Understanding,respecting and integrating difference in therapeutic practice

The purpose of this paper is to promote thought and discussion around how and why we treat patients in chosen ways. In the present climate practitioners are required to treat patients following NICE guidelines in which cognitive behavioural therapy (CBT) is the treatment of choice in the majority of diagnoses. This paper raises concerns that this may lead to an homogenization of treatment, loss of invaluable skills and understanding from other treatment approaches, and loss to the patient who may be best cared for by a combination of treatments and approaches, most notably patients presenting with complex pathology. This paper aims to present this as a general principle, and by way of example, will focus on coupling two specific treatment orientations, cognitive behavioural therapy with psychodynamic psychotherapy, with the specific diagnosis of obsessive compulsive disorder (OCD).

Methods: Clinical material is drawn from case studies from practice in secondary adult mental health care services within the NHS. All patients were referred to the psychological services for treatment for OCD and provided with 1:1 therapy with UKCP‐registered therapists. Details have been anonymized by describing fictitious cases re‐constructed from clinical material. A theoretical understanding is included which provides both an overview for integrating treatment for the specific example of OCD and is intended by extension to other diagnoses.

Results: Working with the commonalities of therapeutic approaches, and integrating specific skills of CBT and psychodynamic psychotherapy, appears to offer a viable mode of treatment for cases resistant to single‐orientation therapies.

Conclusions: Coupling the skills of different therapies can be effective in treating complex patients that are referred to the secondary mental health services. Conversely, restricting practice to single orientation therapies can lead to an impoverished care for patients and diminution of invaluable therapeutic skills which may become underused, undervalued and lost in the practice of mental health care within the NHS. Acknowledgement of the skills of others, valuing these and learning from each other can help to avoid the defensive reactions of practitioners, where each may defensively retreat to their corners of specialism. Respecting and sharing skills from different orientations, and acknowledging this in the NICE guidelines, is good for both mental health services and patient care and addresses the concerns raised by practitioners exemplified by Bateman (2000 Bateman, A. 2000. Integration in psychotherapy: An evolving reality in personality disorder.. British Journal of Psychotherapy, 17(2): 147–156.  [Google Scholar], p. 147) that ‘psychotherapy continues to be bedeviled by ideological schisms with practitioners apparently ignoring alternative conceptualizations and potentially superior interventions’.     

Situational differences in dialectical emotions: Boundary conditions in a cultural comparison of North Americans and East Asians

Past research generally suggests that East Asians tolerate opposing feelings or dialectical emotions more than North Americans. We tested the idea that North Americans would have fewer opposing emotions than East Asians in positive, but not in negative or mixed situations. Forty-seven European American, 40 Chinese, and 121 Japanese students reported the emotions that a protagonist of standardised positive, negative, and mixed situations would feel. Emotions were coded into three valence categories: pleasant, unpleasant, and neither-pleasant-nor-unpleasant. As predicted, cultural differences in opposing emotion associations were found in positive situations only. Moreover, East Asians reported more neither-pleasant-nor-unpleasant feelings, especially in mixed situations, possibly reflecting a deferral of valence appraisal due to expected change.     

Loneliness and social behaviours in a virtual social environment

Feeling lonely motivates people to reconnect with others, but it can also trigger a vicious cycle of cognitions and behaviours that reinforces their loneliness. In this study, we examined the behavioural consequences of loneliness in a virtual social environment. A total of 176 participants navigated a character (protagonist) through a two-dimensional browser game and rated the character's loneliness multiple times during the game. In the first part of the game, another character is introduced as the protagonist's spouse. At one point, the spouse leaves for an undetermined period of time but later returns. Immediately before this separation, higher ascribed loneliness of the protagonist was associated with more frequent interactions with the spouse. After the reunion, however, higher ascribed loneliness was associated with less frequent interactions with the spouse. Ascribed loneliness was not significantly related to the frequency of interactions with others nor to the frequency of solitary activities. These patterns held after controlling for ascribed positive affect. Participants' levels of loneliness were related to the level of ascribed loneliness only when the spouse was present but not when the spouse was absent. In sum, these findings suggest that the conditions that trigger the vicious cycle of loneliness are person- and situation-specific.     

The Evaluation of Psychoanalytical Practice in Stockholm

The authors discuss several surveys that cover the practices of psychoanalysts and psychotherapists in the Stockholm region. They compare these practices with other psychiatrists in both the private and the public sector. In addition, they discuss the results from an attempt towards continuous evaluation of psychoanalytical practices and their treatment standards including an evaluation of the development of individual psychoanalytical processes.     

The hypnotic use of language — a Heideggerian interpretation

Abstract

This paper shows that Heidegger's theory of language has implications for our understanding of hypnosis. A Heideggerian interpretation of samples of trance inductions brings to light the fact that the hypnotic use of language differs from the everyday language in two major dimensions: in hypnosis, language “call” things into being, thus becoming “something more than a simple, practical means of communicating with others and a means of controlling nature” and in hypnosis, humans enter into a reversed relationship with language, a relationship in which it is language, rather than the hypnotist, that “speaks.”     

Bottled memories: On how alcohol affects eyewitness recall

This study investigated how different doses of alcohol affected eyewitness recall. Participants (N = 126) were randomly assigned to three groups with different blood alcohol concentration (BAC), either a control group (mean BAC 0.00%, N = 42), a lower alcohol dose group (mean BAC 0.04%, N = 40), or a higher alcohol dose group (mean BAC 0.06%, N = 44). After consumption, participants witnessed a movie of a mock crime and were interviewed one week later. The main results showed that witnesses with the higher intoxication level recalled fewer details compared to witnesses with the lower intoxication level. The amount of alcohol consumed did not have an impact on the accuracy rate. No sex differences were found. The results are discussed in the light of past research. We conclude that more studies are needed before recommendations can be made to an applied setting.     

Cognitive Defusion Versus Thought Distraction in the Mitigation of Learned Helplessness

The Psychological Record - Recent research suggests that attempting to avoid unwanted psychological events is maladaptive. Contrastingly, cognitive defusion, which is an acceptance-based method for...     

Threat and Right‐Wing Attitudes: A Cross‐National Approach

Threat relates to right‐wing ideological attitudes at the individual level. The present study aims to extend this relationship to the national level. More specifically, in a sample of 91 nations, we collected country‐level indicators of threat (including inflation, unemployment, gross national product, homicide rate, and life expectancy). Moreover, we analyzed data from the European and World Value Survey (total N = 134,516) to obtain aggregated country‐level indicators for social‐cultural and economic‐hierarchical right‐wing attitudes for each of these countries. In accordance with previous findings based on the individual level, a positive relationship between threat indicators and right‐wing attitudes emerged. This relationship was stronger than what was usually reported at the individual level. In the discussion, we focus on the mutually reinforcing influence at the individual and national levels in terms of right‐wing attitudes.     

Whom do children copy? Model-based biases in social learning

This review investigates the presence of young children’s model-based cultural transmission biases in social learning, arguing that such biases are adaptive and flexible. Section 1 offers five propositions regarding the presence and direction of model-based transmission biases in young children’s copying of a model. Section 2 discusses the cognitive abilities required for differing model-based biases and tracks their development in early childhood. Section 3 suggests future areas of research including considering the social aspect of model-based biases and understanding their use within a comparative perspective.     

Predicting short and long-term exercise intentions and behaviour in patients with coronary artery disease: A test of protection motivation theory

The purpose of this study was to examine the utility of protection motivation theory (PMT) in the prediction of exercise intentions and behaviour in the year following hospitalisation for coronary artery disease (CAD). Patients with documented CAD (n?=?787), recruited at hospital discharge, completed questionnaires measuring PMT's threat (i.e. perceived severity and vulnerability) and coping (i.e. self-efficacy, response efficacy) appraisal constructs at baseline, 2 and 6 months, and exercise behaviour at baseline, 6 and 12 months post-hospitalisation. Structural equation modelling showed that the PMT model of exercise at 6 months had a good fit with the empirical data. Self-efficacy, response efficacy, and perceived severity predicted exercise intentions, which, in turn predicted exercise behaviour. Overall, the PMT variables accounted for a moderate amount of variance in exercise intentions (23%) and behaviour (20%). In contrast, the PMT model was not reliable for predicting exercise behaviour at 12 months post-hospitalisation. The data provided support for PMT applied to short-term, but not long-term, exercise behaviour among patients with CAD. Health education should concentrate on providing positive coping messages to enhance patients’ confidence regarding exercise and their belief that exercise provides health benefits, as well as realistic information about disease severity.