Barriers and facilitators affecting the sustainability of dialectical behaviour therapy programmes: A qualitative study of clinician perspectives

Dialectical behaviour therapy (DBT) is a psychological treatment developed for individuals experiencing chronic suicidality and high‐risk behaviours. Despite the substantial evidence supporting the effectiveness of DBT, many programmes have problems with its sustainability. The goals of the current qualitative study were to identify factors that impact the sustainability of DBT programmes within a publicly funded mental health system and identify factors that are particularly relevant for youth DBT programmes. Interviews with trained adult and youth DBT clinicians (N = 31) were conducted to explore their experiences providing DBT. Three major themes that emerged as barriers to the sustainability of DBT programmes included the following: systemic challenges, conflicts within the consultation teams and clinician burnout. Factors influencing the success of DBT programmes included the following: systemic support, clinician commitment and “buy in”, and team cohesion. Factors specific to providing DBT with youth (i.e. level of commitment, simplifying the language, and parental investment) and recommendations for sustainability for adults and youth programmes were also identified. Findings of this study provide valuable information on factors impacting DBT programmes within the unique context of a Canadian mental health service system, where community‐based services are publicly funded. These findings have clear clinical utility and can be used to generate solutions to clinicians' perceived barriers and to foster perceived facilitators within similar contexts.     

Action-based and vision-based selection of input: Two sources of control

In the first part of this paper we review evidence suggesting that there exists a mechanism that selects input on the basis of its similarity to the required action. This response-based input selection differs from the more established space- and object-based input selection in that it is not constrained by the structure of the input. Our evidence suggests that the two-choice Stroop effect is caused by this response-based selection mechanism. By contrast, it is known that the flanker effect is determined by the space- and object- based selection mechanisms. We explore whether the conflict resolution of the Stroop and flanker tasks is different as well by embedding these two tasks in a PRP (Psychological Refractory Period) paradigm. We show that the Stroop and the PRP effects are additive whereas the flanker and the PRP effects are underadditive, suggesting that the processes in charge of the conflict resolution in the Stroop and the flanker tasks are indeed different. We discuss possible reasons for this difference, and discuss possible ways in which the response-based mechanism can be implemented in information processing models.     

Win-shift and win-stay learning in the short-beaked echidna (<Emphasis Type="Italic">Tachyglossus aculeatus</Emphasis>)

Numerous previous investigators have explained species differences in spatial memory performance in terms of differences in foraging ecology. In three experiments we attempted to extend these findings by examining the extent to which the spatial memory performance of echidnas (or "spiny anteaters") can be understood in terms of the spatio-temporal distribution of their prey (ants and termites). This is a species and a foraging situation that have not been examined in this way before. Echidnas were better able to learn to avoid a previously rewarding location (to "win-shift") than to learn to return to a previously rewarding location (to "win-stay"), at short retention intervals, but were unable to learn either of these strategies at retention intervals of 90 min. The short retention interval results support the ecological hypothesis, but the long retention interval results do not. Electronic Publication     

Searching for reliable relationships with statistics packages: an empirical example of the potential problems

Many social scientists appear to possess an overconfidence in the reliability of research results from a single, small-sample, inferential study. In this article, the authors speculate that "user-friendly" statistics packages have the potential to exacerbate statistical misinterpretation by providing researchers with a tool to explore data easily and identify what is interpreted as "reliable" relationships. This article contains an empirical demonstration of the potential problems that arise when a large number of statistical tests are interpreted. Results show that statistically significant results may be unreliable. Also, a zero relationship can erroneously appear as a medium to large effect size relationship when a small sample is used (e.g., n = 30). The authors suggest the need for multiple replications as the criterion of a reliable finding.     

Evaluating gene x psychological risk factor effects in the pathogenesis of anxiety: a new model approach

The present study evaluated the singular and interactive effects of a functional polymorphism (variation) in the serotonin transporter (5-HTT) gene and a psychological trait (anxiety sensitivity [AS], i.e., fear of arousal symptoms) in predicting subjective and physiological responses to a 35% carbon dioxide (CO2) challenge in a community sample (N = 72). Genotypes were divided into 2 groups in accord with prior research. Findings were partially supportive of the hypothesized risk model. These indicated that the Group L genotype (homozygous for the 1 allele), compared with the Group S genotype (homozygous for the s allele plus heterozygous individuals), predicted greater fearful response to the biological challenge. There was also an AS x Genotype interaction predicting heart rate variability (HRV) in response to the CO2, suggesting that high AS plus Group L status predicts decreased HRV.     

Visual perception of mean relative phase and phase variability

Perception of relative phase and phase variability may play a fundamental role in interlimb coordination. This study was designed to investigate the perception of relative phase and of phase variability and the stability of perception in each case. Observers judged the relative phasing of two circles rhythmically moving on a computer display. The circles moved from side to side, simulating movement in the frontoparallel plane, or increased and decreased in size, simulating movement in depth. Under each viewing condition, participants observed the same displays but were to judge either mean relative phase or phase variability. Phase variability interfered with the mean-relative-phase judgments, in particular when the mean relative phase was 0 degrees. Judgments of phase variability varied as a function of mean relative phase. Furthermore, the stability of the judgments followed an asymmetric inverted U-shaped relation with mean relative phase, as predicted by the Haken-Kelso-Bunz model.     

The Factor Structure of the Beavers Interactional Scales

Confirmatory factor analysis and regression analyses of the Beavers Interactional Scales did not appear to support the model offered by its developers, namely, several specified family attributes contributing respectively to two global factors of Family Competence and Family Style. Moreover, regression analysis indicated that only three of 12 items predicted raters' assessments of Global Family Health, and one of seven items predicted Global Family Style. Individuals interested in the family dynamic centripetal/centrifugal might best think of that as a unitary entity and rate it accordingly.     

Diagnosing agoraphobia in the context of panic disorder: examining the effect of DSM-IV criteria on diagnostic decision-making

A diagnostic and statistical manual (DSM)-IV diagnosis of agoraphobia in the context of panic disorder (PD) is based on three nosologically sufficient criteria: (1) avoidance, (2) use of companions, and (3) endurance of situations despite distress. Therefore, an agoraphobia diagnosis can be made across an extremely broad range of cases including when there are no avoidance behaviors (e.g., the patient endures the situation). It was hypothesized that clinicians do not weight these criteria equally and that the DSMs individual, sufficient criteria lead to poor inter-rater reliability. Clinicians (N=48) rated hypothetical patients with symptom profiles emphasizing each of these three criteria. Consistent with expectation, clinicians differentially weighted these criteria. Avoidance was relatively more apt to produce a diagnosis when only one criterion was emphasized in clinical vignettes. Inter-rater reliability was poor in instances when only one sufficient criterion was highlighted. Knowledge concerning DSM criteria resulted in a greater rate of agoraphobia endorsement, but knowledge did not account for the overall pattern of findings.     

Plantinga’s Reformed Epistemology: What’s the Question?

Alvin Plantingas Warranted Christian Belief is without questionone of the central texts of the Reformed epistemology movement. Critiques of Plantingas defence have been both multiple and varied. As varied as these responses are, however, it is my contention that many of them amount to the same thing. It is the purpose of this paper to offer an overview of the main lines of attack that have been directed as Plantingas project, and thereafter to show how many, if not most, of these objections can be understood as versions or aspects of the same criticism, what I call the Inadequacy Thesis.     

Is there a general factor in ratings of job performance? A meta-analytic framework for disentangling substantive and error influences

A database integrating 90 years of empirical studies reporting intercorrelations among rated job performance dimensions was used to test the hypothesis of a general factor in job performance. After controlling for halo error and 3 other sources of measurement error, there remained a general factor in job performance ratings at the construct level accounting for 60% of total variance. Construct-level correlations among rated dimensions of job performance were substantially inflated by halo for both supervisory (33%) and peer (63%) intrarater correlations. These findings have important implications for the measurement of job performance and for theories of job performance.