A comparison of a modified sequential oral sensory approach to an applied behavior‐analytic approach in the treatment of food selectivity in children with autism spectrum disorder

Treatments of pediatric feeding disorders based on applied behavior analysis (ABA) have the most empirical support in the research literature (Volkert & Piazza, 2012); however, professionals often recommend, and caregivers often use, treatments that have limited empirical support. In the current investigation, we compared a modified sequential oral sensory approach (M‐SOS; Benson, Parke, Gannon, & Muñoz, 2013) to an ABA approach for the treatment of the food selectivity of 6 children with autism. We randomly assigned 3 children to ABA and 3 children to M‐SOS and compared the effects of treatment in a multiple baseline design across novel, healthy target foods. We used a multielement design to assess treatment generalization. Consumption of target foods increased for children who received ABA, but not for children who received M‐SOS. We subsequently implemented ABA with the children for whom M‐SOS was not effective and observed a potential treatment generalization effect during ABA when M‐SOS preceded ABA.     

Symptom Severity at Week 4 of Cognitive-Behavior Therapy Predicts Depression Remission

Early response has been shown to predict psychotherapy outcome. We examined the strength of the relationship between early response and remission in 82 patients who received naturalistic cognitive-behavior therapy in a private practice setting, and 158 patients who received protocol cognitive therapy in a research setting. We predicted that the relationship between early response and remission would be substantial enough to guide clinical decision making in both samples, and that a simple model of severity at Week 4 of treatment would predict remission as effectively as a more complex change score. Logistic regressions showed that a simple model based on the Week 4 Beck Depression Inventory (BDI) score was as predictive of remission as more complex models of early change. A receiver operating characteristics analysis showed that BDI score at Week 4 was substantially predictive of remission in both the naturalistic and research protocol samples; the area under the curve was .80 and .84 in the naturalistic and protocol samples, respectively. To guide clinical decision making, we identified threshold scores on the BDI corresponding to various negative predictive values (probability of nonremission when nonremission is predicted). Our results indicate that depressed patients who remain severely depressed at Week 4 of cognitive therapy are unlikely to reach remission at the end of relatively brief (maximum 20 sessions) treatment. We discuss implications of our findings for clinical decision making and treatment development.     

The day‐to‐day concurrence of bodily complaints and affect in patients with severe somatoform disorder

Based on the concept of somatization, psychological distress can be experienced as symptoms of physical illness. This suggests a close‐fitting intra‐individual association between bodily complaints and mood in patients with somatoform disorder (SFD). The contemporaneous day‐to‐day complaints‐mood association was investigated in patients with severe chronic SFD using an ecological momentary assessment (EMA) design. Eleven patients, who had recently received specialized tertiary care treatment for severe chronic SFD, kept an online electronic diary for four consecutive weeks. They were prompted at intervals throughout the day to complete questions on their momentary primary symptoms (pain and fatigue), and mood state (negative and positive). For each measure, day‐mean aggregated values were computed and analyzed using linear multilevel (mixed model) regression analysis. Fixed factor results showed that symptoms were associated with both negative mood state (β = 0.47) and positive mood state (β = –0.59). Random results, however, indicated large inter‐individual differences, with correlations varying between 0.17 and 0.99 for negative affect, and between –0.88 and 0.14 for positive affect. A substantial day‐to‐day contemporaneous association between symptoms and affect across subjects, as well as large inter‐individual differences in this association, were demonstrated in patients with severe chronic SFD. EMA‐data showing the relationship between both negative and (inverse) positive mood and complaints has potential clinical relevance: providing SFD patients with feedback consisting of their personal day‐to‐day concurrency graph may promote their understanding of their own complaints in a broader context than the somatic area.     

Cognitive Behaviour Therapy for Schizophrenia in Patients with Mild to Moderate Substance Misuse Problems

Rates of substance misuse are high among patients with schizophrenia. Cognitive therapies have been developed separately for both problems but little is known about outcome for this group of dual diagnosed patients. Data from a major trial of cognitive behaviour therapy for psychosis was therefore sub‐analysed to determine whether this therapy is effective in those with schizophrenia and mild to moderate substance misuse. During the original study patients received a brief cognitive behaviour therapy‐based intervention for schizophrenia delivered by trained and supervised nurses. The control group received care as usual. The outcome measures included: total psychopathology using the Comprehensive Psychopathological Rating Scale (CPRS) and Health of the Nation Outcome Scale (HoNOS), change in schizophrenic positive symptoms using Schizophrenia Change Scale (SCR), anxiety using the Brief Scale for Anxiety (BAS), depression using the Montgomery‐Asberg Depression Rating Scale (MADRS) and insight using the Assessment of Insight Scale, at baseline and end of therapy. In the original study, patients who received cognitive behaviour therapy showed improvement in overall symptomatology (p = 0.01), insight (p = 0.00) and depression (p = 0.00) compared with the control group. In the present sub‐analysis, no interaction was found between treatment group and presence or absence of substance misuse. There was a reduction in substance misuse after treatment in both the cognitive behaviour therapy and control groups but this did not differ between them. It appears that mild to moderate degrees of substance misuse did not change the outcome of cognitive behaviour therapy for psychosis in this sub‐analysis.     

Idiographic network analysis of discrete mood states prior to treatment

Idiographic network models based on time‐series data have received recent attention for their ability to model relationships among symptoms and behaviours as they unfold in time within a single individual (cf. Epskamp, Borsboom, & Fried, 2018; Fisher, Medaglia, & Jeronimus, 2018). Rather than examine the correlational relationships between variables in a sample of individuals, an idiographic network examines correlations within a single person, averaged over many time points. Because the approach averages over time, the data must be stationary (i.e. relatively consistent over time). If individuals experience varying states over time—different mixtures of symptoms and behaviours in one moment or another—then averaging over categorically different moments may undermine model accuracy. Fisher and Bosley (2019) address these concerns via the application of Gaussian finite mixture modelling to identify latent classes of time points in intraindividual time‐series data from a sample of adults with major depressive disorder and/or generalised anxiety disorder (n = 45). The present paper outlines an extension of this work, wherein network analysis is used to model within‐class covariation of symptoms. To illustrate this approach, network models were constructed for each intraindividual class identified by Fisher and Bosley (137 networks across the 45 participants, mean classes/person = ~3, range = 2–4 classes/person). We examine the relative consistency in symptom organisation between each individual's multiple mood state networks and assess emergent group‐level patterns. We highlight opportunities for enhanced treatment personalisation and review nomothetic patterns relevant to transdiagnostic conceptualisations of psychopathology. We address opportunities for integrating this approach into clinical practice and outline potential shortcomings.     

Comparing the Predictive Accuracy of Case Linkage Methods in Serious Sexual Assaults

The empirical support for linkage analysis is steadily increasing, but the question remains as to what method of linking is the most effective. We compared a more theory‐based, dimensional behavioural approach with a rather pragmatic, multivariate behavioural approach with regard to their accuracy in linking serial sexual assaults in a UK sample of serial sexual assaults (n = 90) and one‐off sexual assaults (n = 129). Their respective linkage accuracy was assessed by (1) using seven dimensions derived by non‐parametric Mokken scale analysis (MSA) as predictors in discriminant function analysis (DFA) and (2) 46 crime scene characteristics simultaneously in a naive Bayesian classifier (NBC). The dimensional scales predicted 28.9% of the series correctly, whereas the NBC correctly identified 34.5% of the series. However, a subsequent inclusion of non‐serial offences in the target group decreased the amount of correct links in the dimensional approach (MSA–DFA: 8.9%; NBC: 32.2%). Receiver operating characteristic analysis was used as a more objective comparison of the two methods under both conditions, confirming that each achieved good accuracies (AUCs = .74–.89), but the NBC performed significantly better than the dimensional approach. The consequences for the practical implementation in behavioural case linkage are discussed. Copyright © 2012 John Wiley & Sons, Ltd.     

The educational impact of team‐skills training: Preparing students to work in groups

Background. Despite a vast literature on collaborative learning (CL), there is little research on preparing students to work collaboratively. Aims. This two‐phase evaluation investigated whether team‐skills training could enhance the performance of collaborative groups through the introduction of a team development programme to a group‐based undergraduate key‐skills unit. Sample. Phase 1 compared two consecutive cohorts of second‐year students, Cohort 1 (N = 94) who received no preparation, and Cohort 2 (N = 113) who received team‐skills training. Phase 2 added Cohort 3 (N = 88), who also received team‐skills training, to extend the analysis. Method. In Phase 1, students in both Cohorts 1 and 2 worked on a series of curriculum based key‐skill tasks across two semesters. Students worked in one group in Semester 1 and were then formed into new groups for Semester 2. Effects of the training were measured by student group marks and key‐skill ratings. Results. Marks and key‐skill ratings were significantly higher for the trained cohort in Semester 1 (p <.01). However, in Semester 2 performance reduced for the trained cohort in comparison to Semester 1. To explore this further, Phase 2 of the study evaluated Cohort 3, where after training, collaborative groups remained intact throughout the academic year. Results for Cohort 3 showed no attenuation of performance effects in Semester 2. Conclusions. Phase 1 results support the use of team‐skills training to enhance CL group performance. The findings for Phase 2 suggest that these benefits may be lost if training groups are disrupted.     

"It's led me astray": How Cognitive Behavioural Therapists experience personal therapy in clinical practice

Personal therapy is considered to be an essential component of most psychotherapeutic training programmes. However, it remains peripheral to cognitive behavioural therapy (CBT) training courses. We present a subsection of results from a qualitative study that examines how CBT therapists use personal therapy in their clinical practice. Seven CBT therapists who have undergone personal therapy were interviewed. Participants were asked about how they used personal therapy in their clinical practice and their accounts were analysed using interpretative phenomenological analysis (IPA) to identify common themes. This article presents the results of the first master theme, “Personal therapy creates conflict”, which explores a paradox that arises between personal therapy and CBT clinical practice; participants suggest that personal therapy equips them with therapeutic tools that paradoxically hinder their capacity to practice a standardised protocol‐led CBT. Results show that participants found personal therapy created considerable internal conflict, where their use of technical evidence‐based treatment protocols as practitioners was experienced in tension with the relationally oriented therapy they had received as clients. We discuss results in the context of Gabriel Marcel's philosophical insights on the dehumanising effects of technology on human relationships. We conclude with a brief consideration of the current political climate that increasingly privileges short‐term technical solutions to psychological distress.     

Evaluation of a Combined Cognitive Behavioural Therapy and Interpersonal Process Group in the Psychotherapy Training of Clinical Psychologists

It is now widely acknowledged that both content and process elements of psychotherapy play a part in client treatment outcomes. Despite this, there are pressures on Australian clinical psychology training programs to teach evidence‐based approaches in a relatively short time frame. Producing clinical psychology graduates who have an adequate level of competence in evidence‐based practice and meeting the demands of professional accreditation requirements can mean that less time is available to teach the process elements of psychotherapy. The aim of this study was to conduct a preliminary evaluation of a clinical psychology psychotherapy training program that combines an interpersonal process group with a cognitive behavioural therapy training model that incorporates self‐reflection and self‐practice. Eleven participants who participated in the training in 2008 completed the Counseling Self‐Estimate Inventory at pre‐ and post‐training. Significant improvements on the majority of the subscales of this inventory were found. A separate sample of nine trainees and clinical psychology registrars who also previously completed the program attended individual interviews in 2010 aimed at gaining their perspective regarding various aspects of the program. Self‐practice of cognitive behavioural therapy techniques was found to be important in the identification and management of trainees’ own core beliefs, and to their appreciation of how challenging this process may be for clients. The interpersonal process group was described by participants as enhancing their competency as psychotherapists. Common themes included the experience of anxiety and a high level of emotion, and understanding how this experience might be similar for clients; increased self‐awareness; and increased competence in process issues. Many participants believed the process and content components of training were equally important to their development as psychotherapists.     

An evaluation of the single‐session interview‐informed synthesized contingency analysis

Functional analysis can often be a lengthy process requiring time and resources not readily available to practitioners working with children who exhibit severe problem behavior. The interview‐informed synthesized contingency analysis (IISCA) was recently developed as an alternative functional analysis format that improved analytic efficiency by requiring only 25 min to conduct. Furthermore, a within‐session analysis of the first test session of the entire IISCA could reduce the process to as little as a single 5‐min session. We extended this previous research by conducting what was termed the single‐session IISCA with three boys who exhibited severe problem behavior. A function‐based treatment package, including reinforcement thinning, informed by the results of the single‐session IISCA nearly eliminated problem behavior for all three participants. We suggest that the single‐session IISCA could be a viable alternative to other functional analysis formats when time is limited.     

Achieving socially significant reductions in problem behavior following the interview‐informed synthesized contingency analysis: A summary of 25 outpatient applications

Jessel, Hanley, and Ghaemmaghami (2016) reported the results of 30 interview‐informed, synthesized contingency analyses (IISCAs) and found the IISCAs to be an effective tool for identifying the functions of problem behavior across a variety of topographies, participants, and settings. Jessel et al. did not, however, include data on the effectiveness of the corresponding treatments. In the current study, we collected and summarized 25 additional applications, from analysis to treatment, in which the IISCA was applied in an outpatient clinic. The IISCA identified various social functions of problem behavior, which informed personalized treatments of functional communication training with contingency‐based reinforcement thinning. A 90% or greater reduction in problem behavior was obtained for every participant by the end of the treatment evaluation. The assessment and treatment process was socially validated by caregivers who rated the procedures highly acceptable and helpful, and the improvement in their child's behavior highly satisfactory.     

EGFR突变NSCLC二线TKIs治疗优化选择

恶性肿瘤的治疗已经进入驱动基因指导下的个体治疗时代,肺癌患者应该进行多基因检测,特别是表皮生长因子受体（EGFR）基因突变。EGFR基因突变的非小细胞肺癌（NSCLC）患者,如果一线接受了化疗,二线应该选择表皮生长因子受体一酪氨酸酶抑制剂（EGFR—TKIs）。EGFR基因突变的NSCLC患者一线EGFR—TKIs治疗失败后,二线治疗应该是个体化合理选择,包括局部放疗、化疗和继续EGFR—TKIs。目前一代和二代EGFR—TKIs药物之间未见到显著疗效差别。第三代EGFR—TKIs是目前的EGFR—TKIs耐药后的最有希望的选择,特别是针对T790M突变耐药。     

Predicting psychological service providers' empowerment in the light of the COVID‐19 pandemic outbreak: A structural equation modelling analysis

This study aimed to investigate the predictors of psychological service providers' empowerment in the light of the COVID‐19 pandemic outbreak. The researcher prepared a psychological service providers' empowerment scale that consisted of 28 items, and this scale was applied in a random sample consisting of 975 psychological service providers. The results showed that the empowerment scale has acceptable validity and reliability. The results of the exploratory factor analysis indicated that the 28 scale items saturate on seven factors, which accounted for 64.42% of the total variance of the scale: the first factor named expect psychological services effectiveness accounted for 27.86%, the second factor named self‐stimulation accounted for 9.71%, the third factor named responsibilities and duties accounted for 7.12%, the fourth factor named psychological services work environment accounted for 6.51%, the fifth factor named psychological service providers’ decision‐making accounted for 5.37%, the sixth factor named creative psychological service provider behaviour accounted for 4.45%, and the seventh factor named psychological services confidence accounted for 3.82% of the total variance of a psychological service providers' empowerment. In order to study the ability to predict the empowerment among psychological service providers, the researcher developed a structural model for psychological service providers' empowerment and then used the structural equation model analysis. The results showed that the proposed structural model of a psychological service providers' empowerment has goodness‐of‐fit, and these results emphasised the ability to predict psychological service providers' empowerment by seven tested factors.     

Enhancing recovery rates: Lessons from year one of IAPT

BackgroundThe English Improving Access to Psychological Therapies (IAPT) initiative aims to make evidence-based psychological therapies for depression and anxiety disorder more widely available in the National Health Service (NHS). 32 IAPT services based on a stepped care model were established in the first year of the programme. We report on the reliable recovery rates achieved by patients treated in the services and identify predictors of recovery at patient level, service level, and as a function of compliance with National Institute of Health and Care Excellence (NICE) Treatment Guidelines.MethodData from 19,395 patients who were clinical cases at intake, attended at least two sessions, had at least two outcomes scores and had completed their treatment during the period were analysed. Outcome was assessed with the patient health questionnaire depression scale (PHQ-9) and the anxiety scale (GAD-7).ResultsData completeness was high for a routine cohort study. Over 91% of treated patients had paired (pre-post) outcome scores. Overall, 40.3% of patients were reliably recovered at post-treatment, 63.7% showed reliable improvement and 6.6% showed reliable deterioration. Most patients received treatments that were recommended by NICE. When a treatment not recommended by NICE was provided, recovery rates were reduced. Service characteristics that predicted higher reliable recovery rates were: high average number of therapy sessions; higher step-up rates among individuals who started with low intensity treatment; larger services; and a larger proportion of experienced staff.ConclusionsCompliance with the IAPT clinical model is associated with enhanced rates of reliable recovery.     

The role of epistemic and social characteristics in children’s selective trust: Three meta‐analyses

Over the last 15 years, researchers have been increasingly interested in understanding the nature and development of children’s selective trust. Three meta‐analyses were conducted on a total of 51 unique studies (88 experiments) to provide a quantitative overview of 3‐ to 6‐year‐old children’s selective trust in an informant based on the informant’s epistemic or social characteristics, and to examine the relation between age and children’s selective trust decisions. The first and second meta‐analyses found that children displayed medium‐to‐large pooled effects in favor of trusting the informant who was knowledgeable or the informant with positive social characteristics. Moderator analyses revealed that 4‐year‐olds were more likely to endorse knowledgeable informants than 3‐year‐olds. The third meta‐analysis examined cases where two informants simultaneously differed in their epistemic and social characteristics. The results revealed that 3‐year‐old children did not selectively endorse informants who were more knowledgeable but had negative social characteristics over informants who were less knowledgeable but had positive social characteristics. However, 4‐ to 6‐year‐olds consistently prioritized epistemic cues over social characteristics when deciding who to trust. Together, these meta‐analyses suggest that epistemic and social characteristics are both valuable to children when they evaluate the reliability of informants. Moreover, with age, children place greater value on epistemic characteristics when deciding whether to endorse an informant’s testimony. Implications for the development of epistemic trust and the design of studies of children’s selective trust are discussed.     

Self‐analysis and the development of an interpretation

In spite of the fact that Freud's self‐analysis was at the centre of so many of his discoveries, self‐analysis remains a complex, controversial and elusive exercise. While self‐analysis is often seen as emerging at the end of an analysis and then used as a criteria in assessing the suitability for termination, I try to attend to the patient's resistance to self‐analysis throughout an analysis. I take the view that the development of the patient's capacity for self‐analysis within the analytic session contributes to the patient's growth and their creative and independent thinking during the analysis, which prepares him or her for a fuller life after the formal analysis ends. The model I will present is based on an over lapping of the patient's and the analyst's self‐analysis, with recognition and use of the analyst's counter‐transference. My focus is on the analyst's self‐analysis that is in response to a particular crisis of not knowing, which results in feeling intellectually and emotionally stuck. This paper is not a case study, but a brief look at the process I went through to arrive at a particular interpretation with a particular patient during a particular session. I will concentrate on resistances in which both patient and analyst initially rely upon what is consciously known.     

An Application of the Complier Average Causal Effect Analysis to Examine the Effects of a Family Intervention in Reducing Illicit Drug Use among High‐Risk Hispanic Adolescents

The Complier Average Causal Effect (CACE) method has been increasingly used in prevention research to provide more accurate causal intervention effect estimates in the presence of noncompliance. The purpose of this study was to provide an applied demonstration of the CACE analytic approach to evaluate the relative effects of a family‐based prevention intervention, Familias Unidas, in preventing/reducing illicit drug use for those participants who received the intended dosage. This study is a secondary data analysis of a randomized controlled trial designed to evaluate the relative efficacy of Familias Unidas with high‐risk Hispanic youth. A total of 242 high‐risk Hispanic youth aged 12–17 years and their primary caregivers were randomized to either Familias Unidas or Community Practice and assessed at baseline, 6 months and 12 months postbaseline. CACE models were estimated with a finite growth mixture model. Predictors of engagement were included in the CACE model. Findings indicate that, relative to the intent‐to‐treat (ITT) analytic approach, the CACE analytic approach yielded stronger intervention effects among both initially engaged and overall engaged participants. The CACE analytic approach may be particularly helpful for studies involving parent/family‐centered interventions given that participants may not receive the intended dosage. Future studies should consider implementing the CACE analysis in addition to ITT analysis when examining the effects of family‐based prevention programs to determine whether, and the extent to which, the CACE analysis has more power to uncover intervention effects.     

Change process in systemic therapy: A qualitative investigation

This study addresses the process of therapeutic change in individuals who received systemic therapy. This study is an exploratory qualitative study based on the client's perceptions and therapeutic experiences. The sample included 10 clients who had completed their therapy with systemic therapists. The method used for the collection of the data was semi‐structured interviews (Change Interview; Elliott, Slatick, & Urman, 2001). The interviews were analysed using grounded theory analysis. The results showed that both specific and common factors in therapy function in a co‐occurring mode, hence suggesting a synergy effect between common factors and specific techniques or therapist factors in psychotherapy. The core category ‘experience of therapeutic change, within the secure frame of therapy, is a process of deconstructing and reconstructing the house you live in: Yourself’ emerged based on self‐exploration and self‐discovery and is then discussed in a theoretical constructivist framework. Implications for research on the issue of the process of therapeutic change are discussed.     

Psychological care demand in clinical practice: treatment and results

With the aim of describing the usual clinical context as opposed to the academic or research context, the characteristics of patients and psychological treatments applied in a sample of 856 patients from the Clinic of Psychology of the Complutense University is analyzed. The disorders that require attention, the characteristics of the therapists and their interventions are identified. Out of the total patients, 24.3% withdrew from treatment; 68.3% of the patients who started treatment completed it with therapeutic success. 83% of patients were assessed in 4 sessions or fewer (median=4). 75.3% of patients who finished the treatment received 18 or fewer treatment sessions (median=11). The generalization of the results and their implications for professional clinical practice and for training clinical psychologists are discussed.