Counselling in primary care: a systematic review of the research evidence

Counselling in primary care in the UK is expanding rapidly, and its evidence base needs to be established. We present the rationale for conducting controlled trials of counselling in primary care, and suggest that a systematic review of controlled trials of counselling in primary care is timely. We describe the process of conducting the review in accordance with Cochrane Collaboration guidelines. The review aimed to assess the effectiveness and cost-effectiveness of counselling in primary care, by systematically reviewing cost and outcome data from randomised controlled trials and controlled patient preference trials of counselling interventions, for patients with psychological and psychosocial problems considered suitable for counselling. The search strategy, inclusion and exclusion criteria, data collection and data analysis are described. The results of the review are presented. The review included only controlled trials of counselling in which counsellors accredited by the British Association for Counselling (or equivalent) provided non-directive counselling in primary care. Four trials met the inclusion criteria. Results indicated that patients who receive counselling show a modest but significant improvement in symptom levels compared with those who receive GP care. Levels of satisfaction with counselling are high. There is very tentative evidence to suggest that counselled patients are more likely to be considered recovered than usual GP care patients. There is limited information about the cost-effectiveness of counselling. We conclude by reflecting upon the results of the review and their implications for counselling research.     

Psychological resources, positive illusions, and health

Psychological beliefs such as optimism, personal control, and a sense of meaning are known to be protective of mental health. Are they protective of physical health as well? The authors present a program of research that has tested the implications of cognitive adaptation theory and research on positive illusions for the relation of positive beliefs to disease progression among men infected with HIV. The investigations have revealed that even unrealistically optimistic beliefs about the future may be health protective. The ability to find meaning in the experience is also associated with a less rapid course of illness. Taken together, the research suggests that psychological beliefs such as meaning, control, and optimism act as resources, which may not only preserve mental health in the context of traumatic or life-threatening events but be protective of physical health as well.     

The stimulus prefix is not irrelevant and is redundant in different ways

The present study examined the stimulus prefix effect of immediate recall under conditions in which the prefix element was defined explicitly as being an irrelevant item that should be ignored, or, alternatively, as an item to be remembered and recalled. Memory was poorer in the latter case. Also examined were the effects of three types of redundancy relation between the prefix and target elements; one of these, interstring redundancy (same prefix precedes each target string), was found to improve recall in a relative sense, and another, conceptual redundancy (prefix and target items belong to the same conceptual category), was found to degrade it. Thus, that part of the conventional stimulus prefix effect attributable to redundancy, per se, can be viewed as a composite of at least two opposing factors. Finally, the independent variables of the present study were interpreted to impose different information-processing requirements on the subject, and an account of these requirements was offered.     

From conditioning to category learning: an adaptive network model

We used adaptive network theory to extend the Rescorla-Wagner (1972) least mean squares (LMS) model of associative learning to phenomena of human learning and judgment. In three experiments subjects learned to categorize hypothetical patients with particular symptom patterns as having certain diseases. When one disease is far more likely than another, the model predicts that subjects will substantially overestimate the diagnosticity of the more valid symptom for the rare disease. The results of Experiments 1 and 2 provide clear support for this prediction in contradistinction to predictions from probability matching, exemplar retrieval, or simple prototype learning models. Experiment 3 contrasted the adaptive network model with one predicting pattern-probability matching when patients always had four symptoms (chosen from four opponent pairs) rather than the presence or absence of each of four symptoms, as in Experiment 1. The results again support the Rescorla-Wagner LMS learning rule as embedded within an adaptive network model.     

Newborns learn to identify a face in eight/tenths of a second?

A number of recent studies have shown that newborns prefer to look at mother's face rather than at the face of a stranger. This preference can be seen as the result of familiarity with the mother's face, stemming from a greater number of encounters with mother's face. A schema theory can deal with this kind of recognition. Recent work with verbal stimuli has shown that newborns are sensitive to primacy and recency as well as simple familiarity. A pilot and one complete experiment were carried out to examine whether primacy and recency operated with faces as well. Results indicated that primacy, but not recency, was effective. The results show very rapid learning, learning that may outpace the capacity of any extant model of perceptual learning.     

Conservation of weight in infants

Conversation of weight can be defined as the ability to affirm that the weight of an object remains invariant during the transformations of the form of the object. It is known to be achieved at a conceptual level at about 9 years of age. The behavior of infants seems to indicate that between 6 and 18 months of age they develop a sensorimotor form of conversation.     

Infant responses to approaching objects: An indicator of response to distal variables

Infants show an adaptive avoidance response to approaching objects. The response is affected by the closeness and speed of approach. It is mediated by visual variables. Air-pressure changes do not elicit the response. This kind of response implies discrimination and response to distal variables rather than merely to their proximal mediators.