The Gap Between Science and Practice: How Therapists Make Their Clinical Decisions

Recent surveys have found that many patients are not receiving empirically supported treatments and that therapists may not update their knowledge of research. Studies have found that therapists prefer to use their clinical experience rather than research findings to improve their practice, although cognitive behavioral (CB) practitioners have been found to use research more frequently than therapists of other theoretical orientations. The organization in which therapists work has been shown to impact attitudes toward working practices, but studies have not examined whether workplace requirements to use research affect therapists’ practice. Studies to date have mainly been conducted in North America. These findings may not be generalizable to the United Kingdom where there is a National Health Service (NHS), which requires the use of empirically supported treatments. The first part of this study aimed to investigate which factors were influential in therapists’ choice of theoretical orientation and to see whether CB practitioners differed from other therapists in the factors that influenced their choice of theoretical orientation. The second part tested whether therapists’ theoretical orientation or their workplace influenced the frequency with which they used research in their clinical decision-making. The final part investigated whether being a CB practitioner or working in the NHS was associated with having a favorable attitude toward research. An online survey was sent to 4,144 psychological therapists in England; 736 therapists responded (18.5%). Therapists reported that research had little influence over their choice of theoretical orientation and clinical decision-making compared to other factors, specifically clinical experience and supervision. CB practitioners and NHS therapists, regardless of their orientation, were significantly more likely to use research than other therapists and were more likely to have a positive attitude toward research.     

Evidence Sensitivity in Weak Necessity Deontic Modals

Kolodny and MacFarlane have made a pioneering contribution to our understanding of how the interpretation of deontic modals can be sensitive to evidence and information. But integrating the discussion of information-sensitivity into the standard Kratzerian framework for modals suggests ways of capturing the relevant data without treating deontic modals as “informational modals” in their sense. I show that though one such way of capturing the data within the standard semantics fails, an alternative does not. Nevertheless I argue that we have good reasons to adopt an information-sensitive semantics of the general type Kolodny and MacFarlane describe. Contrary to the standard semantics, relative deontic value between possibilities sometimes depends on which possibilities are live. I develop an ordering semantics for deontic modals that captures this point and addresses various complications introduced by integrating the discussion of information-sensitivity into the standard semantic framework. By attending to these complexities, we can also illuminate various roles that information and evidence play in logical arguments, discourse, and deliberation.     

Transfer effects between moral dilemmas: A causal model theory

Evaluations of analogous situations are an important source for our moral intuitions. A puzzling recent set of findings in experiments exploring transfer effects between intuitions about moral dilemmas has demonstrated a striking asymmetry. Transfer often occurred with a specific ordering of moral dilemmas, but not when the sequence was reversed. In this article we present a new theory of transfer between moral intuitions that focuses on two components of moral dilemmas, namely their causal structure and their default evaluations. According to this theory, transfer effects are expected when the causal models underlying the considered dilemmas allow for a mapping of the highlighted aspect of the first scenario onto the causal structure of the second dilemma, and when the default evaluations of the two dilemmas substantially differ. The theory’s key predictions for the occurrence and the direction of transfer effects between two moral dilemmas are tested in five experiments with various variants of moral dilemmas from different domains. A sixth experiment tests the predictions of the theory for how the target action in the moral dilemmas is represented.     

Normative Ethics after Pragmatic Naturalism

Philip Kitcher presents an ambitious account of pragmatic naturalism that incorporates an explanatory story of the emergence and development of ethics, a metaethical perspective on progress, and a normative stance for moral theorizing. This article contends that Kitcher's normative stance is incompatible with the explanatory and metaethical components of his project. Instead, pragmatic naturalists should endorse a normative ethics that is experimental, grounded in practice, and acutely aware of cognitive and informational limitations. In particular, the ethical project would benefit from endorsing empirical work on participatory democracy for the identification of mechanisms to guide us on deep moral conflicts.     

The Effects of Prior Learned Strategies on Updating an Opponent's Strategy in the Rock,Paper, Scissors Game

To explore how model building adapts to changing environments, we had participants play “rock‐paper‐scissors” against a computer that played a frequency bias or a player‐dependent bias and then switched. Participants demonstrated their use of prior experience in how quickly they recognized and exploited changes in the computer's play strategy; in general, the more similar the strategies, the more efficient the updating. These findings inform our understanding of previously reported updating impairments in right‐brain damaged patients.     

Urgently Yours: Temporal Communication Norms and Psychological Distance

Communicators have at their disposal an ever‐increasing variety of modalities by which to transmit messages. Do the prominent norms attached to different communication modalities contain information in and of themselves? The present investigation considers this question through the lens of text messages and emails, hypothesized to confer different normative information about urgency. Text messages (vs. emails)—or any communication inferred by receivers to have been sent with greater urgency—cause the content of those messages to seem, in the eyes of receivers, closer in time (Study 1), closer in space (Study 2), and more likely to occur (Study 3). Moderation and mediation analyses confirm the role of urgency underlying the relationship between modality and distance. We provide evidence for these effects in a series of laboratory studies together with a field study in which real text messages and emails impact not only inferred distance but also a behavior deriving therefrom. Theoretical and practical implications highlight the importance, for both researchers and practitioners, of understanding how the medium of communication can shape interpretation of the message.     

Patient preference as a predictor of outcomes in a pilot trial of person-centred counselling versus low-intensity cognitive behavioural therapy for persistent sub-threshold and mild depression

The aim of this analysis was to explore whether pre-treatment intervention preferences were related to outcomes for patients with persistent sub-threshold and mild depression who received one of two treatment types. Thirty-six patients took part in a two-arm, parallel group, pilot randomized controlled trial that compared short term (3 month and 6 month) outcomes of person-centred counselling (PCC) compared with low-intensity, CBT-based guided self-help (LICBT). Patient preferences for the two interventions were assessed at baseline assessment, and analysed as two independent linear variables (pro-PCC, pro-LICBT). Eight out of 30 interactions between baseline treatment preferences and treatment type were found to be significant at the p < .05 level. All were in the predicted direction, with patients who showed a stronger preference for a treatment achieving better outcomes in that treatment compared with the alternative. However, pro-LICBT was a stronger predictor of outcomes than pro-PCC. The findings provide preliminary support that treatment preferences should be taken into account when providing interventions for patients with persistent sub-threshold and mild depression. It is recommended that further research analyses preferences for different treatment types as independent variables, and examines preferences for format of treatment (e.g. guided self-help vs. face-to-face).     

Mindless accuracy: on the ubiquity of content in nature

It is widely held in contemporary philosophy of mind that states with underived representational content are ipso facto psychological states. This view—the Content View—underlies a number of interesting philosophical projects, such as the attempt to pick out a psychological level of explanation, to demarcate genuinely psychological from non-psychological states, and to limn the class of states with phenomenal character. The most detailed and influential theories of underived representation in philosophy are the tracking theories developed by Fodor, Dretske, Millikan and others. Tracking theorists initially hoped to ‘naturalize’ underived representation by showing that although it is distinctively psychological it is not irreducibly so, yet they ended up developing theories of representation that by their own lights don’t pick out a distinctively psychological phenomenon at all. Burge (Origins of objectivity, Oxford University Press, Oxford, 2010) sets out to develop a theory of underived representation that does pick out a distinctively psychological phenomenon. His theory promises to vindicate the Content View and the various philosophical projects that depend on it. In this paper I argue that Burge’s theory dementalizes representation for the same reason tracking theories do: These theories hold that representations are states with underived accuracy conditions, yet such states are found in all sorts of mindless systems, like plants.