LGB-Affirmative Cognitive Behavioral Treatment for Social Anxiety: A Case Study Applying Evidence-Based Practice Principles

Guided by the American Psychological Association's principles of evidence-based practice, this article reviews a single-case treatment outcome study whereby a client characteristic, sexual identity, was integrated into the assessment and treatment of social anxiety symptoms. The case involved a young adult European-American male who presented to a training clinic with a primary diagnosis of social anxiety disorder as well as secondary symptoms of excessive worry and concerns of sexual identity confusion. Recent evidence suggests that gay men report more symptoms of social anxiety when compared to heterosexual men, and those who make more efforts to conceal their sexual identity experience increased anxiety and have greater difficulty committing to a personal identity. Further, it has been hypothesized that fear of rejection from heterosexual individuals underlies this anxiety. The client attended 50 sessions over the course of 18 months. Treatment progress was assessed via self-report questionnaires assessing social anxiety and worry. Consistent with principles of evidence-based practice, a cognitive behavioral treatment protocol was employed at the outset of therapy and resulted in a decline in the client's social anxiety scores. However, once the case conceptualization and treatment focus shifted to focus on sexual identity, his scores continued to decline at an even steeper rate. He ultimately came to identify himself as having a same-sex sexual orientation, began living his life in a manner consistent with that identification, and reported a number of positive outcomes at termination of therapy. Implications for treatment of social anxiety in sexual minorities are discussed.     

When Moral Personality and Moral Ideology Meet Ethical Leadership: A Three-Way Interaction Model

We propose a three-way interaction model based on substitutes for leadership theory to explore the relationship among ethical leadership, moral personality, and moral ideology (i.e., idealism and relativism) on two types of employee voluntary behaviors (i.e., organizational citizenship behavior and workplace deviant behavior). Results from a sample of 218 supervisor–subordinate dyads indicate that moral personality attenuates the relationship between ethical leadership and employee voluntary behaviors. Idealism serves as the boundary condition for the moderating effect of moral personality. However, relativism only serves as the boundary condition for the moderating effect of moral personality when predicting workplace deviant behavior.     

Divorce and Death: A Case Study for Health Psychology

Marital separation and divorce are associated with increased risk for early death, and the magnitude of this association rivals that of many well‐established public health factors. In the case of divorce, however, the mechanisms explaining precisely why and how some people are at risk for early death remain unclear. This paper reviews what is known about the association between divorce and risk for all‐cause mortality, then discusses four emerging themes: the biological intermediaries linking divorce to pathophysiology and disease onset, moving beyond the statistical mean, focusing research on the diathesis‐stress model, and studying how opportunity foreclosures may place people on a trajectory toward poor distal health outcomes. These ideas are grounded in a set of public lay commentaries about the association between divorce and death; in this way, the paper seeks to integrate current research ideas with how the general public thinks about divorce and its correlates. Although this paper focuses on divorce, many of the emerging themes are applicable to the study of psychosocial stress and health more generally. Therefore, the study of divorce and death provides a good case study for health psychology and considers new questions that can be pursued in a variety of research areas.     

Evidence-Based Strategies for Treatment Personalization: A Review

Clinicians in practice routinely make decisions that, in effect, tailor the care they provide to each individual patient. For example, clinicians must decide which treatment package to administer, or what specific skills to introduce. Providers also determine when to change approaches, the frequency of sessions, and when to terminate treatment. In this review, we describe the empirical literature for personalizing the delivery of psychological care that corresponds to the inflection points in treatment that clinicians face. In addition, we provide data-based recommendations to clinicians for personalizing patient care at each of these decision points and suggest areas for future study.     

Exposure-Based Cognitive-Behavioral Therapy for Disruptive Mood Dysregulation Disorder: An Evidence-Based Case Study

Severe, chronic irritability is one of the most frequently reported problems in youth referred for psychiatric care. Irritability predicts adult depressive and anxiety disorders, and long-term impairment. Reflecting this pressing public health need, severe, chronic, and impairing irritability is now codified by the DSM-5 diagnosis of disruptive mood dysregulation disorder (DMDD). Since DMDD has only recently been added as its own nosological class, efficacious treatments that specifically target severe irritability as it presents in DMDD are still being developed. In a recent pilot study, we described the general concept of exposure-based cognitive-behavioral therapy (CBT) for irritability. This mechanism-driven treatment is based on our pathophysiological model of irritability that postulates two underlying mechanisms, which potentiate each other: (1) heightened reactivity to frustrative nonreward, and (2) aberrant approach responses to threat. In this case report, we describe and illustrate the specific therapeutic techniques used to address severe irritability in an 11-year-old boy with a primary diagnosis of DMDD. Specific techniques within this CBT include motivational interviewing to build commitment and target oppositionality; creation of an anger hierarchy; in-session controlled, gradual exposure; and parent training focusing on contingency management to counteract the instrumental learning deficits in irritable youth. Parents learn to tolerate their own emotional responses to their youth’s irritability (e.g., parents engage in their own exposure) and increase their adaptive contingencies for their youth’s behavior (e.g., withdraw attention during unwanted behavior, praise desirable behavior). Future directions in the context of this CBT, such as leveraging technology, computational modeling, and pathophysiological targets, are discussed.     

投资于未来:我国儿童健康政策述评

本文以健康风险—卫生政策为分析思路,梳理了改革开放前后两个阶段儿童健康风险与政策应对。计划经济时期,儿童健康受制于恶劣的自然环境、低下的经济发展水平以及落后的医疗技术条件,其效应的发挥很大程度上得益于政府强大的资源动员能力,以及运动式的环境改造方式。20世纪90年代以来的市场化改革,改变了健康风险,也产生了健康的经济风险和健康不平等。儿童健康问题并不是单纯的医疗领域的问题,而需要综合性手段予以应对,需要多部门的配合。     

对神木医改举措的评述与思考

在对神木医改新举措和特征分析的基础上,提出对人民健康幸福及医药卫生改革将带来一些有利的效应,促进基本卫生保健的可及性,推进城乡医疗保障发展一体化等.但不可忽略的是需要规范医患双方行为、有效地控制道德损害以及确保政府资金的合理和有效分配等一系列问题.提出需进一步完善制度设计的建议,规范医患双方行为,确保政府资金合理和有效分配等.     

A Rationale for Evidence-Based Clinical Supervision

Although modern mental health systems increasingly require evidence-based practice (EBP), clinicians continue to object to restrictions on their professional independence, which they may perceive as counterproductive, divisive and even demeaning. In the face of such deep-seated objections, do we really need to strive for an evidence-based approach to supervision? We believe so, and begin our argument by noting a colourful illustration of the problems that can exist in the absence of EBP, those of poor training, therapist drift and weak professional regulation. Next, we present EBP as a mechanism to reduce such unacceptable variability in the way that treatments are delivered. We then apply the lessons from this divisive situation to the practice of clinical supervision, outlining a rationale for an inclusive, synergistic way forward. A number of fundamental psychological motives for this integration are noted, including supervisor training that is informed by practice-based research, corrective feedback on supervision, and a supportive professional system. Illustrative examples are provided in each of these areas. It is concluded that the traditional gulf between research and practice can and should be bridged in relation to supervision.     

When Rules Go Awry: A Single Case Analysis of Cycle Rage

On a sunny Sunday afternoon in 2012 a conflict arose between two men riding a popular mountain biking track in New Zealand. The bulk of this was filmed from a helmet-mounted action camera, facilitating a single case analysis of the transition from an everyday trouble to an unexpected violent ending. The two riders come across each other travelling downhill at speed on a narrow track. Unease quickly develops for the camera-clad rider wants to pass the rider in front, but except for an intriguing and brief interlude, the first rider will not let the other pass. The second rider grows frustrated, progressing to tailgate the ‘slower’ rider, in the midst of which he invokes a rule of mountain biking conduct. The reflexive implications of the rule-invocation need to be seen to be believed. The video is used as data to get close to such seeing, and despite some limitations, we can see a clear trajectory where the rule significantly contributes to a moment of phenomenological salience. Thereafter, it becomes witnessably relevant to the conflict that develops.     

Health Policies and Bioethics: A Psychosocial Perspective in Managing the Moral Question

In Western democratic society, the specificity of the bioethical debate over the life-sciences involves bringing together many different study factors. The dilemmas raised by the new scientific discoveries highlight how contemporary common sense is plagued by a profound feeling of anguish over possible future anthropological developments. One of the central problems is the social construction of consent as a psychological strategy seeking to orient public opinion toward accepting new applications of science and technology. On the one hand, the general features in the epistemological analysis of the mind-brain identity are called into question; and on the other, together with all those research directions concerned with the “meaning of life,” we enter the dimension of the complex issue inherent in the possibility of establishing if there exists something transcending thought and what it may be. In both cases a problem is raised on which the meaning of human life and the world depend, while between the two universes described by medical science and ethical-philosophical thought a window of opportunity for important psychological research is opened. In order to understand such phenomena the present article defends the theory that social psychology must adopt as its subject matter “thinking society,” that is, society characterized by discussion and reasoning on themes relevant to bioethics.     

Theory-Based Health Behavior Change: Developing, Testing, and Applying Theories for Evidence-Based Interventions

Theories are needed to explain and predict health behavior, as well as for the design and evaluation of interventions. Although there has been a history of developing, testing, applying, and refining health behavior theories, debates and limitations in evidence exist: The component of theories which, for example, predicts change should be better elaborated so that we can more easily understand what actually drives behavior change. Theories need to be empirically testable in two ways. Theories need to specify a set of changeable predictors to describe, explain, and predict behavior change, and they should enable us to design an effective intervention that produces exactly those changes in behavior that are predicted by the relevant theory. To make this possible, theories need to be specified in such a way that they can be rigorously tested and falsified. Moreover, for the design of theory-based interventions it must be possible to derive change techniques from the theory and to use them to generate changes in behavior. Based on eight state-of-the-science articles that make conceptual and empirical contributions to the current debate on health behavior theories, various approaches are discussed to gain further insights into explaining and changing health behaviors and the iterative process of theory development.     

Nanotechnology Policies in Latin America: Risksto Health and Environment

The presence of nanotechnologies grew and spread throughout Latin America during the first decade of the 21st century. Science and Technology policies have played an important role in the performance of these new technologies. Various international institutions, such as the World Bank, the Organization for Economic Co-operation and Development, and the Organization of American States promoted similar Science and Technology policies, and included nanotechnology as a priority area. This article shows the role of these Science and Technology policies in the promotion of specific objectives and the gap that was left due to the failure to incorporate an examination of the potential risks to health and environment, not to mention other labor-related effects. The omission of matters relevant to workers and consumers by these institutions led to a distancing from organized civil society.     

A Model for Adapting Evidence-Based Interventions to Be LGBQ-Affirmative: Putting Minority Stress Principles and Case Conceptualization Into Clinical Research and Practice

The mental health field now possesses clinical trials attesting to the efficacy of affirmative practice with sexual minority individuals. With the goal of efficiently moving the results of these clinical trials into real-world clinical practice, this paper offers a model for adapting existing evidence-based practices originally developed for the general population to be lesbian, gay, bisexual, and queer (LGBQ)-affirmative. The adaptation model presented here guides clinicians to incorporate six LGBQ-affirmative transtheoretical principles of change into practice. These principles facilitate raising awareness of the impact of minority stress on sexual minority clients’ mental health and on client self-evaluation while drawing upon sexual minority resilience and intersectional experiences to build empowering coping skills and validating relationships. The adaptation model also provides a transtheoretical approach to case conceptualization that directs clinicians to consider the role of early and ongoing minority stress on sexual minority clients’ cognitive, affective, motivational, behavioral, and self-evaluative experiences that maintain current distress. This case conceptualization approach highlights common associations among these experiences, suggesting clear routes of interventions for many sexual minority client presentations. Case examples from recent clinical trials of LGBQ-affirmative cognitive-behavioral therapy illustrate how these principles and this case conceptualization can be effectively utilized in practice. While the principles and case conceptualization are meant to be transtheoretical and therefore applicable across therapeutic techniques, to date they have been tested only in clinical trials for cognitive-behavioral treatments. Therefore, this paper concludes with a call for future research to determine the effectiveness of implementing this adaptation model across diverse therapeutic modalities and client presentations.     

When Treatment as Usual Gives You Lemons,Count on EVBPs: Economic Arguments for Training Child Clinicians in Evidence-Based Practices

This article is a commentary advocating for dissemination and implementation workers to incentivize the adoption of evidence-based practices (EVBPs) with youth. Treatment-as-usual in community settings yields weak effectiveness results. EVBPs for youth exist but are not widely adopted. Consequently, “lemons” or poor treatments are added to the behavioral health care marketplace. The economic concept of lemon market theory is explained and its relevance to the behavioral health care marketplace is illustrated. Several recommendations based both on economic and learning theory are offered. The article argues for the increased use of incentives as behavior modifiers for clinicians’ practices. More specifically, proper branding and fidelity, quality improvement measures, and pay for performance initiatives are discussed.