Therapeutic alliance in guided internet-delivered cognitive behavioural treatment of depression, generalized anxiety disorder and social anxiety disorder

Guided internet-delivered cognitive behaviour therapy (ICBT) has been found to be effective in several controlled trials, but the mechanisms of change are largely unknown. Therapeutic alliance is a factor that has been studied in many psychotherapy trials, but the role of therapeutic alliance in ICBT is less well known. The present study investigated early alliance ratings in three separate samples. Participants from one sample of depressed individuals (N = 49), one sample of individuals with generalized anxiety disorder (N = 35), and one sample with social anxiety disorder (N = 90) completed the Working Alliance Inventory (WAI) modified for ICBT early in the treatment (weeks 3-4) when they took part in guided ICBT for their conditions. Results showed that alliance ratings were high in all three samples and that the WAI including the subscales of Task, Goal and Bond had high internal consistencies. Overall, correlations between the WAI and residualized change scores on the primary outcome measures were small and not statistically significant. We conclude that even if alliance ratings are in line with face-to-face studies, therapeutic alliance as measured by the WAI is probably less important in ICBT than in regular face-to-face psychotherapy.     

Dopamine modulates frontomedial failure processing of agentic introverts versus extraverts in incentive contexts

The agency facet of extraversion (aE) describes individual differences in goal-directed behavior and has been linked to dopamine function in incentive contexts. Because dopamine presumably modulates the processing of negative feedback/failure, aE may relate to failure processing in incentive contexts. To test this hypothesis, N = 86 participants performed a virtual ball-catching task. An incentive context was created by displaying potential rewards and subtle manipulations of task performance, which either was (control group) or was not (incentive context group) made explicit. To probe the involvement of dopamine, participants received either placebo or the selective dopamine D2 receptor antagonist sulpiride (200 mg). Failure processing was assessed through negative-feedback-evoked differences in the frontal midline theta electroencephalogram power (DFMT) and in the feedback-related negativity event-related potential component (FRN). Before incentives were introduced, DFMT (but not the FRN) was related to neuroticism/anxiety. Importantly, once incentives were displayed, aE was associated with DFMT, FRN, task performance, and changes in self-reported positive affect, which further depended on incentive context group and/or substance group: In the incentive context group but not in the control group, agentic extraverts showed relatively blunted DFMT after placebo. Sulpiride significantly enhanced DFMT, whereas it reduced FRN amplitudes and performance in agentic extra- versus introverts. These findings provide strong support for current dopamine models of aE and failure processing, and also highlight the importance of task context. Moreover, the dissociations of FRN and DFMT suggest the existence of two nonredundant electrophysiological indices of feedback processing, both relating to dopamine and aE.     

Religious Affiliation and Attitudes Towards Gay Men: On the Mediating Role of Masculinity Threat

Previous research suggests that people from some religious backgrounds hold more negative attitudes towards gay men than others do. The current research focuses on psychological variables as an alternative explanation to religious affiliation, testing whether masculinity beliefs regarding gay men and their perceived threat to one's masculinity can explain such between‐group differences in negative attitudes. With a sample of 155 male heterosexual university students (Muslims and Christians in Germany), we found that Muslims held more negative attitudes towards gay men than Christians did. Yet, this relation was partially mediated by beliefs about the masculinity of gay men and the experience of masculinity threat imposed by gay men, substantially reducing the effect of religious affiliation on antigay attitudes. In sum, similar psychological processes explained antigay attitudes of both Muslims and Christians. Copyright © 2013 John Wiley & Sons, Ltd.     

A Review of Published Self-help Books for Panic Disorder

This brief review of 14 self-help books on panic disorder compares: target group, treatment time, included components, existence of structured exercises, and whether or not daily record-keeping is encouraged. Six of the books cover all components deemed necessary for a multimodal cognitive-behavioral treatment package, and five of these are recommended. The reviews are followed by a brief summary of published bibliotherapy studies in which a selection of the books has been used. The results of these studies suggest that bibliotherapy is effective, with an effect size ranging from d = 0.5 to d = 1.5.     

On Alice in Wonderland,Statistics, and Whether CBT Should Take the Prize

This article reports the development of a protocol for the therapeutic application of “attention control” for chronic pain. Attention control is the limitation of the impact of pain by switching or retuning attention. An expert systems approach was used to develop the protocol. In the first stage an extensive literature search retrieved published and unpublished accounts of attention control strategies and a draft treatment manual was prepared. In the second stage 6 experts were recruited and they independently read and reviewed the draft manual. They were interviewed using a semi‐structured protocol to elicit their views on the draft manual. The manual was then revised to accommodate the information and expertise. In addition to providing expert opinion on the manual the experts also raised issues about the process of change in psychological treatment for chronic pain. These issues were organized into a process model of change in chronic pain.     

CBT and Behavioural Medicine: On Definitions,Applications and Practical Considerations

Abstract

In the late seventies, behavioural medicine was conceptualized as a promising area for the application of cognitive-behaviour therapy (CBT) to medical problems. Although many studies have been published in which CBT has been applied to somatic conditions, they do not always call it behavioural medicine. It is uncertain if the term “behavioural medicine” is the most appropriate to use in the future; its impact on medicine and psychology can be questioned. However, in this paper it is concluded that CBT has great potential in the treatment of somatic conditions. In addition, practical considerations when applying CBT in multidisciplinary somatic team situations are discussed. A combined “scientist-practitioner” role is seen as especially promising for the introduction of CBT in a context wider than isolated research studies.     

Autobiographical Memory in Patients with Tinnitus

Studies on psychiatric patients have found that their memories of the past are often unspecific and overgeneral, but the extent to which this is the case for patients with somatic problems has so far only been examined in patients with chronic pain and in patients with diabetes. The present study investigated autobiographical memories in 19 tinnitus patients and 19 controls without tinnitus. Participants were administered the autobiographical memory test (AMT), the Controlled word association test, and self-report measures of depression, anxiety, and tinnitus distress. Compared to control participants, tinnitus patients had difficulty retrieving specific memories and showed longer retrieval latencies. Additionally, tinnitus patients had fewer specific memories to positive cue words. While AMT responses were associated with depression scores, the difference between controls and patients remained significant for positive cue words after controlling for depression scores. Results suggest that cognitive components should be an integral element of the psychological management of tinnitus. The use in future studies of experimental methods such as AMT in health psychology is encouraged.     

How Does Kant Justify the Universal Objective Validity of the Law of Right?

Abstract

Since more than 50 years Kant scholars debate the question whether the Law of Right as introduced in the Metaphysics of Morals by Kant can be justified by the Categorical Imperative. On the one hand we have those who think that Kant’s theory of right depends from the Categorical Imperative, on the other hand we find a growing group of scholars who deny this. However, the debate has been flawed by confusion and misunderstanding of the crucial terms and principles. Therefore, my first task will be to clarify these terms and principles by introducing distinctions that have been neglected too often. After this I try to show a) that the Law of Right can in fact be justified by using the testing method the Categorical Imperative prescribes and b) that there is no other way to justify it. Doing this I criticize in detail the new arguments adherents of the independence thesis have recently put forward.     

How Much for the Child?

In this paper we explore what sacrifices you are morally required to make to save a child who is about to die in front of you. It has been argued that you would have very demanding duties to save such a child (or any adult who is in similar circumstance through no fault of their own, for that matter), and some examples have been presented to make this claim seem intuitively correct. Against this, we argue that you do not in general have a moral requirement to bear more than moderate cost to save even a child who is just in front of you. Moreover, we explain why you have a much more demanding moral requirement in certain cases by appealing to the notions of undue risk and cost sharing.