studies have demonstrated their efficacy in treating the symptoms associated with PG, opioid antagonists should be considered the first line treatment for PG at this time. Most published studies, however, have employed relatively small sample sizes, are of limited duration and involve possibly non-representative clinical groups (e.g. those without co-occurring psychiatric disorders). Response measures have varied across studies. Heterogeneity of PG treatment samples may also complicate identification of effective treatments. Identification of factors related to treatment response will help inform future studies and advance treatment strategies for PG.

Implicit processes in pathological skin picking: responses to skin irregularities predict symptom severity and treatment susceptibility.

BACKGROUND AND OBJECTIVES: Implicit cognitive processes are relevant in understanding the development and maintenance of psychopathology and dysfunctional behaviours. The present study investigated the role of implicit processes in pathological skin picking (PSP). METHODS: Using an Approach-Avoidance Task (AAT), we examined automatic response tendencies towards skin picking-related photographs in a sample of 34 college students who suffered from PSP and participated in a randomized, waiting-list controlled treatment study. RESULTS: In comparison to a control sample (n = 49), PSP patients displayed significantly decelerated reaction times (distraction) in response to photographs of skin irregularities and a tendency to respond with avoidance to photographs of skin irregularities. Both distraction and avoidance in reaction to photographs of skin irregularities were significantly associated with current skin picking severity. Moreover, the strength of distraction in response to skin irregularities predicted unique variance in skin picking severity at post-measurement, over and above the effect of skin picking severity at pre-measurement and the effect of treatment condition. For the treatment condition, higher initial distraction predicted better treatment outcome (lower skin picking severity at post-measurement), whereas it predicted symptom deterioration at post-treatment for untreated participants. LIMITATIONS: The specific characteristics of PSP patients (mainly female university students) and the relatively small sample size may compromise generalizability of findings. CONCLUSIONS: In PSP, affective distraction in response to skin irregularities seems to characterize an important process related to symptom severity as well as treatment susceptibility.

[Forensic addiction treatment in Germany (section 64 of the penal code): three therapeutically and predicatively relevant clusters of drinkers]. / Drei prognostisch und therapeutisch relevante Gruppen alkoholabhängiger Patienten im Maßregelvollzug gemäß § 64 StGB.

OBJECTIVE: According to section 64 of the German penal code, offenders may be sentenced to compulsory addiction treatment in forensic mental hospitals. An expert witness assesses each candidate regarding the prognosis of treatment. Frequently, optimistic assessments are not confirmed, and approximately half of the patients are returned to prison. The study aims at learning more about patients' characteristics relevant for treatment outcome by considering subgroups of patients. METHODS: 150 drinkers treated according to art. 64 were interviewed and psychologically assessed in an early stage of treatment. Therapists reported on treatment outcome. A cluster analysis was conducted. RESULTS: Like in former research, 3 considerably differing subgroups of patients could be identified. CONCLUSIONS: A "multi-problem" subgroup with early onset of severe behavior problems has a very small chance to profit from treatment. In this group of offenders, the prospects of a detention according to art. 64 of the penal code should be assessed very critically. On the other hand, efforts must be taken to refine treatment methods adequate for this high risk group.

Age of onset in pathological gambling: clinical, therapeutic and personality correlates.

We aimed to explore the association between age of onset of gambling problems and current psychopathological and clinical status, personality profile and therapeutic outcome in a sample of pathological gamblers. A total of 904 consecutive pathological gambling patients were administered several instruments about gambling behavior, psychopathology and personality. They received a 4-month cognitive-behavioral group treatment. Information of dropouts and relapses during treatment was registered. Older age of onset of gambling problems was associated with higher general psychopathology (SCL-90-R Paranoid Ideation, Psychoticism, Depression; P < 0.015). Younger age of onset was related to greater severity of pathological gambling (P < 0.015), higher novelty seeking, and lower self-directedness (P < 0.015). No statistically significant association was found between age of onset and relapse and dropouts during treatment. Age of onset of gambling problems seems to influence the clinical presentation of pathological gambling but not treatment outcome.

Disulfiram, an option for the treatment of pathological gambling?

AIM: Pathological gambling and comorbid alcohol dependence often occur in combination. Disulfiram is one of the proven drugs for alcohol dependence. In addition to its inhibiting acetaldehyde dehydrogenase, disulfiram inhibits dopamine beta-hydroxylase and may thereby increase dopamine and decrease norepinephrine cerebral concentrations. Because there may be common neurochemical substrates and neuronal circuits for pathological gambling and addiction, we wished to explore the effect of disulfiram in gambling. METHOD: We describe the outcome of a patient with alcohol dependence and pathological gambling treated with disulfiram D. RESULTS: During treatment with disulfiram, the patient reported that his desire to gamble disappeared entirely. Follow-up indicated that he has not gambled for >12 months. CONCLUSIONS: Although uncontrolled case observations should be interpreted with caution, disulfiram deserves further investigation in pathological gambling.

Experimental analysis of the game in pathological gamblers: effect of the immediacy of the reward in slot machines.

Slot machines are the most "addictive" games because (a) the disorder (pathological gambling) appears more rapidly in these games than with any other; (b) most patients who seek professional help are mainly addicted to electronic gambling, and (c) even though it is not the more frequent game, most of all the money spent on legal games of chance (at least in Spain) goes to slot machines. Structural characteristics of slot machines induce to gamble because electronic games show the main parameters of operant conditioning, mainly the immediacy of the reinforcement. Ten pathological gamblers played slot machine in two conditions: immediate and delayed reinforcement. The results corroborate the importance of the immediacy of the reinforcement in gambling, because when the result appears immediately (after 2 s), more games are played than when the result is delayed only 10 s. Critical issues in problem gambling prevention and public health are discussed.

Follow-up study of female delinquent adolescents in a detention centre: effectiveness of psychiatric intervention as a mental health service.

RESULTS: of previous studies suggest that many female offenders have co-morbid psychiatric disorders, which require mental health services. However, few longitudinal studies examined subjects during incarceration or detention. This study compares depressive symptoms, abnormal eating behaviour and impulsivity before release from a detention centre and after incarceration, thereby indicating the effectiveness of psychiatric intervention in a Japanese detention centre. METHOD: Of 64 young women, 36 were followed up. Self-report measures were used to assess depression, eating behaviour and impulsivity after incarceration and one month before release. RESULT: s: Of the 36 participants, nine were diagnosed using the MINI-kids as needing mental health services. Those who received psychiatric intervention were diagnosed as having major depression and/or post-traumatic stress disorder. Significant main effects of intervention and effects of time were shown in the DSD. The EAT-26 score demonstrated the significance of the effects of time and interaction. In the BIS-11 scores, neither intervention nor time showed significant effects. CONCLUSIONS: Results of this study showed that the time course and psychiatric intervention contributed to recovery of depression and therapeutic intervention. The time course might reduce eating problems. Psychiatric intervention might be necessary for female juvenile detainees, which presents an important issue for future studies.

Characteristics of pathological gamblers with a problem gambling parent.

This analysis compares the characteristics of adult pathological gamblers with and without a problem gambling parent. A sample of 517 individuals with current DSM-IV pathological gambling was categorized based on presence of a parental problem gambler. Groups were compared on clinical characteristics, gambling severity, gambling-related problems, and psychiatric comorbidity. Although the groups were similar on most measures, pathological gamblers with at least one problem gambling parent were more likely to have a father with an alcohol abuse/dependence problem; have financial and legal problems; and report daily nicotine use. Females with a problem gambling parent had significantly earlier onset of gambling behavior, were significantly more likely to have a father with an alcohol use disorder, and were significantly more likely to have financial problems secondary to gambling than females without a problem gambling parent. Males with a problem gambling parent were significantly more likely to have a father with an alcohol use disorder and have legal problems secondary to gambling compared to males without a problem gambling parent. Treatment approaches may need to be tailored for specific problems secondary to gambling and gender issues based on the history of having a problem gambling parent.

Evidence-based practice in group work with incarcerated youth.

As a result of the Youth Criminal Justice Act's increased focus on restorative justice, treatment, rehabilitation, and reintegration of youth, many more juvenile offenders require mental health services while resident in youth detention facilities [Youth Criminal Justice Act (2002, c.1). Ottawa: Department of Justice Canada. Retrieved September 19, 2008 from http://laws.justice.gc.ca/en/Y-1.5]. Several common characteristics such as violence, aggression, and other antisocial behaviors, associated with criminal behavior, have been identified among male and female offenders. Dialectical behavior therapy, originally developed by Linehan [Linehan, M. M., 1993a. Cognitive-behavioural treatment of borderline personality disorder. New York: Guildford Press] for chronically parasuicidal women diagnosed with borderline personality disorder, has been successfully modified for use with other populations, including violent and impulse-oriented male and female adolescents residing in correctional facilities. The intent of this article is to encourage the wider use of dialectical behavior therapy (DBT) with young offenders. It includes an extensive review of the evidence-base to date and describes some of the creative modifications that have been made to standard DBT program format to meet the particular needs of various groups in both Canada and the United States. In keeping with the movement toward more evidence-based practice, the authors argue that DBT is a promising approach in group work with incarcerated adolescents and should be more widely used.

Pathological gambling and criminality.

PURPOSE OF REVIEW: To review research results on the relationship between pathological gambling and criminality, published in 2007 and 2008, in English and in Spanish. RECENT FINDINGS: An important association between pathological gambling and criminality was confirmed in populations of anonymous gamblers, helpline callers and substance abusers. Helplines provide a timely service to gamblers who have not reached the maximum stages in the development of a pathological gambling pattern. Pathological gambling is associated with violence in couples and dysfunctional families. Inversely, violence is also an antecedent promoting vulnerability toward pathological gambling. Impulsiveness shows diverse relationships with pathological gambling and violence as well. A pathological gambler's involvement in crime is exceptionally considered without responsibility by justice, but it may be an indicator of the disorder severity and the need for special therapeutic tactics. SUMMARY: While reviewing the present study, research work was published that contributed to a better understanding of the association between pathological gambling and criminality and went further into their complex relationship and the formulation of explanatory models related to impulsiveness.

Treatment of pathological gambling.

PURPOSE OF REVIEW: This paper highlights the development of pharmacological and nonpharmacological treatments for pathological gambling and is based on a review of the literature published in the past 12 months. RECENT FINDINGS: The efficacy of naltrexone treatment for pathological gambling has been replicated in a double-blind, placebo-controlled, confirmatory study. For mood stabilizers, whereas carbamazepine and topiramate continued to produce positive results, olanzapine failed to show superior outcomes compared with placebo control. Two new pharmacological agents for pathological gambling, N-acetyl cysteine and modafinil, produced significant improvement for pathological gamblers. Several studies examined the outcomes of nonpharmacological treatments. Recent studies showed that cognitive-behavioral therapy failed to produce superior outcomes compared with other less costly methods such as brief interventions. Two new nonpharmacological treatment methods have been reported, including the use of videoconferencing in delivering ongoing supervisions after exposure therapy and the congruence couple therapy, which aims to heal the person as a system whole. SUMMARY: Recent treatment outcomes studies address not only the effectiveness, but also the efficacy of different treatment approaches. Results of two meta-analysis studies showed that nonpharmacological treatments have a larger overall effect size than pharmacological treatments; however, owing to the diversity in study designs, it is unclear whether nonpharmacological treatments are more effective than pharmacological treatments at this point.