Comparison of outcomes across low-intensity psychological interventions for depression and anxiety within a stepped-care setting: A naturalistic cohort study using propensity score modelling

Low-intensity interventions for common mental disorders (CMD) address issues such as clinician shortages and barriers to accessing care. However, there is a lack of research into their comparative effectiveness in routine care. We aimed to compare treatment effects of three such interventions, utilizing four years' worth of routine clinical data. Users completing a course of guided self-help bibliotherapy (GSH), internet-delivered cognitive behavioural therapy (iCBT) or psychoeducational group therapy (PGT) from a stepped-care service within the NHS in England were included. Propensity score models (stratification and weighting) were used to control for allocation bias and determine average treatment effect (ATE) between the interventions. 21,215 users comprised the study sample (GSH = 12,896, iCBT = 6862, PGT = 1457). Adherence-to-treatment rates were higher in iCBT. All interventions showed significant improvements in depression (PHQ-9), anxiety (GAD-7) and functioning (WSAS) scores, with largest effect sizes for iCBT. Both propensity score models showed a significant ATE in favour of iCBT versus GSH and PGT, and in favour of GSH versus PGT. Discernible differences in effectiveness were seen for iCBT in comparison with GSH and PGT. Given variance in delivery mode and human resources between different low-intensity interventions, building on these findings would be valuable for future service provision and policy decision making.     

Examining how aspects of vocational privilege relate to living a calling

The current study examined how aspects of vocational privilege directly – and indirectly via work meaning and career commitment – related to living a calling. With an economically diverse sample of 361 employed adults, both social class and work volition were found to moderately to strongly correlate with work meaning, career commitment, and living a calling. We used a structural equation model and found career commitment and work meaning to significantly predict living a calling and fully mediate the link between work volition and living a calling. Additionally, social class related to work meaning and career commitment via work volition. Findings suggest that the links between social class, work volition, and living a calling may be explained by individuals working in jobs they are committed to and that are meaningful, and that work volition may represent the gateway from social class to the experience of fulfilling work. Implications for practice are discussed.     

Does the dark side of a calling exist? Examining potential negative effects

The present studies examined the potential dark side of perceiving and living a calling with diverse samples of employed adults. In Study 1, living a calling and life meaning were found to suppress the relation between perceiving a calling and life satisfaction, resulting in these variables being significantly, negatively related. This suggests that perceiving a calling may predict decreased well-being when it is not lived out and does not provide meaning. In Study 2, participants living a calling did not experience greater burnout, workaholism, or organizational exploitation. Additionally, counter to hypotheses, living a calling was found to be a significant buffer in the relation of burnout/exploitation and job satisfaction. Specifically, the slope of the relation between living a calling and job satisfaction was more pronounced with individuals experiencing high levels of burnout/exploitation. These findings suggest that living a calling may help individuals in difficult working conditions maintain job satisfaction.     

Considerations on medical training for gender-affirming care: Motivations and perspectives

Abstract

Background: Many transgender individuals lack access to needed medical care, partially due to a lack of providers with experience in gender-affirming healthcare.

Aims: The purpose of this study was to identify professional motivators for medical providers seeking out training in gender-affirming care and to define which training experiences were most beneficial to their career development. By identifying experienced providers’ recommendations on which training modalities are most relevant to their practice, we aim to suggest future directions for medical education initiatives to effectively expand the transgender care workforce.

Methods: A voluntary cross-sectional electronic survey was distributed through professional listservs and publicly-available referral lists to interdisciplinary providers who self-identified as having experience in providing care to transgender individuals.

Results: One hundred and fifty-three (n?=?153) physicians, physician assistants, or advance-practice nurses responded to the survey. The majority (96.7%) were located in the United States, representing 37 states. The two most common motivators for seeking out training in gender-affirming care were filling a need in the community (73.0%) and/or having met a transgender-identified person in a clinical setting who requested care (63.8%). While many providers gained skills independently (57.3%), the two most commonly-available training opportunities were professional conferences (57.3%) and mentorship (41.3%). Respondents were most likely to recommend that others in their field be trained via structured clinical experience (e.g., a rotation or longitudinal exposure during training), rather than additional didactic training.

Discussion: This study identifies key high-yield training methodologies which could improve access to quality gender-affirming healthcare. Through integration of structured clinical experiences during training, direct clinical mentorship, and professional development at conferences on gender-affirming care, the workforce of welcoming and prepared healthcare providers for transgender patients will increase. This will lead to a tremendous improvement on access to gender-affirming care in our communities.     

Eco-Education: Integrating Nature into Counselor Education

ABSTRACT

This consensual qualitative research study investigated the experiences of 10 counselors-in-training after exposure to nature-based interventions during a semester-long human development class. Interview data revealed four central domains: interpersonal impact, intrapersonal impact, whole-group impact, and feedback on nature-based activities. These findings highlight the benefits of eco-education for counselor development.     

Contextual Strength and the Subordinate Bias Effect: Comment on Martin, Vu, Kellas, and Metcalf

Martin, Vu, Kellas, and Metcalf (this issue) claim to have demonstrated that the subordinate bias effect (when preceding context instantiates the subordinate meaning of an ambiguous word that has a highly dominant meaning, reading time on that word is lengthened) can be eliminated by strong context. They argue that this provides evidence critical to discriminating between competing models of lexical ambiguity resolution: the reordered access model (in which access of meanings for an ambiguous word is exhaustive but in which the order of access is influenced by prior disambiguating context) and the context-sensitive model (in which access is selective in the presence of prior disambiguating information). We argue that there are methodological problems with their demonstration, but even if there were not, it is unclear that the subordinate bias effect is appropriate for discriminating between competing models of lexical ambiguity resolution (the reordered access model and the context-sensitive model). The effect is an empirical finding and not a fundamental tenet of the reordered access model.