A systematic review of the literature on counselling and psychotherapy for the prevention of suicide: 2. Qualitative studies

Scope of review: The paper reports a meta‐synthesis of 13 qualitative studies of counselling and psychotherapy with people at risk of suicide. Publication time span: The studies considered were reported between 1997 and 2006. Publication origin: Seven studies were conducted in the UK, four in the USA, one in Canada, and one in Sweden. Findings: Themes in clients' and therapists' accounts of the process of counselling or psychotherapy were therapist qualities; therapy components; theoretical framework; and therapy techniques. Themes in their accounts of the effectiveness of counselling and psychotherapy were decrease in self‐destructive behaviour, and quality of life. Themes in clients' views of barriers to effective counselling or psychotherapy were therapist characteristics; therapy components; secrecy; and transferring to the real‐life situation. Secrecy was also identified as a barrier by therapists, as were responsibilities of the profession; training; and the nature of suicide and self‐harm. Facilitators of successful counselling and psychotherapy as identified by clients were responsibility; support; and teaching therapy skills to family members, the latter also being identified by therapists.     

Reactive Aggression and Suicide‐Related Behaviors in Children and Adolescents: A Review and Preliminary Meta‐Analysis

The empirical literature on the association between reactive aggression and suicide‐related behaviors in children and adolescents was reviewed. A narrative review of seven studies that met inclusion/exclusion criteria is followed by a preliminary meta‐analysis to provide insight into the strength of the association between reactive aggression and suicide‐related behaviors. Each of the seven studies reported a statistically significant association between reactive aggression and suicide‐related behaviors, including suicide, nonfatal suicide attempt, and suicide ideation. Results from the meta‐analysis indicated a consistent, medium‐sized association (k  = 7; N  = 4,693; rbar = .25). The narrative review and results of the preliminary meta‐analysis support the promise of pursuing future research on reactive aggression and suicide‐related behaviors in children and adolescents. A theoretical model is proposed to guide the development of future research.     

The Evolution of Mindfulness‐based Cognitive Therapy

Metcalf and Dimidjian (this issue) present a timely review of the evolving evidence base and mechanisms of mindfulness‐based cognitive therapy (MBCT). The present commentary extends the discussion on the current evidence base for MBCT based on findings from recent meta‐analytic reviews in this field which attest to the promising outcome for mindfulness‐based therapies, particularly for depressed populations. However, the specific effects of MBCT as applied to anxiety, health and developmental populations is still very much in its infancy. The second objective of this commentary extends discussion on the transdiagnostic applications of MBCT versus traditional cognitive behavioural therapy (CBT). It is recommended that with the continuing expansion of MBCT, the effects of this therapeutic approach needs to be evaluated against other empirically supported therapies, including traditional CBT.     

Preliminary Evidence for the Effectiveness of Dialectical Behavior Therapy for Adolescents

This meta‐analysis evaluated the effectiveness of dialectical behavior therapy for adolescents in reducing symptoms of depression, anxiety, self‐injury, and suicide risk. Twelve between‐group studies (N = 834) were chosen that met the inclusion criteria. Results revealed small‐to‐medium Hedges's g effect sizes for all 4 symptoms compared with control and alternative treatment groups. However, the small number of effect sizes available for each analysis limited the generalizability of the findings. Implications and suggestions for future research are discussed.     

Beyond beliefs: Challenging obsessive thoughts and compulsive behaviours within a collaborative counselling relationship

Three clients with obsessive‐compulsive disorder were studied using a multiple case study approach. Clients' experiences of cognitive‐behavioural therapy, in particular the impact of having their beliefs challenged, and their responses to self‐monitoring tasks and behavioural experiments were investigated. Data included case notes made during therapy, pre‐ and post‐therapy questionnaires, and post‐therapy semi‐structured interviews. Qualitative analysis of the data identified clients' obsessive beliefs, general negative beliefs and meta‐cognitive beliefs, and explored any post‐therapy changes in these beliefs. The results demonstrated similarities between cases in obsessive beliefs (e.g. inflated responsibility for harm), general negative beliefs (e.g. feelings of failure), meta‐cognitive beliefs (e.g. the need to control thoughts) and affect (e.g. guilt). Questionnaire data from all three clients suggested no clinically significant post‐therapy changes in general negative beliefs and meta‐cognitive beliefs. However, idiosyncratic changes in obsessive beliefs were reported during therapy and at post‐therapy interview, and clients reported improved functioning and decreased levels of distress during therapy and at interview. Responses to challenge were uniformly positive, but reactions to self‐monitoring and behavioural experiments varied across cases. The implications of these findings for the treatment of obsessive‐compulsive disorder using cognitive behavioural techniques are discussed.     

The neuropsychological profile of vascular cognitive impairment not demented: A meta‐analysis

The most common cause of vascular cognitive impairment not demented (VCIND) is cerebral small vessel disease leading to diffuse subcortical white matter lesions. While many studies indicate that the core cognitive features of VCIND are executive dysfunction and impaired processing speed, this finding is not always consistent, and may be partially dependent on the comparison group applied. Hence, we undertook two systematic meta‐analytic reviews on neuropsychological test performance across eight cognitive domains: between VCIND and healthy controls (data from 27 studies), and between VCIND and non‐vascular mild cognitive impairment (nv‐MCI; data from 20 studies). Our quantitative synthesis of the research literature demonstrates that individuals with VCIND show weaknesses across all cognitive domains relative to healthy controls, with the greatest impairment in the domain of processing speed (Md = ?1.36), and the least affected being working memory (Md = ?.48) and visuospatial construction (Md = ?.63). When compared directly with nv‐MCI, individuals with VCIND had significantly greater deficits in processing speed (Md = ?.55) and executive functioning (Md = ?.40), while those with nv‐MCI exhibited a greater relative deficit in delayed memory (Md = .41). Our analyses indicate that disruption to subcortical white matter tracts impairs more cognitive processes than is typically thought to be directly related to the fronto‐subcortical network. The data also suggest that differing brain aetiologies can be responsible for similar cognitive profiles. Although the findings do not evince diagnostic value, they allude to the interconnectivity of disparate cognitive processes and call for further research on the behavioural outcome of network disruption.     

A systematic review of the effectiveness of psychoanalysis,psychoanalytic and psychodynamic psychotherapy with adults with intellectual and developmental disabilities: progress and challenges

Objectives: This systematic review aimed to critically appraise the literature on the efficacy and effectiveness of psychoanalysis, psychoanalytic and psychodynamic psychotherapy in adults with intellectual and developmental disabilities (IDD). Method: A systematic search of electronic databases was carried out. The methodological quality of the studies was assessed using a quality assessment tool and comparisons were made with a review of the quality of research on the effectiveness of cognitive behavioural therapy (CBT) for people with IDD. Results: The search yielded 13 papers which provided evidence for the effectiveness but not efficacy of psychoanalytic and psychodynamic psychotherapy; but none were found for psychoanalysis. The quality of the research was generally poor compared to the current research on the effectiveness of CBT. Conclusions: Positive outcomes have been indicated for psychoanalytic and psychodynamic psychotherapy with people with IDD. Larger scale, more controlled research is necessary to advance the evidence base.     

From task characteristics to learning: A systematic review

Wielenga‐Meijer, E. G. A., Taris, T. W., Kompier, M. A. J. & Wigboldus, D. H. J. (2010). From task characteristics to learning: A systematic review. Scandinavian Journal of Psychology, 51, 363–375. Although many theoretical approaches propose that job characteristics affect employee learning, the question is why and how job characteristics influence learning. The present study reviews the evidence on the relationships among learning antecedents (i.e., job characteristics: demands, variety, autonomy and feedback), learning processes (including motivational, meta‐cognitive, cognitive and behavioral processes) and learning consequences. Building on an integrative heuristic model, we quantitatively reviewed 85 studies published between 1969 and 2005. Our analyses revealed strong evidence for a positive relation between job demands and autonomy on the one hand and motivational and meta‐cognitive learning processes on the other. Furthermore, these learning processes were positively related to learning consequences.     

Are Asian cultures really less ageist than Western ones? It depends on the questions asked

Ageism is an increasing concern in ageing populations such as Asia and Europe. A prevalent assumption in psychology is that Eastern cultures may be less prone to ageism because of norms and values that honour and respect elders. Yet, evidence for this culture hypothesis is inconclusive. The current study examines this issue by comparing attitudes towards older people in an Eastern and Western samples of 184 young people from the UK and 249 from Taiwan. Attitudes to old age were measured both as meta‐perceptions (the perceived normative context) and personal attitudes in regard to the cognitive, affective and behavioural components of ageism. Consistent with the culture hypothesis, meta‐perceptions about competence and admiration were more positive in Taiwan than in the UK, yet other meta‐perceptions were more negative pointing to the existence of old age subtypes. Personal attitudes about older people in regard to the affective and behavioural, but not the cognitive component, were more negative in Taiwan than in the UK. Thus, cultural differences in ageism are more nuanced than suggested by previous research. The importance of distinguishing between the normative context and personal attitudes as well as the different components of ageism is highlighted by the present findings.     

Assessment Center Dimensions: Individual differences correlates and meta‐analytic incremental validity

This study provides an investigation of the nomological net for the seven primary assessment center (AC) dimensions identified by Arthur, Day, McNelly, and Eden (Personnel Psychology, 56, 125–154, 2003). In doing so, the authors provide the first robust estimates of the relationships between all primary AC dimensions with cognitive ability and the Big 5 factors of personality. Additionally, intercorrelations between AC dimensions based on sample sizes much larger than those previously available in the meta‐analytic literature are presented. Data were obtained from two large managerial samples (total N=4985). Primary data on AC dimensions, personality, and cognitive ability interrelationships were subsequently integrated with meta‐analytic data to estimate incremental validity for optimally and unit‐weighted AC dimension composites as well as overall AC ratings over psychometric tests of personality and cognitive ability. Results show that unit‐ and optimally weighted composites of construct‐based AC dimensions add incremental validity over tests of personality and cognitive ability, while overall AC ratings (including those obtained using subjective methods of data combination) do not.     

A Meta‐analytic and Conceptual Update on the Associations Between Procrastination and Multidimensional Perfectionism

The equivocal and debated findings from a 2007 meta‐analysis, which viewed perfectionism as a unidimensional construct, suggested that perfectionism was unrelated to procrastination. The present meta‐analysis aimed to provide a conceptual update and reanalysis of the procrastination–perfectionism association guided by both a multidimensional view of perfectionism and self‐regulation theory. The random‐effects meta‐analyses revealed a small to medium positive average effect size (r  = .23; k  = 43, N  = 10 000; 95% confidence interval (95% CI) [0.19, 0.27]) for trait procrastination and perfectionistic concerns and a small to medium negative average effect size (r  = ?.22; k  = 38, N  = 9544; 95% CI [?0.26, ?0.18]) for procrastination and perfectionistic strivings. The average correlations remained significant after statistically accounting for the joint variance between the two perfectionism dimensions via semi‐partial correlations. For perfectionistic concerns, but not perfectionistic strivings, the effects depended on the perfectionism measure used. All effects did not vary by the trait procrastination measure used or the respondent's sex. Our findings confirm that from a multidimensional perspective, trait procrastination is both positively and negatively associated with higher‐order perfectionism dimensions and further highlights the value of a self‐regulation perspective for understanding the cognitive, affective and behavioural dynamics that characterise these traits. Copyright © 2017 European Association of Personality Psychology     

The evidence base for family therapy and systemic interventions for child‐focused problems

This review updates similar articles published in the Journal of Family Therapy in 2001 and 2009. It presents evidence from meta‐analyses, systematic literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with various difficulties. In this context, systemic interventions include both family therapy and other family‐based approaches such as parent training. The evidence supports the effectiveness of systemic interventions either alone or as part of multi‐modal programmes for sleep, feeding and attachment problems in infancy; child abuse and neglect; conduct problems (including childhood behavioural difficulties, attention deficit hyperactivity disorder, delinquency and drug misuse); emotional problems (including anxiety, depression, grief, bipolar disorder and self‐harm); eating disorders (including anorexia, bulimia and obesity); somatic problems (including enuresis, encopresis, medically unexplained symptoms and poorly controlled asthma and diabetes) and first episode psychosis.     

Combat Exposure and Risk for Suicidal Thoughts and Behaviors Among Military Personnel and Veterans: A Systematic Review and Meta‐Analysis

Due to seemingly mixed empirical results, questions persist about the possible role of deployments and combat exposure. We conducted a narrative review and meta‐analysis of 22 published studies to integrate findings regarding the relationship of deployment‐related predictors (i.e., deployment, deployment to a combat zone, combat experience, and exposure to specific combat events) with suicide‐related outcomes (i.e., suicide ideation, attempt, and death). Across all predictors and outcomes, the combined effect was small and positive, r = .08 [0.04, 0.13], and marked by significant heterogeneity, I² = 99.9%, Q(21)=4880.16, p < .0001, corresponding to a 25% increased risk for suicide‐related outcomes among those who have deployed. Studies examining the relationship between exposure to killing and atrocities (k = 5) showed the largest combined effect, r = .12 [0.08, 0.17], and less heterogeneity, I² = 84.4%, Q(4)=34.96, p < .0001, corresponding to a 43% increased risk for suicide‐related outcomes among those exposed to killing or atrocity. Implications for theory, research, and clinical practice are discussed.     

Therapist orientation,supervisor match,and therapeutic interventions: Implications for session quality in a psychotherapy training PRN

Background: Theoretical orientation is a multifaceted construct that is integral to the process of psychotherapy and psychotherapy training. While some research has been conducted on personal identification with particular schools of psychotherapy, techniques used in psychotherapy sessions, and match between trainees and supervisors in training, there is insufficient information regarding how these may interact with one another. Aim: This study, conducted in a practice research network of trainee therapists, was designed to test whether these variables may be related to one another in predicting session quality. Method: The sample comprised 328 sessions from 26 clients and 11 therapists, with the clients completing session quality measures and therapists completing measures of technique immediately post‐session. Results: Using multilevel linear modelling, the data showed varied results. For behavioural therapy and person‐centred therapy, techniques and orientation were unrelated to session quality in the sample. However, process‐experiential, psychodynamic, and cognitive therapy techniques were all involved in interactions with therapist and/or supervisor orientations. Conclusions: These results suggest that the impact of specific psychotherapy techniques sometimes depends on the orientation of the therapist and/or supervisor. For instance, sessions high in cognitive therapy techniques were only associated with positive outcome when both the therapist and supervisor were highly cognitively oriented. Though preliminary, these results suggest that orientation may be an important variable to consider in training and supervision, especially in the context of other variables.     

Disorganized infant attachment and preventive interventions: A review and meta‐analysis

Infant disorganized attachment is a major risk factor for problematic stress management and later problem behavior. Can the emergence of attachment disorganization be prevented? The current narrative review and quantitative meta‐analysis involves 15 preventive interventions (N = 842) that included infant disorganized attachment as an outcome measure. The effectiveness of the interventions ranged from negative to positive, with an overall effect size of d = 0.05 (ns). Effective interventions started after 6 months of the infant's age (d = 0.23). Interventions that focused on sensitivity only were significantly more effective in reducing attachment disorganization (d = 0.24) than interventions that (also) focused on support and parent's mental representations (d = ?0.04). Most sample characteristics were not associated with differences in effect sizes, but studies with children at risk were more successful (d = 0.29) than studies with at‐risk parents (d = ?0.10), and studies on samples with higher percentages of disorganized attachment in the control groups were more effective (d = 0.31) than studies with lower percentages of disorganized children in the control group (d = ?0.18). The meta‐analysis shows that disorganized attachments may change as a side effect of sensitivity‐focused interventions, but it also illustrates the need for interventions specifically focusing on the prevention of disorganization.     

Predicting Psychologists' Intentions to Integrate Complementary and Alternative Therapies Into Their Practice

Drawing on an extended Theory of Planned Behaviour (TPB) framework, we employed a cross‐sectional design study to investigate psychologists' intentions to integrate complementary and alternative therapies (CAT) into their practice via recommending CAT to clients or referring clients to CAT practitioners. Participants were registered practicing psychologists from a range of therapeutic orientations (e.g., narrative, cognitive behavioural, psychodynamic). The psychologists were either recruited by phone, following a search of the Internet, or were contacted through their place of employment (hospitals, university counselling service). Those who agreed to participate (N = 122; n = 88 females, n = 34 males) completed a questionnaire that included standard TPB items of attitude, subjective norm, and perceived behavioural control, along with items measuring perceived risk, past behaviour, CAT knowledge, and gender. The outcome variables of interest were (a) intention to recommend CAT to clients and (b) intention to refer clients to CAT practitioners. Structural equation modelling revealed that the extended model was a good fit, explaining 69% (recommending CAT) and 51% (referring to CAT practitioners) of the variance in intentions. For both behaviours, direct paths from attitude and subjective norm to intentions were observed, with perceived risk and past behaviour influencing the TPB predictors of attitudes, subjective norm, and perceived behavioural control. The findings illustrate the role that cognitive and risk factors have on psychologists' decisions to integrate CAT into their practice. Understanding psychologists' cognitions and decisions about CAT integration forms an important basis on which to consider future changes in policy or practice.     

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.     

The statistical recommendations of the American Psychological Association Publication Manual: Effect sizes,confidence intervals,and meta‐analysis

Estimation based on effect sizes, confidence intervals, and meta‐analysis usually provides a more informative analysis of empirical results than does statistical significance testing, which has long been the conventional choice in psychology. The sixth edition of the American Psychological Association Publication Manual now recommends that psychologists should, wherever possible, use estimation and base their interpretation of research results on point and interval estimates. We outline the Manual's recommendations and suggest how they can be put into practice: adopt an estimation framework, starting with the formulation of research aims as ‘How much?’ or ‘To what extent?’ questions. Calculate from your data effect size estimates and confidence intervals to answer those questions, then interpret. Wherever appropriate, use meta‐analysis to integrate evidence over studies. The Manual's recommendations can assist psychologists improve they way they do their statistics and help build a more quantitative and cumulative discipline.