Worksite Stress Management with High-Risk Maintenance Workers: A Controlled Study

This study evaluated effects of a worksite stress management/health promotion program with primarily minority blue-collar employees showing a number of high-risk health behaviors. In a biopsychosocial approach, participants were assessed with a standardized health risk appraisal that included physical and behavioral variables, plus measures of self-control, health attitudes/satisfaction, and other factors. A controlled group design was employed with pretreatment, treatment, posttreatment, and three-month follow-up. Participants were randomly assigned to a wait-listed control group (n = 26) and a health promotion intervention group (n = 24). The latter received a multimodal intervention including stress management training, educational workshops and counseling, and a self-directed behavior change program. Following posttreatment assessment, the control subjects were given treatment and their data were then added to that of the initial treatment group to comprise a total group of treatment finishers (n = 33). The results revealed a number of significant differences between the two groups at posttreatment and/or for the treatment finishers across time (pretreatment vs. posttreatment and/or follow-up), including certain of the physical and behavioral measures, self-efficacy, and some health attitudes, but no effects for job-related measures, such as absenteeism and job satisfaction.     

Popular or unpopular? Therapists' use of structured interviews and their estimation of patient acceptance

An accurate diagnosis is an important precondition for effective psychotherapeutic treatment. The use of structured interviews provides the gold standard for reliable diagnosis. Suppiger et al. (2009) showed that structured interviews have a high acceptance among patients. On a scale from 0 (not at all satisfied) to 100 (totally satisfied) patients rated overall satisfaction with a structured interview at M = 86.55. Nevertheless, therapists rarely seem to use structured interviews in clinical practice. The aim of this study was to assess how frequently therapists use structured interviews in daily practice. Secondly, we hypothesized that therapists underestimate patient acceptance of structured interviews. As a third goal, we explored further reasons why therapists choose not to use structured interviews. We conducted an online survey of 1,927 psychiatrists and psychotherapists in Switzerland and asked them how frequently they used structured interviews and how they estimated patient satisfaction with these interviews. Furthermore, we asked therapists why they chose to use or not use structured interviews. Therapists reported using structured interviews on average with about 15% of their patients. Furthermore, therapists estimated significantly lower patient acceptance than patients themselves indicated (M_therapist = 49.41, M_patient = 86.55). Our data suggest lack of familiarity with these instruments as well as an overestimation of the utility of open clinical interviews as further reasons for not using structured interviews.     

It Pays to Pay Attention: A Mindfulness-Based Program for Injury Prevention With Soccer Players

The aim of this study was to examine the extent to which a mindfulness-based program could reduce the number of sport injuries in a sample of soccer players. A total of 41 junior elite soccer players were randomly assigned to the treatment or the attentional control group. The treatment group took part in a 7-session program based on the mindfulness, acceptance, and commitment approach. The attentional control group was offered 7 sessions of sport psychology presentations with a particular focus on soccer. There were no statistically significant differences in injury rates between the two groups, U(39) = 149.50, z = ?1.77, p =.077, but there was a medium effect size (adjusted Cohen's d = ? 0.59), approx. 80% confidence interval for d [?0.37, ?0.74]. Moreover, 67% of the players in the mindfulness group remained injury free in comparison to 40% in the control group. This result implies that an intervention program focusing on strategies for improving attention could decrease injury risk. Recommendations include applying mindfulness exercises in athletes’ daily training to help lower injury risk.     

Reflections on Preparing the Group Leader for an Analytic Perspective

Preparation of group therapists for an analytic perspective involves awareness of unconscious processes at the group and individual levels. The adequately prepared group leader should have familiarity with dream interpretation and group-as-a-whole transferences. Training in the use of long-term treatment methods is useful whether or not the practitioner uses these methods in actual practice. The ideal training program would include didactic seminars, weekly supervision, the experience of conducting a long-term (at least two years) therapy group, as well as personal analytic group therapy. Previous individual analytic therapy is also encouraged.     

Cost-effectiveness of online positive psychology: Randomized controlled trial

As yet, no evidence is available about the cost-effectiveness of positive psychological interventions. When offered via the Internet, these interventions may be particularly cost-effective, because they are highly scalable and do not rely on scant resources such as therapists’ time. Alongside a randomized controlled trial of an online positive psychological intervention, a health-economic evaluation was conducted. Mild to moderately depressed adults seeking self-help and recruited in the general population were randomly assigned to the intervention group (n?=?143) and a waitlisted usual care group (n?=?141). Improved clinical outcomes were achieved in the intervention group (at least for depression) at higher costs. When outliers (the top 2.5%, n?=?5 in intervention group, n?=?2 in control group) were removed, cost-effectiveness was increased considerably. For positive psychology, economic evaluations may be a means to nudge policy decision-makers towards placing positive psychological interventions on the health agenda.     

Three preparatory studies for promoting implementation of outpatient schema therapy for borderline personality disorder in general mental health care

ObjectiveThree studies were conducted to prepare for the implementation of Schema Therapy (ST) for Borderline Personality Disorder (BPD) in general mental healthcare settings. Two were surveys to detect promoting and hindering factors, one was a preliminary test of a training program in ST.MethodsIn 2004, a diagnostic analysis of factors promoting and hindering implementation of a new treatment for BPD was conducted among both managers (n = 23) and therapists (n = 49) of 29 Dutch mental healthcare institutes through a written survey (Study 1). Next, a training program, including a set of DVDs displaying the major therapeutic techniques, was developed and tested among eight therapists. The training program was evaluated by the participants. After the training, three independent raters evaluated therapists' adherence and competence, viewing videos of the therapists completing structured role-plays (Study 2). In 2008, a second written survey was conducted in 22 mental health institutes to study factors for future nationwide implementation of ST (Study 3).ResultsBoth surveys indicated that the situation in most institutes was favorable for implementing a new effective treatment, as participants were not satisfied with the existing treatments, had suitable professional backgrounds, worked in settings with (B)PD-oriented care programs, and expressed a need for change. The surveys yielded clear results for promoting or hindering successful implementation of ST. Promoting factors included scientific evidence for the effectiveness of the treatment, structural changes in the patient's personality, rapidly noticeable effects for the patient, low drop-out rates and a favorable cost-effectiveness. Possible barriers included implementation mandated unilaterally by management, choosing ST based on financial or organizational needs, extending implementation over a lengthy period of time and providing telephone support by therapists beyond office hours. The eight-day training program received very positive ratings. After the training, therapists were rated as sufficiently adherent and competent applying ST to treat BPD patients, with peer supervision and supervision recommended as a supplement to the training.ConclusionThis study showed that the situation in 2005 was advantageous to start implementation of ST. Evaluation of the training and the achieved competence scores of trainees concluded that the training program was a good basis for training therapists in ST. Outcome of the survey in 2008 demonstrated that there was a clear interest for implementation of ST for BPD patients in the future.     

Effect of a Vocationally‐Focused Brief Cognitive Behavioural Intervention on Employment‐Related Outcomes for Individuals with Mood and Anxiety Disorders

Internet-delivered cognitive behavioural therapy (CBT) can be an effective method for treating major depression, but it often works best when therapist support is provided in the form of e-mail support or telephone calls. The authors investigated whether there were any intraclass correlations within therapists when delivering CBT for major depression via the Internet. They included data from two trials involving 10 therapists treating a total of 103 patients. The results of a nested one-way model in which participants were treated as raters for different therapists indicated that measures pertaining to symptom reductions (Beck Depression Inventory, Montgomery-Åsberg Depression Rating Scale–Self Report, and Beck Anxiety Inventory) did not support a clustering of data within therapists. However, the outcome on a secondary measure of life satisfaction (Quality of Life Inventory) yielded a significant intraclass correlation coefficient for therapists (r = .24, p = .001). The authors propose that text-based treatments are less sensitive to therapist effects when it comes to the primary symptom measures, but that treatment effects not directly targeted by the specific treatment program may be more dependent on the way the support is given and by whom (therapist effect). Limitations of the study are discussed.     

Effectiveness of cognitive behavioral therapy on health‐related quality of life: An evaluation of therapies provided by trainee therapists

The present study was carried out to examine the treatment effect of cognitive behavioral therapy provided by trainee therapists at a university clinic, focusing on health‐related quality of life (HRQOL) optimism and symptoms. The study was conducted through a repeated measures design and included a treatment group (n = 21), which received cognitive behavioral therapy for an average of 10.7 therapy sessions and a control group (n = 14), that was put on a wait list for 8.6 weeks on average. After treatment, the treatment group improved significantly concerning general health (p = 0.028) and optimism (p = 0.027). In addition, clients improved in several areas within mental health and displayed some reduction in anxiety symptoms. Concurrently, the results also indicated some improvement within the control group, which may have been caused by the initial therapeutic contact, expectancy effects or spontaneous remission. The study concluded that cognitive behavioral therapy provided by trainee therapists may have a positive effect on areas within HRQOL and optimism.     

Behavioral Treatment of Non-Ulcer Dyspepsia

Abstract

A behavioral treatment program, largely based on applied relaxation was tested in a group of patients (n=32) suffering from non-ulcer dyspepsia. They were compared to a randomized Control group (n=33) and a non-randomized Extra control group (n=29), consisting of patients who had declined the offer of behavioral treatment. Self-recorded pain intensity had decreased significantly more in the Treatment group than in the Control group at post-treatment. Also, the Treatment group experienced fewer pain occasions than the Extra controls at post-treatment. There were no differences between groups at the one-year follow-up.     

TEACHING SOCIAL/VOCATIONAL SKILLS TO RETARDED ADULTS WITH A MODIFIED TABLE GAME: AN ANALYSIS OF GENERALIZATION

In this study, a social skills training program for institutionalized mildly or moderately retarded adults was extended to include skills relevant to vocational settings. Target behaviors involving a verbal action or reaction within six skill areas were taught using a commercially available board game, Sorry, and a specially designed card deck. The training program featured response specific feedback, self-monitoring, individualized reinforcers, and individualized performance criterion levels. Using a multiple baseline across two groups (n = 3 per group), the game contingencies increased social/vocational skills in all targeted areas. Generalization was assessed in two settings: a simulated workshop in which pre and post measures were taken and in the institutional workshop where the residents worked. The posttraining simulated workshop results revealed that the residents' newly learned skills had generalized. However, repeated generalization measures of the residents' social interactions in the institutional workshop were equivocal as were measures of their productivity.     

Effectiveness of an attachment-based intervention for the assessment of parenting capacities in maltreating families: A randomized controlled trial

Even though Parenting Capacity Assessments (PCAs) are essential for child protection services to support placement decisions for maltreating families, presently no evidence-based PCA protocols are available. In this randomized controlled trial, we tested the quality of an attachment-based PCA protocol based on Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD). We recruited 56 parent-child dyads (M_age children = 3.48 years) in Dutch family residential clinics that conduct PCAs to support placement decisions. After pretest, families were randomized to receive the Regular Assessment Procedure (RAP) (n = 28), or an additional assessment based on VIPP-SD (n = 28). An immediate post-test and a 10-month follow-up were conducted. Multilevel models showed that therapists felt equally confident about their recommendations regarding child placement for both groups and that they equally often modified their initial placement recommendations. Moreover, children in the VIPP-SD group did not show fewer behavior problems and did not experience recurring child maltreatment less often than children in the RAP group. Thus, we found no evidence that PCAs incorporating the VIPP-SD protocol outperformed PCAs as usual. We discuss possible explanations why in the current study VIPP-SD did not seem to add to the quality of the RAP.     

Differential outcomes of skill training,group counseling,and individual cognitive therapy for persons with acquired visual impairment

As part of the Living Skills Training Program, group counseling and individual cognitive therapy were implemented to decrease psychological distress for adults with acquired visual impairment. This quasi‐experimental design study compared the outcomes of a 6‐month skill training program combined with a group counseling program (n = 37), with (n = 9) or without (n = 10) individual cognitive therapy, and with a control group (n = 42). The outcome measures were the Profile of Mood States and the Nottingham Adjustment Scale Japanese Version. The results showed that participants with low psychological distress decreased anxiety and increased acceptance of disability, even when they did not participate in group counseling. However, among the participants with high distress, they did not show any improvement without group counseling or individual therapy. The participants with high distress who engaged in group counseling showed an improving trend in attitudes toward others. Moreover, the participants who chose to engage in individual therapy in addition to group counseling showed decreased tension‐anxiety, depression, and fatigue, and significantly improved acceptance of disability. These results suggest that group counseling, combined with individual cognitive therapy, can be an effective part of rehabilitation treatment for clients who have high psychological distress.     

Does family therapy produce change? an overview of outcome studies

Summary Families were randomly assigned to one of two forms of conjoint marital therapy: an insight-oriented treatment (n=10) or a problem-solving intervention (n=10.). The results on self-report measures of family functioning indicate that the problem-solving intervention produced more favorable changes after three months. However on long-term follow-up after a year, this more positive effect did not apparently persist, since the insight treatment group reported better results. Experienced therapists did better than inexperienced therapists in the insight treatment condition, but level of experience did not make a difference in the problem-solving intervention. A group of eight families who dropped out of the insight treatment group provided data on correlates of premature termination. Several of the practical obstacles to implementing an experimental design in a clinic setting are illustrated by the research.As we develop more sophisticated methodology, we hope that is the near future family therapy researchers will be better able to state which type of approach is more effective for whom and under what circumstances. A review of current studies of family therapy outcome research indicates that family therapy seems to be as effective as individual psychological treatment.     

Therapists’ Thought-Action Fusion Beliefs Predict Utilization of Exposure in Obsessive-Compulsive Disorder

Although exposure and response prevention (ERP) is considered the gold standard for the treatment of obsessive-compulsive disorder (OCD), it is rarely used in clinical practice. Therapists’ beliefs about ERP affect its utilization, as previous research suggests, but the role of therapists’ cognitive biases is unclear. In particular, susceptibility to thought-action fusion (TAF) may be related to the underutilization of ERP in OCD.Therapists (N = 353) were divided into those recommending (ERP+, n = 228) and not recommending ERP (ERP−, n = 125) as treatment for an OCD case example. TAF in therapists was assessed using behavioral and self-report measures (TAFS).TAF was higher in the ERP− than the ERP+ group, with a small to moderate effect size (0.2 ≤ d ≤ 0.4). ERP− therapists showed more avoidance and neutralizing behavior and a stronger emotional response than the ERP+ therapists during the experimental task. Moreover, higher TAF as measured by the TAFS was associated at a small magnitude with lower likelihood of using ERP in the therapists’ actual clinical practices.Therapists’ cognitive biases should be addressed in their training in order to increase the dissemination of evidence-based treatment (i.e., ERP) and thus improve the treatment of OCD.     

Internet-Delivered Targeted Group Intervention for Body Dissatisfaction and Disordered Eating in Adolescent Girls: A randomized controlled trial

This study evaluated a targeted intervention designed to alleviate body image and eating problems in adolescent girls that was delivered over the internet so as to increase access to the program. The program consisted of six, 90-minute weekly small group, synchronous on-line sessions and was facilitated by a therapist and manual. Participants were 73 girls (mean age=14.4 years, SD=1.48) who self-identified as having body image or eating problems and were randomly assigned to an intervention group (n=36) (assessed at baseline, post-intervention and at 2- and 6-months follow-up) or a delayed treatment control group (n=37) (assessed at baseline and 6–7 weeks later). Clinically significant improvements in body dissatisfaction, disordered eating, and depression were observed at post-intervention and maintained at follow-up. Internet delivery was enthusiastically endorsed. The program offers a promising approach to improve body image and eating problems that also addresses geographic access problems.     

Use of an Orientation Session May Help Decrease Attrition in a Pediatric Weight Management Program for Low-Income Minority Adolescents

This study examined predictors of attrition from a pediatric weight-control program in a low-income minority community and the potential usefulness of an orientation session to increase length of treatment. Participants were 342 children and adolescents (M age=13.0 years old; 54% female; 89% African American; M BMI=44.2, M BMI z-score=6.0) and their caregivers who attended FitMatters, a multidisciplinary cognitive-behavioral program focused on long-term participation. Those who attended an orientation session stayed in treatment significantly longer, but attrition was not affected by demographic factors, weight status, or psychological functioning. These results indicate that an orientation session that clearly delineates the structure of a program and expected attitudinal and behavioral requirements for the families may help align expectations, as well as more effectively identify families who are ready to make concerted efforts to change the family lifestyle in support of their obese children's efforts.     

Rehabilitating civilian victims of war through psychosocial intervention in Sierra Leone

This research assessed an intervention (involving drug therapy and psychoeducational counseling) for war trauma in Sierra Leone. We examine the impact of the intervention on symptoms of post‐traumatic stress disorder (PTSD) and indicators of intergroup emotions and attitudes. Civilian war victims were drawn from a rehabilitation program (Intervention, N=50) or a waiting list Control group (N=50). The rehabilitation program combined general psychiatric treatment with additional life skills support. Those in the Intervention group had significantly lower PTSD symptoms and also scored lower on Intergroup Anxiety and Outgroup Blame, than those in Control. The intervention had an indirect effect on PTSD symptoms through Intergroup Anxiety. The reduction in PTSD in the intervention was greater for participants with a stronger identification with Sierra Leone.     

Psychoanalysis: Practical and Research Aspects by Willi Hoffer

The outcome of clients who saw one of four “expert” professional group therapists selected by peer nomination or four “natural helper” nonprofessionals nominated by students is contrasted in a 15-session psychotherapy group. Process measures tapping specific group and “common factors” were drawn from sessions 3, 8, and 14; outcome was assessed at pre-, mid-, posttreatment, and a 6-month follow-up. Results were examined by leader condition (professional vs. nonprofessional therapists) and time (group development). Virtually no reliable differences were found on measures of outcome primarily because of a floor effect on several measures. Therapist differences on the process measures tapping the “common factors” of therapeutic alliance, client expectancy, and perception of therapists were either nonsignificant or disappeared by the end of treatment. A complex picture of differences on one therapeutic factor (insight), common factor measures, and subtle variation in the outcome data suggests a distinct pattern of change, however. Methodological limitations are also addressed including problems inherent in large-scale clinical-trial studies, ethical concerns raised by using nonprofessional leaders, and problems with generalizability, given the absence of significant psychopathology in group members.     

Psychological Effects of a Life Review Intervention for Persons With HIV Disease

The purpose of this study was to evaluate a life review intervention for persons with HIV disease. Twenty-seven adults with HIV disease (16 had been diagnosed with AIDS) were randomly assigned to 1 of 3 conditions: a group life review intervention (n = 8), a traditional support group (n = 9), or a waiting list (n = 10). Using a pre-post design, participants were compared on psychological measures of optimism, self-esteem, purpose in life, coping ability, psychological distress, and death anxiety. Although analyses revealed no significant differences between the interventions, statistical trends and participants' written evaluations favored the life review intervention. Attrition was a significant problem. Discussion focuses on the special problems encountered in conducting psychological intervention research with an HIV-positive population.