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.     

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.     

What is wrong with religious education? A response to Philip Barnes

This article reviews Philip Barnes’ account of problems with religious eEducation (RE), and explores the practical implications of his position. Acknowledging his compelling logic – that RE is premised on an acceptance of all religions as equally theologically true – this article argues for optimism: with controversy and ambiguity moving to centre stage, a re‐orientation of RE’s attainment targets could focus RE curricula and provide a measure of direction for future progress. Equally, a focus on developing individual values for life in a plural democracy – where personal destinies often conflict both culturally and existentially – would likewise give RE a more potent purpose and the foundations for a normative agenda. Inspired by J.S. Mill, this article concludes that such RE may have to move beyond the classroom to achieve its potential as a critical, inclusive, relevant and progressive subject with coherent social and educational aims.     

Analysis of the Reliability of the Leadership Practices Inventory in the Item Response Theory Framework

The paper examines the psychometric properties of the leadership practices inventory (LPI) in the framework of item response theory (IRT). The LPI assesses five dimensions (i.e. leadership practices) of transformational leadership and consists of 30 items. IRT is a model‐based theory that relates the characteristics of questionnaire items (item parameters) and characteristics of individuals (latent variables) to the probability of choosing each of the response categories. The theory does not assume that the instrument is equally reliable for all levels of the latent variable examined. Samejima's graded response model was used to estimate LPI item characteristics, such as item difficulty and item discrimination power. The results show that some items are redundant in the sense they contribute little to the overall precision of the instrument. Moreover, the LPI seems to be most precise and reliable for respondents with low to medium leadership competence, whereas it becomes increasingly unreliable for high‐quality leaders. These findings suggest that the LPI is best used for training and development purposes, but not for leader selection purposes.     

Remodeling of hippocampal mossy fibers is selectively induced seven days after the acquisition of a spatial but not a cued reference memory task

Relating storage of specific information to a particular neuromorphological change is difficult because behavioral performance factors are not readily disambiguated from underlying cognitive processes. This issue is addressed here by demonstrating robust reorganization of the hippocampal mossy fiber terminal field (MFTF) when adult rats learn the location of a hidden platform but not when rats learn to locate a visible platform. Because the latter task requires essentially the same behavioral performance as the former, the observed MFTF growth is seen as the consequence of specific input-dependent hippocampal activity patterns selectively generated by processing of extramaze but not intramaze cues. Successful performance on the hidden platform task requires formation of spatial memory. Increased MFTFs in hidden platform-trained rats are observed 7 d but not 2 d after training nor in swim controls. These results suggest that structural plasticity of the mossy fiber:CA3 circuit may contribute to the maintenance of long-lasting memory but not to the initial storage of the spatial context.     

Clients’ in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress

Cognitive-behavioral treatment (CBT) is considered to be an effective treatment of distress associated with tinnitus (perception of internal noises without any outer auditory stimulation), but the processes by which the therapy works remain unclear. Mindfulness and acceptance is receiving increased attention in the treatment literature for chronic medical conditions. However, few studies have examined these and related processes with behavioral or observer measures. In the present study 57 videotapes (a total of 1710 min) from 19 clients who participated in a controlled trial of an acceptance-based treatment for tinnitus distress, were coded for frequency and peak level of verbal behaviors expressing either acceptance or cognitive defusion. Frequency of cognitive defusion behaviors and peak level of cognitive defusion as well as peak level of acceptance rated in Session 2, predicted symptom reduction 6 month following treatment. These relationships were not accounted for by the improvement that had occurred prior to the measurement point of the process variables. Moreover, prior symptom changes could not predict process variables rated later in therapy (after most of the improvement in therapy had occurred). Thus, clients’ in-session acceptance and cognitive defusion behaviors appear to play an important role in the reduction of negative impact of tinnitus.