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.     

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.     

Judgements of others’ emotional appropriateness are multidimensional

This study investigated the multidimensional structure of judgements of emotional appropriateness, the degree to which an observer judges a target's emotion to conform to observer-valued expectations for emotion in that context. Participants (N=169) were shown one of two brief video clips of an actor either showing anger or neutral expressions in an anger-evoking situation of either low, medium, or high severity. Participants rated the target's emotion on the Perception of Emotion Appropriateness Rating Scale (PEARS), which taps observers’ perceptions of a target's emotional appropriateness for a specific situation. We found that appropriateness ratings are comprised of three factors, assessment of Type Present (type of emotion in expression); Type Absent (missing key emotions); and Intensity (intensity with which the emotion is felt or expressed). Results are discussed in terms of the usefulness of a multidimensional conceptualisation of emotional appropriateness.     

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.