How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis

Prior meta-analyses have found a moderate but robust relationship between alliance and outcome across a broad spectrum of treatments, presenting concerns, contexts, and measurements. However, there continues to be a lively debate about the therapeutic role of the alliance, particularly in treatments that are tested using randomized clinical trial (RCT) designs. The purpose of this present study was to examine whether research design, type of treatment, or author's allegiance variables, alone or in combination, moderate the relationship between alliance and outcome. Multilevel longitudinal analysis was used to investigate the following moderators of the alliance-outcome correlation: (a) research design (RCT or other), (b) use of disorder-specific manuals, (c) specificity of outcomes, (d) cognitive and/or behavioral therapy (CBT) or other types of treatments, (e) researcher allegiance, and (f) time of alliance assessment. RCT, disorder-specific manual use, specificity of primary and secondary outcomes, and CBT did not moderate the alliance-outcome correlation. Early alliance-outcome correlations were slightly higher in studies conducted by investigators with specific interest in alliance than were those in studies conducted by researchers without such an allegiance. Over the course of therapy, these initial differences disappeared. Apart from this trend, none of the variables previously proposed as potential moderators or mediators of the alliance-outcome relation, alone or in combination, were found to have a mediating impact.     

White-matter microstructure and language lateralization in left-handers: A whole-brain MRI analysis

Most people are left-hemisphere dominant for language. However the neuroanatomy of language lateralization is not fully understood. By combining functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), we studied whether language lateralization is associated with cerebral white-matter (WM) microstructure. Sixteen healthy, left-handed women aged 20–25 were included in the study. Left-handers were targeted in order to increase the chances of involving subjects with atypical language lateralization. Language lateralization was determined by fMRI using a verbal fluency paradigm. Tract-based spatial statistics analysis of DTI data was applied to test for WM microstructural correlates of language lateralization across the whole brain. Fractional anisotropy and mean diffusivity were used as indicators of WM microstructural organization. Right-hemispheric language dominance was associated with reduced microstructural integrity of the left superior longitudinal fasciculus and left-sided parietal lobe WM. In left-handed women, reduced integrity of the left-sided language related tracts may be closely linked to the development of right hemispheric language dominance. Our results may offer new insights into language lateralization and structure–function relationships in human language system.     

Goal orientation, task difficulty, and task interest: A multilevel analysis

We studied whether goal orientation affects the relationships that task difficulty and interest have with self-set goals. Using a sample of 499 undergraduate students who listed grade goals for their classes, we employed Hierarchical Linear Modeling to explain differences in the extent to which difficulty and interest related to goals. Higher goals were set for more interesting and easier classes, and for individuals higher in mastery goal orientation and for those lower in performance-avoidance orientation (at average levels of interest and difficulty). Furthermore, performance-approach and performance-avoidance orientations reduced and strengthened (respectively) the effects of task difficulty on self-set goals, and the buffering effect of mastery orientation was marginally significant. Portions of this paper were presented at the 19^th Annual Conference of the Society for Industrial and Organizational Psychology, Chicago, IL, in April 2004.     

Health locus of control and self-esteem as related to adolescent health behavior and intentions

A health behavior and attitudes questionnaire was administered to 246 fifth-grade and 265 sixth-grade students during class time. The questions included 20 children's health locus of control (CHLC) items reported by Parcel and Meyer (1978), 17 children's self-esteem (CSE) items modified from those reported by Coopersmith (1967), and questions concerning past and current behavior and future intentions with respect to cigarette smoking, alcohol use, and marijuana use. The results indicate that the relationships between dimensions of children's health locus of control and self-esteem and their behaviors and intentions are not large enough to suggest that intervention programs directed at the prevention of detrimental health behaviors focus on the enhancement of self-esteem or the internal locus of control. An appropriate test of the efficacy of such an approach requires a longitudinal rather than a cross-sectional study, monitoring changes in the levels of self-esteem and health locus of control and associated changes in health behavior.     

Examining the relationship between use of sexually explicit media and sexual risk behavior in a sample of men who have sex with men in Norway

The purpose of this study was to investigate consumption patterns of gay‐oriented sexually explicit media (SEM) among men who have sex with men (MSM) in Norway, with a particular emphasis on a possible relationship between gay SEM consumption and HIV risk behavior. Participants included 529 MSM living in Norway recruited online to complete a SEM consumption and sexual risk survey. Of the 507 participants who responded to the all items measuring exposure to SEM, 19% reported unprotected anal intercourse with a casual partner (UAI) in last 90 days, and 14% reported having had sero‐discordant UAI. Among those with UAI experience, 23% reported receptive anal intercourse (R‐UAI) and 37% reported insertive anal intercourse (I‐UAI). SEM consumption was found to be significantly associated with sexual risk behaviors. Participants with increased consumption of bareback SEM reported higher odds of UAI and I‐UAI after adjusting for other factors using multivariable statistics. MSM who started using SEM at a later age reported lower odds of UAI and I‐UAI than MSM who started earlier. Future research should aim at understanding how MSM develop and maintain SEM preferences and the relationship between developmental and maintenance factors and HIV sexual risk behavior.