Statewide Implementation of Cognitive Behavioral Therapy for Psychosis Through a Learning Collaborative Model

Cognitive Behavioral Therapy for Psychosis (CBTp) is an evidence-based psychotherapeutic intervention (EBPI) for adults with schizophrenia spectrum disorders that remains under-implemented in the United States (U.S.). There has been little empirical attention on implementation and dissemination strategies for this EBPI. The Learning Collaborative (LC) model is a method of implementing evidence-based practices across agencies and geographic regions that may facilitate CBTp implementation and dissemination in the US.We applied the LC model in an attempt to enhance the accessibility of CBTp in community mental health settings statewide. Providers (N = 56) from 12 agencies voluntarily participated in an in-person, CBTp workshop followed by 6 months of biweekly phone-based consultation sessions (Phase 1). Twenty-one providers opted to participate in an additional 6-month CBTp LC immediately following completion of the initial CBTp LC (Phase 2). Adoption, penetration, provider-perceived skill development, fidelity, as well as provider-perceived implementation barriers were re-assessed during and 6 months after completion of Phase 2.One year after the completion of the Phase 2 LC, 21% of the original trainee group across 3 of the 12 participating agencies continued to offer CBTp to clients. CBTp trainees were treating between one and two clients each. Self-assessed CBTp skills improved modestly over the Phase 2 consultation period. On average, both clinicians and supervisors reached an acceptable fidelity score on the sessions reviewed. Participating providers identified multiple barriers to CBTp implementation, including features of the training and consultation, the agency, the intervention itself, and psychosocial and clinical challenges associated with the client population.Few CBTp implementation studies have applied a framework to CBTp implementation. The authors adapted the LC model in an attempt to promote adoption of CBTp in community mental health clinics across a large, populous state with poor access to mental health services. Identified challenges and recommendations should be considered in future implementation efforts.     

The influence of perceptual and motor factors on bimanual coordination in a polyrhythmic tapping task

Summary In this study the role of perceptual and motor factors on the motor organization (integrated versus parallel) adopted by musically skilled and unskilled subjects in a polyrhythmic tapping task was investigated. Subjects tapped a 3:2 polyrhythm to match the timing of two isochronous tone trains, one tone train for each hand. Perceptual factors were examined by the manipulation of the frequency difference between the tone trains to produce either an integrated or a streamed percept. Motor factors were examined by comparison of performance on two versions of the 3:2 polyrhythm. In one (simultaneous) version, each cycle of the polyrhythm began with a simultaneous left- and right-hand tap. In the other (shifted) version a 100-ms interval was introduced between the initial left and right taps in each cycle. Examination of the pattern of variances and covariances among intertap intervals suggested that most of the subjects in this study adopted an integrated motor organization that involved interleaving the timing of the two hands. Further analysis revealed that a serial chained model described the pattern of covariances best for the simultaneous pattern, whereas a hierarchical organization described the pattern of covariances for the shifted pattern best. The finding that performance was more accurate with integrated tones than with streamed tones provides some support for a perceptual-motor facilitation hypothesis.     

Relationship stigma and Black-White interracial marital satisfaction: the mediating role of religious/spiritual well-being

Although the percentage of Black-White interracial marriage continues to increase in the United States, research is limited related to the impact of stigma on these couples and the processes that influence their responses to negative racial experiences. In the current study, the Vulnerability-Stress-Adaptation model was used as a theoretical foundation to investigate the relationship between stigma and couple satisfaction among Black-White interracially married couples, along with the potential mediating role of religious/spiritual well-being. A community sample of 180 interracially married individuals responded to surveys assessing their experiences of stigma due to being a member of an interracial couple, religious/spiritual well-being, and couple satisfaction. The analysis revealed that relationship stigma was negatively associated with couple satisfaction, and religious/spiritual well-being mediated the relationship between these two variables. To conclude, recommendations for intervention and prevention in the lives of Black-White interracial couples are offered.     

Seeing Is Believing: Using Video Feedback in Cognitive Therapy for Social Anxiety Disorder

Distorted negative self-images and impressions appear to play a key role in maintaining Social Anxiety Disorder (SAD). In previous research, McManus et al. (2009) found that video feedback can help people undergoing cognitive therapy for SAD (CT-SAD) to develop a more realistic impression of how they appear to others, and this was associated with significant improvement in their social anxiety. In this paper we first present new data from 47 patients that confirms the value of video feedback. Ninety-eighty percent of the patients indicated that they came across more favorably than they had predicted after viewing a video of their social interactions. Significant reductions in social anxiety were observed during the following week and these reductions were larger than those observed after control periods. Comparison with our earlier data (McManus et al., 2009) suggests we may have improved the effectiveness of video feedback by refining and developing our procedures over time. The second part of the paper outlines our current strategies for maximizing the impact of video feedback. The strategies have evolved in order to help patients with SAD overcome a range of processing biases that could otherwise make it difficult for them to spot discrepancies between their negative self-imagery and the way they appear on video.     

Hope as empowerment model: A client-based perspective on the process of hope development

Abstract

Research on the relationship of client hope to successful therapy outcome underlines the need to discover the processes and conditions when hope flourishes. Snyder’s Hope Theory has been applied to psychotherapy but client subjective experiences are needed to illuminate nuances in the process. The present study examined the trajectory of hope development in psychotherapy using interviews with 18 counseling clients, analyzed using grounded theory methodology. Findings were synthesized into a dynamic model titled hope as empowerment model (HEM) that shares features of Snyder’s Hope Theory. HEM introduces patterns of particular salience to psychotherapy. The compatibility of client preferences with therapist input raised faith in the process of counseling and, in turn, hope in a positive outcome. A number of conditions, including the flexibility of client role preferences and the directiveness of hope-inspiring therapeutic strategies, influenced the nature and strength of client hope. Implications for therapy and positive psychology are considered.     

Revisiting the Effects of Anger on Risk‐Taking: Empirical and Meta‐Analytic Evidence for Differences Between Males and Females

That anger elicited in one situation can carry over to drive risky behavior in another situation has been described since the days of Aristotle. The present studies examine the mechanisms through which and the conditions under which such behavior occurs. Across three experiments, as well as a meta‐analytic synthesis of the data, results reveal that incidental anger is significantly more likely to drive risky decision making among males than among females. Moreover, the experiments document that, under certain circumstances, such risk‐taking pays off financially. Indeed, the present experiments demonstrate that, because the expected‐value‐maximizing strategy in these studies rewarded risk‐taking, angry‐male individuals earned more money than did both neutral‐emotion males and angry females. In sum, these studies found evidence for robust disparities between males and females for anger‐driven risk‐taking. Importantly, although men did not experience more anger than women, they did show a heightened tendency to respond to anger with risk‐taking. Published 2016. This article has been contributed to by US Government employees and their work is in the public domain in the USA.     

A simple intervention for stereotypical engagement with an augmentative alternative communicative device

Although electronic devices may enhance the effectiveness of some behavioral interventions for children with autism spectrum disorders, such devices may also give rise to problem behavior such as repetitious button pressing (i.e., object stereotypy). Results of this study showed that a child with autism spectrum disorder only displayed high levels of object stereotypy on an iPad? when presses generated auditory output. Subsequently, results showed that when the participant used the iPad? without auditory output, his stereotypical behavior decreased and his manding for various items simultaneously increased.     

To trust or not to trust: social decision‐making in post‐institutionalized,internationally adopted youth

Chronic parental maltreatment has been associated with lower levels of interpersonal trust, and depriving environments have been shown to predict short‐sighted, risk‐averse decision‐making. The present study examined whether a circumscribed period of adverse care occurring only early in life was associated with biases in trust behavior. Fifty‐three post‐institutionalized (PI) youth, adopted internationally on average by 1 year of age, and 33 never‐institutionalized, non‐adopted youth (M_age = 12.9 years) played a trust game. Participants decided whether or not to share coins with a different anonymous peer in each trial with the potential to receive a larger number of coins in return. Trials were presented in blocks that varied in the degree to which the peers behaved in a trustworthy (reciprocal) or untrustworthy (non‐reciprocal) manner. A comparison condition consisted of a computerized lottery with the same choices and probabilistic risk as the peer trials. Non‐adopted comparison youth showed a tendency to share more with peers than to invest in the lottery and tended to maintain their level of sharing across trials despite experiencing trials in which peers failed to reciprocate. In contrast, PI children, particularly those who were adopted over 1 year of age, shared less with peers than they invested in the lottery and quickly adapted their sharing behavior to peers’ responses. These results suggest that PI youth were more mistrusting, more sensitive to both defection and reciprocation, and potentially more accurate in their trusting decisions than comparison youth. Results support the presence of a sensitive period for the development of trust in others, whereby conditions early in life may set long‐term biases in decision‐making.     

Paternal Caregivers’ Parenting Practices and Psychological Functioning among African American Youth Living in Urban Public Housing

Structural factors associated with public housing contribute to living environments that expose families to adverse life events that may in turn directly impact parenting and youth outcomes. However, despite the growth in research on fathers, research on families in public housing has practically excluded fathers and the role fathers play in the well‐being of their adolescents. Using a sample of 660 African American adolescents recruited from public housing, we examined the relationship between paternal caregivers’ (i.e., fathers’ and father figures’) parenting practices and adolescents’ depressive symptoms, attitudes toward deviance, and self‐efficacy. Using a latent profile analysis (LPA), we confirmed a four‐class model of paternal parenting practices ranging from high to low levels of monitoring and encouragement. Results from a one‐way ANOVA indicated that paternal caregivers with high (compared to moderate) levels of encouragement and monitoring were associated with youth who reported less depressive symptoms, higher levels of self‐efficacy, and less favorable attitudes toward deviance. Discriminant analysis results indicated that approximately half of the sample were correctly classified into two paternal caregiver classes. The findings provide evidence that some of these caregivers engage in parenting practices that support youths’ psychological functioning. More research is needed to determine what accounts for the variability in levels of paternal encouragement and supervision, including environmental influences, particularly for paternal caregivers exhibiting moderate‐to‐low levels of paternal encouragement and monitoring.