Nursing and psychological treatments

Presents a comment on "Psychological Treatments" by D. H. Barlow. In his article, Barlow pointed to the need "to solidify the identification of psychology as a health care profession" by changing the terminology of practice in the health care context from psychotherapy to psychological treatments and suggested that the only persons qualified to carry out such interventions are doctoral-level psychologists. Unfortunately, there was no discussion of the health care professionals who already provide psychological treatments in health care settings and their contribution to the evidence base supporting such treatment. The authors find several aspects of the article to be problematic. Overall, the authors feel that suggesting that psychology should claim treatment of psychological disorders and psychological components of physical disorders in health care settings as exclusively its own domain ignores the research and clinical contributions of others.     

Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: The promise of transdiagnostic interventions

Assessing treatment fidelity is a core methodological consideration in the study of treatment outcome; it influences both the degree to which changes can be attributed to the intervention and the ability to replicate and disseminate the intervention. Efforts to increase access to evidence-based psychological treatments are receiving unprecedented support; but pressures exist to adapt treatments to service settings, running the risk of compromising fidelity. However, little evidence is available to inform the necessary conditions for the transportation of interventions to service provision settings, and the degree to which fidelity is even evaluated or emphasized in dissemination and implementation programs varies dramatically. Moreover, adaptation is associated with several benefits for dissemination efforts and may address relevant barriers to adoption. A particularly promising strategy for maximizing the benefits of both fidelity and adaptation is the use of transdiagnostic interventions. Such treatments allow for greater flexibility of the pacing and content of treatment, while still providing structure to facilitate testing and replication. Preliminary evidence supports the efficacy of this strategy, which may be particularly conducive to dissemination into service provision settings. At this time, further research is needed to evaluate the relationships among fidelity, adaptation, and outcome, and to determine the potential for transdiagnostic treatments to facilitate dissemination.     

Perfectionism and psychological distress: evidence of the mediating effects of rumination

Three studies investigated the role of ruminative tendencies in mediating the effects of multidimensional perfectionism (Hewitt & Flett, 1991) on psychological distress. Study 1 (Sample 1, N = 279; Sample 2, N = 224) and Study 2 (N = 205) found evidence, cross‐sectionally and prospectively, that brooding ruminative response style either fully or partially mediated the effects of socially prescribed and self‐oriented perfectionism on psychological distress, depression and hopelessness levels. In addition, Study 3 (N = 163) confirmed these mediation effects for socially prescribed perfectionism in relation to depression and hopelessness, 2 months later, after initial levels of distress were controlled. Overall, these findings provide evidence that brooding ruminative response style is an important mechanism that can explain, in part, the relationship between perfectionism and distress. Copyright © 2006 John Wiley & Sons, Ltd.     

Improving access to psychological treatments: lessons from developing countries

Even though psychological treatments have been advocated as treatments for a range of mental disorders by the WHO for scaling up through primary care globally, the vast majority of potential beneficiaries are unable to access these treatments. Two major barriers impede the path between evidence based treatments and improved access: the lack of skilled human resources and the acceptability of treatments across cultures. This essay synthesizes the experiences of programs which developed and evaluated psychological treatments for depression in three resource poor developing countries. These programs addressed the human resource barrier by training lay or community health workers to deliver the treatments and addressed the acceptability barrier by systematically adapting the treatment to contextual factors. All programs demonstrated significant benefits in recovery rates when compared with usual care demonstrating the effectiveness of the approach. The implications for these experiences to improving access to psychological treatments in the global context are discussed.     

Childhood trauma and psychosis: Review of the evidence and directions for psychological interventions

There is controversy over whether childhood trauma (CT) is a causal risk factor for psychosis. The aim of this study was to provide psychologists with a brief overview of the research into relationship between childhood trauma and psychosis and directions for psychological interventions. It details six of the highest quality studies in the area and tentatively concludes from these that there is evidence for a relationship between CT and psychosis. Hallucinations and delusions have been implicated as important factors in the relationship between CT and psychotic disorder and these are discussed, along with post‐traumatic intrusions and schemas, which have been conceptualised as part of the psychological mechanisms whereby CT confers a risk for psychosis. The development of psychological interventions for people with psychosis who have experienced CT is in its infancy but has been based on evidence‐based cognitive behavioural interventions in psychosis and post‐traumatic stress disorder. A formulation‐based approach is described in this paper, along with a case study.     

Introduction to the special section on dissemination: dissemination research and research dissemination: how can we close the gap?

One of the greatest challenges facing health promotion and disease prevention is translating research findings into evidence-based public health and clinical practices that are actively disseminated and widely adopted. Despite the tremendous strides made in developing effective disease prevention and control programs, there has been little study of effective dissemination of evidence-based programs to and adoption by community, public health, and clinical practice settings. This special section provides a venue in which to highlight exemplary dissemination research efforts while also identifying limitations in research to date and framing important future research questions. This issue establishes a resource for investigators interested in dissemination research, with relevance to health psychology. In this sense, it can serve as a benchmark by which to examine subsequent progress. The 6 articles reflect the state of the science in dissemination research for the promotion and adoption of health behavior change interventions.     

A comparison of two psychological treatments for bulimia nervosa

Two standardized psychological treatments for bulimia nervosa were studied. A cognitive behavioural approach was compared with a form of short-term focal psychotherapy. Twenty-four patients who met strict diagnostic criteria for bulimia nervosa were randomly allocated to the two treatments. All the interviews were tape-recorded so that checks on their content could be made. Assessments took place at the beginning and end of treatment, and at 4-, 8- and 12-month follow-up. None of the patients dropped out of treatment or follow-up, but 1 patient from each treatment group had to be withdrawn on clinical grounds. Patients in both groups made substantial improvements which were well maintained over the 12-month treatment-free follow-up period. The cognitive behavioural approach was superior to short-term focal psychotherapy in terms of its effect on the patients' overall clinical state, their general psychopathology and social adjustment, and their assessment of their outcome.     

A meta-analysis of psychological and pharmacological treatments for Body Dysmorphic Disorder

Although psychological and pharmacological treatment approaches for Body Dysmorphic Disorder have been evaluated, the relative effectiveness of these two types of interventions has not been examined. We conducted a meta-analysis of randomized clinical trials and case series studies involving psychological (i.e., behavioural, cognitive-behavioural, cognitive) or medication therapies. Our findings support the effectiveness of both types of therapy, but suggest that cognitive-behavioural treatment may be the most useful. These findings require cross-validation through large-scale clinical trials.     

Comparing psychological and pharmacological treatments for hyperkinetic boys and their classmates

This study compares the short-term effects of methylphenidate and of teacher consultation on the on task behavior of diagnosed hyperkinetic outpatient boys and selected classmates. Statistically significant treatment effects were found for both drug treated and behaviorally treated hyperkinetic boys; the size of these effects did not differ between the two types of treatment. Within the behavioral group, the treatment effect spilled over, so that there was also a significant treatment effect on overactive classmates of the behaviorally treated hyperkinetic children and a trend toward a significant treatment effect on their average classmates. Some implications of the findings are discussed.This study was supported by grant number MH-22659 from the National Institute of Mental Health.     

Confession evidence,psychological vulnerability and expert testimony

There have been major changes in English Law with regard to confession evidence, which followed the implementation of the Police and Criminal Evidence Act (PACE) in January 1986. This paper reviews the main legal changes that are relevant to the admissibility and reliability of confessions and their psychological importance within the context of both research and expert testimony.     

The locus of redundant-targets and nontargets effects: evidence from the psychological refractory period paradigm

In target detection tasks, responses are faster when displays have 2 targets (redundant-targets effect; RTE) and slower when they have no targets (nontargets effect; NTE) relative to displays with a single target. The psychological refractory period paradigm was used to localize these effects. In Experiment 1, participants classified tones as high or low and then classified letters as targets or nontargets after a short or long stimulus onset asynchrony (SOA). The magnitudes of the RTE and NTE did not depend on SOA. In Experiment 2, the order of the tasks was reversed, and at short SOAs the RTE and NTE had similar magnitudes for both tone discrimination and target detection responses. These findings suggest that the RTE and NTE arise during response selection. Interactive effects of tone pitch with the number and type of target features were also observed, and these were tentatively interpreted as synesthetic effects.     

Automatic processing of psychological distance: evidence from a Stroop task

A picture-word version of the Stroop task was used to test the automatic activation of psychological distance by words carrying various senses of psychological distance: temporal (tomorrow, in a year), social (friend, enemy), and hypotheticality (sure, maybe). The pictures implied depth, with the words appearing relatively close to or distant from the observer. The participants classified the spatial distance of words faster when the word's implicit psychological distance matched its spatial distance (e.g., a geographically close word was classified faster when it was "friend" than when it was "enemy"). The findings are consistent with the idea that psychological distance is accessed automatically, even when it is not directly related to people's current goals, and suggest that psychological distance is an important dimension of meaning, common to spatial distance, temporal distance, social distance, and hypotheticality.     

Action-effect codes in and before the central bottleneck: evidence from the psychological refractory period paradigm

Voluntary motor actions aim at and are thus governed by predictable action effects. Therefore, representations of an action's effects normally must become activated prior to the action itself. In 5 psychological refractory period experiments the authors investigated whether the activation of such effect representations coincides with the response selection stage of information-processing theories. Participants performed 2 choice reaction tasks, separated by variable stimulus onset asynchronies. The authors varied the compatibility between responses and forthcoming sensorial effects (Experiments 1, 2, 3, and 5) or between responses and effect-resembling stimuli (Experiments 4 and 5) in one of the tasks. They observed that compatibility influences from forthcoming (anticipated) response effects were located within the response selection bottleneck, whereas compatibility influences from action-preceding (perceived) effects were due to processes before the bottleneck. These results point to a crucial role of the endogenous activation of action-effect representations for the selection of voluntary motor responses.     

A comparison of two psychological treatments for bulimia nervosa: Implications for models of maintenance

In an effort to elucidate the role of cognitive factors in the maintenance of bulimia nervosa, the efficacy of two psychological treatments was examined in a randomised control trial: cognitive behaviour therapy in the absence of explicit exposure instructions was compared with exposure and response prevention treatment in the absence of cognitive restructuring procedures. In the short term both treatments were successful at effecting substantial improvement in both the specific and the non-specific psychopathology of the disorder. However, at a one year follow up, whilst improvements were well maintained for those who had received the cognitive-behavioural treatment, virtually all of those who had responded to the purely behavioural treatment had relapsed. This provides some support for the cognitive model of the maintenance of bulimia nervosa. Nevertheless, the two treatment groups could not be distinguished on post-treatment measures of cognitive disturbance and neither was it the case that residual levels of cognitive disturbance, as assessed, predicted relapse. This may suggest that the level at which the necessary cognitive change takes place may not be accessible by conventional assessment procedures.