Welcome to the ‘Paradigm War’: the case of antidepressant medication

Mindfulness-based therapies are a recent development within the cognitive-behavioural tradition and an important element of the third wave cognitive behavioural therapy models. A number of these therapies could be considered to have mindfulness as a major component of the therapy. There has been a considerable growth of interest in these therapies with an accompanying increase in their evidence base. While a number of reviews have been conducted, these therapies were not comprehensively appraised. The most prominent of these therapies, mindfulness-based cognitive therapy, was developed to reduce relapse in recurrent depression. We conducted a meta-analysis which looked at therapies considered to have mindfulness as a major component. We investigated whether this group of therapies was effective in reducing current depressive symptomatology as measured by the Beck depression inventory (BDI). A total of 11 studies were included in the analysis. We found a significant mean reduction score in current depressive symptomatology, as measured by the BDI, of 8.73 points (95% confidence interval?=?6.61, 10.86). We found evidence for the effectiveness of these major-component therapies in reducing levels of active depression. The robustness of these findings is discussed alongside the implications for research and practice within the context of the current literature.     

Nurses’ recognition and reporting of child abuse: A factorial survey

According to interaction ist theory, responses of professionals to potential deviance will vary by characteristics of the event, characteristics of the biography and training of the observer, and characteristics of the organization in which the process occurs. Hypotheses concerning recognition and reporting of child abuse were tested using a factorial survey design. A probability sample of nurses (N = 1,038) judged vignettes, in which case characteristic variables were systematically manipulated, and responded to a questionnaire on their background, professional work, and organization. Case characteristics involving type and level of seriousness of abuse, perpetrator status, and perpetrator psychology had the greatest effects on the average recognition and reporting scores, as shown in the analysis using ordinary least squares regression. Contrary to interaction ist predictions, only a small additional amount of the variance was accounted for when the nurses’ characteristics and organizational characteristics were added to the equation. Implications of the findings for further research and for social policy and practice concerning child abuse are discussed.     

‘A necessary evil’: associations with taking medication and their relationship with medication adherence

Cognitive factors, like beliefs, have been studied extensively as determinants of medication adherence, while affect associated with taking medicines has been studied much less. In the present study (N = 525), we investigated affect by assessing patients’ first associations with taking their medicines. Results showed that these associations were related to self-reported medication adherence: Patients who associated taking medicines with negative affect were the least adherent, while those associating taking medicines with the need to take medicines were the most adherent. Our results support the idea that affect should be considered an important determinant of adherence.     

‘Pre-crime’, Prevent,and practices of exceptionalism: Psychotherapy and the new norm in the NHS

Section ’26 of the Counter-Terrorism and Security Act 2015 places a duty on local authorities and public sector institutions to have ‘due regard to the need to Prevent people from being drawn into terrorism’. Accordingly, NHS staff are now required to attend a Workshop to Raise Awareness of Prevent (WRAP), ensuring they are trained to spot the ideological symptoms and psychosocial vulnerabilities thought to predict extremist activity. In this paper, I suggest that the insertion of counter-radicalisation duties into the work of psychotherapists and other mental health professionals is not simply to be understood as an attempt to forestall and avert extremist activity. Rather, drawing on the work of Georgio Agamben and Judith Butler, I argue it can be viewed as an innovative tactic of governmentality whose technologies of surveillance ensure a culture of conformity in the NHS through which a ‘state of exception’ can be established and normalised. I illuminate this by examining two interrelated aspects of the Prevent duty: one, the decision by the government to embed Prevent within the existing rhetoric and practice of ‘safeguarding vulnerable children and adults’; and two, its discursive representation of the consulting room as ‘pre-criminal space’. I conclude by suggesting that the government’s determination to allow ‘no ungoverned space in which extremism is allowed to flourish’ targets the limits of acceptable speech and so the very conditions for radical thought and critique on which psychotherapy depends.     

A survey of neuropsychologists’ use of validity tests with children and adolescents

A web-based survey of validity test use by North American neuropsychologists was conducted, with 282 participants meeting inclusion criteria. Respondents indicated that they use a median of one stand-alone performance validity test (PVT), one embedded PVT, and one symptom validity test (SVT) per pediatric assessment. The vast majority of respondents indicated they give at least one PVT (92%) and at least one SVT (88%) during each pediatric assessment. A meaningful difference in validity use (i.e., at least a medium effect size) was only found for those who engage in forensic work, with those clinicians giving more stand-alone PVTs than those who do not conduct forensic work. The most frequently used validity measures in pediatric assessments are presented, as are reasons participants reported for both using and not using validity tests. Limitations and qualitative comparisons to other surveys on validity test use with adults are discussed.     

Clients’ Experiences of Disengaged Moments in Psychotherapy: A Grounded Theory Analysis

The study offers an empirically derived model of clients’ experiences of disengaged moments, defined as moments when clients withdraw, distance, or lessen their intensity of involvement with therapy-relevant material or relationships. Interpersonal Process Recall (IPR) interviews were conducted with nine psychotherapy clients of therapists with varied orientations and experience. The interviews were transcribed verbatim and subjected to qualitative analysis using grounded theory analysis (Glaser and Strauss, The discovery of grounded theory: Strategies for qualitative research, 1967) methodology. The results suggested that clients use disengagement for protection from pain, strategic retreat, relationship management, self-through-other discovery, and self-betterment. The core category across all of the experiences of disengagement relates to communicating difficulties and experimenting within the therapy relationship toward self-change. Recommendations are offered for research and practice.     

San Antonio’s Barrio Gangs: Size,Scope, and Other Characteristics

I analyze data gathered from a sample of men who were gang members in San Antonio in the 1950s. Using subject-generated lists of gangs and reputable members citywide, the work examines the size, scope, and other salient characteristics of the barrio gang phenomenon from that era. By extrapolating rough estimates from Census data, qualitative fieldwork, and a police database, I find that the proportion of young Chicano males involved in gang activity today is comparable to what it was in the 1950s. In both eras, nearly 10% of the total population of Chicano males ages 12–19 in San Antonio are and were gang involved. Implications of this finding, study limitations, and future research are discussed.     

A computerized system for recording and analysis of self-observations of couples’ interaction

This paper describes a method for recording couples’ observations of their communications during an ongoing interaction sequence. The procedure allows the recording and decoding of immediate reactions, while maintaining an ecologically valid observation environment. Responses are encoded on a stereo cassette tape player and are decoded by a PDP-11/10 computer with two Schmitt triggers that count the peaks in the tones. The computer provides analysis of the response value and time. Applications for other research problems in the areas of social and applied clinical psychology are discussed.     

Teachers’ creativity,playfulness, and style of interaction with children

Abstract:

This investigation examined the relationships among a teacher's creative thinking, playfulness, and degree of sensitivity in their interactions with preschool children during play. These variables were operationally defined as scores on measures of ideational fluency, playful disposition, and quality of self‐reported play interaction. The Multidimensional Stimulus Fluency Measure, the Adult Behavior Inventory, and the Play Interaction Scale were administered to 46 students and 37 teachers of three‐ and four‐year old children. The Play Interaction Scale, developed for this study, was based on environmental components identified in earlier research as facilitative of play. Subjects indicated the frequency with which they might respond in a structured, elaborative, or unstructured manner to 20 vignettes describing the play of children. Results indicated that the expected positive relationships among creativity, playfulness, and an elaborative teaching style were found only for the students. The predicted negative relationships between creativity and a structured interaction style were found only for the experienced teachers.     

Strong and Weak Readings in the Domain of Worlds: A Negative Polar Modal and Children’s Scope Assignment

This study investigates children’s interpretation of sentences with two logical operators: Dutch universal modal hoeven and negation (niet). In adult Dutch, hoeven is an NPI that necessarily scopes under negation, giving rise to a not > necessary reading. The findings from a hidden-object task with 5- and 6-year-old children showed that children’s performance is suggestive of an interpretation of sentences with hoeft niet in which the modal scopes over negation (necessary > not). This is in line with the Semantic Subset Principle that dictates that children should opt for the strongest possible reading in case of potential scope ambiguities. The full pattern of results, however, seems to be determined, in addition, by a particular strategy children use when facing uncertainty called Premature Closure.     

What’s happening in CAI: A survey of ongoing projects

As there are more CAI papers in this year’s “Computers in Psychology” program than in any past year, the membership was surveyed to provide a broad overview of current trends. This is a report of the obtained data (1) on what courses use CAI and the hardware supporting those courses, (2) on the software and “courseware” involved, (3) on CAI record-keeping and evaluation procedures, and (4) on the financial costs and educational benefits of the various projects.     

What makes labour and birth traumatic? A survey of intrapartum ‘hotspots’

Evidence suggests between 1% and 6% of women develop post-traumatic stress disorder (PTSD) after childbirth. ‘Hotspots’ are moments of extreme distress during traumatising events that are implicated in symptoms of PTSD. This cross-sectional internet survey of hotspots examined (1) the content of intrapartum hotspots and (2) whether particular events, cognitions or emotions during hotspots are related to PTSD. Women (N?=?675) who experienced a difficult or traumatic birth completed a questionnaire composed of a validated measure of PTSD, questions concerning the existence of hotspots, and a newly developed measure of emotions and cognitions during hotspots. The majority of women (67.4%) reported at least one hotspot during birth and 52.9% had re-experiencing symptoms of these hotspots. Women were more likely to have PTSD if hotspots involved fear and lack of control (odds ratio (OR) 1.30, 95% CI 1.17–1.43) or intrapartum dissociation (OR 1.12, 95% CI 1.05–1.19). Risk of PTSD was higher if hotspots concerned interpersonal difficulties (OR 4.34, 95% CI 2.15–8.77) or obstetric complications (OR 3.35, 95% CI 1.64–6.87) compared to complications with the baby.     

Toddler emotional states,temperamental traits,and their interaction: Associations with mothers’ and fathers’ parenting

We investigated the degree to which toddlers’ observed emotional states, toddlers’ temperamental traits, and their interaction accounted for variance in mothers’ and fathers’ parenting. Main effects of two emotional states (positive emotion and negative emotion), three temperamental traits (negative affectivity, effortful control, and surgency) as well as state-by-trait interactions, were examined in relation to parental sensitivity, positive affect, and negative affect. The hypothesis that toddlers’ temperamental traits would moderate the association between their observed emotional states and parenting was partially supported. Significant state-by-trait interactions were found in models predicting the probability that mothers and fathers expressed negative affect toward their toddlers. For parental sensitivity and positive affect, only main effects of temperament and/or emotion expression accounted for variance in parenting.     

AIDS,society, and morality —A philosophical survey

Conclusions Except for the lines of argument we have sketched above, there are not many general conclusions that can be drawn from the ethical and philosophical AIDS discussion at the moment. It may happen that a medical research team comes forward tomorrow or next week with an effective cure for all immunodeficiency-related diseases, including full-blown AIDS, and most of our reflections turn out to be useless from the practical viewpoint. But the formulation of ethical guidelines for medical and social practice is not all there is to moral philosophy. Even after each and every one of the problems dealt with in our study has lost all direct ordinary-life relevance, the principles and their application in new practical situatons remain. Therefore, let us hope that no moral philosopher will be reluctant to participate in the AIDS discussion out of the hopefully well-grounded but rather unethical fear that the problem in its primary medical form will cease to exist in the relatively near future. Our warm thanks are due to the following persons and for the following reasons: to Dr. Reijo Lehtonen, D. Med., for his kind assistance in the search for material from medical journals, to Mr. Matti Virtanen, M.A., for information concerning AIDS news during the years 1987–88, and to Mr. Mark Shackleton, Lecturer in English, University of Helsinki, for kindly revising the language of the paper.