The end of mental illness thinking?

Mental health theory and practice are in a state of significant flux. This theoretical article places the position taken by the British Psychological Society Division of Clinical Psychology (DCP) in the context of current practice and seeks to critically examine some of the key factors that are driving these transformations. The impetus for a complete overhaul of existing thinking comes from the manifestly poor performance of mental health services in which those with serious mental health problems have reduced life expectancy. It advocates using the advances in our understanding of the psychological, social and physical mechanisms that underpin psychological wellbeing and mental distress, and rejecting the disease model of mental distress as part of an outdated paradigm. Innovative research in genetics, neuroscience, psychological and social theory provide the platform for changing the way we conceptualise, formulate and respond to psychological distress at both community and individual levels.     

Standards on how to develop and report systematic reviews in Psychology and Health

Systematic reviews are secondary studies that summarize the best scientific evidence available by means of explicit and rigorous methods to identify, select, appraise, analyse and summarise the empirical studies that enable responding to specific questions. The aim of this theoretical study is to set out a series of standards and recommendations for the planning, development and reporting of a systematic review in the field of the health sciences. The article describes the systematic reviews in the context of practice based on scientific evidence, their rise, justification, applicability and differences compared to traditional literature reviews. Secondly, the methodology is set out for their development and guidelines are established for their preparation; the stages of the process and preparation of a protocol are described with emphasis on the steps to follow to prepare and report a systematic review. Finally, some additional considerations are set out for their preparation and publication in a scientific journal. This guide is aimed both at authors and reviewers of a systematic review.     

Where to look for information when planning scientific research in Psychology: Sources and channels

It is imperative that researchers invest time in the planning of their research, and it is certainly essential to stop and seek information before making any kind of decision. The present work sets out to guide psychologists in this crucial task. To this end we begin by suggesting a visit to the APA website, where a great deal of relevant information on most topics can be found, whether it pertains to new and controversial issues or to those on which there is greater consensus. In this regard we shall consider at length the meanings of the expressions “evidence-based practice” and “scientific evidence” and their inherent methodological aspects, from “scientific evidence” contributed by systematic reviews to the way it can be obtained using handbooks and guidelines of inestimable value for the successful completion of our research. All such resources will help researchers to set out their hypotheses correctly, to test them adequately and to analyze the data in the most appropriate and rigorous fashion. In this way, the quality of the research will undoubtedly improve.     

A systematic review of sexual satisfaction

The present theoretical study is a systematic review of research publications in which sexual satisfaction was the dependent variable. After conducting a literature search in major electronic databases and following a selection process, we provide a summary of the main findings of 197 scientific papers published between 1979 and 2012. The review revealed the complexity and importance of sexual satisfaction, which was associated with the following variables and factors: a) individual variables such as socio-demographic and psychological characteristics as well as physical and psychological health status; b) variables associated with intimate relationships and sexual response; c) factors related to social support and family relationships; and d) cultural beliefs and values such as religion. In conclusion, we observed that sexual satisfaction is a key factor in individuals’ sexual health and overall well-being. However, despite its importance, there is a lack of theoretical models combining the most important factors to explain sexual satisfaction.     

Treatment-resistant depression: A systematic review of systematic reviews

The objective of this research study was to assess pharmacological, somatic and/or psychological treatments in adults with a diagnosis of major depressive disorder who have not responded to at least one course of antidepressant medication. We conducted a systematic review to identify systematic scientific reviews and meta-analyses on treatment-resistant depression (TRD) published until February 2012. Of the sixty studies selected, sixteen met the inclusion criteria and were therefore included in the review. We considered eight main themes, including the definition of TRD, long-term results, and different treatment strategies, including so-called somatic therapies. Based on the review, the definition of TRD should be standardized in order to achieve a shared conceptualization of this disorder. This would allow a better understanding among clinicians and researchers in the field, promoting a homogeneous research methodology and thus leading to more reliable and comparable results. This essential conceptual clarification would also have a positive impact on patients with TRD, their families, and social and health systems.     

Problematic,absent and stigmatizing diagnoses in current mental disorders classifications: Results from the WHO-WPA and WHO-IUPsyS Global Surveys

This study examined English- and Spanish-speaking psychologists’ and psychiatrists’ opinions regarding problematic, absent and stigmatizing diagnoses in current mental disorders classifications (ICD-10 and DSM-IV), and their perceived need for a national classification of mental disorders. Answers to open-ended questions included in WHO-WPA and WHO-IUPsyS surveys were examined using an inductive content-analysis method. A total of 3,222 participants from 35 countries were included. The most problematic diagnostic group was personality disorders, especially among psychiatrists, because of poor validity and lack of specificity. Complex posttraumatic stress disorder was the most frequent diagnosis suggested for inclusion, mainly by psychologists, to better account for the distinct processes and consequences of complex trauma. Schizophrenia was the diagnosis most frequently identified as stigmatizing, particularly by psychiatrists, due to lack of public understanding or knowledge about the diagnosis. Of the 14.4% of participants who perceived a need for a national classification system, two-thirds were from Africa or Latin America. The rationales provided were that mental disorders classifications should consider cultural and socio-historical diversity in the expression of psychopathology, differences in the perception of what is and is not pathological in different nations, and the existence of culture-bound syndromes. Implications for ICD-11 development and dissemination are discussed.     

Emotional inertia: A key to understanding psychotherapy process and outcome

The processes underlying psychotherapeutic change have increasingly been emphasized in both research and clinical practice. Nonlinear dynamical systems theory (NDS) offers a transdisciplinary scientific approach to the study of these processes. This paper introduces the NDS concept of “emotional inertia”, the property of human emotion by which it retains its course so long as it is not acted upon by an external force, as a key to understanding moment-by-moment and also longer-term change processes within psychotherapy. A testable mathematical model of emotional inertia is presented that represents specific impacts of psychotherapeutic processes on emotional dynamics over time. Emotional trajectories in phase space, treatment energy, and the interaction between them are the essential elements of the model, and a detailed explanation is provided. Procedures for testing this model are described, such as by tracking the movement of emotion in phase space within and across therapy sessions, along with clinical implications of the model, which can potentially help to make more clear the complementary roles of therapeutic force, timing, and leverage.