Pilot randomised controlled trial of counselling in a community mental health setting: Pitfalls and learnings

The establishment of counselling and psychotherapy as “evidence‐based” interventions is contingent on the effective implementation of randomised controlled trials (RCTs) in real‐world clinical settings. This paper identifies some of the pitfalls that led to the termination of a practical RCT in a community mental health setting. It reflects upon the significance of the lessons learned by drawing on similar challenges that are documented in the wider literature. Issues surrounding staff turnover, counsellor engagement and procedural clarity are discussed, as is the conflict between the time required for research procedures and counsellors’ clinical time constraints. In our recommendations, we recognise the decisive role of collaboration and counsellor motivation in research partnerships, and the significance of clinical relevance, communication, training and research co‐production in achieving them. Time commitment is identified as the pivotal challenge in the formation and maintenance of collaborative research, but one that also must be overcome for the advancement of the counselling and psychotherapy field.     

EFFECTS OF A FIXED‐TIME SCHEDULE ON ABERRANT AND ADAPTIVE BEHAVIOR

Fixed‐time (FT) schedules of reinforcement have been used to decrease destructive behavior. However, the effects of FT schedules on acquisition and maintenance of appropriate behavior remain unclear. In this study, we present a case in which an FT schedule produced an increase in adaptive behavior and resulted in a significant decrease in destructive behavior.     

Stability of scores for the Slosson Full-Range Intelligence Test

The test-retest stability of the Slosson Full-Range Intelligence Test by Algozzine, Eaves, Mann, and Vance was investigated with test scores from a sample of 103 students. With a mean interval of 13.7 mo. and different examiners for each of the two test administrations, the test-retest reliability coefficients for the Full-Range IQ, Verbal Reasoning, Abstract Reasoning, Quantitative Reasoning, and Memory were .93, .85, .80, .80, and .83, respectively. Mean differences from the test-retest scores were not statistically significantly different for any of the scales. Results suggest that Slosson scores are stable over time even when different examiners administer the test.     

Glucocorticoid administration into the dorsal striatum [corrected] facilitates memory consolidation of inhibitory avoidance training but not of the context or footshock components

It is well established that glucocorticoid administration into a variety of brain regions facilitates memory consolidation of fear-conditioning tasks, including inhibitory avoidance. The present findings indicate that the natural glucocorticoid corticosterone administered into the dorsal striatum (i.e., caudate nucleus) of male Wistar rats produced dose- and time-dependent enhancement of inhibitory avoidance memory consolidation. However, as assessed with a modified inhibitory avoidance procedure that took place on two sequential days to separate context training from footshock training, corticosterone administration into the dorsal striatum did not enhance memory of either the contextual or aversively motivational aspects of the task.     

Racial microaggressions in everyday life: implications for clinical practice

Racial microaggressions are brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults toward people of color. Perpetrators of microaggressions are often unaware that they engage in such communications when they interact with racial/ethnic minorities. A taxonomy of racial microaggressions in everyday life was created through a review of the social psychological literature on aversive racism, from formulations regarding the manifestation and impact of everyday racism, and from reading numerous personal narratives of counselors (both White and those of color) on their racial/cultural awakening. Microaggressions seem to appear in three forms: microassault, microinsult, and microinvalidation. Almost all interracial encounters are prone to microaggressions; this article uses the White counselor--client of color counseling dyad to illustrate how they impair the development of a therapeutic alliance. Suggestions regarding education and training and research in the helping professions are discussed.     

A Review of “Suicidal Intent” Within the Existing Suicide Literature

The results of a systematic literature review that investigated suicide intent are presented. Of the 44 relevant articles identified, 17 investigated the relationships between various suicide risk factors and suicide intent and 25 publications investigated the relationships between suicide intent and various suicide outcomes. Despite recent advancements in the definition and nomological validity of suicide intent, a high degree of variability in the empirical measurement and analysis of suicide intent was found. Such variability limits future research related to measuring suicidal risk and outcomes, reporting suicide intent, or the meaningful comparison of diagnostic approaches or treatments across multiple studies.     

In Search of Serenity: Religious Struggle Among Patients Hospitalized for Suspected Acute Coronary Syndrome

Hospitalization for a sudden cardiac event is a frightening experience, one that is often marked by uncertainty about health status, fear of recurrent cardiac problems, and related existential, religious, and spiritual concerns. Religious struggle, reflecting tension and strain regarding religious and spiritual issues, may arise in response to symptoms of acute coronary syndrome (ACS). The present study examined the prevalence and types of religious struggle using the Brief RCOPE, as well as associations between religious struggle, psychological distress, and self-reported sleep habits among 62 patients hospitalized with suspected ACS. Fifty-eight percent of the sample reported some degree of religious struggle. Questioning the power of God was the most frequently endorsed struggle. Those struggling religiously reported significantly more symptoms of anxiety, depression, and sleep disturbance. Non-White participants endorsed greater use of positive religious coping strategies and religious struggle. Results suggest that patients hospitalized for suspected ACS experiencing even low levels of religious struggle might benefit from referral to a hospital chaplain or appropriately trained mental health professional for more detailed religious and spiritual assessment. Practical means of efficiently screening for religious struggle during the often brief hospitalization period for suspected ACS are discussed.     

Power Within the Counselor Identity Development of African American Women in Pastoral Counseling

This study explored experiences of power among 11 African American female pastoral counselors‐in‐training. Limited research exists within the field of pastoral counseling regarding the dynamics of power within the development of minority counselors‐in‐training. Experiences of power such as microaggressions and empowerment were evidenced in the art created by participants during their qualitative interviews. Use of a heuristic arts‐based research design resulted in 6 final essences (major themes): symbolic analysis of the journey of identity development, empowerment, powerlessness, ownership of power, integration, and pervasive spirituality. Practical implications for counselor educators and pastoral counseling programs are provided.     

An Evaluation of Occupational Behavior in Individuals with and without Attention Deficit/Hyperactivity Disorder

Attention deficit/hyperactivity disorder (ADHD) is now conceptualized as a life-course persistent disorder, including impairments in the occupational functional domains. Occupational impairment is one of the considerations in contemporary diagnostic criteria for ADHD. This study compares the workplace behavior of 26 young adults without ADHD to 24 young adults with ADHD in a simulated pizza restaurant and delivery setting on a job application completion task, in a job interview, and on job performance tasks. Results indicated that there were significant differences in masked ratings of job interview performance, favoring the performance of individuals without ADHD. No significant differences were obtained for job applications and job performance. Results suggest that job interviewing skills may be an important area to address for individuals with ADHD entering the workforce.     

On "risk" and reward: investigating state anhedonia in psychometrically defined schizotypy and schizophrenia

Anhedonia, defined as dysfunction in the experience of pleasant emotions, is a hallmark symptom of the schizophrenia spectrum. Of interest, it is well documented that patients with schizophrenia, at least as a group, do not show reductions in their state experience of pleasant stimuli. However, there is emerging evidence to suggest that individuals with schizotypy--defined as the personality organization reflecting the latent vulnerability for schizophrenia--do show these state deficits. This is paradoxical in that schizophrenia reflects a more pathological state in virtually every conceivable domain as compared with schizotypy. The present study examined self-reported affective reactions to neutral-, bad-, and good-valenced stimuli in individuals with psychometrically defined schizotypy and schizophrenia. Two separate control groups were also included, comprising psychometrically defined controls and stable outpatients with affective disorders. With no exceptions, the schizotypy group reported significantly less pleasant affect for each of the three conditions than each of the other groups. Conversely, the schizophrenia group did not statistically differ from the control groups for any of the conditions. Within both the schizotypy and schizophrenia groups, severity of negative symptoms/traits was associated with less pleasant report. We found that individuals with prominent negative symptoms and traits from the schizophrenia and schizotypy groups resembled each other in terms of state anhedonia. The present findings did not appear to reflect comorbid depression or anxiety. Our discussion centers on this apparent paradox in the schizophrenia spectrum--that individuals with schizotypy exhibit state anhedonia, whereas patients with schizophrenia do not.