Treatment preference, engagement, and clinical improvement in pharmacotherapy versus psychotherapy for depression

Pharmacotherapy and psychotherapy are generally effective treatments for major depressive disorder (MDD); however, research suggests that patient preferences may influence outcomes. We examined the effects of treatment preference on attrition, therapeutic alliance, and change in depressive severity in a longitudinal randomized clinical trial comparing pharmacotherapy and psychotherapy. Prior to randomization, 106 individuals with MDD reported whether they preferred psychotherapy, antidepressant medication, or had no preference. A mismatch between preferred and actual treatment was associated with greater likelihood of attrition, fewer expected visits attended, and a less positive working alliance at session 2. There was a significant indirect effect of preference match on depression outcomes, primarily via effects of attendance. These findings highlight the importance of addressing patient preferences, particularly in regard to patient engagement, in the treatment of MDD.     

Conscientiousness and agreeableness as predictors of rating leniency

The authors studied the relationship between the Big Five personality factors and rating elevation among 111 students making peer evaluations. It was hypothesized that Conscientiousness (C) scores would be negatively correlated with rating level and that Agreeableness (A) scores would be positively correlated with rating level. We further predicted that individuals who were low on C and high on A would produce the most elevated ratings. As predicted, A scores were positively related to rating level (.33, p < .01) and C scores were negatively correlated with rating level (-.37, p < .01). Using the strong hypothesis test (P. Bobko, 1986), the authors found that ratings by low C and high A individuals were more elevated than all other groups of students combined (p < .01).     

Difference scores: A caveat illustrated with neuropsychological measures

Relationships among preferred minus non-preferred hand difference scores from four neuropsychological sensorimotor tests were evaluated in Community (N= 121), Prison Inmate (N = 350), and Psychiatric Inpatient (N = 398) samples. Across the three samples, the average absolute off-diagonal correlations among the four difference scores ranged from .07 to .13, and the squared multiple correlations (used to predict any difference score from the other three) did not exceed .07. Based on the determinant of the correlation matrix (i.e., |R|), the null hypothesis of complete independence was rejected in only the Prison Inmate sample (p < .001), however, departure from the null hypothesis was negligible (i.e., |R| = .94, expected value under the null = .98). Preferred/non-preferred hand ratio scores were very highly correlated with the difference scores and consequently analyses of the ratio scores yielded results that were comparable to those obtained for the difference scores. Results indicate that the four difference scores or four ratio scores measure little in common and therefore cannot corroborate each other. In general, it would be prudent to exercise considerable caution when using difference scores or ratio scores obtained from non-independent measures, either singly or in combination.     

Difference scores: A caveat illustrated with neuropsychological measures

Relationships among preferred minus non-preferred hand difference scores from four neuropsychological sensorimotor tests were evaluated in Community (N= 121), Prison Inmate (N = 350), and Psychiatric Inpatient (N = 398) samples. Across the three samples, the average absolute off-diagonal correlations among the four difference scores ranged from .07 to .13, and the squared multiple correlations (used to predict any difference score from the other three) did not exceed .07. Based on the determinant of the correlation matrix (i.e., |R|), the null hypothesis of complete independence was rejected in only the Prison Inmate sample (p < .001), however, departure from the null hypothesis was negligible (i.e., |R| = .94, expected value under the null = .98). Preferred/non-preferred hand ratio scores were very highly correlated with the difference scores and consequently analyses of the ratio scores yielded results that were comparable to those obtained for the difference scores. Results indicate that the four difference scores or four ratio scores measure little in common and therefore cannot corroborate each other. In general, it would be prudent to exercise considerable caution when using difference scores or ratio scores obtained from non-independent measures, either singly or in combination.     

The power motive, n power, and fear of weakness

Among 85 male undergraduates, high need for power as measured by the 1968 Winter scoring system is shown to relate to high drinking frequency (p less than .01), high alcohol consumption (p less than .05), and taking the first drink at age 16 or less (p less than .05); to the Disinhibition ("Swinger") factor on Zuckerman's Sensation Seeking Scale (p less than .05) to poor academic performance (p less than .05); and to generate a regression equation with the California Psychological Inventory that suggests qualities of personal disorderliness and intellectual aggression. These findings, considered in terms of power motive theory, are seen as replicating earlier evidence that high n Power is maladaptie, voyeuristic and power avoidant.     

A Secondary Analysis of Integrated Pediatric Chronic Pain Services Related to Cost Savings

Youth with chronic pain have high healthcare utilization and associated costs. Research supports integrated treatment; though, it’s unclear which treatments are used and cost-effective. This study expands on work that found reduced service use and cost savings following participation in an outpatient integrated pediatric pain clinic. We explored which services were commonly used and which individual (psychotherapy, medication management, acupuncture, massage, biofeedback) and/or combinations of services were associated with service use reduction and cost savings. Medication management and psychotherapy were more common than complementary integrative medicine (CIM) services. Massage services were associated with reduced inpatient costs. There were trends of fewer emergency department visits for participants who received CIM services in addition to medication management and psychotherapy, and more visits for those with biofeedback. Findings suggest that a more detailed examination of service utilization is needed to better understand cost outcomes related to the integrated treatment of pediatric chronic pain.

     

Basic psychological needs satisfaction,working alliance,and early termination in psychotherapy

The goal of this study was to evaluate the relationship between basic psychological needs satisfaction and working alliance in psychotherapy and to determine whether client ratings of basic needs and working alliance during psychotherapy were associated with early termination of therapy. Former psychotherapy clients (n = 87) completed a semi-structured interview regarding basic needs satisfaction in therapy, working alliance and dropout status. Participant ratings on the Basic Needs Satisfaction in Psychotherapy scale (BNSP) and the Retrospective Working Alliance Inventory – Short (RWAI-S) were significantly correlated (r = .77) in our sample. A comparison of intercorrelations between working alliance subscales and basic needs subscales indicated higher factorial distinctiveness within the basic needs measure. T-tests comparing those who terminated psychotherapy early with those who had planned endings on scores on the BNSP and RWAI-S were significant (Cohen’s d = .65 and 1.82, respectively). Results suggest that the basic needs measure might tap into a wider breadth of the therapist and client interaction than the RWAI-S.     

Attitude towards euthanasia in relation to death anxiety among a sample of 343 nurses in India

Scores on Attitude towards Euthanasia were correlated with scores on Death Anxiety among 343 female nurses in India using Templer's Death Anxiety Scale and the authors' 24-item attitude scale. No significant correlation was found between the two sets of scores (r = -.09) or a nonlinear score on relation. Age of nurses was not significantly related to Attitude towards Euthanasia (r = .07) or Death Anxiety (r = .11). As measured, death anxiety has no bearing on attitude about euthanasia.     

诱发及个体自发认知重评对情绪唤醒反应及情绪记忆的影响

为了明确诱发（IRE）及个体习惯化的自发（SRE）认知重评策略对情绪唤醒反应及情绪记忆的影响,在测量被试SRE水平的基础上,先呈现一系列中性与负性情绪图片,要求被试对图片内容进行自然观看或认知重评,同时记录被试的主观与生理唤醒水平,之后对图片进行自由回忆及再认测试。发现IRE显著降低了情绪唤醒水平及再认正确率,但只对情绪唤醒反应较高的LR（SRE水平较低）被试有效。结果提示,IRE对情绪唤醒反应与情绪记忆的调控受到SRE的影响。     

Specific fears as predictors of generalized anxiety in children

The study investigated the relationship between fear and anxiety in childhood. One hundred fifty-one children aged 6 to 11 years (mean=8.7 years) completed the Fear Survey Schedule for Children-Revised (FSSC-R) and the Revised Children's Manifest Anxiety Scale (RCMAS). Correlational analyses demonstrated that the FSSC-R and each of the fear factors were significantly correlated with each other and with the RCMAS score. A stepwise regression procedure was used to determine if the FSSC-R or any of its five factors was significantly related to scores on the RCMAS. Results indicated that Factor 1 (Failure and Criticism) accounted for 31% of the variance (p < .0001)and Factor 2 (Fear of the Unknown) accounted for an additional 1% of the variance (p < .03)in the RCMAS scores. The relationship between these results and those from a similar study with adults (Goetsch, Tishelman, & Adams, 1987), as well as how the results add to an understanding of childhood anxiety, is discussed.This study was supported by BRSG Grant S07RR0714917 from the Biomedical Research Support Grant Program, Division of Research Resources, National Institute of Health, to the Research Foundation of the State University of New York at Binghamton.     

Laboratory strength measures of talented and less talented Greek children ages 9 to 10 years

The purpose was twofold: (1) to assess whether laboratory tests can distinguish talented groups and less talented groups of children identified by their total scores in a battery of field tests and (2) to evaluate whether scores in field and laboratory tests are correlated. 36 children (ages 9 to 10 years) were divided into groups of higher and lower total scores on standing long jump, medicine ball throw, and sprint. Both groups were tested for maximum isometric force, force produced at the initial 100 msec., reactive force index, drop jump height, squat jump height, and maximum pedaling rate. Analysis showed the talented group had significantly (p < or = .05) higher scores on maximum isometric force, force produced in the initial 100 msec., and drop jump height than less talented children. Moderate to high correlations were found among scores for field performance tests with maximum pedaling rate. In conclusion, the laboratory tests distinguished the talented and less talented children in maximal isometric force, the force produced at the initial 100 msec., the reactive force index, and the drop jump height.     

Type A behaviour in pre-school children: Interrater reliability, stability over six months and subcomponents

Type A behaviour was measured in 250 boys and 245 girls (ages 3-7) using a Swedish version of Matthews' Youth Test for Health (MYTH). In addition, speech and voice characteristics (speed, loudness, response latency) were measured. Each child was independently rated by two play group leaders and measurements were repeated after a six month interval. Interrater reliability (first session) was 0.76 for both sexes and did not change with the age of the child. Boys obtained significantly (p less than 0.0001) higher scores than girls. Correlations over the six month period were 0.64 and 0.60 (p less than 0.001) for the two possible combinations of different raters and slightly higher (0.75 and 0.68, p less than 0.001) when the same rater was used. Two components of Type A behaviour were identified from a factor analysis of the data: impatience and competitiveness, and they accounted for 57% of the total variance. As for the total scale, boys obtained significantly higher scores than girls on both subscales. Scores on the competitiveness scale increased systematically with age. Speech and voice characteristics correlated significantly with Type A scores (total Type A behaviour: r = 0.50, using different raters, and 0.71, using the same raters, p less than 0.001) and, once again, boys obtained significantly (p less than 0.001) higher scores than girls. The results are in close agreement with the American findings from the original scale. It was concluded that the scale provides a reliable and valid instrument for measuring Type A or Type A-like behaviours in pre-school children.     

The Effectiveness of a REBT Training Program in Increasing the Performance of High School Students in Mathematics

The efficacy of an REBT-based skill training program on the mathematics performance of disadvantaged black eleventh graders enrolled in Upward Bound was examined. Fifty-six students (18 males and 37 females) were randomly assigned to Perception Analysis Training (PAT) or an attention control group (ACG). The two groups met at the same hour each week for eight-weeks. PAT consisted of instruction in the application of RET strategies to the management of emotions that interfere with the development of proficiency in mathematics. ACG group members discussed films pertaining to career and personal development. Pre-test results confirmed a relationship between beliefs and mathematics achievement. Three measures of problematic beliefs concerning mathematics were significantly correlated (p>.01) with high school math grades and performance on the California Achievement Test-Math (CAT). At post-test PAT participants were less committed to self-defeating beliefs regarding mathematics than AGC members. ANCOVAs showed that PAT students made significantly greater pre- to post-test gains in their mathematical performance than control group members. PAT group members out performed AGC subjects in terms of Upward Bound math grades (ES=0.61; p >.0008), high school math grades (ES = 1.09; p>.0001), and scores on the CAT (ES=0.40; p >.02).     

Attention to novelty, fear-anxiety, and age: their effects on conduct problems

The authors investigated the effects of attention to novelty, fear-anxiety, and age on 3 measures of conduct problems. They found several main and interaction effects. The results indicated the presence of the hypothesized 3-way interaction for 2 dependent measures (i.e., conduct problem, socialized aggression); the 3rd dependent measure (i.e., conduct disorder) approached significance (p = .07). Participants who were older, had low attention to novelty, and high fear-anxiety generally had the highest conduct-problem scores among 8 comparison groups. Older students with high attention to novelty and low fear-anxiety had significantly lower conduct-problem scores that were unremarkable. The findings are congruent with J. Gray's (1987) theory of behavioral activation and inhibition, and the results support R. C. Eaves' (1993) integrated theory of human behavior, which postulates that the level of attention to novelty, fear-anxiety, and age interact to produce individuals with conduct problems.     

Psychotherapy for the treatment of depression: a comprehensive review of controlled outcome research

Previous quantitative reviews of research on the efficacy of psychotherapy for depression have included only a subset of the available research or limited their focus to a single outcome measure. The present review offers a more comprehensive quantitative integration of this literature. Using studies that compared psychotherapy with either no treatment or another form of treatment, this article assesses (a) the overall effectiveness of psychotherapy for depressed clients, (b) its effectiveness relative to pharmacotherapy, and (c) the clinical significance of treatment outcomes. Findings from the review confirm that depressed clients benefit substantially from psychotherapy, and these gains appear comparable to those observed with pharmacotherapy. Initial analysis suggested some differences in the efficacy of various types of treatment; however, once the influence of investigator allegiance was removed, there remained no evidence for the relative superiority of any 1 approach. In view of these results, the focus of future research should be less on differentiating among psychotherapies for depression than on identifying the factors responsible for improvement.     

The relationship among genital herpes simplex virus, stress, and social support

Despite widespread popular belief in the activation of recurrent lesions in genital herpes simplex virus (HSV) by psychosocial stress, little empirical evidence supports that contention. This study retrospectively examined the role of stress in activation of HSV lesions as mediated by social support. Participants were 59 volunteers who had self-reported culture-positive genital HSV for at least 10 months. Measures of stress proneness (State-Trait Anxiety Inventory; STAI-Trait), recent stressful events (Schedule of Recent Events; SRE), and subjective appraisal of stress (global self-rating) were administered along with measures of general social support and herpes-specific social support. When retrospective reports of HSV symptoms were examined using a multiple-regression approach, duration of disease and amount of herpes-specific social support were found to be significant moderators of the relation between stress and number of HSV recurrences in the preceding 12 months. When duration of disease was short (less than 4 years), stress (SRE) and number of recurrences were positively associated; when disease duration was longer, there was no relationship. Similarly, at low levels of herpes-specific social support, a positive relation between stress (SRE) and number of recurrences was found. However, at higher levels of herpes-specific social support, no association was found. No relation was found between stress proneness (STAI-Trait) and HSV symptoms. However, subjective appraisal (global rating) of stress in the preceding 12 months was positively and significantly correlated with reported number of recurrences. Results are discussed in terms of their clinical implications.     

Measuring the speed of recognising facially expressed emotions

Faces provide identity- and emotion-related information—basic cues for mastering social interactions. Traditional models of face recognition suggest that following a very first initial stage the processing streams for facial identity and expression depart. In the present study we extended our previous multivariate investigations of face identity processing abilities to the speed of recognising facially expressed emotions. Analyses are based on a sample of N=151 young adults. First, we established a measurement model with a higher order factor for the speed of recognising facially expressed emotions (SRE). This model has acceptable fit without specifying emotion-specific relations between indicators. Next, we assessed whether SRE can be reliably distinguished from the speed of recognising facial identity (SRI) and found latent factors for SRE and SRI to be perfectly correlated. In contrast, SRE and SRI were both only moderately related to a latent factor for the speed of recognising non-face stimuli (SRNF). We conclude that the processing of facial stimuli—and not the processing of facially expressed basic emotions—is the critical component of SRE. These findings are at variance with suggestions of separate routes for processing facial identity and emotional facial expressions and suggest much more communality between these streams as far as the aspect of processing speed is concerned.     

Intelligence and imagery in personality.

One hundred college undergraduates were administered the Richardson revision of the Gordon Test of Visual Imagery Control, the Betts-Sheehan Questionnaire Upon Mental Imagery, and the Shipley-Hartford Institute of Living Scale. The latter provided a conceptual quotient (CQ) score of intellectual impairment based upon a ratio between vocabulary and abstraction scores. Subjects with CQs above 100 had significantly higher control scores (p less than .02). High control subjects had significantly higher total IQ scores than did low control subjects (p less than .04). Subjects with high and medium range control had higher vocabulary scores than those with low control. This suggests possible assessment of proneness toward introverted and extraverted neuroticism based upon a combination type of imagery score and the ratio between abstract or vocabulary scores. The connection of imagery with dimensions of IQ may be a start toward a more refined measure of this aspect of personality. Problems and implications are discussed.     

Construct Validity of Parent Ratings of Inhibitory Control

Recent literature has emphasized the need to examine executive functions (EF) in children using multiple sources, including both parent rating and performance-based measures. Computerized Go/No-Go tests, including commercially available continuous performance tests (CPTs), represent one of the most commonly used methods of assessing inhibitory control—a variable central to the executive function construct. We examined the relationship between parent ratings of inhibitory control and CPT performance in two mixed clinical samples. Experiment 1 examined 109 children ages 6–18 using the Behavior Rating Inventory of Executive Function (BRIEF; Gioia, Isquith, Guy, & Kenworthy, 2000) and the Conners' CPT-II (Conners, 2000). In this sample, ratings on the BRIEF Inhibit scale (mean T-score?=?62.3) were significantly higher than the CPT-II commissions score (mean T-score?=?50.7; p < .0001); and the BRIEF and CPT-II scores were not highly correlated (r?=???.12). Experiment 2 examined a sample of 131 children ages 7–18 using the BRIEF and the Tests of Variables of Attention (TOVA; Greenberg, 1996). In this sample, parent ratings on the BRIEF Inhibit scale (mean T-score?=?56.8) were similar to TOVA commissions scores (mean T-score?=?58.6; p?=?.33), although still poorly correlated (r?=??.02). Factor analyses exploring covariance between BRIEF scales CPT-II variables (Experiment 1) and between BRIEF and TOVA (Experiment 2) yielded similar findings. In both experiments, all eight BRIEF scales loaded on a single factor, with no overlap with either the CPT-II or the TOVA. In mixed outpatient clinical samples, the BRIEF appears to measure different elements of inhibitory control than those assessed by computerized continuous performance tests.     

Therapeutic alliance in guided internet-delivered cognitive behavioural treatment of depression, generalized anxiety disorder and social anxiety disorder

Guided internet-delivered cognitive behaviour therapy (ICBT) has been found to be effective in several controlled trials, but the mechanisms of change are largely unknown. Therapeutic alliance is a factor that has been studied in many psychotherapy trials, but the role of therapeutic alliance in ICBT is less well known. The present study investigated early alliance ratings in three separate samples. Participants from one sample of depressed individuals (N = 49), one sample of individuals with generalized anxiety disorder (N = 35), and one sample with social anxiety disorder (N = 90) completed the Working Alliance Inventory (WAI) modified for ICBT early in the treatment (weeks 3-4) when they took part in guided ICBT for their conditions. Results showed that alliance ratings were high in all three samples and that the WAI including the subscales of Task, Goal and Bond had high internal consistencies. Overall, correlations between the WAI and residualized change scores on the primary outcome measures were small and not statistically significant. We conclude that even if alliance ratings are in line with face-to-face studies, therapeutic alliance as measured by the WAI is probably less important in ICBT than in regular face-to-face psychotherapy.