Designs for studying the effectiveness of long-term psychoanalytic treatments: balancing level of evidence and acceptability to patients

Long-Term Psychoanalytic Treatments (LTPT) include both long-term psychoanalytic psychotherapy (LTPP) and psychoanalysis (PsAn). Current opinion seems to be that there is some evidence for the effectiveness of LTPP, but none for that of PsAn. This may be due in part to researchers not balancing the level of evidence of randomized controlled studies (RCTs), cohort studies, and pre-post studies with patients' acceptance of these various research designs used in studying the effectiveness of LTPT. After a review of the merits of eight possible control conditions for LTPT in RCTs and cohort studies, and a consideration of the limitations and merits of pre-post studies, it was found that RCTs pair high levels of evidence with limited degrees of patient acceptance, especially where PsAn is concerned. Cohort studies appear to provide at most a moderate level of evidence. Their acceptability is hardly better than that of RCTs, as it depends on the acceptability of control conditions similar to those of RCTs. The acceptability of pre-post studies is much better, but they can provide, at most, a moderate level of evidence. Apart from randomization, they can meet all methodological criteria for high-quality research (often they do not, but there are ways to correct this). In summary, in the long-term treatment of complex mental disorders with LTPT, RCTs often pair a high level of evidence with limited patient acceptance of the method. Compared to RCTs, cohort studies show a lower level of evidence without much gain in acceptability. Pre-post studies pair the highest level of acceptability with the lowest level of evidence of the three designs. Limited acceptability is not to be confused with no acceptability, nor moderate level of evidence with none.     

Walter the banker: the conjunction fallacy reconsidered

In a famous experiment by Tversky and Kahneman (Psychol Rev 90:293–315, 1983), featuring Linda the bank teller, the participants assign a higher probability to a conjunction of propositions than to one of the conjuncts, thereby seemingly committing a probabilistic fallacy. In this paper, we discuss a slightly different example featuring someone named Walter, who also happens to work at a bank, and argue that, in this example, it is rational to assign a higher probability to the conjunction of suitably chosen propositions than to one of the conjuncts. By pointing out the similarities between Tversky and Kahneman’s experiment and our example, we argue that the participants in the experiment may assign probabilities to the propositions in question in such a way that it is also rational for them to give the conjunction a higher probability than one of the conjuncts.     

Haptic pop-out of movable stimuli

When, in visual and haptic search, a target is easily found among distractors, this is called a pop-out effect. The target feature is then believed to be salient, and the search is performed in a parallel way. We investigated this effect with movable stimuli in a haptic search task. The task was to find a movable ball among anchored distractors or the other way round. Results show that reaction times were independent of the number of distractors if the movable ball was the target but increased with the number of items if the anchored ball was the target. Analysis of hand movements revealed a parallel search strategy, shorter movement paths, a higher average movement speed, and a narrower direction distribution with the movable target, as compared with a more detailed search for an anchored target. Taken together, these results show that a movable object pops out between anchored objects and this indicates that movability is a salient object feature. Vibratory signals resulting from the movable ball were found to be a reasonable explanation regarding the sensation responsible for the pop-out of movability.     

The Distinction Between Quantitative and Qualitative Dimensions of Emotions: Clinical Implications

REBT theoreticians and practitioners describe two sets of emotions (and behaviors) as a reaction to adversity, whether these are functional or dysfunctional. This article deals with the ways in which REBT practitioners and theoreticians interpret these two sets of reactions, using either a quantitative or qualitative method. It favors the qualitative approach and illustrates it with a graphical representation of the two sets. The use of graphs turns out to be particularly useful for explaining certain phenomena to clients and for teaching novice practitioners. It also provides a framework for establishing an effective new thought or rational belief.     

Orchiectomy in transgender individuals: A motivation analysis and report of surgical outcomes

Abstract

Background: Different surgical procedures are available for transgender women wishing to undergo genital gender-affirming surgery.

Aim: To assess preoperative motivations, the frequency of orchiectomy procedures, and postoperative outcomes of orchiectomy in transgender individuals.

Methods: All transgender individuals who underwent orchiectomy in the period between January 2012 and January 2020 at our institution were retrospectively identified. A chart study was conducted, recording motivations, demographics, perioperative characteristics and surgical outcomes. The frequency of orchiectomy and vaginoplasty procedures during the study period were determined and compared.

Results: During the study period, an increase of performed orchiectomy procedures was observed. The orchiectomy/vaginoplasty ratio was 0.01–0.07 in the period 2012–2018 and 0.24 in 2019. A total of 43 transgender individuals were retrospectively identified. Sixteen (37%) initially wished to undergo a vaginoplasty, but did not meet institutional requirements (nonsmoker, BMI < 30kg/m²) or were not eligible for vaginoplasty surgery because of interfering somatic or mental health issues. Fourteen (33%) individuals who underwent orchiectomy regarded it as a preceding step to a future vaginoplasty procedure. Out of these fourteen, one person is now on the waiting list for vaginoplasty surgery. Thirteen (30%) others did not report a desire to pursue vaginoplasty in the future. This was mostly motivated by the absence of genital dysphoria or motivations related to their gender identity, with a desire to discontinue anti-testosterone treatment. The postoperative course was uncomplicated in 39 (91%) individuals.

Conclusion: In the Netherlands, especially in the last year, the frequency of orchiectomy procedures has increased. Reasons that people chose to undergo this procedure include: not being eligible for a vaginoplasty procedure, seeing it as a preceding step to a possible future vaginoplasty or other identity-related motivations (i.e., non-binary gender identification or absence of genital dysphoria).     

Officially Registered Criminal Careers of Members of Dutch Outlaw Motorcycle Gangs and Their Support Clubs

ABSTRACT

Decisive action against criminal outlaw motorcycle gangs (OMCGs) ranks high on the criminal justice agenda. Nevertheless, in many Western European countries the number of OMCG chapters has increased rapidly. Official OMCG support clubs also have mushroomed. The present study extends prior research from the Netherlands and elsewhere by employing a gang database of 1,617 OMCG members and 473 support club members maintained by the Dutch police and examining members’ juvenile and adult criminal careers based on judicial data. While committing an offense was no prerequisite of being included in the database, criminal career data show that the majority of OMCG and support club members is convicted at least once. In addition, we find there is ample variation in both the level and shape of these individual’s criminal trajectories. In line with prior research, the majority of OMCG and support club members are found to be adult onset offenders. A considerable share of both samples however, follows criminal trajectories characterized by early onset, frequent and persistent criminal behavior. Building on prior theoretical accounts of OMCG evolution, these findings are interpreted against the background of recent changes in the Dutch outlaw biker landscape. Implications for the Dutch whole-of-government approach are discussed.