Mindfulness‐based cognitive therapy is effective as relapse prevention for patients with recurrent depression in Scandinavian primary health care

This study examined the effectiveness of mindfulness‐based cognitive therapy (MBCT) in primary care for patients with recurrent depression (major depressive disorder: MDD). According to the World Health Organization (WHO), MDD is now the leading cause of disease burden in middle‐ and high‐income countries. Patients (N = 45) with three or more previous depressive episodes were recruited to participate in MBCT as a preventative intervention. Using a benchmarking approach, outcome data was compared with data from a recent efficacy study. The methodology is a rigorous approach to assessing effectiveness when evidence‐based UK protocols are transferred into the existing Scandinavian service delivery. Additionally, a person‐centred methodological approach was used to assess clinical significance on the Reliable Change Index (RCI). The analysis revealed comparable or larger effects from pre‐test to post‐test in reduced psychiatric symptoms, increased quality of life and level of mindfulness, and the effects were maintained over 14 months. Analysis of the relapse rate in the current study (16%) compared to the TAU in the efficacy study (68%) yielded an h value of 0.78, a moderate effect size. Only 13% dropped out of the treatment. According to the RCI findings, 65% to 67% of participants in the clinical group improved, no individual worsened, and women showed a significantly greater improvement of depression and anxiety than men. Therapeutic alliance and motivation had no impact on the outcome. The overall result suggests that MBCT can be implemented successfully in Scandinavian primary health care as a preventive intervention for patients with recurrent depression.     

Thriving,burnout, and coping strategies of early and later career counseling center psychologists in the United States

We interviewed seven early career psychologists (ECPs) and seven later career psychologists (LCPs) employed at university counseling centers in the United States about their experiences with thriving, burnout, and coping. We analyzed the data using Consensual Qualitative Research. Typical factors that contributed to thriving included recognition for achievement and the climate of counseling center and campus, although the latter was more important for ECPs than LCPs. Typical factors that contributed to burnout included challenges with tasks and responsibilities and challenges related to professional relationships. Finally, interpersonal support (general), self-care, cognitive strategies, and behavioral strategies (typical) were coping strategies used by both ECPs and LCPs, but only ECPs identified using personal therapy. Implications for counseling centers and for research are presented.     

Rigid and non-rigid kinetic depth effect with rotating discrete helices

Summary To examine the conditions in which human observers fail to recover the rigid structure of a three-dimensional object in motion we used simulations of discrete helices with various pitches undergoing either pure rotation in depth (rigid stimuli) or rotation plus stretching (non-rigid stimuli). Subjects had either to rate stimuli on a rigidity scale (Experiments 1 and 2) or to judge the amount of rotation of the helices (Experiments 3 and 4). We found that perceived rigidity depended on the pitch of the helix rather than on objective non-rigidity. Furthermore, we found that helices with a large pitch/radius ratio were perceived as highly non-rigid and that their rotation was underestimated. Experiment 5 showed that the detection of a pair of dots rigidly related (located on. the helix) against a background of randomly moving dots is easier at small phases in which the change of orientation across frames is also small. We suggest that this is because at small phases the grouping of dots in virtual lines does occur and that this may be an important factor in the perceived nonrigidity of the helices.This research was supported by MPI 60% (1987, 1988) and CNR (1986), 1987, 1988) grants to Clara Casco and Sergio Roncato and Grant CNR 90.01603.PS93 to Giorgio Ganis.     

Prevention of admission and continuity of care

An in-depth analysis of the recent reform in Italian psychiatry reveals that the relevance of these changes transcends national borders. However, these changes are, from the scientific point of view, worth much more than mere biased pragmatic interest. The reshaping of theory made possible by the transformation of Italian psychiatry in fact opens up new prospects for a scientifically founded form of psychiatric care. Thanks to the new Mental Health Act (No. 180 of 1978),² it has been possible to set up a type of administrative and institutional organization in which the psychiatric hospital no longer constitutes a functional part of the structures of psychiatric care. This reform thus provides the launching path for a real alternative where current psychiatric ideas and working methods can no longer be accepted as the gospel truth. This paper discusses how a correct problem-definition of psychiatric admission can provide a basis for a correct approach to psychopathological behaviour in a setting where the psychiatric hospital has no role to play and for the consolidation of this new practice.     

Establishing equivalence–equivalence analogical relations via tact and listener training

We investigated the role of verbal behavior on the emergence of analogy-type responding as measured via equivalence–equivalence relations. In Experiment 1, 8 college students learned to label arbitrary stimuli as, “vek,” “zog,” and “paf”, and in Experiment 2, 8 additional participants learned to select these stimuli when hearing their names in an auditory–visual matching-to-sample (MTS) task. Experimenters tested for the emergence of relational tacts (i.e., “same” and “different”) and equivalence–equivalence relations (analogy tests) via visual–visual MTS. Half of the participants were exposed to a think-aloud procedure. Even though they all passed analogy tests while tacting stimuli relationally, only participants exposed to tact training (Experiment 1) did so without the need for remediation. The results of these experiments confirm that individual discriminative and relational control of stimuli established through verbal behavior training is sufficient to produce equivalence–equivalence analogical responding, advancing the analysis of complex cognitive (problem-solving) phenomena.     

Gesturing helps memory encoding in aMCI

Encoding in episodic memory is a step often impaired in patients with amnestic Mild Cognitive Impairment (aMCI). However, procedural memory processes are still relatively preserved. In line with previous research on the enactment effect, we investigated the potential benefit of encoding words combined with imitative gestures on episodic memory. Based on the Grober and Buschke’s free/cued recall procedure, we developed the Symbiosis test in which 13 patients with aMCI and 16 healthy elderly participants learned 32 words belonging to 16 different semantic categories either in a verbal encoding (A) or a bimodal (B; verbal and motor imitation) condition, using a blocked ABBA/BAAB procedure. Overall, memory retrieval was better in healthy participants than in patients with aMCI, and better for cued retrieval in the bimodal encoding (gesture cues) than the verbal encoding (category cues) condition, but there was no interaction effect between group and encoding conditions. These results show that performing concomitant gestures can enhance cued episodic memory retrieval in patients with aMCI and in healthy elderly controls. The Symbiosis test broadens the scope of the enactment effect, from action phrases to isolated words learning in patients with aMCI. Future work should investigate how bimodal encoding provides novel perspectives for memory rehabilitation in patients with aMCI.     

Connecting the dots: Illusory pattern perception predicts belief in conspiracies and the supernatural

A common assumption is that belief in conspiracy theories and supernatural phenomena are grounded in illusory pattern perception. In the present research we systematically tested this assumption. Study 1 revealed that such irrational beliefs are related to perceiving patterns in randomly generated coin toss outcomes. In Study 2, pattern search instructions exerted an indirect effect on irrational beliefs through pattern perception. Study 3 revealed that perceiving patterns in chaotic but not in structured paintings predicted irrational beliefs. In Study 4, we found that agreement with texts supporting paranormal phenomena or conspiracy theories predicted pattern perception. In Study 5, we manipulated belief in a specific conspiracy theory. This manipulation influenced the extent to which people perceive patterns in world events, which in turn predicted unrelated irrational beliefs. We conclude that illusory pattern perception is a central cognitive mechanism accounting for conspiracy theories and supernatural beliefs.     

Factors affecting agreement between severely mentally ill alcohol abusers' and collaterals' reports of alcohol and other substance abuse.

This study examined subject-collateral reports of alcohol use among a sample of 167 dually diagnosed individuals seeking outpatient treatment at a community mental health clinic. All subjects met Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) criteria for a schizophrenia-spectrum or bipolar disorder and for alcohol abuse or dependence. Subjects were recruited within 2 weeks of treatment entry and completed measures of cognitive functioning, alcohol dependence severity, psychiatric symptoms, and quantity and frequency of substance use over the previous 60 days using the Timeline Follow-Back interview (L. C. Sobell & M. B. Sobell, 1996). They also provided a urine sample, which was screened for recent drug use. Collateral interviews were conducted by phone and included an assessment of the subject's alcohol and drug use over the same 60-day period. Collaterals also reported their confidence in the accuracy of their reports. Overall, the results indicated generally poor subject-collateral agreement. However, subject-collateral agreement appeared better for those individuals (n = 97) with negative urine drug screens. The most consistent predictor of subject-collateral discrepancy scores was subjects' recent drug use. Recommendations for enhancing the validity of self-reports of substance use in a severely mentally ill population are discussed.     

How Risk is Perceived, Constructed and Interpreted by Clients in Clinical Genetics, and the Effects on Decision Making: Systematic Review

As an individual’s understanding of their genetic risk may influence risk management decisions, it is important to understand the ways in which risk is constructed and interpreted. We systematically reviewed the literature, undertaking a narrative synthesis of 59 studies presenting data on the ways in which individuals perceive, construct and interpret their risk, and the subsequent effects. While most studies assessed perceived risk quantitatively, the combined evidence suggests individuals find risk difficult to accurately quantify, with a tendency to overestimate. Rather than being a stand-alone concept, risk is something lived and experienced and the process of constructing risk is complex and influenced by many factors. While evidence of the effects of perceived risk is limited and inconsistent, there is some evidence to suggest high risk estimations may adversely affect health and lead to inappropriate uptake of medical surveillance and preventative measures by some individuals. A more focused approach to research is needed with greater exploration of the ways in which risk is constructed, along with the development of stronger theoretical models, to facilitate effective and patient-centered counseling strategies.     

The Importance of Program Evaluation: How Can it be Applied to Diverse Genetics Education Settings?

The role of a genetic counselor often entails providing education to patient, community and/or health professional groups. While counseling supervision assists genetic counselors to be reflective about their clinical work and to enhance clinical skills, evaluation is a rather analogous process in the provision of education. Program evaluation of education activities can be applied to provide information about the needs of the target group (needs assessment), the delivery of the program (process evaluation) as well as determining the extent to which the education activity has met its intended aims (summative evaluation). Evaluation assists the educator to assess the impact of their program and provides an evidence base about genetics education. Although program evaluation can be a complex activity, the tools are ones that can be used by individuals to evaluate single or simple education activities. The components of evaluation are discussed with reference to genetic counseling practice and three very different examples of actual evaluations are provided to illustrate the diversity of evaluation strategy and programs to which it can be applied.