Challenges using motivational interviewing as an adjunct to exposure therapy for obsessive-compulsive disorder

Exposure and response prevention (EX/RP) is an efficacious treatment for obsessive-compulsive disorder (OCD). However, patients often do not adhere fully to EX/RP procedures. Motivational interviewing (MI) has been shown to improve treatment adherence in other disorders. This pilot study used a randomized controlled design to examine whether MI can be successfully added to EX/RP and whether this intervention (EX/RP + MI) could improve patient adherence to between-session EX/RP procedures relative to EX/RP alone. Thirty adults with OCD were randomized to 18 sessions of EX/RP or EX/RP + MI. Therapists rated patient adherence at each exposure session. Independent evaluators assessed change in OCD and depressive symptoms, and patients completed self-report measures of readiness for change and quality of life. The two treatment conditions differed in degree of congruence with MI but not in conduct of EX/RP procedures. Both groups experienced clinically significant improvement in OCD symptoms, without significant group differences in patient adherence. There are several possible reasons why EX/RP + MI had no effect on patient adherence compared to standard EX/RP, each of which has important implications for the design of future MI studies in OCD. We recommend that MI be further evaluated in OCD by exploring alternative modes of delivery and by focusing on patients less ready for change than the current sample.     

Interrogation,Interpretation and Integration of Spirituality: Insights from Sri Aurobindo for “Care for Creation”

This paper brings together three strands of enquiry – interrogation of spirituality, interpretation of spirituality and Sri Aurobindo's integrative spirituality – which form the three natural parts of the paper. In the first part I interrogate the idea and category “spirituality” and argue that this term came to be understood in opposition to the “material” only in medieval times, and thus the common notion of spirituality as opposed to materiality is misplaced. In the second part, in light of George Lindbeck's work, I will explore the question – is it possible for different traditions that interpret spirituality differently to hold a common unifying position? I will argue that if we are to arrive at an understanding of spirituality that will be acceptable to different traditions, then the very conception of spirituality must be informed by all. In the final part, I will argue that Sri Aurobindo's integrative spirituality offers a sufficient rationale for creation‐care by proposing a view of spirituality which, on the one hand, overcomes the spiritual‐material dichotomy, while on the other, contains an implicit guard against imposing its view of spirituality on other traditions. Finally, by bringing Sri Aurobindo into the dialogue I demonstrate how insights from another tradition can be drawn to enrich our understanding of spirituality.     

The creativity quotient: An objective scoring of ideational fluency

A classical test for accessing the potential creativity of an individual is based on ideational fluency, where a person is asked to generate all possible uses for a familiar item like a piece of paper. In scoring the results, it is intuitive that the suggested uses should not be weighted equally. Those suggested in radically different categories are “worth more”; than those suggested within the same category only. We used information theory to derive a simple mathematical expression for a more objective measure of ideational fluency. We call this the creativity quotient (CQ). This innovative measure was examined using a small sample of participants, and is illustrated by the responses of two typical individuals from an ideational fluency task. The CQ accounts for the number of ideas (fluency), plus the number of categories (flexibility). Ongoing research will examine the independence of CQ from established measures of intelligence and personality.     

Are Human Rights Redundant in the Ethical Codes of Psychologists?

The codes of ethics and conduct of a number of psychology bodies explicitly refer to human rights, and the American Psychological Association recently expanded the use of the construct when it amended standard 1.02 of the Ethical Principles of Psychologists and Code of Conduct. What is unclear is how these references to human rights should be interpreted. In this article I examine the historical development of human rights and associated constructs and the contemporary meaning of human rights. As human rights are generally associated with law, morality, or religion, I consider to which of forms of these references most likely refer. I conclude that these references in ethical codes are redundant and that it would be preferable not to refer to human rights in codes. Instead, the profession should acknowledge human rights as a separate and complimentary norm system that governs the behavior of psychologists and should ensure that they have adequate knowledge of human rights and encourage them to promote human rights.     

Effects of Electromyostimulation on Knee Extensors and Flexors Strength and Steadiness in Older Adults

It is known that electromyostimulation (EMS) alone or superimposed over voluntary contraction (EV) can effectively improve muscle strength. However, the effect of this type of training on the ability to control force production at submaximal levels is unknown. The authors examined the effects of EV training on steadiness in force production of knee extensors and flexors in older adults. Forty participants, including 20 men and 20 women, 60–77 years of age, were randomly allocated into a control group (CG) and an electromyostimulation superimposed over voluntary contraction (EVG) group. The EVG performed 30 bilateral isometric knee extension and flexion contractions per session, 3 training sessions per week, for 6 weeks. The variations in force production, expressed in absolute (standard deviation [SD]) and relative (coefficient of variation [CV]) terms, were assessed in isometric contractions at 5%, 15% and 25% maximal voluntary contraction (MVC) levels. Results indicated that MVC increased in knee extension and flexion in EVG (p < .05) after the training; steadiness CV also improved at 15% MVC in knee flexion (p < .05) but no significant changes were found in knee extension and steadiness SD. The training-induced changes in MVC were not correlated to steadiness CV that might indicate different mechanisms underlying these adaptations.     

Understanding and Assisting Couples Affected by an Eating Disorder

This article reviews the existing literature on heterosexual intimate relationships in which the female partner has an eating disorder. These couples often have trouble in a number of areas, including communication, sexual functioning, relational boundaries, and emotional health. Not only do these problems contribute to lower rates of relational satisfaction but they also affect a woman's chances for recovery. An understanding of this literature can inform family therapy practice. Recommendations are offered for those who provide counseling to these couples.     

Addictive states of mind

This paper explores the meaning of the pregnancy of the therapist as a challenge to the maintenance of the setting for therapy. The patient I shall describe was born ‘black’ in a ‘white’ family and was thus a challenge to her father's sense of paternity and her parents as a couple. She was the visual evidence of an infidelity. The problem had been denied in various ways, going as far as the attempt to deny her very existence. The therapist's pregnancy signified a betrayal of the ideal of a stable setting which was compounded by an earlier absence through illness. This ‘breaking of rules or promises' was then the setting for a re-working of the patient's story.

Setting, it is argued, can helpfully be seen as the mental space created by the partnership within the therapist between maternal and paternal relating to the ‘baby’ of the therapy. This enables a sense of negotiation and relationship in the creation of setting, which can include disruptions and other babies. At the same time the therapy had to work with a fundamental issue of illegitimacy or lack of belonging and the therapist's response to this. The ‘rules' of setting are a means to ensure a place to belong or attach to, but this work emphasized ‘setting’ and belonging as issues of relationship supported and enabled by our rules of engagement, but not reducible to them.     

Advances in Neuropsychoanalysis,Attachment Theory,and Trauma Research: Implications for Self Psychology

In 1971, Heinz Kohut, trained in neurology and then psychoanalysis, published The Analysis of the Self, a detailed exposition of the central role of the self in human existence. This classic volume of both twentieth century psychoanalysis and psychology was more than a collection of various clinical observations—rather it represented an overarching integrated theory of the development, structuralization, psychopathogenesis, and psychotherapy of disorders of the self. Although some of these ideas were elaborations of previous psychoanalytic principles, a large number of his concepts, including an emphasis on self rather than ego, signified an innovative departure from mainstream psychoanalysis and yet a truly creative addition to Freud's theory.     

Do Maximizers Predict Better than Satisficers?

We examine the relationship between maximizing (i.e., seeking the best) versus satisficing (i.e., seeking the good enough) tendencies and forecasting ability in a real‐world prediction task: forecasting the outcomes of the 2010 FIFA World Cup. In Studies 1 and 2, participants gave probabilistic forecasts for the outcomes of the tournament and completed a measure of maximizing tendencies. We found that although maximizers expected themselves to outperform others much more than satisficers, they actually forecasted more poorly. Hence, on net, they were more overconfident about their relative performance. Decompositional analyses of overall accuracy revealed that differences in forecasting abilities were primarily driven by maximizers' tendency to give more noisy estimates. In Study 3, participants played a betting task where they could choose between safe and uncertain gambles linked to World Cup outcomes. Again, maximizers did more poorly and earned less, because of greater noise in their choice‐based responses. Copyright © 2011 John Wiley & Sons, Ltd.