Efficacy of telephone-administered cognitive behaviour therapy for obsessive-compulsive spectrum disorders: case studies

Cognitive behaviour therapy is effective for obsessive-compulsive disorder and for obsessive-compulsive spectrum disorders such as trichotillomania. Unfortunately, many people with these disorders, especially those living in rural areas, have limited access to treatment. Telephone-administered cognitive behaviour therapy may help address this problem. In a recent study of telephone treatment for obsessive-compulsive disorder, we found that such treatment was often effective (42% in remission at post-treatment, and 47% in remission at 12-week follow-up). This article presents 2 case reports of the same treatment, applied to obsessive-compulsive spectrum disorders (trichotillomania and compulsive skin picking). Treatment was associated with symptom reduction for both participants, although one subsequently relapsed. Possible reasons for relapse are discussed. The findings encourage further studies to identify the characteristics of people most likely to benefit from telephone treatment for spectrum disorders.     

Performance of Dyslexic Children on Cerebellar and Cognitive Tests

In a previous study (A. J. Fawcett, R. I. Nicolson, & P. Dean, 1996), the authors had found strong behavioral evidence for cerebellar deficit in a panel of children with dyslexia. In the present study, the generality of those results was assessed. A battery of clinical tests for cerebellar dysfunction was administered, together with selected cognitive tests, to a further 59 dyslexic and 67 control children. The dyslexic children showed highly significant impairments on the cerebellar tests, with deficits on postural stability and muscle tone comparable in magnitude with their reading and spelling deficits. Furthermore, over 95&percent; of the dyslexic children showed clear evidence of deficit on muscle tone or stability. The findings provide further evidence of the generality of cerebellar impairment in dyslexia. The implications of the cerebellar tests for screening in dyslexia are discussed.     

"I" Value Freedom, But "We" Value Relationships: Self-Construal Priming Mirrors Cultural Differences in Judgment

The distinction between relatively independent versus interdependent self-construals has been strongly associated with several important cultural differences in social behavior. The current studies examined the causal role of self-construal by investigating whether priming independent or interdependent self-construals within a culture could result in differences in psychological worldview that mirror those traditionally found between cultures. In Experiment 1, European-American participants primed with interdependence displayed shifts toward more collectivist social values and judgments that were mediated by corresponding shifts in self-construal. In Experiment 2, this effect was extended by priming students from the United States and Hong Kong with primes that were consistent and inconsistent with their predominant cultural worldview. Students who received the inconsistent primes were more strongly affected than those who received the consistent primes, and thus shifted self-construal, and corresponding values, to a greater degree.     

Shades of the mirror effect: Recognition of faces with and without sunglasses

A mirror effect was found for a stimulus manipulation introduced at test. When subjects studied a set of normal faces and then were tested with new and old faces that were normal or wearing sunglasses, the hit rate was higher and the false alarm rate was lower for normal faces. Hit rate differences were reflected in remember and sure recognition responses, whereas differences in false alarm rates were largely seen in know and unsure judgments. In contrast, when subjects studied faces wearing sunglasses, the hit rate was greater for test faces with sunglasses than for normal faces, but there was no difference in false alarm rates. These findings are problematic for single-factor theories of the mirror effect, but can be accommodated within a two-factor account.     

Borderline functioning, work, and outcome in intensive evening group treatment.

Cluster analysis was used to identify subgroups of a sample of 40 patients with borderline personality disorder (BPD). The BPD patients were part of a larger sample that had participated in an intensive, group-oriented Evening Treatment Program. A set of pretherapy outcome measures was used to represent patient "attributes" for the cluster analysis. Eight clusters were identified. Two, each defined by a single patient with pronounced pathology, were deleted from further analyses. In a discriminant-function analysis, four dimensions emerged that differentiated the six remaining clusters. Significant relationships among the four dimensions and measures of therapeutic work and treatment outcome were identified. The relationships reflected the impact of behavioral characteristics associated with BPD on participation in and benefit from intensive group-oriented evening treatment. Implications of these exploratory findings for the understanding and treatment of BPD are discussed.     

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.     

Faces in Motion: Age‐Related Changes in Eyewitness Identification Performance in Simultaneous,Sequential, and Elimination Video Lineups

The identification performance of children (5 to 6 years, n = 180; 9 to 10 years, n = 180) and adults (n = 180) was examined using three types of video lineup procedures: simultaneous, sequential and elimination. Participants viewed a videotaped staged theft and then attempted to identify the culprit from a target‐present or target‐absent video lineup. Correct identifications in simultaneous and elimination video lineups did not differ as a function of age. The sequential video lineup was associated with a reduction in correct identifications for both child groups compared with adults. With respect to the target‐absent lineup condition, the video elimination lineup was associated with an increase in correct rejection rates for adult witnesses. Age was also significantly associated with accuracy. Differences in correct rejection rates were observed between adults and children and also between the two child groups. Implications and future directions are discussed. Copyright © 2011 John Wiley & Sons, Ltd.