The relationship between alliance ruptures and hope for change through counseling: A mixed methods study

The negative impact of alliance ruptures on clients’ experiences within the therapeutic process is well documented. One such negative influence may include clients’ hope for counseling as a helpful process. This study used a mixed methods design to explore how alliance ruptures are related to hope for change through counseling. Quantitative data (N = 105) indicated that those who experienced ruptures reported lower levels of the components of hope for change through counseling, (a) pathways and agency, and (b) goal identification. More frequent ruptures and rupture repairs were significantly related to participants’ (n = 35) pathways and agency. Phenomenological analysis of qualitative participants’ (N = 5) experiences elicited 218 meaning units grouped into four themes: disengagement and mistrust in therapy, deepened distress, questioning one’s hope for and belief in therapy, and resilience for therapy. Qualitative and quantitative data indicate that alliance ruptures are related to lower degrees of hope for change through counseling. Results suggest that clients’ perceptions of ruptures fostered disengagement and mistrust of therapists. However, when therapists act to repair ruptures, they may effectively re-engage some degree of hope for change through counseling in clients. Lastly, the role of clients’ persistence in therapy despite experiencing ruptures is discussed.     

Coaching Paraprofessionals to Promote Engagement and Social Interactions During Small Group Activities

Paraprofessionals need adequate training and supports to assist young children with autism spectrum disorders to engage in appropriate social interactions during small group activities with their peers. In this study, we used in situ coaching and brief post-session feedback to improve the use of environmental arrangement, prompting, and praise by three paraprofessionals working in inclusive classrooms. Results suggested the brief coaching intervention was effective for improving target behaviors. In addition, generalized use of behaviors and child outcomes were positive. In situ feedback is a promising practice for improving use of evidence-based practices by non-certified personnel in early childhood settings.     

Parent-Led Exposure Therapy: A Pilot Study of a Brief Behavioral Treatment for Anxiety in Young Children

Despite prevalence rates as high as 9.4%, few studies have examined the applicability of cognitive-behavioral therapy for treatment of anxiety disorders in very young children (i.e., below the age of 7 years). The present study examined the preliminary efficacy of a parent-led exposure therapy protocol (PLET) designed for young children with anxiety disorders. Twenty-two youth aged 4–7 years and their parents participated in this pilot randomized control trial. Families of youth with significant anxiety concerns were randomized to either PLET (n?=?12), a 10 session/5-week family-based exposure therapy program designed to target anxiety in young children, or treatment as usual (TAU; n?=?10). Children in the PLET condition demonstrated a greater reduction in anxiety symptoms compared to TAU (d?=?3.18), with 90.91% of PLET participants (active condition) being classified as treatment responders at post-treatment as opposed to 0 in the TAU condition. Gains were maintained at 1 month-follow-up. Although pilot in nature, these data suggest in a preliminary fashion that a parent led exposure therapy protocol that is adapted appropriately for developmental age and incorporates an active coaching component for parents may be efficacious for the treatment of young children with anxiety disorders. This clinical trial was registered through clinicaltrials.gov under the following identifier: NCT02051192.     

In-Session Stuck Points and Pitfalls of Community Clinicians Learning CBT: Qualitative Investigation

Given the preponderance of evidence supporting the efficacy of cognitive behavior therapy (CBT), there has been an increased emphasis on dissemination to community mental health systems (CMH). Trainers from two large-scale dissemination initiatives (n = 27) were surveyed regarding the common pitfalls and difficulties encountered by CMH clinicians learning CBT. Common pitfalls were organized according to the items of the Cognitive Therapy Rating Scale (CTRS; Young & Beck, 1980) and reviewed. Guided discovery was reported to be the most challenging CBT competency to learn. Qualitative methods were used to construct a grounded theory; trainer responses indicated they viewed the practice of CBT as not only a set of discrete skills, but also a way of thinking. Efforts may be needed to provide support, assistance, and resources to these CMH clinicians as they continue to build CBT competency.     

Long-Term Outcomes of Youth Treated for an Anxiety Disorder: A Critical Review

Pediatric anxiety disorders are common, disabling, and chronic conditions. Efforts over the past two decades have focused on developing and testing effective treatments. Short-term efficacy of both Cognitive Behavioral Therapy (CBT) and selective serotonin reuptake inhibitors has been established. Data are emerging on the long-term (i.e., 2 years or longer) effectiveness of these treatments, but this literature has yet to be adequately synthesized. This study presents a systematic and critical qualitative review of published long-term follow-up (LTFU) studies of youth treated for an anxiety disorder. A comprehensive search of several databases identified 21 published reports (representing 15 LTFU cohorts of treated youth) meeting specified inclusion criteria. LTFU assessments occurred a mean of 5.85 years after initial treatment (range 2–19 years). Diagnostic rates at LTFU and predictors (e.g., demographic, baseline child clinical variables, treatment type) of outcomes at LTFU were also examined. A discussion of the limitations of this literature is provided to qualify interpretations of findings and to inform future studies. Findings can aid clinicians and families in making treatment decisions and setting reasonable expectations for the long-term prognosis after treatment for anxiety.     

Demographic and familial predictors of early executive function development: Contribution of a person-centered perspective

Executive function (EF) skills are integral components of young children’s growing competence, but little is known about the role of early family context and experiences in their development. We examined how demographic and familial risks during infancy predicted EF competence at 36 months of age in a large, predominantly low-income sample of nonurban families from Pennsylvania and North Carolina in the United States. Using latent class analysis, six ecological risk profiles best captured the diverse experiences of these families. Profiles with various combinations of family structure, income, and psychosocial risks were differentially related to EF. Much of the influence of early risks on later EF appears to be transmitted through quality of parent-child interactions during infancy. Findings suggest that early family environments may prove to be especially fruitful contexts for the promotion of EF development.     

Individual differences in ego depletion: The role of sociotropy-autonomy

In his cognitive theory of depression, Beck (1987) suggested that highly sociotropic individuals have a strong need for social acceptance whereas highly autonomous individuals have an excessive need for achievement. Research by Baumeister (2000) has suggested that a phenomenon known as ego depletion, the weakening of performance on tasks following active self-control, occurs because it depletes a limited inner resource. The present study examined whether individuals who are highly sociotropic or autonomous would respond differently when faced with tasks requiring self-control. Participants completed the Sociotropy-Autonomy Scale (Clark et al. 1995) and engaged in two active self-control tasks. The results revealed that sociotropy levels were negatively correlated with persistence on tasks that require self-control whereas autonomy was positively correlated to persistence on the same task. In addition, the results suggested that, following a task requiring self-control, highly sociotropic individuals expend less effort, whereas highly autonomous individuals expend more effort on subsequent tasks requiring self-control.     

Effects of acute stress and GluN2B-containing NMDA receptor antagonism on object and object–place recognition memory

The mechanisms underlying the complex effects of acute stress on memory are incompletely understood. Previous work suggests that the activation of N-methyl-d-aspartate (NMDA) receptors specifically containing GluN2B subunits may underlie the disruptions in spatial memory retrieval caused by acute stress (Wong et al., 2007 PNAS 104:11471). The present experiments were designed to assess whether a similar mechanism is involved in recognition memory. Recognition memory retrieval was assessed in Sprague–Dawley rats using an object recognition test and an object–place recognition test, both of which rely on patterns of spontaneous exploration. Exposure to acute stress for 30 min immediately before the test phase of either test disrupted memory retrieval. Administration of the GluN2B-selective antagonist Ro25-6981 (6 mg/kg; i.p.) enhanced memory in the object recognition test regardless of whether animals were exposed to acute stress. In the object–place test, Ro25-6981 had no effect on memory retrieval in the absence of stress but promoted memory following acute stress. These data highlight the specific contributions made by GluN2B-containing NMDA receptors to recognition memory for different types of stimuli.     

Religious Believers Do Not Distinguish Good from Poor Reasons for God’s Existence

Can people discriminate good from bad reasons for their beliefs about God? Research shows that religious believers favor intuitive processing, suggesting they may be less discriminating than nonbelievers. Indeed, in Experiment 1 and a replication, people listed 15 reasons for their beliefs about God, then evaluated the quality of either their first 3 reasons (presumably their best) or their last 3 (their worst); in both experiments, nonbelievers rated their good reasons as better than their bad reasons, whereas believers rated the 2 types of reasons equally. Experiments 2 and 3 revealed that this difference was limited to beliefs about God and was specific to believers’ own beliefs about God: Both believers and nonbelievers discriminated reasons for other people’s beliefs, as long as the reasons were congruent with their own. Whether cognitively or motivationally driven, our findings help explain why religious beliefs, in particular, are often immune to logical argument.     

Sadness and ruminative thinking independently depress people's moods

Depression and rumination often co‐occur in clinical populations, but it is not clear which causes which, or if both are manifestations of an underlying pathology. Does rumination simply exacerbate whatever affect a person is experiencing, or is it a negative experience in and of itself? In two experiments we answer this question by independently manipulating emotion and rumination. Participants were allocated to sad or neutral (in Experiment 1), or sad, neutral or happy (Experiment 2) mood conditions, via a combination of emotionally evocative music and autobiographical recall. Afterwards, in both studies, participants either ruminated by thinking about self‐relevant statements or, in a control group, thought about self‐irrelevant statements. Taken together, our data show that, independent of participants' mood, ruminators reported more negative affect relative to controls. The findings are consistent with theories suggesting that self‐focus is itself unpleasant, and illustrate that depressive rumination comprises both affective and ruminative components, which could be targeted independently in clinical samples.