Exploring Decision Making Around Therapist Self‐Disclosure in Cognitive Behavioural Therapy

Background

Therapist self‐disclosure (TSD) usage varies greatly among different psychotherapy orientations. Anecdotal evidence seems to suggest that there are reasons for its judicious use, and a small number of researchers have proposed guidelines for how TSD should be used to help therapists across psychotherapy models make decisions around disclosure. However, there is almost no literature specifically exploring how cognitive behaviour therapy (CBT) practitioners make decisions around employing TSD within the CBT framework.

Objective

This study aimed to explore how experienced CBT practitioners make decisions around TSD.

Method

In‐depth qualitative interviews were conducted with six clinical psychologists who were trained and experienced in CBT, and the interviews were analysed thematically.

Results

There were two overarching themes in terms of how they made decisions to self‐disclose: (A) the rules for TSD use, which included sub‐themes (a) it must have a clear purpose, (b) it must fit, (c) the therapist must maintain boundaries, and (d) the therapist must always reflect on his/her use of TSD; and (B) how they use TSD, which included subthemes of (a) using it as a tool for change and (b) using it to manage the therapeutic relationship.

Conclusion

Participants’ decisions on whether or not to self‐disclose were strongly influenced by the CBT model, and this process went beyond what is suggested in the transtheoretical literature. Understanding this process may lead to the development of CBT‐specific guidelines for making TSD‐related decisions.     

Gender differences in a clinical sample of patients with borderline personality disorder

The aim of the study was to investigate gender differences and similarities in patients with borderline personality disorder (BPD) with respect to Axis I comorbidity, Axis II comorbidity, general psychopathology (Symptom Checklist 90-Revised), and dimensional personality traits (NEO-Personality-Inventory Revised [NEO-PI-R] and the Dimensional Assessment of Personality Profile Basic questionnaire [DAPP-BQ]). Fifty-seven men and 114 women with BPD were included in the study. Regarding Axis I and II disorders in an exploratory analysis, men with BPD more often fulfilled the diagnostic criteria for binge eating disorder, antisocial personality disorder, narcissistic personality disorder, and conduct disorder in childhood, whereas women had higher frequencies of bulimia nervosa, posttraumatic stress disorder, and panic disorder with agoraphobia. After correcting for multiple tests, only the gender differences in narcissistic and antisocial personality disorder remained significant. In the SCL-90-R profile, no significant gender differences could be identified. In the exploratory analysis of the dimensional personality traits, women showed higher rates on the NEO-PI-R main factors (Neuroticism and Agreeableness) compared to men. In the DAPP-BQ profile, men reached higher sores on the main factor, Dissocial Behavior. When correcting for multiple tests, gender differences still existed for Neuroticism and Dissocial Behavior. Our results argue for gender differences in Axis I and II comorbidity and dimensional personality traits in BPD. However, in general, more similarities than differences were shown in this study.     

The role of warning behaviors in threat assessment: an exploration and suggested typology

The concept of warning behaviors offers an additional perspective in threat assessment. Warning behaviors are acts which constitute evidence of increasing or accelerating risk. They are acute, dynamic, and particularly toxic changes in patterns of behavior which may aid in structuring a professional's judgment that an individual of concern now poses a threat - whether the actual target has been identified or not. They require an operational response. A typology of eight warning behaviors for assessing the threat of intended violence is proposed: pathway, fixation, identification, novel aggression, energy burst, leakage, directly communicated threat, and last resort warning behaviors. Previous research on risk factors associated with such warning behaviors is reviewed, and examples of each warning behavior from various intended violence cases are presented, including public figure assassination, adolescent and adult mass murder, corporate celebrity stalking, and both domestic and foreign acts of terrorism. Practical applications and future research into warning behaviors are suggested.     

Adapted group-based dialectical behaviour therapy for binge eating in a practicing clinic: clinical outcomes and attrition

Research evidence has been accumulating for the efficacy of dialectical behaviour therapy (DBT) for binge eating. However, support for its effectiveness and transportability beyond efficacy trials is lacking. The current study evaluated the feasibility of group-based DBT for binge eating within the context of an operating community clinic. Women ages 24-49 (M?=?39.60, SD?=?9.53) with either subthreshold and full-threshold binge eating disorder or bulimia nervosa formed the group and comprised the sample (n?=?5 treatment completers). Positive outcomes included significant improvement in both binge eating and secondary outcomes with the Eating Disorder Inventory subscales of Bulimia, Ineffectiveness, Perfectionism and Interpersonal Distrust. Attrition was elevated compared with previous efficacy trials, suggesting the need for increased attention to how to improve retention within routine practice settings. Given our limited sample size, these findings are viewed as promising but preliminary.     

Social anxiety mediates the effect of autism spectrum disorder characteristics on hostility in young adults

Problems with social anxiety are frequently reported in people with autism spectrum disorders (ASD). It is possible that social anxiety, when present, exacerbates the experience of hostility and other forms of aggression in relation to ASD symptoms. This study sought to determine if social anxiety symptoms mediate the relationship between features of ASD and feelings of hostility in young adults. Self-report measures of social anxiety, ASD, and facets of aggression were collected in a non-clinical sample (n = 618) of college students. Social anxiety was found to partially mediate the relationship between ASD features and self-reported hostility. There was also evidence for inconsistent mediation, such that social anxiety dampened the strength of the relationship between ASD symptoms and verbal and physical aggression. Findings highlight the potential influence of associated psychiatric symptoms in people with ASD. In addition, dimensional conceptualization of ASD symptoms, as opposed to a categorical approach solely, may be a useful approach to studying complex personality processes.     

Emotion and decision-making: affect-driven belief systems in anxiety and depression

Emotion processing and decision-making are integral aspects of daily life. However, our understanding of the interaction between these constructs is limited. In this review, we summarize theoretical approaches that link emotion and decision-making, and focus on research with anxious or depressed individuals to show how emotions can interfere with decision-making. We integrate the emotional framework based on valence and arousal with a Bayesian approach to decision-making in terms of probability and value processing. We discuss how studies of individuals with emotional dysfunctions provide evidence that alterations of decision-making can be viewed in terms of altered probability and value computation. We argue that the probabilistic representation of belief states in the context of partially observable Markov decision processes provides a useful approach to examine alterations in probability and value representation in individuals with anxiety and depression, and outline the broader implications of this approach.     

Relationship between biological markers and psychological states in elite basketball players across a competitive season

ObjectiveThe main objective of the study was to examine the relation of different biological markers to a variety of pleasant and unpleasant psychobiosocial (PBS) states in response to precompetitive stress in sport.DesignA longitudinal design was adopted to assess biological markers and PBS states before several games.MethodA whole team of high-level professional basketball players (9 men, aged from 23 to 37 years) took part in the study. The biological measures included the salivary concentration of testosterone, cortisol, aamylase, and chromogranin A. The psychological measures involved emotional, cognitive, motivational, bodily, kinesthetic, performance, and communicative components of PBS states assessed according to the dimensions of their intensity, frequency, and direction (i.e., perceived effect on performance). Assessment was conducted within 1 h prior to competition on an approximately weekly basis across the whole championship for a total of 12 games played at the team's home.ResultsA series of canonical correlation analyses showed that an increase in the salivary concentration of biological variables was associated with enhanced intensity and frequency scores of pleasant PBS states, as well as enhanced directional values (i.e., perception of facilitative effects) of a range of both pleasant and unpleasant PBS states.ConclusionFindings suggest that elevation of testosterone, cortisol, α-amylase, and chromogranin A in basketball players prior to competition can have a perceived functional effect with respect to the upcoming performance.     

Differential effects of seating arrangements on disruptive behavior of fifth grade students during independent seatwork

We investigated teacher versus student seat selection in the context of group and individual seating arrangements. Disruptive behavior during group seating occurred at twice the rate when students chose their seats than when the teacher chose. During individual seating, disruptive behavior occurred more than three times as often when the students chose their seats. The results are discussed in relation to choice and the matching law.     

Young children can tell strategic lies after committing a transgression

This study investigated whether young children make strategic decisions about whether to lie to conceal a transgression based on the lie recipient's knowledge. In Experiment 1, 168 3- to 5-year-olds were asked not to peek at the toy in the experimenter's absence, and the majority of children peeked. Children were questioned about their transgression in either the presence or absence of an eyewitness of their transgression. Whereas 4- and 5-year-olds were able to adjust their decisions of whether to lie based on the presence or absence of the eyewitness, 3-year-olds did not. Experiments 2 and 3 manipulated whether the lie recipient appeared to have learned information about children's peeking from an eyewitness or was merely bluffing. Results revealed that when the lie recipient appeared to be genuinely knowledgeable about their transgression, even 3-year-olds were significantly less likely to lie compared with when the lie recipient appeared to be bluffing. Thus, preschool children are able to make strategic decisions about whether to lie or tell the truth based on whether the lie recipient is genuinely knowledgeable about the true state of affairs.     

A confirmatory factor analytic approach on perceptions of knowledge and skills in teaching (PKST)

This paper reports the cross-validation of the factor pattern of the Perceptions of Knowledge and Skills in Teaching (PKST) survey, which was used to assess the self-perceived pedagogical knowledge and skills of pre-service and beginning teachers. The sample comprised 323 pre-service teachers enrolled in a 1-yr. post-graduate teacher education program in Singapore. The survey had 37 items distributed across six scales: student learning, lesson planning, instructional support, accommodating diversity, classroom management, and care and concern. A confirmatory factor analysis (CFA) was used to cross-validate the survey's factor pattern. The results showed that the model was an acceptable fit to the data. The PKST survey can thus be adapted by different teacher education programs to assess pre-service and beginning teachers' progress in developing their pedagogical knowledge and skills.