Clinically significant but impractical? A response to Hageman and Arrindell

Hageman, and Arrindell [Hageman, W.J., & Arrindell, W.A. (in press). Establishing clinically significant change: increment of precision and the distinction between individual and group level of analysis. Behavior Research and Therapy.] suggest adaptations to the traditional clinical significance model originally developed by Jacobson, Follette, and Revenstorf [Jacobson, N.S., Follette, W.C., & Revenstorf, D. (1984). Toward a standard definition of clinically significant change. Behavior Therapy, 17, 308-311.]. They observe that one must distinguish between analysis at the individual and group level and based upon an alternative decision-making strategy have formulated different procedures for assessing clinically significant change that incorporate the unreliability inherent in testing measures. A comparison of the traditional method with Hageman and Arrindell's suggested approach is conducted utilizing data originally presented by Jacobson and Truax [Jacobson, N.S., & Truax, P., Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12-19.] and implications of this comparison for the method developed by Hageman and Arrindell's method are discussed. Although this revised method has much to recommend it, it seems to yield results at the individual level that are quite similar to those derived from the traditional method. Given the complexity of the revised method, the traditional model developed by Jacobson, Follette, and Revenstorf (1984) still seems to be preferable.     

Stop Thinking and Start Doing: Switching From Cognitive Therapy to Behavioral Activation in a Case of Chronic Treatment-Resistant Depression

Several recent investigations have demonstrated that Cognitive Therapy (CT) and Behavioral Activation (BA) are both efficacious treatments for depression (Butler, Chapman, Forman, & Beck, 2006; Dimidjian et al., 2006; Dobson, 1989; Gloaguen, Cottraux, Cucherat, & Blackburn, 1998; Hollon, Thase, & Markowitz, 2002; Jacobson et al., 1996). This investigation focuses on the treatment of Mr. X, a 62-year-old man with chronic treatment-resistant depression and comorbid personality pathology. After a course of 21 sessions of CT, treatment was switched to BA. We present daily mood data from 147 days of each treatment. Generalized least squares analyses of these time series data demonstrated that BA was associated with improved mood and these results were supported by clinical observation of improved functioning during the course of BA. We hypothesize that efforts at cognitive restructuring had an iatrogenic effect on this client and paradoxically triggered depressive rumination; these failed efforts provided further evidence in support of his underlying defectiveness schema. We also speculate that this client's dependent personality ran counter to CT's emphasis on autonomous homework assignments. Future randomized clinical trials are needed to investigate if nonresponders to CT benefit by switching to BA.     

Abstracts

Articles abstracted:
Hetherington, E. M. and Stanley-Hagan, M. (1999) The adjustment of children with divorced parents: a risk and resiliency perspective. Journal ofChild Psychology and Psychiatry , 40: 129-140.
Webster-Stratton, C. and Hammond, M. (1999) Marital conflict managementskills, parenting style, and early-onset conduct problems: processesand pathways. Journal of Child Psychology and Psychiatry , 40: 917-928.
Shaw, D. S., Winslow, E. B. and Flanagan, C. (1999) A prospective study ofthe effects of marital status and family relations on young children's adjustment among African American and European American Families. ChildDevelopment , 70: 742-755.
Lindahl, K. M. and Malik, N. M. (1999) Marital conflict, family process,and boys' externalising behaviour in Hispanic American and EuropeanAmerican families. Journal of Clinical Child Psychology , 28: 12-24.
Hart, C. H., Nelson, D. A., Robinson, C. C., Olsen, S. F. and McNeilly-Choque, M. K. (1998) Overt and relational aggression in Russian nursery-school-age children: parenting style and marital linkages. DevelopmentPsychology , 34: 687-697.
Shek, D. T. (1999) Parenting characteristics and adolescent psychologicalwell-being: a longitudinal study in a Chinese context. Genetic, Social andGeneral Psychology Monographs , 125: 27-44.     

Clinically significant and practical! Enhancing precision does make a difference. Reply to McGlinchey and Jacobson, Hsu, and Speer

Based on a secondary analysis of the Jacobson and Truax [Jacobson, N.S. & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12-19.] data using both their own traditional approach and the refined method advanced by Hageman and Arrindell [Hageman, W.J.J.M., & Arrindell, W.A. (1999). Establishing clinically significant change: increment of precision and the distinction between individual and group level of analysis. Behaviour Research and Therapy, 37, 1169-1193], McGlinchey and Jacobson [McGlinchey, J. B., & Jacobson, N. S. (1999). Clinically significant but impractical? A response to Hageman and Arrindell. Behaviour Research and Therapy, 37, 1211-1217.] reported practically identical findings on reliable and clinically significant change across the two approaches. This led McGlinchey and Jacobson to conclude that there is little practical gain in utilizing the refined method over the traditional approach. Close inspection of the data used by McGlinchey and Jacobson however revealed a serious mistake with respect to the value of the standard error of measurement that was employed in their calculations. When the proper index value was utilised, further re-analysis by the present authors disclosed clear differences (i.e. different classifications of S's) across the two approaches. Importantly, these differences followed exactly the same pattern as depicted in Table 2 in Hageman and Arrindell (1999). The theoretical advantages of the refined method, i.e. enhanced precision, appropriate distinction between analysis at the individual and group levels, and maximal comparability of findings across studies, exceed those of the traditional method. Application of the refined method may be carried out within approximately half an hour, which not only supports its practical manageability, but also challenges the suggestion of McGlinchey and Jacobson (1999) that the relevant method would be too complex (impractical) for the average scientist. The reader is offered the opportunity of obtaining an SPSS setup in the form of an ASCII text file by means of which the relevant calculations can be carried out. The ways in which the valuable commentaries by Hsu [Hsu, L. M. (1999). A comparison of three methods of identifying reliable and clinically significant client changes: commentary on Hageman and Arrindell. Behaviour Research and Therapy, 37, 1195-1202.] and Speer [Speer, D. C. (1999). What is the role of two-wave designs in clinical research? Comment on Hageman and Arrindell. Behaviour Research and Therapy, 37, 1203-1210.) contribute to a better understanding of the technical/statistical backgrounds of the traditional and refined methods were also discussed.     

The relationship between rumination, avoidance and depression in a non-clinical sample

Recent commentaries have proposed conceptualizations of rumination in terms of both cognitive and behavioral avoidance. This study examined the relationship between rumination, avoidance and depression using a newly developed self-report measure of avoidance in depression, the Cognitive-Behavioral Avoidance Scale (CBAS) [Ottenbreit, N.D., & Dobson, K.S. (2004). Avoidance and depression: The construction of the cognitive-behavioral avoidance scale. Behaviour Research and Therapy, 42, 293-313]. A non-clinical sample (N=104) of undergraduate students completed self-report measures of depression, anxiety, rumination and avoidance. Rumination, avoidance and depression were all significantly correlated. Rumination and behavioral avoidance remained intercorrelated when anxiety was controlled, confirming an association that is independent of anxiety. By contrast, the relationship between cognitive avoidance and rumination disappeared when anxiety was partialled out. Notably, avoidance predicted unique variance in depression scores, over and above anxiety and rumination. Consistent with the proposal of Ottenbreit and Dobson [Avoidance and depression: The construction of the cognitive-behavioral avoidance scale. Behaviour Research and Therapy, 42, 293-313], our findings support the value of clinicians and psychopathologists giving consideration to avoidance in their conceptualization of depression.     

Abstracts

McDaniel, S. H. (1990) Marital therapy and the resolution of gender role conflict. Journal of Family Psychotherapy
Storm, C. L. and Heath, A. W. (1991) Problem-focused supervision: rationale, exemplification, and limitations. Journal of Family Psychotherapy
Burkett, L. P. (1991) Parenting behaviours of women who were sexually abused as children in their families of origin. Family Process
Palmer, R. L., Chaloner, D. A. and Oppenheimer, R. (1992) Childhood sexual experiences with adults reported by female psychiatric patients. Journal of Psychiatry
Brewin, C. R., MacCarthy, B., Duda, K. and Vaughn, C. E. (1991) Attribution and expressed emotion in the relatives of patients with schizophrenia. Journal of Abnormal Psychology     

The concept of disorder as a foundation for the DSM's theory-neutral nosology: response to Follette and Houts, Part 2.

Follette and Houts [Follette, W. C., Houts, A. C. (1996). Models of scientific progress and the role of theory in taxonomy development: a case study of the DSM. Journal of Consulting and Clinical Psychology, 64, 1120-1132] argue that 'mental disorder' and 'function' are value concepts that offer no scientific basis for the DSM's theory-neutral nosology or for distinguishing disorders from other behavioral problems. They also claim that the DSM presupposes a biological theory of etiology, thus is not really theory-neutral. They recommend replacing the DSM by theory-laden diagnostic manuals. I argue: (1) DSM criteria do not imply a biological model of disorder, (2) 'mental disorder' and 'function' have scientific content that allows one to distinguish disorder from nondisorder, (3) the evolutionary 'harmful dysfunction' analysis of disorder [Wakefield, J. C. (1992a). The concept of mental disorder: on the boundary between biological facts and social values. American Psychologist, 47, 373-388] coherently demarcates disorder from nondisorder, (4) the proposed behaviorist alternative to the DSM illustrated by the articles in Follette's special section [Follette, W. C. (Ed.) (1996a). Special section on the development of theoretically coherent alternatives to the DSM system. Journal of Consulting and Clinical Psychology, 64, 1117-1201] is incoherent because it does not distinguish disorder from nondisorder.     

Book Review Section

Books reviewed in this article:
H aire , M ason . Psychology in Management.
S tone , C. H arold, and K endall , W illiam E. Effective Personnel Selection Procedures.
A nstey , E., and M ercer , E. O. Interviewing for the Selection of Staff.
L uck , T homas J. Personnel Audit and Appraisal.
Z aleznik , A. Worker Satisfaction and Development: A Case Study of Work and Social Behavior in a Factory Group.
L aird , D onald A., and L aird , E leanor C. Practical Business Psychology.
S togdill , R alph M., and S hartle , C arroll L. Methods in the Study of Administrative Leadership.
S togdill , R alph M., S hartle , C arroll L., et al . Patterns of Administrative Performance.
S cott , E llis L. Leadership and Perceptions of Organization.
H ärnqvist , K jell . Adjustment: Leadership and Group Relations in a Military Training Situation.
S tern , G eorge G., S tein , M orris I., and B loom , B enjamin S. Methods in Personality Assessment: Human Behavior in Complex Social Situations.
W arner , W. L loyd, and A begglen , J ames C. Occupational Mobility in American Business and Industry, 1928–1952.
L aird , D onald A., and L aird , E leanor C. The New Psychology for Leadership.     

A test of the interactive effects of anxiety sensitivity and mindfulness in the prediction of anxious arousal, agoraphobic cognitions, and body vigilance

The present investigation sought to examine the interactive effects of anxiety sensitivity [AS; Reiss, S., & McNally, R. J. (1985). Expectancy model of fear. In S. Reiss, & R. R. Bootzin (Eds.), Theoretical issues in behavior therapy (pp. 107-121). San Diego: Academic Press] and mindfulness [Brown, K. W., & Ryan, R. M. (2003). The benefit of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822-848] in predicting panic-relevant processes. A community sample of 248 individuals participated in the study by completing a battery of self-report instruments. Consistent with prediction, the interaction between AS and mindfulness significantly predicted anxious arousal symptoms and agoraphobic cognitions, above and beyond the individual main effects, and did not significantly predict anhedonic depression symptoms. Contrary to prediction, the AS by mindfulness interaction did not significantly predict body vigilance. Theoretical implications are discussed and future directions are delineated.     

Announcement

We are pleased to announce that effective this issue, Teresa Ostler, a member of our Consulting Editor Board, will begin serving as an associate editor of The Journal of Genetic Psychology. She will replace Janina Jolley in this position. We wish to take this opportunity to thank Dr. Jolley, our good friend and colleague, for her many contributions to the success of the journal.     

Depression,Quantified Medication Adherence,and Quality of Life in Renal Transplant Candidates and Recipients

Journal of Clinical Psychology in Medical Settings - Like patients with many chronic illnesses, ESRD patients experience psychological challenges with greater incidence of depression and reduced...     

Book Review Section

Books reviewed in this article:
C ros , P ierre , E mmanuel , L ucas L., G amble , R obert B., E t A l . Imagination-Undeveloped Resource
R oe , A nne . The Psychology of Occupations
F raser , J ohn M unro . Psychology: General, Industrial, Social
M aier , N orman R. F., S olem , A llen R., AND M aier , A yesha A. Supervisory and Executive Development: A Manual for Role Playing
U rwick , L yndall F. The Pattern of Management
H emphill , J ohn K. Group Dzmensions: A Manual for Their Measurement
C ampbell , D onald T. Leadership and Its Egects Upon the Group
C alhoon , R ichard P., AND K irkpatrick , C. A. Influencing Employee Behavior
S priegel , W illiam R., S chulz , E dward , AND S priegel , W illiam B. Elements of Supervision
A bruzzi , A dam . Work, Workers, and Work Measurement
S togdill , R alph M., S cott , E llis L., AND J aynes , W illiam E. Leadership and Role Expectations
S elekman , S ylvia , AND S elekman , B enjamin . Power and Morality in a Business Society
S tunkel , E va R ussell , H eitman , S ara M., AND D avidoff , I sabel S. Improving Employment Reference Checks     

Children living with violence within the family and its sequel: A meta-analysis from 1995–2006

Based on 37 articles published in international refereed journals between 1995 and 2006, this meta-analytical review attempted to study the sequel of children living with family violence. It specifically attempted to identify the overall effect size of family violence on children's adjustment outcomes. Moderators that exerted their effects on the relationship were also studied. The overall effect size generated from the 353 study-level effect sizes was rather small (Z_r = .201). Moderating analysis on study designs, sample sources, child developmental stages and gender did not show significant heterogeneity in effect sizes, while there was significant dispersion in effect sizes among different types of child adjustment outcomes. Results of this study are basically resonant with the meta-analyses of Kitzmann et al. [Kitzmann, K. M., Gaylord, N. K., Holt, A. R., & Kenny, E. D., (2003). Child witnesses to domestic violence: A meta-analytic review. Journal of Consulting and Clinical Psychology, 71, 339–352] and Wolfe et al. [Wolfe, D. A., Crooks, C. V., Lee, V., McIntyre-Smith, A., & Jaffe, P. G., (2003). The effects of children's exposure to domestic violence: A meta-analysis and critique. Clinical Child and Family Psychology Review, 6, 171–187], but add new information in that the report source of family violence was not a significant moderator, while that of child adjustment outcomes was.     

Rumination-focused cognitive behaviour therapy for residual depression: a case series

The treatment of chronic and recurrent depression is a priority for the development of new interventions. The maintenance of residual symptoms following acute treatment for depression is a risk factor for both chronic depression and further relapse/recurrence. This open case series provides the first data on a cognitive-behavioural treatment for residual depression that explicitly targets depressive rumination. Rumination has been identified as a key factor in the onset and maintenance of depression, which is found to remain elevated following remission from depression. Fourteen consecutively recruited participants meeting criteria for medication--refractory residual depression [Paykel, E.S., Scott, J., Teasdale, J.D., Johnson, A.L., Garland, A., Moore, R. et al., 1999. Prevention of relapse in residual depression by cognitive therapy--a controlled trial. Archives of General Psychiatry 56, 829-835] were treated individually for up to 12 weekly 60-min sessions. Treatment specifically focused on switching patients from less helpful to more helpful styles of thinking through the use of functional analysis, experiential/imagery exercises and behavioural experiments. Treatment produced significant improvements in depressive symptoms, rumination and co-morbid disorders: 71% responded (50% reduction on Hamilton Depression Rating Scale) and 50% achieved full remission. Treating depressive rumination appears to yield generalised improvement in depression and co-morbidity. This study provides preliminary evidence that rumination-focused CBT may be an efficacious treatment for medication--refractory residual depression.     

Internal external control of reinforcement as a determinant of study habits and academic attitudes

This study tested Rotter's hypothesis that internals would show more achievement-striving behaviors than externals using a direct measure of such behavior. Rotter's I-E scale and the Survey of Study Habits and Attitudes (SSHA) were administered to 123 male and 130 female undergraduate subjects. Significant sex differences were found on the SSHA scales but not on the I-E scale. Results indicated significant differences between internals and externals within each sex in terms of the average SSHA profiles and the individual SSHA scales. Using H. L. Mirels' (Journal of Consulting and Clinical Psychology, 1970, 34, 226–228) I-E subscales, similar results were obtained with the personal-control scale but not the political-control scale. Results provide additional evidence supporting the multidimensional interpretation of the I-E scale.     

An overview and analysis of journal operations, journal publication patterns, and journal impact in school psychology and related fields

This article describes the results of three studies designed to understand better the journal operations, publishing practices, and impact of school psychology journals in recent years. The first study presents the results of a survey focusing on journal operations and peer-review practices that was completed by 61 journal editors of school psychology and aligned journals. The second study presents the results of review and classification of all articles appearing in one volume year for nine school psychology journals (i.e., The California School Psychologist, Canadian Journal of School Psychology, Journal of Applied School Psychology, Journal of School Psychology, Psychology in the Schools, School Psychology Forum, School Psychology International, School Psychology Quarterly, and School Psychology Review). The third study employed multilevel modeling to investigate differences in the longitudinal trends of impact factor data for five school psychology journals listed in the Web of Science (i.e., Journal of School Psychology, Psychology in the Schools, School Psychology International, School Psychology Quarterly, and School Psychology Review). The article addresses implications for authors, editors, and journal editorial teams as well as the status and impact of school psychology journals.     

Non-ruminative processing reduces overgeneral autobiographical memory retrieval in students

It has been suggested that overgeneral memory (OGM) represents a vulnerability marker for depression [Williams, J. M. G., Barnhofer, T., Crane, C., Hermans, D., Raes, F., Watkins, E., et al. (2007). Autobiographical memory specificity and emotional disorder. Psychological Bulletin, 133, 122-148]. One important underlying mechanism involved is rumination [e.g., Watkins, E., & Teasdale, J. D. (2001). Rumination and overgeneral memory in depression: Effects of self-focus and analytic thinking. Journal of Abnormal Psychology, 110, 353-357; Watkins, E., & Teasdale, J. D. (2004). Adaptive and maladaptive self-focus in depression. Journal of Affective Disorders, 82, 1-8]. It is as yet unclear to what extent the relationship between rumination and OGM also applies to nonclinical groups. The present study investigated this relationship in a nonclinical student sample, using an innovative sentence completion procedure to assess OGM. As hypothesized, the experimental induction of a concrete, process-focused (or non-ruminative) thinking style (n=102) led to less OGMs as compared to the experimental induction of an abstract, evaluative (or ruminative) thinking style (n=93). The present results add to the accumulating body of evidence that abstract, evaluative (or ruminative) thinking is a crucial underlying process of OGM, and expand prior literature by extending this idea to nonclinical individuals and by using a new procedure to assess OGM.     

Do Cognitive Therapy Skills Neutralize Lifetime Stress to Improve Treatment Outcomes in Recurrent Depression?

Cognitive therapy (CT) is an efficacious treatment for major depressive disorder (MDD), but not all patients respond. Past research suggests that stressful life events (SLE; e.g., childhood maltreatment, emotional and physical abuse, relationship discord, physical illness) sometimes reduce the efficacy of depression treatment, whereas greater acquisition and use of CT skills may improve patient outcomes. In a sample of 276 outpatient participants with recurrent MDD, we tested the hypothesis that patients with more SLE benefit more from CT skills in attaining response and remaining free of relapse/recurrence. Patients with more pretreatment SLE did not develop weaker CT skills, on average, but were significantly less likely to respond to CT. However, SLE predicted non-response only for patients with relatively weak skills, and not for those with stronger CT skills. Similarly, among acute-phase responders, SLE increased risk for MDD relapse/recurrence among patients with weaker CT skills. Thus, the combination of more SLE and weaker CT skills forecasted negative outcomes. These novel findings are discussed in the context of improving CT for depression among patients with greater lifetime history of SLE and require replication before clinical application.