Comparison of outcomes across low-intensity psychological interventions for depression and anxiety within a stepped-care setting: A naturalistic cohort study using propensity score modelling

Low-intensity interventions for common mental disorders (CMD) address issues such as clinician shortages and barriers to accessing care. However, there is a lack of research into their comparative effectiveness in routine care. We aimed to compare treatment effects of three such interventions, utilizing four years' worth of routine clinical data. Users completing a course of guided self-help bibliotherapy (GSH), internet-delivered cognitive behavioural therapy (iCBT) or psychoeducational group therapy (PGT) from a stepped-care service within the NHS in England were included. Propensity score models (stratification and weighting) were used to control for allocation bias and determine average treatment effect (ATE) between the interventions. 21,215 users comprised the study sample (GSH = 12,896, iCBT = 6862, PGT = 1457). Adherence-to-treatment rates were higher in iCBT. All interventions showed significant improvements in depression (PHQ-9), anxiety (GAD-7) and functioning (WSAS) scores, with largest effect sizes for iCBT. Both propensity score models showed a significant ATE in favour of iCBT versus GSH and PGT, and in favour of GSH versus PGT. Discernible differences in effectiveness were seen for iCBT in comparison with GSH and PGT. Given variance in delivery mode and human resources between different low-intensity interventions, building on these findings would be valuable for future service provision and policy decision making.     

Randomized trial of a brief depression prevention program: an elusive search for a psychosocial placebo control condition

This trial compared a brief group cognitive-behavioral (CBT) depression prevention program to a waitlist control condition and four placebo or alternative interventions. High-risk adolescents with elevated depressive symptoms (N=225, M age=18, 70% female) were randomized to CBT, supportive-expressive group intervention, bibliotherapy, expressive writing, journaling, or waitlist conditions and completed assessments at baseline, termination, and 1- and 6-month follow-up. All five active interventions showed significantly greater reductions in depressive symptoms at termination than waitlist controls; effects for CBT and bibliotherapy persisted into follow-up. CBT, supportive-expressive, and bibliotherapy participants also showed significantly greater decreases in depressive symptoms than expressive writing and journaling participants at certain follow-up points. Findings suggest there may be multiple ways to reduce depressive symptoms in high-risk adolescents, although expectancies, demand characteristics, and attention may have contributed to the observed effects.     

Simulation and virtual reality in medical education and therapy: a protocol.

Continuing medical education has historically been provided primarily by didactic lectures, though adult learners prefer experiential or self-directed learning. Young physicians have extensive experience with computer-based or "video" games, priming them for medical education--and treating their patients--via new technologies. We report our use of standardized patients (SPs) to educate physicians on the diagnosis and treatment of biological and chemical warfare agent exposure. We trained professional actors to serve as SPs representing exposure to biological agents such as anthrax and smallpox. We rotated workshop participants through teaching stations to interview, examine, diagnose and treat SPs. We also trained SPs to simulate a chemical mass casualty (MASCAL) incident. Workshop participants worked together to treat MASCAL victims, followed by discussion of key teaching points. More recently, we developed computer-based simulation (CBS) modules of patients exposed to biological agents. We compare the strengths and weaknesses of CBS vs. live SPs. Finally, we detail plans for a randomized controlled trial to assess the efficacy of virtual reality (VR) exposure therapy compared to pharmacotherapy for post-traumatic stress disorder (PTSD). PTSD is associated with significant disability and healthcare costs, which may be ameliorated by the identification of more effective therapy.     

Creative novation behaviour therapy as a prophylactic treatment for cancer and coronary heart disease: Part II--Effects of treatment

In this article we consider the effectiveness of creative novation behaviour therapy in preventing cancer and coronary heart disease in disease-prone probands, and also its effectiveness in extending life for patients suffering from terminal cancer. In all cases, suitably matched controls are provided as part of the general methodology, and results are reported to testify to the effectiveness of the therapy, whether administered a long-term individual therapy, group therapy, or bibliotherapy plus short-term individual treatment. We also consider the negative effects of psychoanalysis on outcome.     

The Attention Training Technique as an Attempt to Decrease Intrusive Thoughts in Obsessive–Compulsive Disorder (OCD): From Cognitive Theory to Practice and Back

The attention training technique (ATT) is a cognitive treatment method that is aimed at ameliorating intrusive thoughts in anxiety disorders. To the best of our knowledge, no randomized controlled study has yet been conducted on individuals with obsessive–compulsive disorder (OCD). For the present study, we recruited 80 participants with OCD over the internet and allocated them to an experimental (ATT implemented as bibliotherapy) or a wait-list condition. Assessments were made at baseline and four weeks later. Groups performed similar at both time points on the self-report version of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Obsessive Compulsive Inventory-revised (OCI-R). The present study speaks against the effectiveness of ATT as a stand-alone bibliotherapeutical approach for OCD. From our data and increasing evidence that OCD patients do not suffer from severe attention or executive deficits we consider an approach targeting attentional biases for certain OCD-related events more useful than a generic (i.e., OCD-unspecific) cognitive remediation approach.     

Evidence for processing stages in skill acquisition: a dual-task study

We investigated the changes of resource demand during the acquisition of a sensorimotor skill, namely the tracking of a visual target under reversed visual feedback. This acquisition task was performed alone or concurrently with one of four manual reaction-time tasks as loading tasks, designed to tap different computational resources. As expected, we found tracking performance to deteriorate upon vision reversal and then to gradually improve with practice. We further found that acquisition task and loading task interfered little before vision reversal but substantially afterwards. Most importantly, we observed a different time-course of interference for each of our four loading tasks. The particular pattern led us to conclude that resources related to spatial attention and sensory transformations are in highest demand early during skill acquisition and those pertinent to movement preparation somewhat later. Our findings thus provide experimental support for the theory that motor learning progresses in stages characterized by different resource requirements.     

Reduced substance use as a secondary benefit of an indicated cognitive-behavioral adolescent depression prevention program

Our first aim was to test whether a group cognitive-behavioral (CB) depression prevention program reduces substance use escalation over 2-year follow-up relative to two active comparison interventions and a brochure assessment control. Our second aim examined whether reductions in depressive symptoms mediate intervention effects, as posited by the affect-regulation model of substance use. In this indicated prevention trial, 341 high school adolescents at risk for depression because of the presence of elevated depressive symptoms were randomized to a Group CB intervention, group supportive-expressive group intervention, CB bibliotherapy, or educational brochure control condition. Participants in Group CB had significantly lower rates of substance use compared with brochure control participants at both 1- and 2-year follow-up and lower substance use at 2-year follow-up relative to bibliotherapy participants; no other condition differences were significant. Mediational analyses suggested that reductions in depressive symptoms from baseline to posttest accounted for changes in substance use over 2 years for participants in Group CB relative to brochure control participants but did not mediate effects relative to those receiving bibliotherapy. Results suggest that a secondary benefit of this CB group indicated depression prevention program is lower rates of long-term substance use. Findings supported the hypothesis that, relative to a nonactive comparison condition, reductions in depressive symptoms mediated the effects of Group CB prevention on substance use escalation. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

The Job Hunt: A Modern Test of Survival

Job clubs and other self-directed group job search processes have proven successful interventions. Job Search Education attempts to convert this process for use in secondary and postsecondary educational settings, and combines self-assessment with self-directed job seeking. The two processes are compared.     

A process study of long-term treatment: comparing a successful and a less successful outcome

This study examined therapist technique and patient change in emotional experiencing and defense mechanisms in the successful and unsuccessful long-term psychoanalytic treatments of two male patients. Two consecutive sessions every 6 months were analyzed for each patient. Therapist interventions, patient defense mechanisms, and patient emotional experiencing were assessed using the Psychodynamic Intervention Rating Scale, Defense Mechanism Rating Scale and the Experiencing Scale, respectively. Between and within-session analyses were conducted to determine the impact of the patient’s defensive functioning and experiencing on therapist interventions, and the effect of therapist interventions on those same two patient variables. Pearson’s Coefficient was utilized for between-session analysis; within-session analysis tracking moment-to-moment changes in patient and therapist functioning was performed using lag sequential analysis. Across therapy, therapist use of Interpretive Interventions was associated with increased emotional engagement and decreased defense maturity; the use of Supportive Interventions had the opposite effect. Within-session analysis revealed that use of Supportive Interventions when emotional engagement is low, followed by interpretative interventions, occurred in the successful case. Persistent use of Supportive Interventions in the context of low emotional engagement was observed in the unsuccessful case. This study suggests that failure to stimulate emotional engagement through interpretation can negatively affect therapeutic outcome.     

Ressourcenorientierte Psychotherapie

Resource orientation is a transdiagnostic and integrative approach. It is more than just a technique and corresponds closer to a therapeutic attitude. Disorder-specific models and resource orientation complement each other. Resource activation aims at the utilization of already existing resources to achieve the therapeutic targets. Resource orientation has many advantages: the working alliance is improved, the patient experiences positive emotions in therapy sessions, the expectations of self-efficacy and self-confidence are strengthened and problem solving is promoted. The article presents practically relevant tangible methods in terms of systematic resource diagnostics and helpful resource activating interventions. An appropriate balance between problem actualization and resource activation is necessary so that the patient does not get the impression that the individual suffering will be trivialized, negated or made taboo.     

COGNITIVE DISABILITY IN A SOCIETY OF EQUALS

Abstract: This essay considers the range of possible policy options that are available if we wish to attempt to treat people with cognitive disabilities as equal members of society. It suggests that the goal of policy should be to allow each disabled person to establish a worthwhile place in the world and sets out four policy options: cash compensation, personal enhancement, status enhancement, and targeted resource enhancement. The essay argues for the social policy of targeted resource enhancement for individuals with cognitive disabilities, in the form of providing cash, with some limits on its use. Taking the example from the United Kingdom of "self-directed support," it argues that such policies can be cost-effective and advance the autonomy of people with cognitive disabilities, especially when compared with current policies of centrally provided services.     

Resources on Same-Sex Couples for Therapists and Clients

SUMMARY

This article provides a brief annotated bibliography of resources for working with same-sex couples. We provide summaries of articles, book chapters, books, and web sites which we have found to be particularly helpful in working with same sex couples. Books covered include those targeted to therapists as well as those targeted to clients (self-help and bibliotherapy books).     

Reward, Punishment, Privatization, and Moral Suasion in a Commons Dilemma

Strategies such as privatization, counterreinforcers, and moral suasion have been suggested and tested as means of preserving shared, slowly regenerating resources such as whales, clean air, and forests. We hypothesized that reinforcers would preserve a shared simulated resource best when it was shared in a commons dilemma format, and would be relatively ineffective when the resource was divided into private territories. Subjects in groups of three played a game in which they had to harvest resources from a slowly regenerating pool without depleting the resource. Three levels of reinforcement (reward, punishment, or no reinforcement) were crossed with three game structures (territoriality. Golden Rule moral suasion, and basic structure). Results showed that neither reward nor punishment helped the management of the commons when the resource was broken down into private segments, but both reward and punishment helped in the Golden Rule and basic structure conditions. Subjects perceived the territorial condition to be more competitive and more under their control compared to the moral suasion or basic structure conditions. In the moral suasion condition. subjects enjoyed either reinforcement condition (reward or punishment) more than no reinforcement.     

In search of durable positive psychology interventions: Predictors and consequences of long-term positive behavior change

A number of positive psychology interventions have successfully helped people learn skills for improving mood and building personal resources (e.g., psychological resilience and social support). However, little is known about whether intervention activities remain effective in the long term, or whether new resources are maintained after the intervention ends. We address these issues in a 15-month follow-up survey of participants from a loving-kindness meditation intervention. Many participants continued to practice meditation, and they reported more positive emotions (PEs) than those who had stopped meditating or had never meditated. All participants maintained gains in resources made during the initial intervention, whether or not they continued meditating. Continuing meditators did not differ on resources at baseline, but they did show more PE and a more rapid PE response to the intervention. Overall, our results suggest that positive psychology interventions are not just efficacious but of significant value in participants’ real lives.     

Learning from within: Therapists' actions in daily clinical practice

The integration of theories and techniques is part of family therapists' daily practice, raising the need to understand which resources are used in this professional's clinical actions. Our aim is to reflect on the use of theoretical and technical resources by family therapists in their daily practice. We developed an inquiry process inspired by collaborative action research and social constructionism. Couple and family therapy sessions were conducted by two family therapists, and we developed subsequent dialogs with them focused on describing theoretical and technical inspirations for their actions. Next, we named four categories of actions in this process: exploratory actions, actions for the construction of relational visions, actions for the construction of communication, and actions for family orientation. The therapists-participants referred to many theoretical and technical resources that inspired their practice. For them, the choice of using one or another resource was based on the demands of the interactive moment, which involves their relational and embodied responses to what was experienced in the sessions. We argue that epistemological coherence is not something that guides the therapist's practice a priori, but something that can be achieved by talking about and reflecting on their actions. This article can contribute to clinical practice and training in family therapy by presenting an interesting reflexive process that can be useful to enhance practice in couple and family therapy (FAPESP, Process n. 2015/21316–1).     

In search of durable positive psychology interventions: Predictors and consequences of long-term positive behavior change

A number of positive psychology interventions have successfully helped people learn skills for improving mood and building personal resources (e.g., psychological resilience and social support). However, little is known about whether intervention activities remain effective in the long term, or whether new resources are maintained after the intervention ends. We address these issues in a 15-month follow-up survey of participants from a loving-kindness meditation intervention. Many participants continued to practice meditation, and they reported more positive emotions (PEs) than those who had stopped meditating or had never meditated. All participants maintained gains in resources made during the initial intervention, whether or not they continued meditating. Continuing meditators did not differ on resources at baseline, but they did show more PE and a more rapid PE response to the intervention. Overall, our results suggest that positive psychology interventions are not just efficacious but of significant value in participants' real lives.     

Bibliotherapy as a Counseling Adjunct: Research Findings

Counselors have been prompted to use bibliotherapy, but recommendations for using the technique are rarely based on published research. This article reviews the effectiveness of the technique and is intended to help counselors draw implications for using bibliotherapy in their professional practices.     

Structure, Self-Regulating Sequences, and Institutional Third Parties in Therapy: The Veterans Administration as a Model

This article examines the structural organization and sequences of interaction among therapists, institutions, and patients and their families that contribute to the problem of institutional dependence. Our contention is that when patients have become dependent on an institution for the livelihood and/or for the stability it represents, they are only one part of a systemic relationship characterized structurally by enmeshed boundaries, and sequentially by self-regulating feedback loops. We use this premise to outline the nature of the enmeshed transactions in patient-therapist, patient-institution, and therapist-institution relationships. Family interfaces with this triad are also addressed. Sequentially, we outline the interactions among patient, family, therapist, and institution that lead to hierarchical incongruities. These sequences tend to produce self-regulating feedback loops that perpetuate and maintain the structure of the system and its patterns of interaction. The final part of this article demonstrates how we strategically use a therapy team to manipulate the hierarchical incongruities and, hence, the recursive complementarity, that characterize the interactions between and among the members of this suprasystem. Besides manipulating the role of the therapist through team intervention, we also present several paradoxical and structural interventions that have been helpful when institutions have become third parties to therapy.