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.     

Are today's Millennials splintering into a new generational cohort? Maybe!

A new generational cohort is emerging from the Millennial market segment as a result of cataclysmic events that have occurred since 2008. Interviews with college upperclassmen in the United States identified significant events influencing their values, the values arising from these events, and new values not associated with older Millennials. The most important events identified included the Great Recession, 9/11, and the election of the first African-American president. Values of Millennials were assessed in online surveys of college juniors and seniors in the United States in the fall of 2009 and 2010 and among older Millennials, aged 27–31, during the summer of 2010. The values most strongly differentiating the younger and older Millennials were “piety” and “thrift.” Younger Millennials in the United States are less thrifty and more secular and sexually permissive than older Millennials. They are also less patriotic and less concerned about politics, sustainability, saving, and making mistakes in life. This suggests a splintering of the Millennials cohort as a result of the Great Recession and the potential emergence of a younger “entitlement” cohort. It also suggests further investigation of cross-national value shifts among younger Millennials, prompted by the Great Recession. Copyright © 2012 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.     

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.     

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.     

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.