Inherited Thrombophilia: Key Points for Genetic Counseling

With the evolution of medical genetics to focus on highly prevalent, multifactorial conditions, it is inevitable that genetic counselors will be called upon to participate in the evaluation and counseling of individuals with inherited thrombophilia. The purpose of this review is to educate the genetic counselor on key issues related to risk assessment and genetic counseling for hereditary thrombophilia. The information contained in this document is derived from an extensive review of the literature, as well as the author's personal expertise. Upon completion of this review, the genetic counselor will be able to: a) describe inherited and acquired risk factors for thrombosis, b) collect and interpret personal and family histories to assess risk related to hereditary thrombophilia, c) discuss the potential advantages and disadvantages of thrombophilia testing, including psychosocial aspects and implications for medical management, and d) identify educational and support resources for patients and families.     

Emotion Beliefs and Cognitive Behavioural Therapy for Social Anxiety Disorder

Despite strong support for the efficacy of cognitive behavioural therapy (CBT) for social anxiety disorder (SAD), little is known about mechanisms of change in treatment. Within the context of a randomized controlled trial of CBT, this study examined patients' beliefs about the fixed versus malleable nature of anxiety—their ‘implicit theories’—as a key variable in CBT for SAD. Compared to waitlist (n = 29; 58% female), CBT (n = 24; 52% female) led to significantly lower levels of fixed beliefs about anxiety (M_baseline = 11.70 vs. M_Post = 7.08, d = 1.27). These implicit beliefs indirectly explained CBT-related changes in social anxiety symptoms (κ² = .28, [95% CI = 0.12, 0.46]). Implicit beliefs also uniquely predicted treatment outcomes when controlling for baseline social anxiety and other kinds of maladaptive beliefs (perceived social costs, perceived social self-efficacy, and maladaptive interpersonal beliefs). Finally, implicit beliefs continued to predict social anxiety symptoms at 12 months post-treatment. These findings suggest that changes in patients' beliefs about their emotions may play an important role in CBT for SAD.     

Comorbidity and Internet-Delivered Transdiagnostic Cognitive Behavioural Therapy for Anxiety Disorders

Internet-delivered transdiagnostic anxiety interventions aim to reduce symptoms across several anxiety disorders using one treatment protocol. However, it is unclear whether comorbidity affects outcomes of such treatment. This study re-examined data from a recent randomised controlled trial (N = 129) that evaluated the efficacy of an Internet-delivered transdiagnostic cognitive behavioural therapy (iCBT) intervention for participants with principal diagnoses of generalised anxiety disorder (GAD), social phobia (SP) panic disorder and agoraphobia (PDA), of whom 72% met criteria for a comorbid anxiety disorder or depression. Participants were divided into two groups based on whether or not they had a comorbid disorder before treatment. Participants with comorbid conditions reported higher symptom levels at pre-treatment, post-treatment, and follow-up across a range of measures. Both groups showed significant reductions in symptoms over treatment; however, participants with comorbid disorders showed greater reductions in measures of GAD, PDA, SP, depression, and neuroticism. In addition, treatment significantly reduced the number of comorbid diagnoses at follow-up. These results indicate transdiagnostic iCBT protocols have the potential to reduce comorbidity.     

Cognitive Load Theory,Element Interactivity,and the Testing and Reverse Testing Effects

Summary: The testing effect arises when learners who are tested rather than relearning material obtain superior scores on a final test than those who relearn. Based on cognitive load theory, six experiments examined whether the effect was evident under low or high element interactivity (a measure of complexity) conditions. Students learning to write types of text were participants. In all experiments, effects on a final common test of two presentations were compared with a single presentation followed by a preliminary test. The testing effect on immediate tests was larger and more likely using lower element interactivity materials. A reverse testing effect was likely on immediate tests tapping higher element interactivity material but possibly eliminated by using a delayed test. Copyright © 2017 John Wiley & Sons, Ltd.     

Behavioural and ERP Effects of Cognitive and Combined Cognitive and Physical Training on Working Memory and Executive Function in Healthy Older Adults

Cognitive and physical training have been shown to be effective in improving older adults’ cognition. However, it is not yet clear whether combined cognitive and physical training offers an advantage compared to cognitive training alone. Twenty-two older adults performed cognitive or combined cognitive and physical training in order to compare their effects on working memory event-related potentials (ERPs) and on working memory and executive function performance. Before and after eight weeks of training, performance in Plus Minus, Flanker, Updated Span, and Complex Span tasks was measured, and ERPs were registered during performance of an n-back task (0-back, 2-back, and 3-back). Post-training behavioural improvement was observed in Updated Span, Complex Span, and n-back tasks. During the n-back task, the N2/P3 complex was modulated by training, with a decrease in N2 amplitude and an increase in P3 amplitude in the posttraining session compared to the pretraining session. These changes in ERP components suggest that both types of training potentially reduce the need for attentional control to perform the tasks correctly and increase working memory capacity. Thus, based on our data, no conclusion can be reached on the direct advantage of combined training, either at behavioural or at neural level. However, the present study might suggest an indirect advantage of such a combined training, because the cognitive benefit was found to be highly similar in both types of training. Using combined cognitive and physical training may produce a potential improvement in general fitness and an increased appeal of training.     

Training Aboriginal Practitioners in Cognitive Behavioural Therapy

Comments on an article by Bennett‐Levy and colleagues. This commentary reviews a dissemination of cognitive behavioral therapy (CBT) for Aboriginal Australians, with regard to the strengths of the dissemination effort and areas for future efforts. As an initial step in bringing CBT to a population that has been severely limited in access to evidence based practice, despite a notable need, this study was an important step forward. Feedback from the participatory action research group (n = 5 Aboriginal Australian counsellors) identified CBT elements and adaptations perceived to be particularly effective with Aboriginal Australian clients. Case conceptualization was identified as a potential avenue for further tailoring CBT to the individual needs of clients. Several factor including the success of the dissemination effort, reports that clients shared CBT techniques with their communities, and the skill‐building nature of CBT raised the possibility of future community‐based dissemination.     

The Establishment of Cognitive Behavioural Therapy in Argentina

Although Argentina is well known for the popularity of psychoanalysis, in recent years the field of psychotherapy has been expanded to include cognitive behavioural therapy. At present, cognitive behavioural therapy has become much more common in universities and postgraduate educational programmes in Argentina. This work aims to describe the development of cognitive behavioural therapy in Argentina. First, we will depict some general characteristics of psychology in Argentina. Then, we will refer to the first cognitive behavioural therapists in Argentina, highlighting the trajectories of the local main figures, and the events that paved the road for the development of this model in Argentina, such as the visit of Hans Eysenck to Buenos Aires, the impact of Aaron T. Beck's work, and the presence of Vittorio Guidano. Then, we will describe the various institutions that, in the 1990s, established the Argentinian Cognitive Therapies Association. Finally, we will describe the current development of cognitive behavioural therapy in Argentina, and analyse its characteristics and the challenges of local culture.     

The Nature and Significance of Behavioural Genetic Information

In light of the human genome project, establishing the genetic aetiology of complex human diseases has become a research priority within Western medicine. However, in addition to the identification of disease genes, numerous research projects are also being undertaken to identify genes contributing to the development of human behavioural characteristics, such as cognitive ability and criminal tendency. The permissibility of this research is obviously controversial: will society benefit from this research, or will it adversely affect our conceptions of ourselves and each other? When assessing the permissibility of this research, it is important to consider the nature and deterministic significance of behavioural genetic information. Whilst todate there has been much discussion and debate about the properties of genetic information per se and genetic determinism, this has not been applied to behavioural genetic research and its ethical implications. Therefore, this paper elucidates how behavioural genetic information can be distinguished from other types of genetic and non-genetic information and also synthesises the determinative significance of genetic factors for the development of human behavioural traits. Undertaking this analysis enables the ethical issues raised by this research to be debated in an appropriate context and indicates that separate policy considerations are warranted.

     

Family Augmented Cognitive Behavioural Therapy: Make Room for Mum!

Familial processes are gaining an increased amount of attention in cognitive behavioural therapy. Their role in initiating, maintaining, and exacerbating distress in children and adolescents has clear clinical implications. Therefore, including parents in their children’s therapy sessions as coaches, collaborators, and co-patients is becoming commonplace in CBT approaches to internalizing disorders such as anxiety. This article describes a case of a 13?year old female who presented with features of Generalized Anxiety Disorder and Separation Anxiety whose course of treatment involved her mother as a coach, collaborator and co-patient. A case formulation is offered and the specific examples of CBT practices used in each session are detailed. Ways of evaluating treatment outcome are also discussed.     

关于基因检测的伦理思考

随着基因组学的发展,在临床医学中出现了基因检测的新方法,它的临床应用带来了一些伦理、法律和社会问题.从伦理学的角度出发,对基因检测中出现或有可能出现的伦理问题进行探讨,提出进行基因检测应遵循的伦理原则.     

The Effects of Cognitive: Linguistic Variables and Language Experience on Behavioural and Kinematic Performances in Nonword Learning

The aim of the present study was to investigate the effects of cognitive-linguistic variables and language experience on behavioral and kinematic measures of nonword learning in young adults. Group 1 consisted of thirteen participants who spoke American English as the first and only language. Group 2 consisted of seven participants with varying levels of proficiency in a second language. Logistic regression of the percent of correct productions revealed short-term memory to be a significant contributor. The bilingual group showed better performance compared to the monolinguals. Linear regression of the kinematic data revealed that the short-term memory variable contributed significantly to movement coordination. Differences were not observed between the bilingual and the monolingual speakers in kinematic performance. Nonword properties including syllable length and complexity influenced both behavioral and kinematic performance. The findings supported the observation that nonword repetition is multiply determined in adults.     

Advances in the Cognitive Behavioural Treatment of Obsessive Compulsive Disorder

The aim of this paper is to highlight key advances in the cognitive-behavioural treatment of obsessive compulsive disorder over the course of Professor Lars Göran Öst's illustrious career. The paper will focus on three specific areas of interest: the treatment of obsessions, compulsive checking, and the fear of contamination. It will also highlight recent advances concerning the broader need to ensure that treatment is acceptable. An increase in acceptability could result in improvements in completion rates so that more patients benefit from the recent improvements in the science and therapy for this disabling disorder.     

具有认知诊断功能的多阶段自适应测验及其影响因素研究

MST结合了纸笔测验和CAT的优势,现阶段在美国的许多大型考试中得到了应用。本文结合MST、认知诊断、CD-CAT和OMST的思想对CD-MST的可行性进行研究。CD-MST具有认知诊断和自适应的功能,能够使用较少的题目为被试提供即时的、准确的、丰富的诊断信息;同时它计算速度较快,允许考生返回检查和修改,更符合实际考试情境,且在测验的编制上更容易控制。本研究考察了选题策略和题库质量对不同测验设计的CD-MST的影响,并同CD-CAT进行了比较。通过模拟研究发现：MPWKL、GDI和SHE选题策略同样也适用于CD-MST的选题,在题库质量好的情况下这三种选题策略的判准率同CD-CAT持平。CD-MST的测验时间要比CD-CAT缩短2/3以上。     

Online Cognitive Behavioural Therapy Training for Therapists: Outcomes,Acceptability, and Impact of Support

The objectives of the present study were to assess the effects of online cognitive behavioural therapy (CBT) training for therapists on measures of CBT knowledge, skills, confidence, and utilisation; to determine what differences might exist between a group supported by regular telephone contact and an independent group who undertook online training without additional support; and to determine the acceptability of CBT online training among rural and remote mental health professionals. Mental health practitioners were randomly allocated to a supported training group (six sessions of 15‐min support) or an independent group. They undertook a 12‐week online CBT training program. The two groups showed similar gains on an objective test of knowledge of CBT, and on self‐report measures of knowledge, skills, confidence levels, and utilisation of skills. However, the supported training group had a significantly higher program completion rate than the independent group. Participants evaluated the program favourably. The results suggest that online CBT training represents a promising and cost‐effective approach to training the mental health workforce, and may be particularly attractive for those who live in regional, rural, and remote communities. A challenge is to determine the most cost‐effective ways to enhance program completion rates and trainee skills.     

顿悟:是进程监控还是表征转换

当前解释顿悟问题解决机制的理论主要有表征转换理论和进程监控理论。进程监控理论主要解释了顿悟问题为什么困难,但事实上它并没有说明顿悟问题为什么会解决,只回答了在什么情况下被试才会寻求其他的方法,而且它把顿悟问题解决的一般过程看成是同常规问题解决方法相同的过程。而表征转换理论主要解释了顿悟是如何获得的——顿悟的获得是由于问题解决者对问题的表征实现了正确的转变,但它并没有解释表征什么时候、怎么样才能转变?顿悟问题的解决经历了三个认知加工阶段,顿悟问题的解决需要在消除定势情况下激活正确的启发信息(线索),并验证了顿悟问题的原型激活和关键启发信息理论假说。     

Clinical Expertise in Cognitive Behavioural Therapy: Definition and Pathways to Acquisition

Evidence-Based Practice is premised on current research evidence, patient factors, and clinical expertise. The definition of clinical expertise has been the most contentious, primarily owing to the ambiguity of the construct. However, attempts have been made by the American Psychological Association to outline standards of clinical competence required for psychologists, irrespective of theoretical orientation, and the Improving Access to Psychological Therapies program in the UK has recently outlined a framework for therapist competences in cognitive behavioural therapy (CBT) in particular. This paper aims to review these recent conceptual developments in defining competence and addresses current training programs and certification standards that aim to ensure that CBT therapists acquire these standards of competence.