Working alliance as a predictor of change in depression during blended cognitive behaviour therapy

Blended Cognitive Behaviour Therapy (bCBT) is a new form of treatment, mixing internet-based modules and face-to-face therapist sessions. How participants rate the therapeutic alliance in bCBT has not yet been thoroughly explored, and neither is it clear whether therapist- and patient-rated alliances are predictors of change in depression during treatment. Depression and alliance ratings from 73 participants in a treatment study on bCBT (part of the E-COMPARED project) were analysed using growth curve models. Alliance, as rated by both patients and therapists, was high. The therapist-rated working alliance was predictive of subsequent changes in depression scores during treatment, whereas the patient-rated alliance was not. A therapeutic alliance can be established in bCBT. The role of the therapist-rated alliance seems to be of particular importance and should be carefully considered when collecting data in future studies on bCBT.     

A Direct-Learning Approach to Acquiring a Bimanual Tapping Skill

The theory of direct learning (D. M. Jacobs &; C. F. Michaels, 2007 Jacobs, D. M., &; Michaels, C. F. (2007). Direct learning. Ecological Psychology, 19, 321–349.[Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]) has proven useful in understanding improvement in perception and exploratory action. Here the authors assess its usefulness for understanding the learning of a motor skill, bimanual tapping at a difficult phase relation. Twenty participants attempted to learn to tap with 2 index fingers at 2 Hz with a phase lag of 90° (i.e., with a right-right period of 500 ms and a right-left period of 125 ms). There were 30 trials, each with 50 tapping cycles. Computer-screen feedback informed of errors in both period and phase for each pair of taps. Participants differed dramatically in their success. Learning was assessed by identifying the succession of attractors capturing tapping over the experiment. A few participants’ attractors migrated from antiphase to 90° with an appropriate period; others became attracted to a fixed right-left interval, rather than phase, with or without attraction to period. Changes in attractor loci were explained with mixed success by direct learning, inviting elaboration of the theory. The transition to interval attractors was understood as a change in intention, and was remarkable for its indifference to typical bimanual interactions.     

Acceptance and commitment therapy versus tinnitus retraining therapy in the treatment of tinnitus: a randomised controlled trial

The study compared the effects of Acceptance and Commitment Therapy (ACT) with Tinnitus Retraining Therapy (TRT) on tinnitus impact in a randomised controlled trial. Sixty-four normal hearing subjects with tinnitus were randomised to one of the active treatments or a wait-list control (WLC). The ACT treatment consisted of 10 weekly 60 min sessions. The TRT treatment consisted of one 150 min session, one 30 min follow-up and continued daily use of wearable sound generators for a recommended period of at least 8 h/day for 18 months. Assessments were made at baseline, 10 weeks, 6 months and 18 months. At 10 weeks, results showed a superior effect of ACT in comparison with the WLC regarding tinnitus impact (Cohen’s d = 1.04), problems with sleep and anxiety. The results were mediated by tinnitus acceptance. A comparison between the active treatments, including all assessment points, revealed significant differences in favour of ACT regarding tinnitus impact (Cohen’s d = 0.75) and problems with sleep. At 6 months, reliable improvement on the main outcome measure was found for 54.5% in the ACT condition and 20% in the TRT condition. The results suggest that ACT can reduce tinnitus distress and impact in a group of normal hearing tinnitus patients.     

Preparing to move and deciding not to move

A commentary is given on Trevena and Miller (2010). The comparability of their experimental task and of the potential they recorded with those used and recorded by Libet, Gleason, Wright, and Pearl (1983a) is questioned. An interpretation is given for the similarity of event-related potentials recorded when subjects decided to move and when they decided not to move.     

Death Anxiety and Symbolic Immortality in Relatives at Risk for Familial Amyloid Polyneuropathy Type I (FAP I,ATTR V30M)

This study is an investigation of the impact of familial amyloid polyneuropathy type I (FAP I, ATTR V30M) on death anxiety and symbolic immortality. Templer and Drolet’s scales were administered to 524 individuals: (1) 84 relatives at risk, (2) 92 relatives not at risk for FAP I; and (3) a control group (n = 348) with no known hereditary disease in their families. At-risk relatives had, on average, a higher score for death anxiety and a lower score for symbolic immortality, than either those not-at-risk or controls. There were no significant differences in scores on either measure for those not-at-risk versus controls. Being at risk increases death anxiety and threatens the sense of symbolic immortality and psychosocial wellbeing. This may be true for other serious hereditary disorders as well. Genetic counsellors should become familiar with these concepts, feel comfortable initiating discussions about death with their patients, and be able to identify and reinforce their patients’ and family members’ sense of symbolic immortality.     

A randomized clinical trial on the effectiveness of a reintegration training program versus booster sessions after short-term inpatient psychotherapy

Although several studies show symptomatic improvements in patients with personality disorders after short-term inpatient psychotherapy, reintegration remains difficult. In this study the effectiveness of a specifically designed reintegration training program is investigated. One hundred twenty-eight patients were randomized to either a reintegration training program aimed at improving general functioning and work resumption, or booster sessions. Outcome measures used were symptom level, work status, absence from and impediments at work. The results showed that compliance in the booster session group was significantly better than in the reintegration training program. The percentage of persons with a paid job increased during the booster sessions from 64 to 87%, but not during the reintegration training (76%). There were no differences in the other outcome measures. We concluded that reintegration training was not more (cost)-effective than booster sessions. Our hypothesis is that continuity of care (same therapists and program) explains the favorable results of the booster sessions.