Improving Delivery Behaviors During Exposure for Pediatric OCD: A Multiple Baseline Training Trial With Community Therapists

This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors (i.e., indicators of quality) that have been associated with youth outcomes in prior clinical trials of exposure therapy. Six therapists at a community mental health agency (CMHA) provided exposure therapy for 8 youth with obsessive–compulsive disorder (OCD). Using a nonconcurrent multiple baseline design with random assignment to baseline lengths of 6 to 16 weeks, therapists received gold-standard exposure therapy training with weekly consultation (baseline phase) followed by addition of EG training and feedback (intervention phase). The primary outcome was therapist behavior during in-session exposures, observed weekly using a validated coding system. Therapist behavior was evaluated in relation to a priori benchmarks derived from clinical trials. Additional outcomes included training feasibility/acceptability, therapist response to case vignettes and beliefs about exposure, and independent evaluator-rated clinical outcomes. Three therapists reached behavior benchmarks only during the EG (intervention) phase. Two therapists met benchmarks during the baseline phase; one of these subsequently moved away from benchmarks but met them again after starting the EG phase. Across all therapists, the percentage of weeks meeting benchmarks was significantly higher during the EG phase (86.4%) vs. the baseline phase (53.2%). Youth participants experienced significant improvement in OCD symptoms and global illness severity from pre- to posttreatment. Results provide initial evidence that adding the EG to gold-standard training can change in-session therapist behaviors in a CMHA setting.     

Reading as a source of knowledge

Synthese - This paper argues that reading is a source of knowledge. Epistemologists have virtually ignored reading as a source of knowledge. This paper argues, first, that reading is not to be...     

Yes,they can! Efficient physical effort mobilization according to task difficulty in schizophrenia

The current literature has largely highlighted a deficit of effort-based decision-making for reward in schizophrenia. However, not all studies have dissociated effort from reward, while other studies emphasize that difficulty is the main determinant of effort rather than reward. In this study, 33 individuals with schizophrenia and 32 healthy controls were recruited to perform a decision-making isometric force task. According to motivational intensity theory, task difficulty (i.e., required force) but not reward was manipulated from easy to impossible. Accuracy between force exerted and force required, and choice to perform a task or not were our effort measures. Clinical variables including depression, defeatist beliefs, and apathy were assessed. Our results demonstrated that the schizophrenia group chose to perform easy, moderate, and difficult tasks and exerted the necessary effort to succeed similarly to the non-clinical group. No association between effort and clinical variables was found. Our findings provide new understandings related to effort mechanisms in schizophrenia.

     

Nonsuicidal Self-injury,Suicide Planning,and Suicide Attempts Among High-risk Adolescents Prior to Psychiatric Hospitalization

Research on Child and Adolescent Psychopathology - The purpose of this study was to understand the trajectories of nonsuicidal self-injury (NSSI) and suicide plans (SP) in the 90 days...