An Experimental Therapeutics Focus on Novel Mechanistic Targets in Cognitive Behavioral Treatments: Introduction to the Special Section

This article introduces the special section, “An Experimental Therapeutics Focus on Novel Mechanistic Targets in Cognitive Behavioral Treatments.” The purpose of this special section is to highlight research that follows the recommended Science of Behavior Change (SOBC) developmental progression for an experimental medicine approach to identifying and testing mechanisms of behavior change. Emphasis was placed on the earlier stage “pipeline” of investigations of novel mechanisms for behavior change: mechanisms that are undergoing the initial stages of validation. In this series, seven empirical articles are presented and are followed by an article detailing a checklist for reporting mechanistic research studies in order to improve communication of findings in the field. The final article in this series discusses the history, current status, and future directions for the SOBC approach to mechanistic science as viewed by National Institute of Health program officials.     

Changes in Decentering Across Cognitive Behavioral Group Therapy for Social Anxiety Disorder

To further improve treatments, we need to better understand potential common treatment mechanisms, such as decentering, or the ability to observe thoughts and feelings as objective events in the mind rather than personally identifying with them (Safran & Segal, 1990). Therefore, this study examined whether 12 sessions of Cognitive Behavioral Group Therapy (CBGT) for 63 clients (57.6% female, 50.8% White) diagnosed with social anxiety disorder led to increases in decentering and whether increased decentering was associated with improved outcome. Furthermore, this study examined whether decentering was associated with outcome over and above a competing mechanism—cognitive reappraisal. Overall, results indicated that CBGT in this study led to similar outcomes compared to previous studies and decentering increased over CBGT (d’s from 0.81 to 2.23). Change in decentering predicted improvement on most, but not all, measures of outcome and those who no longer met criteria for social anxiety disorder at posttreatment had significantly greater change in decentering across therapy and significantly higher decentering scores at post-treatment compared to those who retained a social anxiety disorder diagnosis at posttreatment. Finally, changes in decentering predicted outcome over and above changes in reappraisal on all outcome measures. These results largely support the role of decentering in CBGT for social anxiety; however, the implications of the inconsistencies in results based on which outcome measure was used are discussed.     

Descriptive Study of the Socratic Method: Evidence for Verbal Shaping

In this study we analyzed 65 fragments of session recordings in which a cognitive behavioral therapist employed the Socratic method with her patients. Specialized coding instruments were used to categorize the verbal behavior of the psychologist and the patients. First the fragments were classified as more or less successful depending on the overall degree of concordance between the patient’s verbal behavior and the therapeutic objectives. Then the fragments were submitted to sequential analysis so as to discover regularities linking the patient’s verbal behavior and the therapist’s responses to it. Important differences between the more and the less successful fragments involved the therapist's approval or disapproval of verbalizations that approximated therapeutic goals. These approvals and disapprovals were associated with increases and decreases, respectively, in the patient’s behavior. These results are consistent with the existence, in this particular case, of a process of shaping through which the therapist modifies the patient’s verbal behavior in the overall direction of his or her chosen therapeutic objectives.     

Defining and Measuring Mechanisms of Change in Psychological Therapies: The Path Not Taken

Metcalf and Dimidjian (this issue) have provided an important review of the current evidence base for mindfulness‐based cognitive therapy (MBCT) and presented a helpful summary of the proposed mechanisms of change. It is necessary to engage in a continuous dialogue regarding the evidence base for change mechanisms, and the article by Metcalf and Dimidjian highlights an important barrier of concern to the field of treatment outcome research. The present commentary aims to expand the discussion regarding the definition, measurement, and evaluation of “mechanisms of change.” Using MBCT as an example, this commentary addresses the ambiguity surrounding the definition and operationalisation of these mechanisms in research on psychological therapies and how the method of measurement may impact the results obtained in clinical trials. It is argued that a potentially fruitful avenue of future research would involve investigation of techniques, important client‐therapeutic processes, and mechanisms in a single study in order to comprehensively evaluate how change occurs.     

The Importance of Theory in Cognitive Behavior Therapy: A Perspective of Contextual Behavioral Science

For the past 30 years, generations of scholars of cognitive behavior therapy (CBT) have expressed concern that clinical practice has abandoned the close links with theory that characterized the earliest days of the field. There is also a widespread assumption that a greater working knowledge of theory will lead to better clinical outcomes, although there is currently very little hard evidence to support this claim. We suggest that the rise of so-called “third generation” models of CBT over the past decade, along with the dissemination of statistical innovations among psychotherapy researchers, have given new life to this old issue. We argue that theory likely does matter to clinical outcomes, and we outline the future research that would be needed to address this conjecture.     

早期亲子触觉经验促进个体社会性发展的心理机制

近期研究显示,早期亲子触觉经验和个体的社会性发展存在密切联系。关于这种联系产生的原因,已有研究多从神经科学的角度,探讨CT传入神经(C-tactile afferents)及有关环路在其间可能起到的作用。基于已有文献,本文将提出一个综合模型,系统阐述背后涉及的心理机制,着重论证亲子关系、个体探索行为以及与之关联的心理成分在其间扮演的角色,并在此基础上从研究设计的局限、有关变量关系的多元性以及未来可拓展方向对该领域研究进行进一步讨论和展望。     

Extensions and Mechanisms of Mindfulness‐based Cognitive Therapy: A Review of the Evidence

Mindfulness‐based cognitive therapy (MBCT) was originally developed to prevent depressive relapse and recurrence and has also been widely extended to new patient populations and target problems over the last 14 years. We provide a comprehensive review of this literature, examining the strength of the evidence base for specific populations and target problems and identifying questions for future research to address. Specifically, we review studies addressing the use of MBCT for depressive disorders (prevention of depressive relapse and treatment of residual and current depressive symptoms), the use of MBCT in the treatment or management of other mental disorders (bipolar disorder, anxiety disorders, mixed anxiety and depression symptoms, disordered eating, personality disorders, and psychosis), and the use of MBCT in behavioural medicine contexts. Additionally, we discuss the extension of MBCT during specific developmental periods, like childhood, pregnancy and post‐partum, and adult caregiving, and, finally, we address the use of MBCT among clinical health‐care providers. In the second section, we review hypothesised mechanisms of change in MBCT and reflect on implications for theories of how MBCT works in the application to various patient populations and target problems. We also consider research addressing active ingredients and what is known about the “dosage” of meditation practice. We conclude with a summary of recommendations for future research.     

Guidelines for Cognitive Behavioral Training Within Doctoral Psychology Programs in the United States: Report of the Inter-Organizational Task Force on Cognitive and Behavioral Psychology Doctoral Education

The Association for Behavioral and Cognitive Therapies initiated an interorganizational task force to develop guidelines for integrated education and training in cognitive and behavioral psychology at the doctoral level in the United States. Fifteen task force members representing 16 professional associations participated in a yearlong series of conferences, and developed a consensus on optimal doctoral education and training in cognitive and behavioral psychology. The recommendations assume solid foundational training that is typical within applied psychology areas such as clinical and counseling psychology programs located in the United States. This article details the background, assumptions, and resulting recommendations specific to doctoral education and training in cognitive and behavioral psychology, including competencies expected in the areas of ethics, research, and practice.     

The Role of Time in the Quest for Understanding Psychological Mechanisms

The lead-lag structure of multivariate time-ordered observations and the possibility to disentangle between-person (BP) from within-person (WP) sources of variance are major assets of longitudinal (panel) data. Hence, psychologists are making increasing use of such data, often with the intent to delineate the dynamic properties of psychological mechanisms, understood as a sequence of causal effects that govern psychological functioning. However, even with longitudinal data, psychological mechanisms are not easily identified. In this article, we show how an adequate representation of time may enhance the tenability of causal interpretations in the context of multivariate longitudinal data analysis. We anchor our considerations with an example that illustrates some of the main problems and questions faced by applied researchers and practitioners. We distinguish between static versus dynamic and discrete versus continuous time modeling approaches and discuss their advantages and disadvantages. We place particular emphasis on different ways of addressing BP differences and stress their dual role as potential confounds versus valuable sources of information for improving estimation and aiding causal inference. We conclude by outlining an approach that offers the potential of better integration of information on BP differences and WP changes in the search for causal mechanisms along with a discussion of current problems and limitations.     

The phenomenology of action: a conceptual framework

After a long period of neglect, the phenomenology of action has recently regained its place in the agenda of philosophers and scientists alike. The recent explosion of interest in the topic highlights its complexity. The purpose of this paper is to propose a conceptual framework allowing for a more precise characterization of the many facets of the phenomenology of agency, of how they are related and of their possible sources. The key assumption guiding this attempt is that the processes through which the phenomenology of action is generated and the processes involved in the specification and control of action are strongly interconnected. I argue in favor of a three-tiered dynamic model of intention, link it to an expanded version of the internal model theory of action control and specification, and use this theoretical framework to guide an analysis of the contents, possible sources and temporal course of complementary aspects of the phenomenology of action.     

内隐序列学习的表征机制及年龄效应研究

该研究从年龄效应这一独特视角探讨了内隐序列学习的表征机制。结果表明:(1)内隐序列学习存在具体联结和抽象层级编码双重表征机制,且在该研究中以抽象编码为主;(2)老、青、幼三组被试的内隐序列学习无显著差异,间接支持了具体联结机制不起主要作用的结论。该研究的推论是:(1)内隐序列学习的表征是一个遵循“最优级编码”的动态过程;(2)该过程不涉及注意机制和短时记忆。     

The Persistence-Strengthening Effects of DRA: An Illustration of Bidirectional Translational Research

We summarize a series of bidirectional research studies that demonstrate the persistence-strengthening effects of differential reinforcement of alternative behavior on problem behavior. We model a possible solution to this problem with rats followed by replication with a human clinical population. The importance of coordinated basic and applied research to stimulate new behavioral technologies is emphasized.     

Developing Standard Recommendations (Guidelines) for Genetic Counseling Practice: A Process of the National Society of Genetic Counselors

The National Society of Genetic Counselors (NSGC) supports the development of practice recommendations (guidelines) in the field of genetic counseling. This paper reviews the basic components of NSGC genetic counseling practice recommendations as well as the process for formal adoption of such documents, as approved by the Board of Directors of the NSGC.     

Practices for Improving Secondary School Climate: A Systematic Review of the Research Literature

School climate has received increased attention in education policy and, in response, educators are seeking strategies to improve the climates of their middle and high schools. However, there has been no comprehensive synthesis of the empirical evidence for what works in school climate improvement. This article constitutes a systematic review of programs and practices with empirical support for improving school climate. It defines school climate and provides a methodology for identifying and evaluating relevant studies. The review identified 66 studies with varying strength of evidence and nine common elements that cut across reviewed programs and practices. The review concludes with a critical appraisal of what we know about school climate improvement and what we still need to know.     

具身认知视角下语义理解中的身体角色:以研究方法为线索

具身认知认为,概念形成和语言理解等高级心理过程本质上是以感知觉和运动经验为基础的。神经影像学研究发现,理解身体动作词激活了支配该部分肢体的感觉运动脑区。理解手部、脚部和面部动作词能够相应激活支配手部、脚部和面部的感觉运动脑区,体现出一种身体动作词语义理解激活的脑区与真实身体动作激活脑区的耦合效应。临床和经颅磁刺激研究结果表明,感觉运动皮层的激活与身体动作词语义处理具有因果性作用。未来研究应关注身体动作词语义理解的具身程度以及相关语言疗法在临床患者机能恢复中所起的作用。     

Pavlov And Skinner: Two Lives In Science (An Introduction To B. F. Skinner's "Some Responses To The Stimulus 'Pavlov' ")

The sesquicentennial of Ivan Petrovich Pavlov's birth in September 1999 is being celebrated in Russia by a special issue of the Russian Journal of Physiology (the former I. M. Sechenov Physiological Journal, founded by Pavlov in 1917). The following article and the address by Skinner that it introduces are scheduled to appear in Russian translation in that special issue. Skinner's “Some Responses to the Stimulus ‘Pavlov’” was his presidential address to the Pavlovian Society of North America in 1966. The following article provides the context for Skinner's address by describing some ways in which Pavlov's research influenced Skinner's contributions.     

工匠传统在心理治疗(咨询)中的复兴

作者站在科学史的高度,分析了学者传统对心理咨询的方向性误导。从精神分析、行为主义,以至人本主义,心理治疗显示朝向整体论的倾向。但此种倾向被作为科学时代范式的学者传统所阻碍。心理治疗仍专注于根本原因,而忽视效果;专注于学派提供的片面视野,而忽视解决问题的完整过程;重于知而轻于行。伊根博士的模式提供了真正整体论的．能将各种视野,方法有效组织起来的心理咨询路线图,它能将知行整合、创造心理咨询最大成效。推动了心理咨询方法论根本转变。     

Mechanisms of change in cognitive behaviour therapy for panic disorder: The role of panic self-efficacy and catastrophic misinterpretations

The efficacy of cognitive behavioural therapy (CBT) for panic disorder with or without agoraphobia (PD) is well-established; however, little is known about the underlying change processes of clinical improvement during therapy. According to cognitive theories, CBT for PD primarily works by changing catastrophic misinterpretations of bodily symptoms and panic attacks. However, panic self-efficacy, i.e. the perceived ability to cope with panic attacks, has also been suggested as an important change mechanism in CBT for PD. The aim of the study was to investigate if change in catastrophic misinterpretations and panic self-efficacy mediated change in the level of anxiety during the course of thirteen sessions of group CBT for PD. Forty-five participants completed weekly self-report measures of the possible cognitive mediators and the level of anxiety throughout therapy. The results indicated that within-person change in panic self-efficacy in one session, but not in catastrophic misinterpretations, predicted within-person level of anxiety symptoms the following week. However, in a reversed analysis, prior change in level of anxiety symptoms also predicted change in panic self-efficacy the following session. These results support panic self-efficacy as a mediator of change in CBT for PD, although a reciprocal causal relationship between panic self-efficacy and level of anxiety seems to be implied.