Clinical Psychology – Dr Martin Fracker

Not Getting Enough Sleep Affects Your Emotional Health

We have all experienced nights when we didn’t get enough sleep. And we may have noticed that as a result we were more irritable or more anxious or generally less able to handle stressful situations. In order to understand better the effects of sleep deprivation on our emotional health, Palmer and colleagues conducted a meta-analysis over 154 relevant studies. They found that, as many of us may have experienced, sleep deprivation often reduces positive emotions and increases anxiety. The authors also found that disrupting REM (normal dreaming) sleep increased negative emotions more than disruptions during other stages of sleep.

Cognitive Behavior Therapy Works with Depressed Young People By Reducing Negative Thinking

The authors of this study tried to determine the mechanisms by which two types of psychotherapy help relieve clinical depression in young people: Cognitive Behavior Therapy (CBT) and Interpersonal Psychotherapy (IPT). To do this, they examined the results of 34 randomized controlled experiments, 27 of which focused on CBT while only 6 examined IPT studies and one included both CBT and IPT. Among their results, they found clear evidence that CBT helps to alleviate depression by reducing negative thinking.

But how does CBT reduce negative thinking? In theory, CBT should reduce negative thinking by improving the person’s problem solving skills and helping them to reframe or change how they think about problems in their lives. But the authors did not find evidence that CBT improved problem solving or reframing. Does this mean that CBT doesn’t work the way we think it does? Or does it mean that we are just not very good at measuring problem solving skill or reframing? Answers to those questions remain for the future. For now, it may be sufficient to know that CBT does reduce negative thinking in young people and thereby helps them to overcome depression.

One Session Treatments for Phobias in Young People with Autism Spectrum Disorder (ASD)

Children and young people with Autism Spectrum Disorder (ASD) commonly experience various fears and phobias. Davis & Brennan reviewed evidence for the effectiveness of treatments of these anxiety disorders, including the adaptation of One Session Treatments for ASD youth.

Two-Step Family Cognitive Behavior Therapy May Benefit Some Autism Spectrum Disorder (ASD) Children with Anxiety

Cognitive behavior therapies are generally effective for treating anxiety, but modifications may be needed when anxiety is accompanied by Autism Spectrum Disorder (ASD). Storch and associates evaluated the effectiveness of a two-step approach to family-based cognitive behavior therapy for anxiety with ASD children up to 14 years of age. The first step was parent-led with therapist assistance. The second step was therapist-led for children who had not shown improvement in step 1 (non-responders). These non-responders generally had higher levels of pre-treatment anxiety than those who had improved.

All children were evaluated again 12 weeks following step 1. At this point, the authors reported no difference between those that had improved in step 1 and those that had continued into step 2. A major weakness of this study however was a high attrition rate: of the 76 children who started in step 1, only 45 completed their entire treatment program. The authors noted that this attrition rate is higher than that observed with more standard forms of Cognitive Behavior Therapy, and noted that some of the attrition may have been due to the COVID-19 pandemic.

Patients with Autism Spectrum Disorder (ASD) and Anxiety Can Benefit From Cognitive Behavior Therapy

Standard Cognitive Behavior Therapy (CBT) focuses on teaching patients to recognize self-defeating ways of thinking and replace them with more constructive thoughts. Hollocks and colleagues knew that CBT treatments for Autism Spectrum Disorder (ASD) patients with anxiety were most effective when tailored to the specific needs of ASD patients. They hypothesized that patient decision-making ability and sensitivity to reward contingencies might underlie the superiority of specially tailored CBT treatments. Accordingly, they assessed the decision-making ability and reward sensitivity of 148 children with ASD who were randomly assigned to standard CBT or tailored CBT treatments. Their results suggested that ASD patient decision-making ability and reward sensitivity accounted for the superiority of tailored CBT.

Children with Autism Spectrum Disorder (ASD) Engage in More Verbal Aggression with Greater Intensity than Others

Quetsch and colleagues compared 450 autistic children to 432 neurotypical controls based on caregiver reports of aggressive behavior. Their analysis of results indicated that, across development, autistic children engaged in more verbal aggressive behavior with greater intensity than neurotypical children, although the degree of difference diminished as the children grew older.

Aggressive Behavior by Youth with Autism Spectrum Disorder (ASD) Is Influenced by the Environment

To what extent is the aggressive behavior of youth with Autism Spectrum Disorder (ASD) moderated (or aggravated) by attributes of their environment? Brown and colleagues tried to answer this question based on caregiver reports for 511 ASD youth. Overall, their data indicated that demographic and environmental factors accounted for up to 40% of the variance in children’s aggressive behavior. The main factors influencing reported aggressive behavior were:

Family income
The child’s age and social communication skills
Parental distress arising from having to deal with a difficult child

Besides these factors, the researchers also found a slight effect of family warmth as measured by the Family Environment Scale and Caregiver-Child Dyad Satisfaction, but this factor barely accounted for an additional one percent of the observed total variance.

High Functioning Individuals with Autistic Spectrum Disorder (ASD) Are Less Able to Process Their Emotions

Hill and colleagues compared 27 high functioning adults with Autism Spectrum Disorder (ASD) to 35 neurotypical controls and 49 biological relatives. They found that ASD individuals were less able to process their emotions and, perhaps for that reason, more depressed than both the controls and the relatives. Their findings join others in showing that, even for high functioning individuals, ASD is associated with poorer emotion regulation and higher negative affect.

Higher Functioning in Autism Spectrum Disorder (ASD) is Associated with Improved Emotion Regulation

While individuals with Autism Spectrum Disorder (ASD) generally may be less able to regulate their emotions and handle frustration than neurotypical individuals, we might reasonably expect higher functioning individuals with ASD to be better able to control their emotions than those who are lower functioning. In this article, Konstantareas and Stewart report data supporting this expectation, but they also found that higher functioning individuals experienced higher negative affectivity including more negative emotions such as anger or sadness and potentially lower self-esteem.