Who drops-out? Do measures of risk to self and to others predict unplanned endings in primary care counselling?

Aims: Unplanned endings, where clients unilaterally end therapy, are of concern for psychological therapy services generally as they raise questions about the appropriateness of the treatment and it's delivery for some clients. Limited available data indicates that those who drop-out often have more severe symptoms at entry, and have poorer clinical outcomes. This raises further questions about risk to self and others for those clients who leave therapy prematurely and how these clients might be identified and kept engaged. Method: This paper uses a large dataset of CORE data collected routinely in a primary care counselling service between 2000 and 2003. Logistic regression was utilised to consider different measures of risk and other client characteristics recorded at assessment to predict drop-out from the service. Results: These indicate that younger age, greater psychological distress at assessment, an addiction problem and greater risk to others, are associated with an unplanned ending. However, no reliable logistic regression model could be produced. This may be partly due to data quality issues or important characteristics not being available in the data. Implications for practice: The paper concludes that counsellors should actively seek to minimise unplanned endings, as amongst them may be represented the more distressed and risky clients referred to primary care counselling.     

Understanding the Progression from Early Alcohol Use Experimentation to Alcohol Use Disorder: Testing Vulnerability by Experience Interactions Using a Two-Part Latent Growth Curve Model

Most adolescents experiment with alcohol, but a smaller percentage advance to heavy alcohol use (AU) and AU disorder (AUD). Understanding for whom and how early risk leads to AUD is of interest to prevention, treatment, and etiology of AUD. Informed by developmental and behavioral neuroscience theory, the current study tested whether temperament (effortful control, surgency, and negative affect), peer AU (multi-reporter), and AU with parents’ permission interacted to distinguish youth who experiment with alcohol from those who escalate to AUD. Community adolescents (N?=?765, 53% female) were assessed annually for seven years (M_age?=?11.8, range: 10–13 at Year 1; M_age?=?18.7; range?=?17–20 at year 7). Temperament by early experience interactions were expected to predict amount of AU. Amount of AU was expected to mediate the relationship between the interactions and AUD symptoms (assessed at Years 3 and 7, M_age?=?13.8 and 18.7) above and beyond a range of confounds (e.g., problem behavior and parental AU and AUD). Supporting hypotheses, effortful control and surgency interacted with AU with parents’ permission and peer AU, respectively, to predict higher amount of AU (R²?=?0.47) and AUD symptoms (R²?=?0.03). Results support developmental and behavioral neuroscience theory. High surgency and low effortful control in conjunction with peer AU and AU with parents’ permission were associated with large effects on AU and moderate mediated effects through AU to AUD. AU with parents’ permission was risky at low and high effortful control and protective when peers used alcohol.

     

To Be or Not: A Brief History of the Health Humanities Consortium

The Health Humanities Consortium (HHC) was established in 2015 to “promote health humanities scholarship, education, and practice through transdisciplinary methods and theories that focus on the intersection of the arts and humanities, health, illness, and healthcare.” As the founding co-chairs of the HHC, we provide a history of the founding of this organization in this article, describing the journey of its creation, the choices and challenges it faced as a new organization, and our hopes for a rich future.

     

Justice and power: when will justice concerns encourage the advantaged to support policies which redistribute economic resources and the disadvantaged to willingly obey the law?

Two studies are presented which test whether justice can motivate support for government policies and authorities even when such support is not in people's obvious personal or group interest. In the first study, White San Francisco Bay area residents' attitudes toward Congressionally-authored affirmative action policies and anti-discrimination laws were investigated. In the second study, African-American San Francisco Bay area residents' feelings of obligation to obey the law were investigated. The results from both studies show a significant relationship between evaluations of social justice and respondents' political attitudes. More importantly, a significant relationship between relational evaluations of Congress and political attitudes is found in both studies. This relationship suggests how justice can motivate policy and government support even if such support does not yield direct personal or group benefits. Finally, the results from both studies indicate when instrumental and relational concerns will be related to political attitudes. If people identified with their particular advantaged or disadvantaged group, instrumental concerns were more strongly related to their political attitudes, but if people identified with a superordinate category that included both potential outgroup members and relevant superordinate authorities, relational concerns were more strongly related to their political attitudes.     

Re-exposure to reinforcement in Context A during treatment in Context B reduces ABC renewal

Previous work from our laboratory showed that intermittently re-exposing rats to reinforcement for lever pressing in a training (A) context, while eliminating lever pressing in a second (B) context, increased ABA renewal of lever pressing relative to rats that experienced only Context B during response elimination. In the current study, we replicated these procedures while assessing renewal in the presence of a novel context (i.e., ABC renewal). Unlike the findings described above, renewal was reduced in the group that experienced re-exposure to Context A during lever-press elimination relative to rats that experienced only Context B. These findings suggest that alternating between contexts associated with reinforcement and extinction during treatment reduces the probability that organisms will respond in novel contexts. These outcomes may be the result of discrimination and/or generalization processes. Moreover, this training procedure may offer a potential mitigation strategy for ABC renewal.     

Aggression-consistent, -inconsistent,and -irrelevant priming effects on selective exposure to media violence

Priming with aggressive concepts increases males' attraction to media violence. It was hypothesized that priming with schema-irrelevant concepts would decrease interest relative to the effects of schema-relevant concepts, whether or not the schema-relevant concepts were also schema-consistent. Thirty male undergraduates used lists including aggressive (schema-consistent and schema-relevant), positive or prosocial (schema-inconsistent yet relevant), or entirely neutral (schema-irrelevant) words to write short stories (priming task), then received an opportunity to select videotaped film clips for viewing. Subjects primed by aggressive word lists included more aggression, anger, fear, and violence in their stories than did those in the aggression-inconsistent and aggression-irrelevant conditions, whereas aggression-inconsistent priming yielded more fun, helping, and joy than did other conditions. Aggressively primed subjects expressed more interest in films containing violence and hostility than did neutrally primed subjects, whereas aggression-inconsistent priming did not differ significantly from either aggressive (schema-consistent) or neutral (schema-irrelevant) priming. Findings indicate that the aggressive priming activates aggressive concepts that make violence and hostility more salient to individuals. Because male undergraduates typically express interest in violence, enhanced salience leads to increased interest. © 1992 Wiley-Liss, Inc.